背景:前交叉韧带(ACL)的功能完整性影响膝关节骨关节炎(KOA)患者的手术决策。本研究旨在比较X线摄影和磁共振成像(MRI)在确定ACL功能状态中的诊断价值。
方法:我们使用术前髋至踝关节前后站立(APS)X光片回顾性分析了306个膝盖,前后位(AP)和外侧膝部X光片,AP外翻应力(VS)力射线照片,和标准正交MRI。基于术中可视化,将膝关节分为ACL功能完整组和ACL功能缺陷组(ACLD).诊断的有效性和可靠性是基于X线摄影参数计算的,例如髋-膝-踝角度(HKA),胫骨近端内侧角(MPTA),股骨远端外侧角(LDFA),胫骨后斜坡(PTS),矢状位胫股半脱位(STFS),冠状胫股半脱位(CTFS),联合线会聚角(JLCA),胫骨近端平台的最大磨损点(MWPPT%),和MRI参数,包括ACL等级和MWPPT%。
结果:HKA,MPTA,PTS,STFS,JLCA,APS和AP射线照片上的CTFS,X线片和MRI显示MWPPT%具有显着诊断价值(P<0.05)。X线片和MRI的单个参数没有统计学上的显着差异。在构建逻辑回归模型后,MRI显示灵敏度更高,特异性,和准确性,达到96.8%,79.9%,83.3%,分别(P<0.001)。
结论:在KOA患者中,单一影像学或MRI参数在评估ACL功能完整性方面的诊断价值相当.然而,通过构建预测模型,与X线摄影相比,MRI可以显着提高诊断有效性。
BACKGROUND: The functional integrity of the anterior cruciate ligament (ACL) influences surgical decision-making in patients with knee osteoarthritis (KOA). This study aimed to compare the diagnostic value of
radiography and magnetic resonance imaging (MRI) in determining the functional status of ACL.
METHODS: We analyzed 306 knees retrospectively using preoperative hip-to-ankle anteroposterior standing (APS) radiographs, anteroposterior (AP) and lateral knee radiographs, AP valgus stress (VS) force radiographs, and standard orthogonal MRI. Based on the intraoperative visualization, the knees were grouped into ACL functionally-intact and ACL functionally-deficient (ACLD) groups. The diagnostic validity and reliability were calculated based on the radiograph parameters such as hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA), posterior tibial slope (PTS), sagittal tibiofemoral subluxation (STFS), coronal tibiofemoral subluxation (CTFS), joint line convergence angle (JLCA), the maximum wear point of the proximal tibia plateau (MWPPT%), and MRI parameters including ACL grades and MWPPT%.
RESULTS: HKA, MPTA, PTS, STFS, JLCA, and CTFS on APS and AP radiographs, and MWPPT% on radiographs and MRI showed a significant diagnostic value (P < 0.05). There were no statistically significant differences in the single parameters from radiographs and MRI. After constructing the logistic regression models, MRI showed higher sensitivity, specificity, and accuracy, reaching 96.8%, 79.9%, and 83.3%, respectively (P < 0.001).
CONCLUSIONS: In patients with KOA, the diagnostic value of single radiographic or MRI parameter in assessing the functional integrity of the ACL are equivalent. However, by constructing predictive models, MRI could significantly improve diagnostic validity compared with
radiography.