未经证实:磁共振成像(MRI)对多发性韧带膝关节损伤(MLKIs)的诊断准确性有限,尤其是后外侧角(PLC)损伤。
UNASSIGNED:MRI对MLKIs的诊断准确性仅对某些膝关节结构中等。患者相关因素和损伤模式可以改变MRI的诊断准确性。
未经批准:队列研究;证据水平,3.
UNASSIGNED:对2014年1月至2020年12月在参与研究的中心接受手术治疗的所有MLKIs患者进行审查。我们记录了性爱,年龄,损伤机制,从受伤到MRI的时间,血管和神经相关病变。前交叉韧带(ACL)损伤,后交叉韧带,内侧副韧带,外侧副韧带(LCL),足肌腱,后腓骨韧带,髂胫带,肱二头肌肌腱,内侧和外侧半月板,并从MRI报告和手术记录中收集关节软骨.敏感性,特异性,正预测值,负预测值,诊断准确性,诊断赔率比,正负似然比,计算每个膝关节结构的MRI组内相关系数。使用逻辑回归,评估患者和损伤特征与MRI准确性之间的关联.
未经批准:共178例患者(男性127例;平均年龄,包括33.1年)。高能创伤是最常见的损伤机制(50.6%),其次是运动创伤(38.8%)和低能量创伤(8.4%)。ACL是具有最佳诊断准确性的结构,诊断赔率比,和阳性预测值(94.4%,113.2和96.8%,分别)。PLC结构在膝关节韧带(pop肌腱:76.2%;LCL:80.3%)和诊断优势比(po肌腱:9.9;LCL:17.0;pop腓上韧带:17.5)中显示最差的诊断准确性。MRI在检测半月板和软骨病变的缺失方面比识别它们更可靠。Logistic回归发现,Schenck分类对诊断准确性有影响,较高的申克等级对外周结构的诊断准确性较差(iliotibband,足肌腱,和二头肌肌腱),并提高了ACL和后交叉韧带的诊断准确性。
未经评估:MRI对MLKIs的诊断准确性在膝关节结构中差异很大,他们中的许多人都有误诊的风险,尤其是PLC,半月板,和软骨损伤。MLKIs的严重程度降低了MRI对周围结构的诊断准确性。
Magnetic resonance imaging (MRI) has shown limited diagnostic accuracy for multiple ligament knee injuries (MLKIs), especially posterolateral corner (PLC) injuries.
The diagnostic accuracy of MRI for MLKIs will only be moderate for some knee structures. Patient-related factors and injury patterns could modify the diagnostic accuracy of MRI.
Cohort study; Level of evidence, 3.
All patients with MLKIs surgically treated between January 2014 and December 2020 in the centers participating in the study were reviewed. We recorded sex, age, mechanism of injury, time from injury to MRI, and vascular and neurological associated lesions. Lesions to the anterior cruciate ligament (ACL), posterior cruciate ligament, medial collateral ligament, lateral collateral ligament (LCL), popliteus tendon, popliteofibular ligament, iliotibial band, biceps tendon, medial and lateral meniscus, and articular cartilage from MRI reports and surgical records were also collected. The sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy, diagnostic odds ratio, positive and negative likelihood ratio, and intraclass correlation coefficient of MRI were calculated for each knee structure. With logistic regression, associations between patient and injury characteristics and MRI accuracy were assessed.
A total of 178 patients (127 male; mean age, 33.1 years) were included. High-energy trauma was the most common mechanism of injury (50.6%), followed by sports trauma (38.8%) and low-energy trauma (8.4%). The ACL was the structure with the best diagnostic accuracy, diagnostic odds ratio, and positive predictive value (94.4%, 113.2, and 96.8%, respectively). PLC structures displayed the worst diagnostic accuracy among knee ligaments (popliteus tendon: 76.2%; LCL: 80.3%) and diagnostic odds ratio (popliteus tendon: 9.9; LCL: 17.0; popliteofibular ligament: 17.5). MRI was more reliable in detecting the absence of meniscal and chondral lesions than in identifying them. Logistic regression found that the diagnostic accuracy was affected by the Schenck classification, with higher Schenck grades having worse diagnostic accuracy for peripheral structures (iliotibial band, popliteus tendon, and biceps tendon) and improved diagnostic accuracy for the ACL and posterior cruciate ligament.
The diagnostic accuracy of MRI for MLKIs largely varied among knee structures, with many of them at risk of a misdiagnosis, especially PLC, meniscal, and chondral lesions. The severity of MLKIs lowered the diagnostic accuracy of MRI for peripheral structures.