Le Vot J, Solacroup J C, Leonetti P, Nun P, Gueguen E, Le Bihan E, Tourrette J H, Gadea J F, Germanetto P
Service de Radiologie de l'HIA Sainte-Anne, Toulon, Naval.
J Radiol. 1993 Oct;74(10):483-92.
Authors study retrospectively 81 cases of isolated recent (less than three months) knee traumas. These include clinical aspects, NMR, arthroscopy. Clinical examinations have been graded: 1. possible lesion; 2. likely lesions; 3. confirmed lesions. Clinical examinations and NMR results are compared to arthroscopy considered as reference. Clinical examination of acute traumatic knee is essential. Nevertheless, its value for detecting precise lesions is poor, except for knee locking well correlated with meniscal tears. Results show that NMR provide better results than clinical examination. NMR is reliable for detecting tears of posterior cruciate ligament, tears of posterior horn of menisci (sensibility: 93%; specificity: 80%). Its results are less effective for appreciation of lesion of anterior cruciate ligament (sensibility: 88%; specificity: 78%) because of partial tears and functional but not morphologic damage. It is the only method able to evidence osteochondral injuries and soft-tissues associated lesions in traumatic knees. Emergency NMR scans show results no differences in results compared with routine examinations. However, one should keep in mind that negative NMR cannot exclude small cartilaginous lesions and partial tears of anterior cruciate ligament. According to these results and the known qualities of NMR (non invasive), we propose that this type of investigation should be more largely included in diagnostic attitude for acute injured knee. Emergency diagnostic arthroscopy could be efficiently replaced by NMR knee examination.
作者回顾性研究了81例单纯近期（少于三个月）膝关节创伤病例。这些研究涵盖了临床症状、核磁共振成像（NMR）以及关节镜检查。临床检查分为三个等级：1. 可能存在的损伤；2. 可能的损伤；3. 确诊的损伤。将临床检查和NMR结果与被视为参考标准的关节镜检查结果进行比较。急性创伤性膝关节的临床检查至关重要。然而，除了与半月板撕裂密切相关的膝关节交锁情况外，其检测精确损伤的价值较低。结果表明，NMR比临床检查能提供更好的结果。NMR在检测后交叉韧带撕裂、半月板后角撕裂方面是可靠的（敏感度：93%；特异度：80%）。由于部分撕裂以及功能性而非形态学损伤，其在前交叉韧带损伤评估方面的效果较差（敏感度：88%；特异度：78%）。它是唯一能够发现创伤性膝关节骨软骨损伤和软组织相关损伤的方法。急诊NMR扫描结果与常规检查相比并无差异。然而，应记住，NMR结果为阴性并不能排除小的软骨损伤和前交叉韧带部分撕裂。根据这些结果以及NMR已知的特性（非侵入性），我们建议在急性膝关节损伤的诊断流程中应更广泛地采用这种检查方式。急诊诊断性关节镜检查可被膝关节NMR检查有效替代。
