History, clinical findings, magnetic resonance imaging, and arthroscopic correlation in meniscal lesions
History, clinical findings, magnetic resonance imaging, and arthroscopic correlation in meniscal lesions
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DOI：
10.1007/s00167-011-1636-4
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发表时间：
2012-05-01
影响因子：
3.8
通讯作者：
Cetinus, Ercan Mahmut
中科院分区：
文献类型：
--
作者：
Ercin, Ersin;Kaya, Ibrahim;Cetinus, Ercan Mahmut
本前瞻性研究的目的是比较临床检查和磁共振成像（MRI）与关节镜检查结果的准确性，并确定经验丰富的检查者在临床决策中的价值。所有患者均由经验丰富的膝关节外科医生、普通骨科专家、高级住院医师和四年住院医师进行临床检查。这些检查者记录并评估了七项试验的结果：内侧和外侧关节线压痛试验、McMurray试验、阿普利试验、Stienmann I试验、Payr试验、奇尔德里斯征和Ege试验。如果有两个阳性的测试，损伤被归类为踝关节撕裂。临床病史，体格检查，MRI结果与关节镜检查结果进行比较。然后计算这些评估方法的准确性、敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。由经验丰富的膝关节外科医生进行的临床检查具有更好的特异性（90% vs. 60%）、阳性预测值（95% vs. 83%）、阴性预测值（90% vs. 86%）和诊断准确性（93% vs. 83%）。这些参数显示外侧髋臼撕裂仅存在微小差异。与其他三位检查者相比，经验丰富的膝关节外科医生对内侧半月板撕裂的敏感性、特异性、预测值和诊断准确性参数更高。这些结果表明，由经验丰富的检查者进行多项半月板试验的临床检查足以诊断内侧半月板撕裂。
The aim of this prospective study was to compare the accuracy of clinical examination and magnetic resonance imaging (MRI) versus arthroscopic findings and to determine the value of an experienced examiner in clinical decision making.A total of 30 patients with a preoperative MRI underwent arthroscopy over a 5-month period. All patients had a clinical examination performed by an experienced knee surgeon, a specialist in general orthopedics, a senior resident, and a fourth-year resident. These examiners recorded and evaluated the results of seven tests: the medial and lateral joint line tenderness test, the McMurray test, the Apley test, the Stienmann I test, the Payr's test, Childress' sign, and the Ege's test. The injury was classified as a meniscal tear if there were two positive tests.Clinical history, physical examination, and MRI findings were compared with the arthroscopic findings. The accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of these methods of evaluation were then calculated.Clinical examination performed by an experienced knee surgeon had better specificity (90% vs. 60%), positive predictive value (95% vs. 83%), negative predictive value (90% vs. 86%), and diagnostic accuracy (93% vs. 83%) than MRI for medial meniscal tears. These parameters showed only a marginal difference in lateral meniscal tears. The experienced knee surgeon had better sensitivity, specificity, predictive values, and diagnostic accuracy parameters for medial meniscus tears in comparison with the other three examiners.These results indicate that clinical examination by an experienced examiner using multiple meniscus tests is sufficient for a diagnosis of a meniscal tear.II.