Evaluation of the two bundles of the anterior cruciate ligament with 1.5 tesla magnetic resonance imaging
Evaluation of the two bundles of the anterior cruciate ligament with 1.5 tesla magnetic resonance imaging
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DOI：
10.3944/aott.2010.2246
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发表时间：
2010-01-01
影响因子：
1
通讯作者：
Benli, I. Teoman
中科院分区：
文献类型：
--
作者：
Kaya, Alper;Karadag, Demet;Benli, I. Teoman
目的：前交叉韧带（ACL）的解剖学研究表明，正常ACL由两个功能束组成，即前内侧束（AM）和后外侧束（PL）。在本研究中，我们使用临床上常规使用的1.5睾丸磁共振成像（MRI）来评估ACL的AM和PL束。（96名女性，54名男性;平均年龄33.4 ± 11.6岁;年龄范围18 - 59岁），没有任何ACL功能不全的迹象，并且由于其他原因通过MRI检查了膝关节。标准磁共振图像（右侧77例，左侧73例）由一名骨科医生和一名放射科医生根据可区分的ACL束进行独立评价。在矢状面和冠状面上测量ACL（和每个束）与胫骨平台之间的角度。64例（42.7%）患者进行了关节镜手术的初步诊断和关节镜下和MRI结果进行了比较。93例患者（62%）的ACL在轴向、冠状和矢状平面上被评估为单束。57例（38%）患者观察到双束表现，14例（9.3%）患者涉及所有三个平面，41例（27.3%）患者涉及轴向和冠状平面，1例（0.7%）患者涉及冠状和矢状平面，1例（0.7%）患者仅涉及冠状平面。在显示单束ACL的MRI切片上，发现ACL和胫骨平台之间的平均角度在矢状面为55.3度，在冠状面为70.3度。在双束切面上，冠状面和矢状面AM束与胫骨平台之间的平均角度分别为70.1 °和55.1 °。PL束的相应角度分别为81 °和53.5 °。MRI冠状面、矢状面和轴向切片中双束ACL出现的发生率不受性别和侧位的影响（p>0.05）。两个观察者在每个平面上识别的束数没有显示出显著差异（p>0.05）。在关节镜手术中，所有患者的两个束都被确定为ACL的正常完整性和功能。其中，MRI可以描绘双束外观在一个或多个平面中只有42.2%的patients.Conclusion：即使标准的1.5 testa MRI，常规用于临床实践中，有一个非常高的成功率，在显示ACL，它可以可视化的两束结构，只有约三分之一的患者。
Objectives: Studies on the anatomy of the anterior cruciate ligament (ACL) have shown that the normal ACL consists of two functional bundles named as anteromedial (AM) and posterolateral (PL) bundles. In this study, we evaluated the AM and PL bundles of the ACL using 1.5 testa magnetic resonance imaging (MRI), which is routinely used in clinical practice.Methods: The study included 150 patients (96 females, 54 males; mean age 33.4 +/- 11.6 years; range 18 to 59 years) who did not have any signs of ACL insufficiency and whose knees were examined by MRI for other reasons. Standard magnetic resonance images (77 right, 73 left) were evaluated independently by an orthopedist and a radiologist in terms of distinguishable ACL bundles. The angle between the ACL (and each bundle) and the tibial plateau was measured on sagittal and coronal sections. Arthroscopic surgery was performed in 64 patients (42.7%) for primary diagnoses and arthroscopic and MRI findings were compared.Results: Magnetic resonance imaging showed an intact ACL in all the patients. The ACL was assessed as a single bundle in the axial, coronal, and sagittal planes in 93 patients (62%). A double-bundle appearance was noted in 57 patients (38%), involving all three planes in 14 patients (9.3%), axial and coronal planes in 41 patients (27.3%), coronal and sagittal planes in one patient (0.7%), and only coronal plane in one patient (0.7%). On MRI sections showing a single bundle ACL, the mean angle between the ACL and the tibial plateau was found as 55.3 degrees in the sagittal plane, and 70.3 degrees in the coronal plane. On sections with a double-bundle appearance, the mean angles between the AM bundle and the tibial plateau were 70.1 degrees and 55.1 degrees in the coronal and sagittal planes, respectively. The corresponding angles for the PL bundle were 81 degrees and 53.5 degrees The incidence of double bundle ACL appearance in coronal, sagittal, and axial MRI sections was not influenced by sex and side (p>0.05). The number of bundles identified in each plane did not show a significant difference between the two observers (p>0.05). During arthroscopic surgery, both bundles were identified with normal integrity and function of the ACL in all the patients. Of these, MRI could depict a double-bundle appearance in one or more planes in only 42.2% of the patients.Conclusion: Even though standard 1.5 testa MRI, routinely used in clinical practice, has a very high success rate in demonstrating the ACL, it can visualize the two-bundle structure only in about one-third of the patients.