Feasibility of point-of-care knee ultrasonography for diagnosing anterior cruciate and posterior cruciate ligament tears in the ED |
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| Institution: | 1. Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, 1342 Dongil-ro, Nowon-gu, Seoul 01757, Republic of Korea;2. Department of Radiology, G SAM Hospital, 591 Gunpo-ro, Gunpo-si, Gyeonggi-do 15839, Republic of Korea;3. Department of Emergency Medicine, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea;4. Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea;1. Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan;2. Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka-shi, Tokyo, Japan;3. Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan;1. Chapman University, School of Pharmacy, Irvine, CA, United States of America;2. University of Southern California, Department of Emergency Medicine, Los Angeles, CA, United States of America;3. University of California, Irvine, Department of Emergency Medicine, Orange, CA, United States of America;4. University of California, San Diego, Department of Emergency Medicine, San Diego, CA, United States of America;5. California Poison Control System – San Diego Division, San Diego, CA, United States of America |
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| Abstract: | 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. |
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