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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >High Rate of Missed Lateral Meniscus Posterior Root Tears on Preoperative Magnetic Resonance Imaging
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High Rate of Missed Lateral Meniscus Posterior Root Tears on Preoperative Magnetic Resonance Imaging

机译：术前磁共振显像高漏诊半月板后根部眼泪的发生率

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Background: Lateral meniscus posterior root tears (LMPRTs), if left untreated, can cause devastating effects to the knee, with rapid articular cartilage degeneration and loss of the meniscus as a secondary stabilizer. Detection and surgical repair of these defects have been linked to favorable outcomes, but preoperative identification of LMPRTs continues to be challenging. Purpose: To determine the rate of LMPRTs diagnosed preoperatively on magnetic resonance imaging (MRI) in a consecutive series of arthroscopically confirmed LMPRTs. Study Design: Case series; Level of evidence, 4. Methods: A retrospective cohort of 45 consecutive patients with arthroscopically confirmed LMPRTs between 2010 and 2017 were included in this study. The preoperative MRI report for each patient was evaluated and compared with intraoperative findings. Each preoperative MRI study was then reviewed by 2 fellowship-trained musculoskeletal radiologists who worked in consensus. Results: A total of 45 patients (32 males, 13 females) with arthroscopically confirmed LMPRTs and a mean age of 27 years (range, 14-54 years) were included in the study. Only 15 of 45 LMPRTs (33%) were initially diagnosed on preoperative MRI. Past or concurrent anterior cruciate ligament (ACL) reconstruction was present in 37 of 45 cases (82%). Upon retrospective review, 15 of the 30 missed LMPRTs were “clearly evident,” 12 “subtly evident,” and 3 “occult” (unavoidably missed). There were no significant differences in the rate of LMPRT diagnosis based on history of prior knee surgery, meniscus extrusion, or tearing of the meniscofemoral ligament. Conclusion: Despite improved identification of other meniscus tear patterns on MRI, a high percentage of LMPRTs were still missed. In the setting of previous ACL reconstruction, if the root cannot be confidently identified, the MRI interpretation should indicate that “the root is poorly visualized” to alert the surgeon to thoroughly evaluate this structure. The surgeon should maintain a high index of suspicion and carefully probe the posterior root of the lateral meniscus at the time of arthroscopy, especially in cases of ACL injury.
机译：背景：半月板后根撕裂症（LMPRTs）如果不及时治疗，可能会对膝盖造成毁灭性影响，使快速的关节软骨变性和作为第二稳定剂的半月板丧失。这些缺陷的检测和手术修复与良好的预后相关，但是术前对LMPRTs的识别仍然具有挑战性。目的：确定在一系列经关节镜检查证实的LMPRTs中，在磁共振成像（MRI）术前诊断出的LMPRTs的比率。研究设计：案例系列;证据级别，第4级。方法：本研究纳入了2010年至2017年之间连续45例经关节镜确认LMPRT的患者的回顾性队列。评估每位患者的术前MRI报告，并将其与术中发现进行比较。然后，每位术前MRI研究均由两名经过共同研究的进修过的受过训练的肌肉骨骼放射科医生进行审查。结果：本研究共纳入45例经关节镜检查证实为LMPRTs的患者（男32例，女13例），平均年龄27岁（范围14-54岁）。术前MRI最初诊断出45个LMPRT中只有15个（33％）。 45例病例中有37例发生了过去或同期的前交叉韧带（ACL）重建（82％）。经过回顾性审查，在30个错过的LMPRT中有15个“明显”，12个“较明显”和3个“隐匿”（不可避免地被遗漏）。根据既往膝关节手术史，半月板挤压或半月板膜韧带撕裂史，LMPRT诊断率无显着差异。结论：尽管在MRI上可以更好地识别其他半月板撕裂类型，但仍漏掉了高百分比的LMPRT。在先前的ACL重建中，如果无法确定根部，则MRI解释应表明“根部可视性差”，以提醒外科医生彻底评估该结构。在进行关节镜检查时，特别是在ACL受伤的情况下，外科医生应保持高度怀疑，并仔细探查半月板外侧后根。

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