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.     

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。     

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。     

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。     

关节镜下修复重建前交叉韧带合并半月板损伤的临床效果分析

目的探讨关节镜下修复重建前交叉韧带(ACL)合并半月板损伤的临床效果。方法选取ACL合并半月板损伤患者40例,分为实验组(同时修复ACL以及半月板),对照组(修复半月板),分别观察两组患者各自的术前术后的Lysholm评分,以及两组患者术后的Lysholm评分。观察两组患者术后半月板愈合率以及2年后半月板再手术率的比较。结果两组患者术后Lysholm评分均高于术前,但实验组患者术后Lysholm评分高于对照组。实验组术后愈合率高于对照组,2年后半月板再手术率低于对照组。结论关节镜下同时修复重建ACL和半月板损伤,可以提高治愈率,有利于术后患者康复,并且远期效果明显,值得推广。     

膝关节半月板桶柄状撕裂的MRI诊断

目的分析膝关节半月板桶柄状撕裂的MRI表现特点。方法对16例膝关节半月板桶柄状撕裂的MRI特点,包括双后交叉韧带征、双前交叉韧带征、半月板反转征、空领结征、碎块内移征、外周残半月板征进行回顾性总结分析。结果 16例半月板桶柄状撕裂中,双后交叉韧带征8例;双前交叉韧带征2例,碎块内移征16例,外周残半月板征16例,16个可见空领结征,3例可见半月板翻转征。结论半月板桶柄样撕裂在MRI上具有特征性表现,可作为半月板桶柄样撕裂的一种有效的影像学检查手段。     

Mittelfristige Ergebnisse nach Meniskusrefixation in Kombination mit einer VKB-Rekonstruktion mittels autologem Hamstringtransplantat

lnjuries of the anterior cruciate ligament (ACL) are frequently associated with meniscal lesions Reconstruction of the ACL and restoration of rotational stability and repair of meniscal lesions are indicated to ensure long term knee function and avoid subsequent articular cartilage damage. This is particularly important in the young patient with lesions of the lateral meniscus which frequently occur in combination with ACL ruptures. Between September 2003 and April 2004 in 74 patients meniscal repair was performed in combination with ACL reconstruction using hamstring tendon autograft. After a mean follow-up of 53 months 65 patients (88%) were clinically evaluated. These 65 patients had a total of 72 meniscal repairs (21 lateraI/51 medial). 63 of 72 meniscal repairs (87.5%) had no clinical signs of meniscal instability and had no subjective symptoms more than 4 years postoperatively (51–59 months). Particularly the lateral meniscal repairs showed high healing results with 95.2% compared to sutures of the medial meniscus with 84.3%.     

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。     

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.     

The Landing Error Scoring System Real-Time test as a predictive tool for knee injuries: A historical cohort study

PurposeTo assess the value of the Landing error score system - real time test as a predictive tool for knee injuries among combat soldiers in the Israeli defense forces.MethodsAll 2474 Israeli defense forces' combat soldiers enrolled at the Israeli defense forces Injury Prevention and Rehabilitation Center were included. A retrospective cohort study was conducted. The predictive variable assessed was the landing error score system – real time score. The three main outcome variables were the incidence of overuse knee injuries, the meniscal injury, and the anterior cruciate ligament injury. Receiver operator characteristic analysis was performed to evaluate the test's potential as a predictive tool and in order to establish optimal cutoff scores.ResultsThe area under the curve of the receiver operation curves demonstrated no predictive value of the landing error score system – real time test for all three outcome variables (knee injuries: area under the curve 0.526, 95% confidence interval 0.498, 0.554, anterior cruciate ligament injuries: area under the curve 0.496, 95% confidence interval 0.337, 0.656, meniscus injuries: area under the curve 0.515, 95% confidence interval 0.454, 0.576).InterpretationBased on the results of this study, the landing error score system – real time test has no predictive value for knee overuse injuries, meniscal injuries, and anterior cruciate ligament injuries. However, due to the small number of cases of anterior cruciate ligament injuries, the predictive value for anterior cruciate ligament injuries of this test should be further investigated.     

Meniskusteilresektion

Traumatic or degenerative meniscus tears usually require surgical treatment. If reconstruction is not possible a partial meniscectomy is performed which involves resection of unstable tissue but intact tissue should be preserved. Postoperative complications or ongoing discomfort are rare. Variables associated with poor long-term radiographic and clinical outcomes are total meniscectomy, degenerative tears, obesity, anterior cruciate ligament (ACL) deficiency, chondral lesions, age and high activity levels.     

磁共振间接膝关节造影诊断膝关节损伤的价值

目的：评价磁共振间接关节造影诊断膝关节损伤的价值。方法：应用磁共振间接膝关节造影对31例膝关节损伤患者进行检查,并与关节镜或手术的诊断结果作比较。结果：磁共振间接膝关节造影诊断半月板损伤的敏感度为92.86%、特异度为98.73%;诊断前交叉韧带损伤的敏感度为100%、特异度为96%;诊断后交叉韧带损伤的敏感度为100%、特异度为100%;诊断侧副韧带损伤的敏感度为100%、特异度为96.08%。上述各项指标较平扫高,标志诊断可靠性的Kappa值两者无显著差异。结论：磁共振间接关节造影在膝关节损伤的诊断中有一定价值,可以作为平扫的补充检查手段。     

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。     

Evaluation of acute traumatic hemarthrosis of the knee joint

Acute hemarthrosis of the knee usually results from a significant injury. Preoperative assessment, examination under anesthesia, and arthroscopic examination were conducted on patients with a total of 132 acutely injured knees associated with hemarthrosis and minimal clinical laxity to determine the presence and extent of injury to ligamentous and/or intra-articular structures. Partial or complete tear of the anterior cruciate ligament was found in 101 (77%) of the knees. Peripheral meniscal tears were responsible for the hemarthrosis in 17 cases (13%), and osteochondral fractures were found in 11 cases (8%). Injury to the anterior cruciate ligament was frequently associated with concomitant injury to other structures: meniscal tears (61%), ligament/capsular injury (40%), and hyaline chondral damage (16%). Patients' responses to preoperative anterior drawer, pivot shift, and Lachman tests were within normal limits in 18%, 29%, and 73% of cases, respectively. Patients under anesthesia responded to the anterior drawer and pivot shift tests normally 50% and 74% of the time. The Lachman test, performed under anesthesia, was 98% accurate in predicting anterior cruciate injury. Experience gained in evaluating posttraumatic hemarthrosis of the knee suggests clinical examination alone may not demonstrate the severity of many of these injuries. Arthroscopy, although not necessary to determine competence of the anterior cruciate ligament, is invaluable in determining the existence of other injuries with or without an associated anterior cruciate ligament tear.     

Feasibility of point-of-care knee ultrasonography for diagnosing anterior cruciate and posterior cruciate ligament tears in the ED

ObjectiveTo evaluate the feasibility of point-of-care knee ultrasonography (POCUS) compared with knee magnetic resonance imaging (MRI) for diagnosing anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) tears in patients with acute knee trauma.Material and methodsA prospective study was conducted in a tertiary hospital emergency department; acute (within 1-week) knee trauma patients with suspected ACL or PCL tear were recruited. Two POCUS performers (a board-certified emergency physician and a musculoskeletal radiologist) independently evaluated the ACL and PCL using POCUS. Findings were classified as normal appearance or ligament tear. Final radiology reports of knee MRI were used as the reference standard. We calculated the diagnostic values (sensitivity, specificity, and accuracy) for POCUS obtained by both POCUS performers. Kappa values (k) were calculated for inter-observer agreement between the two POCUS performers.ResultsSixty-two patients were enrolled. Compared with the reference standard, POCUS showed acceptable sensitivity (90.6–100%), specificity (90.0–97.7%), and accuracy (91.9–96.8%). Inter-observer agreement between the two POCUS performers was excellent (k = 0.853–0.903).ConclusionPOCUS demonstrates excellent precision as compared to MRI in the diagnosis of ACL and PCL tears. The findings of POCUS could be used for immediate diagnosis and further pre-operative imaging in patients with acute knee trauma.     

Avulsionsverletzungen

An avulsion of the insertion of the meniscus is defined as a root tear. In the clinical practice the incidence of this lesion is often underestimated. However, several biomechanical studies have shown that the effect of a root tear is comparable to a meniscectomy. Clinical studies documented progredient arthritic changes thereby supporting the basic science studies.The injury mechanism of a root tear can be a valgus/rotational trauma of the knee joint resulting in an isolated avulsion or associated lesion of the anterior cruciate ligament (ACL) rupture. Another mechanism is a posterior tibial tunnel placement during ACL reconstruction. The diagnostic approach is limited by unspecific clinical symptoms and MRI can be helpful for evaluating meniscal extrusion as a sign of a root tear. During arthroscopy the function of the root can be assessed using a probe. However, visualization of the medial and lateral meniscus insertion is challenging. A refixation of the root can be performed using an anchor or tibial tunnel approach and a two suture technique.     

All-Inside Meniscus Repair

Purpose of ReviewThe indications for partial meniscectomy are becoming increasingly limited, and recent evidence suggests that the meniscus should be preserved whenever possible. Because of its many proposed advantages, all-inside meniscus repairs are becoming increasingly common. This review discusses the indications, advantages, disadvantages, and biomechanical and clinical outcomes of all-inside meniscus repair.Recent FindingsAll-inside meniscus repair demonstrates equal functional outcomes, healing rates, and complications compared to inside-out repair of vertical longitudinal and bucket-handle tears with the advantages of decreased surgical time and faster post-operative recovery. In addition, return-to-sport and activity levels are high following all-inside repair regardless of whether concomitant anterior cruciate ligament reconstruction is performed. Biomechanical studies have demonstrated advantages of all-inside meniscal based repairs on radial and horizontal tears.SummaryAll-inside meniscus repair compares favorably to inside-out repair of vertical longitudinal and bucket-handle tears and continues to increase in popularity. Both capsular based and meniscal based repairs can be used to repair a variety of tear patterns. While biomechanical results are encouraging, further research on the clinical outcomes of meniscal based repairs is needed to elucidate the role of these techniques in the future.     

膝横韧带所致外侧半月板前角假撕裂的发生机制与鉴别方法

目的 明确膝横韧带所致外侧半月板前角假撕裂的发生机制，探讨外侧半月板前角假撕裂与真撕裂的鉴别方法。方法 采用40例成人尸体膝关节标本，观察膝横韧带与外侧半月板前角的关系。对50例正常膝进行矢状及冠状位MR扫描，观察膝横韧带的MRI表现。结果 膝横韧带在尸膝标本的出现率为80％，该韧带与外侧半月板前角及其中央腱性附着部之间以脂肪组织分隔。在MR矢状像上，可见脂肪组织在膝横韧带与外侧半月板前角之间形成的线样稍高信号裂隙，类似外侧半月板前角撕裂，被称为假撕裂。这种假撕裂的出现率为30％，多表现为外侧半月板形态规则、撕裂线斜行，矢状位图像可连续显示膝横韧带，冠状位图像能显示该韧带的长轴。结论 根据外侧半月板前角形状、撕裂线方向、观察矢状和冠状位图像，可正确区分外侧半月板前角的真、假撕裂。     

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.