医学
磁共振成像
内侧半月板
矢状面
病变
前交叉韧带
前交叉韧带重建术
外侧半月板
关节镜检查
弯月面
核医学
放射科
骨关节炎
外科
病理
替代医学
物理
光学
入射(几何)
作者
Sanshiro Yasuma,Makoto Kobayashi,Yusuke Kawanishi,Hiroaki Fukushima,Jirō Katō,Tetsuya Takenaga,Masahito Yoshida,Gen Kuroyanagi,Yohei Kawaguchi,Yuko Waguri‐Nagaya,Hideki Murakami,Masahiro Nozaki
标识
DOI:10.1016/j.jos.2021.07.020
摘要
Meniscal ramp lesion (RL) is the peripheral lesion of the posterior horn of the medial meniscus (PHMM) associated with anterior cruciate ligament (ACL) tear. The purpose of this study was to evaluate the accuracy of pre-operative magnetic resonance imaging (MRI) evaluation in diagnosing RL and to identify whether the difficulty in diagnosis differs depending on the location of RL. ACL-injured patients undergoing ACL reconstruction from January 2017 to January 2019 were enrolled. A methodical arthroscopic exploration to identify RL was conducted intra-operatively using three steps, namely, the anterior visualization step, the inter-condylar visualization step, and the posteromedial step. The location of the RLs was evaluated and classified into two types as follows: Red-red zone (RR) - a meniscal tear of the red-red zone of the PHMM. Menisco-capsular junction (MCJ) - a lesion at the menisco-capsular junction of the PHMM, which is more peripheral than RR. Furthermore, the accuracy of 1.5-T MRI evaluation to diagnose RL by two testers using sagittal proton-density fat-saturated images was calculated. Of the 81 patients enrolled, 11 had RL: 5 cases each were at the MCJ and RR, and 1 case was at both locations. The sensitivity of MRI for detecting RL was 27.3–45.5%, whereas the specificity was 84.3–95.7% in total. The sensitivity of MRI in detecting RL at the RR and MCJ was 40.0–80.0%, 0–20.0%, respectively. The intra-observer reliability of the MRI evaluation was moderate (κ coefficient: 0.40–0.46), while the inter-observer reliability was fair to moderate (κ coefficient: 0.27–0.41). A low sensitivity of the MRI in detecting RL at the MCJ was observed, and the reliability of the MRI evaluation for diagnosis of RL was not high. Therefore, methodical arthroscopic exploration is essential to diagnose RL even when it is not suspected on pre-operative MRI.
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