Mueller Maximilian M, Conner-Rilk Sebastian, De Lorenzi Vincent J, Monteleone Tatiana C, O'Brien Robert J, van der List Jelle P, DiFelice Gregory S, Mintz Douglas N
Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, HSS - East River Professional Building, 523 East 72nd Street, 2nd Floor, New York, NY, 10021, USA.
Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Klinikum Hamburg, Hamburg, Germany.
Skeletal Radiol. 2025 Sep 12. doi: 10.1007/s00256-025-05026-w.
To introduce a tear location classification system for posterior cruciate ligament (PCL) injuries, aiming to unify diagnostic criteria and improve clinical decision-making based on tear location.
A retrospective analysis was conducted using magnetic resonance imaging (MRI) examinations from a single institution, identifying all patients with acute or subacute PCL injuries from 2008 to 2024. Ligament sprains without significant fiber disruption and chronic injuries were excluded. Tears were classified by four independent observers according to the relative length (%) of the intact distal remnant compared to the total PCL length: Type I (> 90%), Type Ib (femoral bony avulsion), Type II (90-75%), Type III (75-25%), Type IV (distal tear 10-25%), Type V (< 10%), and Type Vb (tibial bony avulsion). For intra-observer reliability analysis, measurements were repeated once by two observers after 4 weeks.
A subset of 45 MRIs with diagnosed PCL injuries that met the inclusion criteria (mean age 40.5 ± 19.2 years, 40% female) had 24% proximal tears, 33% midsubstance tears, 33% distal tears, and 11% single-bundle injuries. Inter-observer reliability (Fleiss' kappa, 0.88; 95% CI, 0.84-0.94; p < 0.01) and intra-observer reliability demonstrated to be almost perfect (Cohen's kappa, 0.95; 95% CI, 0.86-0.99 & 0.92; 95% CI, 0.84-0.99).
The proposed MRI-based classification system-which includes femoral avulsion, proximal quarter, midsubstance (50%), distal quarter, and tibial avulsion injuries-offers a reliable method for identifying the anatomical location of partial and complete PCL injuries. Standardizing tear localization has the potential to improve diagnostic consistency and inform more tailored, evidence-based treatment strategies.
Diagnostic study; III.
介绍一种用于后交叉韧带（PCL）损伤的撕裂部位分类系统，旨在统一诊断标准并改善基于撕裂部位的临床决策。
对来自单一机构的磁共振成像（MRI）检查进行回顾性分析，确定2008年至2024年期间所有急性或亚急性PCL损伤患者。排除无明显纤维断裂的韧带扭伤和慢性损伤。由四名独立观察者根据完整远端残端相对于PCL总长度的相对长度（%）对撕裂进行分类：I型（>90%）、Ib型（股骨骨撕脱）、II型（90 - 75%）、III型（75 - 25%）、IV型（远端撕裂10 - 25%）、V型（<10%）和Vb型（胫骨骨撕脱）。对于观察者内可靠性分析，两名观察者在4周后重复测量一次。
符合纳入标准的45例诊断为PCL损伤的MRI子集（平均年龄40.5±19.2岁，40%为女性），近端撕裂占24%，中部撕裂占33%，远端撕裂占33%，单束损伤占11%。观察者间可靠性（Fleiss' kappa，0.88；95% CI，0.84 - 0.94；p < 0.01）和观察者内可靠性显示几乎完美（Cohen's kappa，0.95；95% CI，0.86 - 0.99和0.92；95% CI，0.84 - 0.99）。
所提出的基于MRI的分类系统——包括股骨撕脱、近端四分之一、中部（50%）、远端四分之一和胫骨撕脱损伤——为识别部分和完全PCL损伤的解剖位置提供了一种可靠方法。标准化撕裂定位有可能提高诊断一致性，并为更具针对性的循证治疗策略提供依据。
诊断性研究；III级
