后交叉韧带作为间接MR影像在前交叉韧带损伤中的诊断价值

目的评价后交叉韧带(PCL)作为间接MR影像在前交叉韧带(ACL)损伤中的诊断价值.方法回顾分析78例经关节镜证实的膝关节MRI资料,其中ACL损伤33例,正常45例.盲法分析MR影像的以下PCL参数:PCL线、PCL角和PCL指数.结果阳性PCL线诊断ACL 损伤的敏感性和特异性分别是75.6% 和 97.8%,PCL角小于109°分别是66.7% 和96.6%.ACL 损伤的PCL角为(102±10.1)°,正常时PCL角为(116±9.8)°(P< 0.001).ACL 损伤时PCL指数为3.76±0.93,正常为4.95±0.63(P<0.01).结论 PCL角小于109°和阳性PCL 线的高特异性说明可以用其诊断ACL损伤.PCL角度和PCL指数越小,ACL损伤的可能性越大.     

MRI辅助征象对前交叉韧带撕裂的诊断价值

目的 观察ACL撕裂MRI辅助征象的发生率,探讨其对ACL撕裂的诊断价值. 方法回顾性分析209例膝关节关节镜检查和(或)治疗且有MRI资料患者中,胫骨平台后外侧或股骨外侧髁挫伤、外侧半月板后角向后移位、后交叉韧带夹角小于105度和半月板外周部垂直撕裂四个辅助征象,计算其对ACL撕裂检出的敏感性、特异性和阳性预测值,比较其在ACL撕裂和ACL完整患者中的发生率的差别.结果 209例患者中,关节镜检查ACL撕裂36例,完整173例.胫骨平台后外侧或股骨外侧髁挫伤、外侧半月板后角向后移位、后交叉韧带夹角小于105°和半月板外周部垂直撕裂对ACL撕裂检出的敏感性分别为0.72、 0.64、0.31和 0.67,特异性为0.91、0.93、0.97和0.88,PPV为0.62、0.66、0.64和0.34;在ACL撕裂患者中发生率高于ACL完整患者,差异有统计学意义.结论 胫骨平台后外侧或股骨外侧髁挫伤、外侧半月板后角向后移位、后交叉韧带夹角小于105度和半月板外周部垂直撕裂等征象与ACL撕裂相伴发生,认识这些征象有助于ACL撕裂的检出,特别是在ACL撕裂直接征象模棱两可时.     

30°屈曲位膝关节MRI评价前交叉韧带断裂的价值

目的 探讨30°屈曲体位膝关节MRI对显示前交叉韧带（ACL）和评价ACL断裂的应用价值。方法 选取64例接受膝关节镜检查的膝关节外伤患者,依次行微屈位（约17°）及30°屈曲位膝关节MRI,由2名医师分别对ACL全长、双束结构、断裂ACL的断裂点及残端状况显示进行评分,并以关节镜结果为金标准,计算诊断ACL断裂的敏感度、特异度和准确率。结果 微屈位MRI诊断ACL断裂的敏感度、特异度和准确率分别为97.44%（38/39）、100%（25/25）和98.44%（63/64）,30°屈曲位MRI均为100%,二者诊断ACL断裂的一致性好（Kappa=0.967）。30°屈曲位扫描对ACL全长、断裂点及残端的显示优于微屈位（P均<0.001）,二者对ACL双束结构的显示差异无统计学意义（P=0.223）。结论 30°屈曲位与微屈位MR扫描诊断ACL断裂的敏感度、特异度及准确率均较高,30°屈曲位显示ACL全长及其断裂情况优于微屈位。     

半月板周缘垂直撕裂与前交叉韧带损伤相关性的MRI研究

目的：探讨半月板周缘垂直撕裂与前交叉韧带损伤（ACL）的相关性。方法：对178例经关节镜证实,诊断为半月板撕裂的膝关MRI进行回顾性研究,对半月板撕裂的部位和裂口方向及ACL的情况进行诊断分析。并比较半月板周缘垂直撕裂患者和其他类型半月板撕裂患者ACL的发生率。结果：178例患者中有22例被证实为半月板周缘垂直撕裂,其中18例合并急性或慢性ACL,占81．8％,另4例前交叉韧带完整。在156例其他类型半月板撕裂患者中,13例合并急性或慢性ACL,占8．3％。两者比较具有统计学意义（P〈0．001）。结论：半月板周缘垂直撕裂与急性或慢性前ACL密切相关。膝关节MRI图像上,半月板周缘垂直撕裂可作为ACL的辅助诊断依据之一,可以提高诊断ACL的准确率。     

急性膝关节前交叉韧带撕裂的MRI直接征象初探

目的 初步探讨急性膝关节前交叉韧带(ACL)撕裂MRI直接征象及其价值.方法 对46例急性膝关节损伤患者的MRI图像进行回顾性研究,对比关节镜所见,分析ACL撕裂的MRI直接征象及各征象的灵敏度、特异度、阳性似然比、阴性似然比.结果 46例中,MRI诊断ACL撕裂18例、正常28例,其灵敏度为94.12％、特异度为93.10％、阳性似然比为13.65、阴性似然比为0.063,其中ACL信号异常及连续性中断征象灵敏度、特异度分别为70.59％、93.10％及76.47％、96.55％.结论 ACL信号异常及连续性中断为ACL撕裂的主要MRI直接征象,具有重要诊断价值.     

前交叉韧带损伤的3D MRI诊断价值

目的 评价3D MRI在前交叉韧带(ACL)损伤诊断中的价值.方法 对膝关节损伤拟行关节镜检查的病人行术前MRI扫描,46只患膝在常规MRI序列完成后加扫3D MRI序列.在不知道病人信息和病史的情况下先评估常规MR图像,然后评估3D MR图像.评估内容限于ACL完整或撕裂的表现.最后以关节镜检查结果为准,分别计算常规MRI和3D MRI诊断ACI.损伤的敏感性、特异性和准确性.结果 常规MRI诊断ACL损伤的敏感性、特异性和准确性分别为92.0%、95.2%和93.5%;3D MRI诊断ACL损伤的敏感性、特异性和准确性分别为96.0%、100%和97.8%.结论 3DMRI可以提高前交义韧带损伤诊断的敏感性、特异性和准确性.     

膝关节前交叉韧带撕裂的MRI诊断

目的　研究膝关节前交叉韧带 (ACL)撕裂的MRI表现及其诊断价值。方法　对 32例手术或关节镜证实的ACL撕裂和 2 0例ACL正常病例的膝关节MRI资料进行分析 ,对ACL的形态特征、走行、信号强度以及ACL撕裂的伴随征象均作了观察与分析 ,并判断有无ACL撕裂。结果　MRI诊断ACL完全性撕裂的敏感性、特异性和准确性分别为 92 % ,95 %和 93%。MRI诊断ACL部分性撕裂与手术、关节镜完全符合 4例 ,1例诊断为完全性撕裂 ,2例假阴性。ACL撕裂的伴随征象主要有胫骨平台骨折 ,骨挫伤 ,半月板、侧副韧带损伤 ,PCL曲度异常 ,胫骨前移或外侧半月板后角后移等。结论　MRI诊断急性完全性ACL撕裂的准确性均较高 ,对于慢性或部分性撕裂 ,其诊断准确性相对较低。     

膝关节前交叉韧带损伤的MRI检查与诊断

目的探讨膝关节前交叉韧带(ACL)损伤的MRI检查方法与诊断。方法采用膝关节伸直位、微屈位和屈曲位斜矢状位快速自旋回波序列,对36例疑有膝关节ACL损伤患者进行MRI扫描,分析其显示效果及MRI表现。结果膝关节前交叉韧带损伤在斜矢状面伸直位、微屈位和屈曲位显示率分别为55.60%、83.33%、92.0%,微屈位和屈曲位2者之间无统计学差异(P>0.05),但2者均明显高于斜矢状面伸直位(P<0.01)。结论 ACL带在MRI上屈曲位斜矢状面显示最佳,可作为其诊断的首选检查方法。     

Anterior cruciate ligament injury: diagnosis, management, and prevention

There are an estimated 80,000 to 100,000 anterior cruciate ligament (ACL) repairs in the United States each year. Most ACL tears occur from noncontact injuries. Women experience ACL tears up to nine times more often than men. Evaluation of the ACL should be performed immediately after an injury if possible, but is often limited by swelling and pain. When performed properly, a complete knee examination is more than 80 percent sensitive for an ACL injury. The Lachman test is the most accurate test for detecting an ACL tear. Magnetic resonance imaging is the primary study used to diagnose ACL injury in the United States. It can also identify concomitant meniscal injury, collateral ligament tear, and bone contusions. Treatment consists of conservative management or surgical intervention, with the latter being the better option for patients who want to return to a high level of activity. Patients who undergo surgery must commit to appropriate rehabilitation for the best outcome. Long-term sequelae of ACL injury include knee osteoarthritis in up to 90 percent of patients. Primary prevention of ACL injury includes specific proprioceptive and neuromuscular training exercises to improve knee stability.     

膝关节韧带损伤及伴发半月板损伤的MRI分析

目的：探讨膝关节单发韧带损伤、多发韧带损伤及二者伴发半月板损伤的特点,比较分析MRI诊断单发韧带损伤、多发韧带损伤及伴发半月板损伤的准确性。方法对187例经临床手术证实为膝关节韧带损伤的MRI病例资料进行回顾性分析。结果187例病例中,单发韧带损伤103例,多发韧带损伤84例;单发韧带损伤组中,前交叉韧带（ACL）损伤38例,内侧副韧带（MCL）损伤36例,后交叉韧带（PCL）损伤14例,内侧髌股韧带（MPFL）损伤10例,髌韧带（PT）损伤3例,外侧副韧带（LCL）损伤2例,伴发内侧半月板（MM）损伤35例,伴发外侧半月板（LM）损伤23例;多发韧带损伤组中, ACL、MCL联合损伤37例,ACL、PCL联合损伤21例,ACL、PCL、MCL联合损伤10例,MPFL、MCL联合损伤8例,MPFL、MCL、ACL联合损伤4例,ACL、PT联合损伤2例,ACL、PCL、LCL联合损伤2例,伴发MM损伤43例,伴发LM损伤35例;单发韧带组与多发韧带组中,MRI诊断韧带损伤的敏感性、特异性、准确性分别为90.3%、97.7%、96.4%和81.5%、88.4%、85.9%,二者比较差异均有统计学意义（P＜0.05）;二者伴发MM、LM损伤的发生率分别为34%、22.3%和51.2%、41.7%,二者比较差异有统计学意义（P＜0.05）,MRI诊断二者间伴发MM损伤的敏感性、特异性、准确性分别为88.6%、89.7%、89.3%和76.7%、65.9%、71.4%,二者比较特异性、准确性差异有显著统计学意义（P＜0.01）,而敏感性差异无统计学意义（P＞0.05）,MRI诊断二者间伴发LM损伤的敏感性、特异性、准确性分别为87%、93.8%、92.2%和85.7%、77.6%、77.4%,二者比较特异性、准确性差异有统计学意义（P＜0.05）,而敏感性差异无统计学意义（P＞0.05）。结论单发韧带损伤以ACL损伤最为多见,其次为MCL;多发韧带损伤以ACL、MCL联合损伤最为常见,其次为ACL、PCL联合损伤,再次为ACL、PCL、MCL联合损伤;MRI诊断多发韧带损伤的敏感性、特异性、准确性均较单发韧带损伤下降;多发韧带损伤较单发韧带损伤更易伴发 MM、LM损伤;多发韧带组与单发韧带组比较,虽然MRI诊断伴发MM、LM损伤敏感性无明显差异,但特异性、准确性均较单发韧带组明显降低。     

Diagnosis of Simultaneous Acute Ruptures of the Anterior Cruciate Ligament and Posterior Cruciate Ligament Using Point-of-Care Ultrasound in the Emergency Department

Background

Patients with acute anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) injuries from sport-related activities are frequently seen in the emergency department (ED). However, knee instability tests are known to show variable sensitivity and specificity. These tests would also have limited functionality in patients with severe pain and swelling in the knee.

Anterior cruciate ligament tears and associated injuries

Anterior cruciate ligament (ACL) tears are a commonly sustained sports injury, often occurring in association with meniscal tears and trauma to other ligamentous structures around the knee. Diagnosis can often be made clinically, but assessment may be difficult in the acute setting when there is a large joint effusion and severe pain. Plain radiographs may detect the presence of a joint effusion and any associated fractures. However, magnetic resonance imaging is vital for assessing acute knee injuries and plays an important role in deciding treatment options and planning surgical intervention. Some of the associated meniscal and ligamentous injuries can be subtle and may easily be overlooked if these structures are not scrutinized closely. This article will discuss the anatomy of the ACL and the mechanisms and initial clinical assessment of ACL injuries, and review the imaging features of ACL tears and some of the associated injuries, including the posterolateral corner structures. These associated injuries have important implications for determining treatment options and subsequent return to athletic activities.     

MR在膝关节外伤中的诊断价值

本文对20例膝关节外伤的MR检查作了研究，其中9例施行了关节手术，并与常规X线检查进行了对照，MR显示半月板撕裂及前十字韧带撕裂的正确率均为90％。对膝关节不完全骨折、骨挫伤及软骨骨折的显示，明显优于常规X线检查。     

MRI在膝关节前交叉韧带撕裂的应用价值

目的:探讨膝关节前交叉韧带撕裂患者行MRI检测的临床价值。方法:以2019年1月至2020年1月我院经关节镜确诊的膝关节前交叉韧带撕裂患者64例为研究对象,所选患者均行MRI检查。以关节镜检查为金标准,分析MRI检查膝关节前交叉韧带的准确性。结果:以关节镜为金标准,提示MRI检测完全撕裂灵敏度明显高于部分撕裂,差异显著(P<0.05)。结论:MRI检测膝关节前交叉韧带完全撕裂准确性较高,临床价值大,可以作为该病无创检查的首选。     

A difference in rotational alignment of the tibio-femoral joint after anterior cruciate ligament reconstruction between the bone-patellar tendon-bone and semitendinosus-gracilis grafts

BackgroundA question as to the effect of the graft choice on rotational kinematics after anterior cruciate ligament reconstruction remains unclear. The purpose of this study was to determine if there were any differences in rotational alignment of the knee after anterior cruciate ligament (ACL) reconstruction using bone-patellar tendon-bone (BTB) graft compared to that using semitendinosus-gracilis (STG) graft.MethodsTen patients with BTB graft and 10 patients with STG graft were assessed at 3 months after ACL reconstruction. We compared the 6 degrees-of-freedom alignment of the tibiofemoral joint in the fully extended position between knees reconstructed with BTB graft and STG graft using the uninvolved knee as a control.FindingsThe BTB graft group showed no difference in knee alignment between the ACL reconstructed knee and uninvolved knee, whereas the STG graft group showed greater external rotation in the ACL reconstructed knee than in the uninvolved knee (median values, 8.4° vs 5.8°; p = 0.022).InterpretationACL reconstruction with the STG graft leads to increased external tibial rotation. Our findings suggest that clinicians should make an effort to prevent increased external tibial rotation during the rehabilitation process in patients with STG graft.     

Magnetic resonance imaging in the evaluation of knee injuries

To better define the role of magnetic resonance imaging (MRI) in the evaluation of knee injuries, we analyzed 10 recently published articles comparing MRI and arthroscopy in the detection of meniscal and anterior cruciate ligament tears. Sensitivity (SN), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) for medial meniscus (MM) tears, lateral meniscus (LM) tears, and anterior cruciate ligament (ACL) tears were either obtained or calculated from data contained in each article. The medians of measurements for MM tears were 97% SN, 89% SP, 88% PPV, and 96% NPV. Measurement medians for LM tears were 85% SN, 94% SP, 86% PPV, and 95% NPV. ACL tear measurement medians were 100% SN, 96% SP, 80% PPV, and 98% NPV. High NPVs were found in several studies, many of which were 100%. The high NPV of MR imaging suggests that diagnostic arthroscopic surgery is not necessary in the evaluation of patients with negative MRI studies. The superior sensitivity of MRI in detecting frank posterior horn tears, intrasubstance meniscal tears, and significant incidental findings also suggests that screening MRI scans can facilitate preoperative planning.     

MRI在前交叉韧带重建术联合滑膜部分切除术中的应用

目的探讨MRI在前交叉韧带（ACL）重建术联合滑膜部分切除术前指导及手术效果评估中的应用价值。方法选择2017年1月~2019年1月我院收治的80例ACL损伤患者作为观察组,接受ACL重建术和滑膜部分切除术治疗;另外选择无损伤的MRI检查者40例作为对照组。观察组手术前后、对照组均进行MRI检查,记录两组的ACL角、PCL夹角、PCL指数、Blumensaat角、胫骨前移指标。观察组患者术后1年来院接受MRI检查,进行前抽屉实验、Lachman实验、轴移实验,用Lysholm评分、Tegner评分评估膝关节功能,计算ACL移植物MRI评分。结果观察组术后ACL角较术前升高,PCL指数、Blumensaat角、胫骨前移较术前降低（P < 0.05）,与对照组差异无统计学意义（P < 0.05）,术后PCL夹角较术前升高,高于对照组（P < 0.05）。80例患者中,前抽屉实验、Lachman实验、轴移实验3项检查结果均为阴性者70例（87.50%）,1项或以上为阳性者10例（12.50%）。移植物的完整性和信号依据Rak’s法分级:1级73例（92.25%）,2级7例（8.75%）。Lysholm膝关节评分88.63±6.51分,Tegner膝关节运动评分8.02±1.56分,较术前升高（P < 0.05）,ACL移植物MRI评分72.13±10.02分。Pearson相关性分析结果显示,ACL移植物MRI评分与Lysholm膝关节评分、Tegner膝关节运动评分呈正相关（r=0.675、0.742,P < 0.05）。结论ACL重建术联合滑膜部分切除术对ACL损伤患者有较好的治疗效果,可恢复膝关节功能和稳定性,MRI是术前指导、术后手术效果评估的有力工具。      

Hamstring tendon graft for anterior cruciate ligament reconstruction

In an age of increasing emphasis on sports, the most common contact injury of the lower extremity is anterior cruciate ligament (ACL) rupture. The classic history of an ACL injury is a sudden twisting of the knee accompanied by a popping or snapping sound. The patient usually complains of a feeling of hesitation, instability, or giving way of the knee. By the end of the day, the patient's knee will be swollen and unstable. There are many ways that the ACL can rupture, but a common method is a contact injury in which a valgus force is applied to the flexed, rotated externally knee. This can produce tears to the ACL, medial collateral ligament, and menisci. Noncontact injuries, such as those incurred while skiing or jumping, occur when the knee is extended and the tibia is internally rotated on the femur. There are several methods of repairing a ruptured ACL, such as using an allograft or autograft of the patella tendon or a hamstring tendon graft for the repair. This article focuses on the use of a hamstring tendon graft for ACL reconstruction and how to care for patients undergoing this procedure. AORN J 76 (Oct 2002) 612-624.     

Management of soft tissue knee injuries in an accident and emergency department: the effect of the introduction of a physiotherapy practitioner

Objective: To assess the effect of the introduction of a physiotherapist with an extended scope of practice in the management of acute soft tissue knee injuries in an accident and emergency (A&E) department.

Methods: The A&E department established an Acute Knee Screening Service (AKSS) in 1998. An experienced physiotherapist was appointed to run the AKSS after additional training. Local guidelines and protocols were developed in conjunction with trauma knee surgeons, radiologists, physiotherapists, and A&E doctors. This study describes 100 consecutive patients managed by the AKSS over a three month period and comparisons are made over a similar period before the introduction of the AKSS.

Results: The initial diagnosis of patients with acute knee injuries referred to the service showed meniscal injuries (38%), cruciate ligament injuries (18%), fractures (2%), patellofemoral joint injuries (10%), and others (32%). Ninety five per cent of patients referred to AKSS were seen within one week. Medical time was saved in both A&E and trauma clinic. Fifty nine per cent of patients were treated and discharged from the service without further medical review. Thirty nine per cent (39) were referred to trauma clinic and of these 44% (17) had MRI scans performed as requested by the physiotherapist. Eighty eight per cent (15) of these scans showed significant abnormality: (nine, anterior cruciate ligament tears, one, posterior cruciate ligament tears, and nine meniscal tears).

Conclusions: A physiotherapy practitioner working with an extended role is a valuable addition to an A&E department. The AKSS improves the quality of care of acute knee injuries, saves medical time, and fosters cooperation across services within the NHS.

     

Differences in gait and muscle strength of patients with acute and chronic anterior cruciate ligament injury

BackgroundAnterior cruciate ligament (ACL) injury is one of the most common injuries of the area surrounding the knee. Muscle strength deficiency is observed following an ACL injury. Determining differences in muscle strength and gait between patients with acute and chronic ACL injury will provide crucial information for assessments and treatment plans.MethodsWe evaluated 60 patients with ACL rupture. Patients were classified into acute and chronic groups. We compared measurements of anthropometric parameters, muscle strength, gait and functional questionnaire.FindingsThe muscle strength of both knee extensors and flexors was higher in the chronic group than in the acute group. The muscle strength index for extensors was 57% in the acute group and 73% in the chronic group. However, the hamstring-to-quadriceps ratio for peak torque of the injured leg in the acute and chronic groups was similarly high at 98% and 101%, respectively. In gait, asymmetry in the hip and knee was observed in the acute group but not in the chronic group. The Knee Injury and Osteoarthritis Outcome Scores (KOOS) for symptoms, pain, activities of daily living, sports and recreational activities were higher in the chronic group than in the acute group.InterpretationCompared with the acute group, the gait of the chronic group is more symmetrical, and the score of KOOS is also higher. The muscle training protocols could be strategically planned according to these differences. Patients with ACL injury are characterized high hamstrings-to quadriceps peak torque ratio.