Masciocchi C, Barile A, Simonetti C, D'Archivio C, De Stefano N, Mastri F
Catteda di Radiologia CLO, Università de L'Aquila.
Radiol Med. 1993 Apr;85(4):378-83.
The diagnostic capabilities of Magnetic Resonance Imaging (MRI) were investigated in the study of occult intraosseous fractures of the knees in athletes; this pathologic condition is difficult to assess with conventional diagnostic techniques. Twelve athletes were considered and submitted to MR examinations 1-8 days after trauma. All patients had undergone plain films, 6 of them CT and 3 scintigraphy. Four patients were followed with MRI at 15 and 30 days. Plain films were negative in all patients. On CT, in one case only an area of segmental osteoporosis was identified at the anterolateral tibial plateau. Scintigraphy provided positive but aspecific results in all three patients. MRI demonstrated all lesions: 3 at the tibial plateau, 5 at the lateral femoral condyle and 2 at the medial femoral condyle. Double localizations were observed in two patients, femorotibial and tibiopatellar, respectively. In no case lesions of meniscal and/or capsuloligamentous structures of the knee were associated. Arthroscopy, which was employed in two patients, confirmed MR diagnosis. Thanks to its high spatial and contrast resolution and to its multiplanar capabilities, MRI can be considered the method of choice in the study of occult intraosseous fractures of athletes' knees. Beside localizing the lesion site, MRI allows the evaluation of its extent (linear or reticulo-geographic patterns) and the exclusion of possible involvement of meniscal and/or capsulo-ligamentous structures. MRI follow-up of this condition showed the "restitutio ad integrum" of the medullary trabecular bone as early as at 15 and 30 days, depending on lesion pattern and extent. On the basis of our experience, MRI emerges as the only diagnostic technique allowing the accurate evaluation of occult intraosseous fractures of the knee in athletes, because it provides early and detailed information which is valuable for the therapeutic approach, which is of fundamental importance to resume sports activity quickly.
在对运动员膝关节隐匿性骨内骨折的研究中，对磁共振成像（MRI）的诊断能力进行了调查；这种病理状况很难用传统诊断技术进行评估。研究纳入了12名运动员，在受伤后1 - 8天接受了MR检查。所有患者均进行了X线平片检查，其中6例进行了CT检查，3例进行了骨闪烁显像检查。4例患者在15天和30天时接受了MRI随访。所有患者的X线平片均为阴性。在CT上，仅1例在胫骨平台前外侧发现节段性骨质疏松区域。骨闪烁显像在所有3例患者中均给出了阳性但非特异性的结果。MRI显示了所有病变：3例位于胫骨平台，5例位于股骨外侧髁，2例位于股骨内侧髁。2例患者分别观察到股骨 - 胫骨和胫骨 - 髌骨关节面双部位损伤。在所有病例中均未发现膝关节半月板和/或关节囊韧带结构损伤。2例患者接受了关节镜检查，证实了MR诊断。由于其高空间分辨率和对比分辨率以及多平面成像能力，MRI可被视为运动员膝关节隐匿性骨内骨折研究的首选方法。除了定位病变部位外，MRI还能评估其范围（线性或网状 - 地理模式），并排除半月板和/或关节囊韧带结构可能受累的情况。对这种情况的MRI随访显示，根据病变模式和范围，早在15天和30天时骨髓小梁骨就实现了“完全恢复”。根据我们的经验，MRI是唯一能够准确评估运动员膝关节隐匿性骨内骨折的诊断技术，因为它能提供早期且详细的信息，这对治疗方法很有价值，对于快速恢复体育活动至关重要。
