前交叉韧带损伤的MRI相关征象分析

目的：分析膝关节多种MRI征象对诊断前交叉韧带（ACL）损伤的价值.方法：经关节镜证实的194例患者（包括前ACL正常膝97例、ACL损伤膝97例）,对ACL损伤的相关MRI直接征象和间接征象进行评价.结果：在评价的4个直接征g（ACI,连续性中断、信号缺失、形态异常及走行异常）中,除ACL信号缺失外,其余直接征象对诊断ACL损伤均具有统计学意义,其中韧带连续性中断具有较高的诊断敏感度（83.5%）、特异度（97.9%）及阳性似然比（39.8）.大多数间接征象具有较高的特异性和相对低的敏感性,其中Notch征、骨挫伤、外侧半月板后角裸露征及胫骨前移等征象具有较高的阳性似然比,分别为：＋∞、9.0、55.70和8.0.结论：前交叉韧带损伤的MRI直接征象是其诊断的主要依据;由于其间接征象具有较高的特异性和＋LR,因此可作为前交叉韧带损伤的辅助诊断依据,尤其是直接征象难以确诊的可疑ACL损伤者.     

膝关节急性前交叉韧带撕裂的常见MRI征象分析

目的 :分析膝关节急性前交叉韧带(anterior cruciate ligament,ACL)撕裂的MRI征象,提高对ACL撕裂的术前诊断和评估能力。方法:回顾性分析117例经关节镜或手术证实急性ACL撕裂患者的临床及影像学资料,分析其MRI征象。结果:117例MRI直接征象主要为ACL纤维中断或部分不连续、弥漫性增粗并信号增高、走行异常、胫骨附着处撕脱骨折;间接征象主要为胫、股骨外侧髁的"对吻性"骨挫伤或骨折、后交叉韧带曲率增大、胫骨前移位、内侧副韧带损伤、内侧半月板撕裂。评估分析5种MRI直接征象得出,ACL走行异常具有相对高的诊断敏感度和特异度;5种MRI间接征象均诊断特异度高而敏感度低。结论 :MRI直接征象能较准确地诊断急性ACL撕裂,并评估其撕裂程度,可作为主要诊断依据;而MRI间接征象特异度较高、敏感度相对较低,不能作为主要诊断依据,但对明确诊断具有较大帮助,可作为辅助诊断依据。     

前交叉韧带撕裂的MRI诊断

目的:研究膝关节前交叉韧带撕裂的MRI表现。方法:回顾分析30例经关节镜证实的前交叉韧带撕裂MR图像及40例完好的ACL,分析其直接及间接征象的特征。结果:在评价的直接征象中,ACL不连续和ACL走行异常均具有相对高的诊断敏感性、特异性;在评价的间接征象中,后交叉韧带角、Blumensaat角、后交叉韧带指数、半月板后移征、“对吻性”骨挫伤、胫骨前移位等6个征象具有相对高的特异性,后交叉韧带角、Blumensaat角具有较高的敏感性。结论:ACL损伤的直接征象为诊断主要依据,ACL损伤的间接征象具有辅助诊断意义。     

前后交叉韧带及半月板损伤的MDCT与关节镜的对比研究

目的探讨多层螺旋CT在膝关节外伤中前后交叉韧带与半月板损伤的诊断价值。方法回顾性分析45例经膝关节镜证实的前后交叉韧带和半月板损伤的多层螺旋CT直接征象和间接征象。结果前后交叉韧带损伤的直接征象表现为韧带断裂、密度欠均匀,韧带附着点撕脱性骨折,间接征象表现为韧带肿胀,周围脂肪间隙模糊欠清;半月板损伤的MDCT直接征象是形态失常、密度不均匀及裂隙征,间接征象是膝关节滑膜增厚、关节囊关节腔内积液、损伤的半月板周围软组织肿胀等。45例患者中,MDCT显示前交叉韧带损伤14例(14/20),后交叉韧带损伤11例(11/15),内侧半月板损伤8个(8/12),外侧半月板损伤12个(12/20),交叉韧带与半月板同时损伤10例,韧带附着点及胫骨平台骨折18例。结论多层螺旋CT在膝关节外伤中的前后交叉韧带及半月板的损伤有一定的诊断价值,可为缺少磁共振设备的基层医院提供一有用的检查方法。     

膝关节韧带损伤MRI诊断的评价(附36例分析)

目的：探讨膝关节韧带损伤的MRI表现及诊断价值。方法：分析36例经手术或关节镜证实的膝关节韧带损伤患者的MRI材料，重点分析了前交叉韧带(ACL)损伤的MRI表现。结果：前交叉韧带部分性撕裂为T1WI、T2WI、T2^*像上韧带内信号均增高，但纤维束仍保持其连续性和完整性；完全性撕裂的直接征象为韧带连续性中断、增粗或扭曲变形；看不到正常的ACL，于附着处出现一团块影，T2WI韧带内呈弥漫高信号；间接征象有胫骨前置和后交叉韧带变形等。结论：ACL损伤在MBI上有一定的特点。MRI是诊断膝关节韧带损伤的一种有效的无创性检查方法。     

后交叉韧带MRI相关指标在前交叉韧带损伤诊断中应用的研究进展

前交叉韧带(ACL)的主要功能是维持膝关节稳定, 防止胫骨平台前移。ACL损伤的占比已超过膝关节损伤的50%, 若诊治不及时, 将增加半月板和软骨等结构继发性损伤的风险, 造成膝关节慢性疼痛及退变。虽然大部分ACL损伤可通过其在MRI上的直接征象确定, 但对一些复杂情况及ACL部分撕裂的辨别仍不够明确, 继而影响治疗策略。ACL损伤后, 膝关节内部解剖关系的改变也会导致后交叉韧带(PCL)等其他结构在MRI上形态的改变, 这些间接征象可以辅助诊断ACL损伤。笔者就PCL MRI相关指标在ACL损伤诊断中应用的研究进展进行综述, 以期为临床决策提供参考和新思路。     

儿童和青少年前交叉韧带断裂后延迟重建对半月板和关节软骨的影响

目的 评估儿童和青少年前交叉韧带(ACL)断裂后延迟重建对半月板和软骨损伤的影响.方法 回顾性分析2005年1月—2020年12月西安交通大学第二附属医院骨科因ACL断裂行韧带重建手术患者126例,男性84例,女性42例;年龄8～18岁,平均13.4岁;左膝56例,右膝70例.均为创伤导致,按照致伤原因分为非接触性损伤(主要是运动损伤,如打篮球时转身起跳)和高能量接触性损伤(如道路交通伤、高处坠落伤),非接触性损伤95例,高能量接触性损伤31例.患者被连续登记并根据术前损伤时间不同分为急性期组71例(＜6周)、亚急性期组29例(6～12周)和慢性期组26例(＞12周).受伤时轴移试验Ⅲ度患者共35例,其中急性期组18例,亚急性期组8例,慢性期组9例.评价各组患者半月板撕裂和软骨损伤的发生率、部位和类型等情况.根据国际关节镜、膝关节外科和骨科运动医学学会(ISAKOS)半月板分类标准记录半月板损伤的类型.参考Copper分型,记录半月板撕裂的区域,并记录每个区域半月板撕裂的数目.根据国际软骨修复学会(ICRS)标准记录软骨损伤的位置和分级.结果 126例患者中,发生内侧半月板撕裂52例(41.3％),外侧半月板撕裂34例(27.0％).慢性期组中内侧半月板撕裂发生率(22/26,84.6％)较急性期组(20/71,28.2％)和亚急性期组(10/29,34.5％)显著升高(P＜0.05).30例(23.8％)软骨损伤在ICRSⅡ级及以上,其中慢性期组股骨内侧髁软骨损伤(10/26,38.5％)和内侧胫骨平台损伤(6/26,23.1％)发生率高于急性期组(3/71,4.2％;1/71,1.4％)和亚急性期组(5/29,17.2％;2/29,6.9％),P＜0.05.三组86例半月板撕裂患者中,内侧半月板后角发生率最高(27.9％),随后是内侧半月板体部(19.8％),而在外侧半月板前角撕裂发生率最低(4.6％),在慢性期组内侧半月板桶柄样裂和纵裂较急性期组和亚急性期组高(P＜0.05).结论 延迟ACL重建增加儿童和青少年患者继发半月板和软骨损伤的风险,半月板撕裂以纵行裂和桶柄裂多见,多发生于内侧半月板后角,软骨损伤多发生于内侧股骨髁和内侧胫骨平台.     

前交叉韧带断裂后半月板和软骨损伤的临床研究

目的　研究前交叉韧带 (ACL)断裂所致的膝关节不稳对关节半月板及软骨的影响。方法　回顾分析 1992～ 2 0 0 2年间收治的 4 8例ACL断裂患者半月板和软骨损伤的分布、程度、发生率与伤后不同时段的关系。　结果　半月板损伤率从急性期组→亚慢性期组→慢性期组分别为6例 (5 5 % ,6 11)、13例 (6 8% ,13 19)、17例 (94 % ,17 18) ,差异具有显著性意义 (P <0 .0 5 ) ;各组中内侧半月板损伤率明显高于外侧半月板 ;慢性期组内侧半月板后角损伤 10例 (5 6 % ,10 18) ,是该期半月板损伤的主要类型 ;亚慢性期、慢性期组内髁软骨损伤率明显高于外髁 ;随病程延长软骨损伤程度加重 ,至慢性期组 ,Ⅲ度软骨损伤达 32处 (6 8% ,32 4 7) ;内髁软骨损伤与内侧半月板并内髁软骨损伤发病率差异无显著性意义 ,而外髁软骨损伤与外侧半月板并外髁软骨损伤发病率差异具有显著性意义 (P <0 .0 5 )。　结论　ACL断裂后可并发半月板及软骨损害 ,并随病程延长而加重 ,ACL损伤后胫骨向前半脱位和过度内旋是造成内髁软骨损伤的主要原因 ,而外髁软骨损伤主要是由于外侧半月板损伤所致。     

膝关节前交叉韧带撕裂的低场强MRI诊断

膝关节前交叉韧带（ACL）是膝关节重要但最易受损伤的稳。定结构之一。MRI具有较高的软组织对比度,是前交叉韧带损伤最重要的无创性诊断手段。MRI对ACL损伤的诊断主要依靠直接征象,间接征象作为补充。本研究复习125例经关节镜证实的膝关节损伤MRI资料,对其中34例ACL损伤的MRI征象进行分析,总结MRI在ACL损伤中的诊断价值。     

无移位半月板桶柄样撕裂的诊断与可修复性判断

目的:回顾性研究进行手术修补的半月板桶柄样撕裂(BHT)的病例,探讨无移位的半月板桶柄样撕裂的临床诊断方法及可修补性判断。方法:2002年9月~2006年10月,对实施修补手术的126例129个半月板桶柄样撕裂的术前核磁共振(MRI)表现(是否存在Ⅲ度信号及其形态、发生区域、累计层面等)以及相关因素(临床表现、是否合并陈旧前交叉韧带(ACL)损伤、发生侧别以及可修复性判断等)进行评估和统计分析。结果:在进行BHT修补手术的129个半月板中,术前MRI无移位表现的共38例39个半月板(30.2%),其中外侧半月板7个(17.9%),内侧半月板32个(82.1%)。在上述39个半月板中,19个冠状面或矢状面出现Ⅲ度信号(垂直或斜形)的层数≥3(层厚0.4mm,间距4.0mm),术前存在特异性的交锁-解锁症状26例(68.4%),合并陈旧性ACL损伤35例(92.1%),均为完全性ACL损伤。结论:无移位的半月板桶柄样撕裂,建议诊断方法如下:(1)冠状面或矢状面出现Ⅲ度信号的层数≥3(层厚0.4mm,间距4.0mm);(2)交锁和伸膝受限;(3)合并陈旧性ACL损伤(受伤至手术时间大于6周)。可修复性MRI判断标准如下:(1)Ⅲ度信号距离滑膜缘小于4mm;(2)Ⅲ度信号距离滑膜缘小于4mm的MRI冠状位层数≥3(层厚0.4mm,间距4.0mm);(3)半月板无明显退行性变。     

Partial and complete tear of the anterior cruciate ligament

PURPOSE: To analyze MR direct and indirect signs for knees with anterior cruciate ligament (ACL) partial or complete tear. MATERIAL AND METHODS: According to documented MR direct and indirect signs for ACL tear, we retrospectively reviewed the incidence of those signs in 15 partial ACL tear and 17 complete ACL tear patients. The findings were also compared with duration of injury (less or more than 6 weeks, as acute or chronic stages). RESULTS: A residual straight and tight ACL fiber in at least one pulse sequence was more frequently detected in partial ACL tears. The empty notch sign, a wavy contour of ACL, bone contusion at lateral compartment and lateral meniscus posterior horn tear were significantly more frequently seen in complete tear cases. The posterior cruciate ligament angle in chronic complete ACL tear cases (109 degrees +/-20 degrees ) had a tendency to be less than in chronic partial ACL tear cases (119+/-18 degrees ). CONCLUSION: The empty notch sign, a wavy ACL, bone contusion, and posterior horn of lateral meniscus tears are suggestive of a complete ACL tear. A residual straight and tight ACL fiber seen in at least one image section is a helpful sign to diagnosis of partial ACL tear. In the acute ACL injury stage, a focal increase of the ACL signal intensity is more suggestive of a partial ACL tear.     

Anterior cruciate ligament tears: MR imaging-based diagnosis in a pediatric population

PURPOSE: To evaluate the diagnostic accuracy of primary and secondary magnetic resonance (MR) imaging findings of anterior cruciate ligament (ACL) tears in young patients with immature skeletal systems. MATERIALS AND METHODS: MR images obtained in 43 patients aged 5-16 years who underwent arthroscopy were retrospectively reviewed. Two reviewers evaluated primary findings (abnormal signal intensity, abnormal course as defined by Blumensaat angle, and discontinuity), secondary findings (bone bruise in lateral compartment, anterior tibial displacement, uncovering of posterior horn of lateral meniscus, posterior cruciate ligament line, and posterior cruciate angle), and meniscal and other ligamentous injuries. RESULTS: There were 19 ACL tears and 24 intact ACLs. Overall sensitivity and specificity of MR imaging in detecting ACL tears were 95% and 88%, respectively. Sensitivities of the primary findings were 94% for abnormal Blumensaat angle; 79%, abnormal signal intensity; and 21% discontinuity. The specificity of all primary findings was 88% or greater. The sensitivity and specificity of the secondary findings, respectively, were 68% and 88% for bone bruise; 63% and 92%, anterior tibial displacement; 42% and 96%, uncovered posterior horn of lateral meniscus; 68% and 92%, positive posterior cruciate line; and 74% and 71%, abnormal posterior cruciate angle. Fifteen (79%) patients had meniscal tears, and five (26%) had collateral ligament injuries. CONCLUSION: Primary and secondary findings of ACL tears in young patients have high specificity and are useful for diagnosis.     

外伤性膝关节前外侧韧带损伤的MR影像特征及相关性分析

目的探讨外伤所致膝关节前外侧韧带损伤病人的MR影像特征,并分析其与前交叉韧带撕裂、外侧半月板撕裂及骨挫伤的相关性,为深入研究前外侧韧带对膝关节稳定性的作用提供可靠依据。方法回顾性分析2016年1月—2017年2月间因外伤进行膝关节MRI检查的320例病人(共321膝)的影像资料。采用美国GE公司生产的Signa HDe 1.5 T MR扫描设备,分别行膝关节斜矢状面T1WI、质子密度加权成像(PDWI)和冠状面、横断面PDWI扫描。根据前外侧韧带的完整性和损伤部位对所有病人进行分类统计。采用独立性卡方检验对前外侧韧带撕裂与前交叉韧带撕裂、外侧半月板撕裂及骨挫伤的相关性进行分析。结果全部病人膝关节MR影像均可显示前外侧韧带,显示率为100%。151/321膝(47.0%;95%CI为41.6%~52.5%)存在前外侧韧带损伤,其中累及胫骨部、股骨部及半月板部的分别为97膝、96膝及65膝。前交叉韧带撕裂158膝,外侧半月板撕裂98膝,股骨外侧髁挫伤58膝,外侧胫骨平台挫伤71膝,分别与前外侧韧带撕裂具有相关性(均P0.001)。结论 MRI检查可以很好地显示前外侧韧带解剖及其损伤情况。膝关节前外侧韧带损伤与前交叉韧带撕裂、外侧半月板撕裂及膝外侧骨挫伤具有相关性。     

Simultaneous bucket handle tear of both medial and lateral menisci of a knee with chronic anterior cruciate ligament deficiency

Bucket handle meniscus tears constitute about 10% of all meniscal tears. Bucket handle tears of medial meniscus is three times more than lateral meniscus. Most of these tears are associated with anterior cruciate ligament (ACL) deficiency. Lateral meniscus lesions are more common with acute ACL deficiency, where medial meniscus lesions are more associated with chronic ACL deficiency. We identified bucket handle tears of each meniscus of a 30-year-old male patient while performing diagnostic arthroscopy during ACL reconstruction procedure. We present an ACL deficient knee with bucket handle tears of medial and lateral meniscus of the same knee and discuss the treatment.     

外侧半月板桶柄状撕裂低场MRI特殊征象分析

目的分析膝关节外侧半月板桶柄状撕裂(bucket-handletears,BHT)的低场MRI特殊征象。资料与方法回顾性分析12例经关节镜证实为膝关节外侧半月板BHT患者的低场强MRI图像,总结MRI征象,除碎块内移征、外周残半月板征、半月板翻转征、空领结征外,着重分析双前交叉韧带征、厚饼征、三韧带征。结果 12例外侧半月板BHT中,碎块内移征10例、外周残半月板征9例、半月板翻转征6例、空领结征12例、双前交叉韧带征3例、厚饼征4例、三韧带征3例。结论碎块内移征、外周残半月板征、半月板翻转征、空领结征见于内侧半月板BHT,同样见于外侧半月板BHT,前交叉韧带征、厚饼征和三韧带征为外侧半月板BHT特殊征象。     

The use of MRI scan of knee injuries in an emergency department

We present a retrospective study of the number of arthroscopically verified total meniscus and cruciate ligament tears seen in our Emergency department one year before, and one year after introducing magnetic resonance imaging (MRI) as a diagnostic tool. The number of total ruptures of the anterior cruciate ligament increased from 34 (1.7% of total 2003 patients) to 67 (2.9% of total 2277). The number of ruptures of the medial meniscus increased from 42 (2.1%) to 87 (3.8%). The number of ruptures of the lateral meniscus remained unchanged. In the first 12 months after introducing MRI we ordered 513 (23%) scans of the total number of 2277 patients with an acute knee condition. Thirty-nine (8%) of these were described with no pathology, 227 (44%) showed total meniscus or cruciate ligament tears. The remaining 247 (48%) were mainly degenerative or partial injuries. The cost per additional new diagnosis was approximately USD 800. The introduction of MRI has enabled us to identify a larger number of patients with meniscus and cruciate ligament injuries.     

Preoperative instrumented testing of anterior and posterior knee laxity

A prospective study was performed on 50 patients who were thought or suspected to have cruciate ligament tears. Each patient had a clinical examination preoperatively and under anesthesia and instrumented examination using the MedMetric KT-1000 arthrometer, Stryker knee laxity tester, and Genucom knee analysis. The diagnosis was confirmed by arthrotomy or arthroscopy. Thirty had acute knee injuries (within 2 weeks), 9 had subacute (2 weeks to 3 months), and 11 had chronic injuries. The surgical findings demonstrated that five had other maladies, but no cruciate ligament tears. Two had a partial ACL tear, and the remaining 43 patients had at least one cruciate tear. The preoperative clinical examination for cruciate ligament integrity was completely correct in 92%, correct but incomplete in 6%, and incorrect in 2%. Examination under anesthesia was correct in 98%, the KT-1000 was correct in 75% (involved knee minus noninvolved knee was greater than or equal to 3 mm laxity equal to ACL tear), the Stryker was correct in 75%, and Genucom in 70%. The average laxity of those with ACL tears was 4.4 mm with the KT-1000, 4.6 mm with the Stryker, and 2.0 mm with the Genucom. The methods of testing with the Stryker and the KT-1000 are similar and the laxity recorded in patients with a torn ACL were almost identical. However, the KT-1000 can be used to identify the quadriceps neutral position and therefore more accurately determine PCL instability. The Genucom has the most versatility, but the laxity recorded in patients with a torn ACL was significantly lower than the other devices.(ABSTRACT TRUNCATED AT 250 WORDS)     

Indirect signs of anterior cruciate ligament injury on SPET: comparison with MRI and arthroscopy

Indirect signs of anterior cruciate ligament (ACL) injury on magnetic resonance imaging (MRI) include bony contusions in the lateral femoral condyle and the posterior portion of the lateral tibial plateau. This study was undertaken to assess the value of single photon emission tomography (SPET) in the diagnosis of ACL injury by examining the uptake pattern in the distal femur and the proximal tibia. Thirty-five patients were examined using SPET, MRI and arthroscopy. Seventeen patients were found to have ACL tears on arthroscopy. The duration of symptoms was 4 days to 10 years (mean 26.4 months). MRI and SPET images were analysed retrospectively without information from arthroscopic examination. Radionuclide uptake in the lateral femoral condyle and the posterior lateral tibial plateau was considered an indirect sign of ACL injury on SPET. We evaluated the diagnostic value of indirect signs of ACL injury obtained on SPET by comparing these findings with arthroscopic and MRI results. Fifteen of 17 patients with ACL injury showed indirect signs on SPET. The sensitivity, specificity, positive predictive value and negative predictive value for indirect signs of ACL injury were 88%, 56%, 65% and 83% on SPET and 59%, 94%, 91% and 71% on MRI, respectively. However, despite the higher sensitivity of indirect signs on SPET than on MRI, the overall diagnostic value of MRI is better than that of SPET. In the clinical setting, indirect signs of ACL injury may be of value in interpreting incidental findings on SPET.     

The double ACL sign: an unusual bucket-handle tear of medial meniscus

Several characteristic magnetic resonance imaging (MRI) signs of meniscal bucket-handle tears are well known and widely used. This case report presents a new MRI sign of a meniscal bucket-handle tear. A 17-year-old boy visited our hospital because of the pain in his left knee. Preoperative MRI on sagittal view showed a tear in the anterior horn of the medial meniscus and a displaced fragment of the medial meniscus in front of the original anterior cruciate ligament (ACL), which looks like another ACL. Under arthroscopic examination, the bucket-handle medial meniscus displaced parallel to the ACL was observed. A longitudinal tear was extended from the anterior horn to the posterior horn of medial meniscus. To our knowledge, this new MRI sign of bucket-handle tear, “the double ACL sign”, has not been previously reported. Level of evidence V.