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Jiao X, Cao G, Wu J, Li Z, An S, Huang J. Assessing lateral femoral condyle cartilage prior to medial UKA: MRI vs. Valgus stress radiograph. BMC Musculoskelet Disord 2023; 24:681. [PMID: 37633881 PMCID: PMC10463517 DOI: 10.1186/s12891-023-06802-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 08/16/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND The cartilage quality of the lateral compartment needs to be clarified prior to medial unicompartmental knee arthroplasty (UKA). Valgus stress radiograph has been recommended as the preferred tool. Some studies also show that magnetic resonance imaging (MRI) has a higher diagnostic value. So, we conducted this study to compare whether valgus stress radiographic lateral joint space width (LJSW) and MRI grading can accurately reflect cartilage quality and its screening value for UKA-suitable patients. METHODS One hundred and thirty eight knees proposed for UKA were enrolled prospectively. Valgus stress radiograph was taken to measure LJSW. LJSW > 4 mm was considered normal and suitable for UKA. For weight-bearing area cartilage of lateral femoral condyle, Recht grade was assessed by MRI preoperatively. Recht grades ≤ 2 were treated as non-high-grade injuries while Recht grades > 2 were treated as high-grade injuries. Outerbridge grade was the gold standard and was assessed intraoperatively. Patients with Outerbridge grades 0-2 (non-high-grade injuries) underwent UKA, and patients with Outerbridge grades 3-4 (high-grade injuries) underwent total knee arthroplasty (TKA). The diagnostic parameters of valgus stress radiograph and MRI for the selection of UKA candidates were calculated, and receiver operating characteristic curves were drawn. P < 0.05 was considered significant. RESULTS Of 138 knees, 120 underwent UKAs, and 18 underwent TKAs. In terms of selecting UKA candidates, the sensitivity was close between MRI (95.0%) and valgus stress radiograph (96.7%), and the specificity, accuracy, positive predictive value and negative predictive value of MRI (94.4%, 94.9%, 99.1%, 73.9%, respectively) were higher than that of valgus stress radiograph (5.9%, 85.5%, 88.0%, 20.0%, respectively). The difference in area under the curve (AUC) between MRI (0.950) and LJSW (0.602) was significant (P = 0.001). CONCLUSION Compared with valgus stress radiograph, MRI has excellent evaluation value in diagnosing lateral weight-bearing cartilage injuries and can be used as a reliable tool for selecting suitable UKA patients.
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Affiliation(s)
- Xufeng Jiao
- Department of Orthopedics, Xuanwu Hospital Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Guanglei Cao
- Department of Orthopedics, Xuanwu Hospital Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China.
| | - Jiangpeng Wu
- Department of Orthopedics, Xuanwu Hospital Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Zheng Li
- Department of Orthopedics, Xuanwu Hospital Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Shuai An
- Department of Orthopedics, Xuanwu Hospital Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Jiang Huang
- Department of Orthopedics, Xuanwu Hospital Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
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Sanjay N, Shanthappa AH, Kurahatti A, Kumaar A. Comparison of Clinical, Magnetic Resonance Imaging (MRI) and Arthroscopic Findings in Assessment of Cartilage Defects and Internal Derangement of Knee. Cureus 2023; 15:e40110. [PMID: 37425579 PMCID: PMC10329210 DOI: 10.7759/cureus.40110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND The knee is the most commonly injured joint because of its anatomical structure, its exposure to external forces, and its functional demands. Orthopaedic surgeons previously relied on clinical evaluation for diagnosing any internal derangement of the knee joint. With the advent of new clinical methods for diagnosing ligament injuries and cartilage defects, there are very less studies comparing the accuracy of all three methods, clinical examination, magnetic resonance imaging (MRI) and arthroscopy to reach a definitive diagnosis. OBJECTIVE This study aims to compare the sensitivity, specificity, accuracy and predictive values of clinical examination and MRI with that of arthroscopy which is the ideal investigation of choice for cartilage defects and internal derangements of the knee. MATERIAL AND METHODS A prospective, observational and hospital-based study was done on patients with internal derangement of knee and cartilage defects. Clinical examination (based on the clinical tests for each ligament), MRI (1.5 T) and arthroscopy were done on all patients, the findings of which were compared using the Chi-square test. The following parameters were assessed while using arthroscopy as the gold standard of reference: accuracy, specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS Anterior cruciate ligament (ACL) was the most common ligament to be injured followed by the medial meniscus. The overall accuracy of clinical evaluation and MRI to diagnose meniscal injuries was found to be 94% and 91% respectively. The clinical examination had sensitivity and specificity of 96% and 82% in diagnosing ACL tears, respectively, whereas MRI had sensitivity and specificity of 88% and 76% respectively. For the medial meniscus, the clinical examination had sensitivity and specificity of 93% and 96% respectively whereas MRI had a sensitivity of 100% and specificity of 89%. We observed that the accuracy of MRI for grading ACL and meniscal tears was similar i.e. 79% and 78% respectively, but was slightly low (70%) for grading of chondromalacia patellae. CONCLUSION This study supports the use of MRI and clinical assessment in the diagnosis of chondral defects and internal knee derangement. Clinical tests are reliable and have high sensitivity in diagnosing ACL tears and chondral defects when compared to MRI. Not all lesions should routinely undergo MRI for diagnostic purposes; only a few circumstances warrant its usage. MRI is less reliable in grading ACL tears, meniscal tears and chondral injuries.
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Affiliation(s)
- Nandini Sanjay
- Department of Orthopaedics, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - Arun H Shanthappa
- Department of Orthopaedics, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - Ajay Kurahatti
- Department of Orthopaedics, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - Arun Kumaar
- Department of Orthopaedics, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
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Xu J, Lian Y, Sun S, Yang Z, Chen H. Diagnostic Performance of Multi-Direction Adjusted Multi-Planar Reconstruction with Helical CT for Evaluating Continuity of the Anterior Cruciate Ligament. Acad Radiol 2022; 29:e240-e247. [PMID: 35246375 DOI: 10.1016/j.acra.2021.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/30/2021] [Accepted: 12/30/2021] [Indexed: 11/23/2022]
Abstract
RATIONALE AND OBJECTIVES To analyze the diagnostic performance of MDA-MPR with CT for evaluating ACL structural continuity. METHODS A total of 145 patients with highly suspected ACL injury admitted to our hospital between January 2016 and May 2021 were retrospectively enrolled. All patients had undergone examination with MRI, CT, and arthroscopy. Taking arthroscopy results as the gold standard, the diagnostic accuracy for identifying ACL rupture by MRI and MDA-MPR with CT were compared. RESULTS The receiver operator characteristic curves demonstrated that both MRI and MDA-MPR with CT performed well in the diagnosis of ACL tears. The sensitivities of MRI and MDA-MPR with CT for diagnosing complete ACL tears were 95.16% (59/62) and 90.32% (56/62), respectively. Their specificities in this regard were 77.11% (64/83) and 84.34% (70/83), respectively. MRI had a higher sensitivity but MDA-MPR with CT had a higher specificity for detecting complete ACL tears, and the differences were statistically significant (p <.05). The sensitivities of diagnosing partial ACL tears using MRI and MDA-MPR with CT were 78.79% (26/33) and 75.76% (25/33), respectively, while the specificities were 86.61% (97/112) and 90.18% (101/112), respectively. These differences were non-significant (p >.05). CONCLUSION MDA-MPR with CT has high diagnostic efficiency for ACL injuries, especially in the diagnosis of complete ACL tears.
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Affiliation(s)
- Jun Xu
- Department of Radiology, The Affiliated Hospital of Qingdao University, Jiangsu Road, Qingdao City, 266003, Shandong Province, China
| | - Yuanyuan Lian
- Department of Radiology, The Affiliated Hospital of Qingdao University, Jiangsu Road, Qingdao City, 266003, Shandong Province, China
| | - Shiqing Sun
- Department of Radiology, The Affiliated Hospital of Qingdao University, Jiangsu Road, Qingdao City, 266003, Shandong Province, China
| | - Zhitao Yang
- Department of Radiology, The Affiliated Hospital of Qingdao University, Jiangsu Road, Qingdao City, 266003, Shandong Province, China
| | - Haisong Chen
- Department of Radiology, The Affiliated Hospital of Qingdao University, Jiangsu Road, Qingdao City, 266003, Shandong Province, China.
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Figueiredo S, Sa Castelo L, Pereira AD, Machado L, Silva JA, Sa A. Use of MRI by radiologists and orthopaedic surgeons to detect intra-articular injuries of the knee. Rev Bras Ortop 2018; 53:28-32. [PMID: 29367903 PMCID: PMC5771798 DOI: 10.1016/j.rboe.2016.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 12/15/2016] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE Magnetic resonance imaging (MRI) is paramount in the assessment of knee pathology, particularly when planning for a surgical procedure. This study compared the diagnostic accuracy in MRI reading of pathological knees by radiologists and orthopaedic surgeons. MATERIALS AND METHODS Cross-sectional study comprising 80 randomly selected patients previously submitted to arthroscopic surgery after clinical examination and MRI. A diagnosis by MRI interpretation was requested from the two teams, one of radiologists and another of orthopaedic surgeons. The conclusions of each team were later compared. Statistical significance was considered for p < 0.05. RESULTS The radiologists' findings achieved statistical significance regarding osteochondral injuries, ACL, and medial meniscus (p < 0.05), and orthopaedic surgeons regarding ACL injuries and menisci (p < 0.05). ACL injuries demonstrated a statistically significant association between teams (p < 0.001). CONCLUSIONS MRI appears to offer reliable readings of ACL injuries, regardless the specialty of the observer. The lateral compartment is scarcely well read.
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Affiliation(s)
| | - Luis Sa Castelo
- Departamento de Ortopedia, Centro Hospitalar de Tras-os-Montes e Alto Douro, Vila Real, Portugal
| | | | - Luis Machado
- Departamento de Ortopedia II, Centro Hospitalar de Leiria, Portugal
| | - Joao Andre Silva
- Departamento de Ortopedia II, Centro Hospitalar de Leiria, Portugal
| | - Antonio Sa
- Departamento de Ortopedia II, Centro Hospitalar de Leiria, Portugal
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Li K, Du J, Huang LX, Ni L, Liu T, Yang HL. The diagnostic accuracy of magnetic resonance imaging for anterior cruciate ligament injury in comparison to arthroscopy: a meta-analysis. Sci Rep 2017; 7:7583. [PMID: 28790406 PMCID: PMC5548790 DOI: 10.1038/s41598-017-08133-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 06/30/2017] [Indexed: 12/11/2022] Open
Abstract
We performed this meta-analysis to examine the diagnostic accuracy of MRI for the diagnosis of anterior cruciate ligament (ACL) injury in comparison to arthroscopy. We also compared the diagnostic accuracy of MRI with magnetic field intensities (MFI) greater than or equal to 1.5T with those below 1.5T, in addition to different MRI sequences. Studies relevant to the diagnosis of ACL injury by MRI and arthroscopy were analyzed. Computer and manual retrieval were carried out on studies published between January 1, 2006 and May 31, 2016. Twenty-one papers were included. Neither threshold nor non-threshold effects were present (p = 0.40, p = 0.06). The pooled sensitivity (SE), specificity (SP), positive likelihood ratio (LR+), negative likelihood ratio (LR−) and diagnostic odds ratio (DOR) with 95% confidence interval (CI) were 87% (84–90%), 90% (88–92%), 6.78 (4.87–9.44), 0.16 (0.13–0.20) and 44.70 (32.34–61.79), respectively. The area under the curve (AUC) was 0.93. The risk of publication bias was negligible (p = 0.75). In conclusion, examination by MRI is able to provide appreciable diagnostic performance. However, the principle, which states that the higher the MFI, the better the diagnostic accuracy, could not be verified. Additionally, conventional sequences (CSs) associated with proton density-weighted imaging (PDWI) are only slightly better than CSs alone, but not statistically different.
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Affiliation(s)
- Kun Li
- Department of Orthopedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Jun Du
- Department of Orthopedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, 215000, China.,Department of Orthopedic Magnetic Resonance Chamber, First Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Li-Xin Huang
- Department of Orthopedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Li Ni
- Department of Orthopedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Tao Liu
- Department of Orthopedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, 215000, China
| | - Hui-Lin Yang
- Department of Orthopedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, 215000, China.
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Sun X, Zhang J, Qu X, Zheng Y. Arthroscopic posterior cruciate ligament reconstruction with allograft versus autograft. Arch Med Sci 2015; 11:395-401. [PMID: 25995757 PMCID: PMC4424256 DOI: 10.5114/aoms.2015.50971] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Revised: 04/22/2013] [Accepted: 05/11/2013] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION The aim of the study was to compare and analyze retrospectively the outcomes of arthroscopic posterior cruciate ligament reconstruction with autograft versus allograft. MATERIAL AND METHODS Seventy-one patients who underwent arthroscopic posterior cruciate ligament reconstruction with an autograft or allograft met our inclusion criteria. There were 36 patients in the autograft group and 35 patients in the allograft group. All the patients were evaluated by physical examination and a functional ligament test. Comparative analysis was done in terms of operation time, incision length, fever time, postoperative infection rate, incidence of numbness and dysesthesia around the incision, as well as a routine blood test. RESULTS The average follow-up of the autograft group was 3.2 ±0.2 years and that of the allograft group was 3.3 ±0.6 years; there was no significant difference (p > 0.05). No differences existed in knee range of motion, Lysholm scores, International Knee Documentation Committee standard evaluation form and Tegner activity score at final follow-up (p > 0.05), except that patients in the allograft group had a shorter operation time and incision length and a longer fever time (p < 0.05). We found a difference in posterior drawer test and KT-2000 arthrometer assessment (p < 0.05). The posterior tibia displacement averaged 3.8 ±1.5 mm in the autograft group and 4.8 ±1.7 mm in the allograft group (p < 0.05). The incidence of numbness and dysesthesia around the incision in the autograft group was higher than that in the allograft group (p < 0.05). There was no infection postoperatively. The white blood cells and neutrophils in the allograft group increased more than those in the autograft group postoperatively (p < 0.05). CONCLUSIONS Both groups of patients had satisfactory outcomes after the operation. However, in the instrumented posterior laxity test, the autograft gave better results than the allograft. No differences in functional scores were found.
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Affiliation(s)
- Xiujiang Sun
- Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, China
| | - Jianfeng Zhang
- Department of Orthopedics, Yantaishan Hospital, Yantai, China
| | - Xiaoyi Qu
- Nurse School of Yantai, Yantai, China
| | - Yanping Zheng
- Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, China
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