Noyes F R, Paulos L, Mooar L A, Signer B
Phys Ther. 1980 Dec;60(12):1596-1601. doi: 10.1093/ptj/60.12.1596.
A retrospective study and a prospective study comprising 186 patients with "typical knee sprains" were conducted at the University of Cincinnati Sports Medicine Institute. We concluded that the commonly encountered mild knee sprain may actually be a serious knee injury whose severity is easy to underestimate. Traumatic hemarthrosis indicates a serious knee injury. Arthroscopy showed that a surprising 72 percent of the patients in the prospective study had disruption of the anterior cruciate ligament (partial tear in 28%, complete tear in 44%). In addition of the 72 percent of anterior cruciate ligament tears, associated injuries included meniscus tears (62%), osteochondral fractures or fissures to the joint surface (20%), and other significant ligament disruptions (20%). Any joint effusion within 24 hours of knee injury, no matter how trivial, suggests a need for further diagnostic tests beyond the initial examination. In our study, our clinical examination alone consistently underestimated the extent of injury, resulting in inadequate information for treatment descisions. Conversely, arthroscopy and examination under anesthesia provided information on the extent of injury, allowing an accurate diagnosis and formulation of a rational treatment program.
辛辛那提大学运动医学研究所对186例“典型膝关节扭伤”患者进行了一项回顾性研究和一项前瞻性研究。我们得出结论，常见的轻度膝关节扭伤实际上可能是一种严重的膝关节损伤，其严重程度很容易被低估。创伤性关节积血表明膝关节损伤严重。关节镜检查显示，在前瞻性研究中，令人惊讶的是72%的患者存在前交叉韧带断裂（28%为部分撕裂，44%为完全撕裂）。除了72%的前交叉韧带撕裂外，相关损伤还包括半月板撕裂（62%）、关节面骨软骨骨折或裂隙（20%）以及其他严重韧带断裂（20%）。膝关节损伤后24小时内出现的任何关节积液，无论多么轻微，都表明除了初步检查外还需要进一步的诊断测试。在我们的研究中，仅靠临床检查一直低估了损伤程度，导致治疗决策信息不足。相反，关节镜检查和麻醉下检查提供了损伤程度的信息，从而能够进行准确诊断并制定合理的治疗方案。
