Reliability of Clinical Findings and Magnetic Resonance Imaging for the Diagnosis of Chondromalacia Patellae
Reliability of Clinical Findings and Magnetic Resonance Imaging for the Diagnosis of Chondromalacia Patellae
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DOI：
10.2106/jbjs.h.01527
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发表时间：
2010-04-01
影响因子：
5.3
通讯作者：
Mattila, Ville M.
中科院分区：
文献类型：
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作者：
Pihlajamaki, Harri K.;Kuikka, Paavo-Ilari;Mattila, Ville M.
工作背景：本诊断研究进行，以确定前膝关节疼痛和髌骨软骨软化症之间的相关性，并定义的可靠性，磁共振成像诊断髌骨软骨软化症。方法：五十六年轻人（平均年龄，19.5岁）与前膝关节疼痛的膝关节磁共振成像，然后关节镜检查。通过磁共振成像确定的髌骨软骨病变进行了比较与关节镜findings.Results：关节镜检查证实存在髌骨软骨软化症在25（45%）的五十六个膝关节，滑膜皱襞在25个膝关节，在4个膝关节的膝关节撕裂，和股胫软骨病变在4个膝关节;正常解剖结构被认为是在6个膝关节。在关节镜下观察到的髌骨软骨软化症的严重程度与膝前疼痛综合征的临床症状之间没有发现相关性（p = 0.83）。1.0-T磁共振成像检测髌骨软骨软化症能力的阳性预测值为75%（95%可信区间，53%~ 89%），阴性预测值为72%（95%可信区间，56%~ 84%），敏感性为60%（95%可信区间，41%~ 77%），特异性为84%（95%可信区间，67%~ 93%），诊断准确性为73%（95%可信区间，60%~ 83%）。敏感性为13%（95%置信区间，2%至49%），I级病变和83%（95%置信区间，59%至94%），II级，III级，或IV级lesions.Conclusions：髌骨软骨软化症不能诊断的基础上的症状或与目前的体检方法。目前的研究表明髌骨软骨软化症的严重程度与前膝疼痛综合征的临床症状之间没有相关性。因此，前膝疼痛综合征的症状不应作为膝关节镜检查的指征。1.0-T磁共振成像对I级病变的敏感性较低，但对更严重（II级、III级或IV级）病变的敏感性要高得多。磁共振成像可以被认为是一个准确的诊断工具，用于确定更严重的情况下髌骨软骨软化症。
Background: This diagnostic study was performed to determine the correlation between anterior knee pain and chondromalacia patellae and to define the reliability of magnetic resonance imaging for the diagnosis of chondromalacia patellae.Methods: Fifty-six young adults (median age, 19.5 years) with anterior knee pain had magnetic resonance imaging of the knee followed by arthroscopy. The patellar chondral lesions identified by magnetic resonance imaging were compared with the arthroscopic findings.Results: Arthroscopy confirmed the presence of chondromalacia patellae in twenty-five (45%) of the fifty-six knees, a synovial plica in twenty-five knees, a meniscal tear in four knees, and a femorotibial chondral lesion in four knees; normal anatomy was seen in six knees. No association was found between the severity of the chondromalacia patellae seen at arthroscopy and the clinical symptoms of anterior knee pain syndrome (p = 0.83). The positive predictive value for the ability of 1.0-T magnetic resonance imaging to detect chondromalacia patellae was 75% (95% confidence interval, 53% to 89%), the negative predictive value was 72% (95% confidence interval, 56% to 84%), the sensitivity was 60% (95% confidence interval, 41% to 77%), the specificity was 84% (95% confidence interval, 67% to 93%), and the diagnostic accuracy was 73% (95% confidence interval, 60% to 83%). The sensitivity was 13% (95% confidence interval, 2% to 49%) for grade-I lesions and 83% (95% confidence interval, 59% to 94%) for grade-II, III, or IV lesions.Conclusions: Chondromalacia patellae cannot be diagnosed on the basis of symptoms or with current physical examination methods. The present study demonstrated no correlation between the severity of chondromalacia patellae and the clinical symptoms of anterior knee pain syndrome. Thus, symptoms of anterior knee pain syndrome should not be used as an indication for knee arthroscopy. The sensitivity of 1.0-T magnetic resonance imaging was low for grade-I lesions but considerably higher for more severe (grade-II, Ill, or IV) lesions. Magnetic resonance imaging may be considered an accurate diagnostic tool for identification of more severe cases of chondromalacia patellae.