Diagnostic Values of 3 Methods for Evaluating Meniscal Healing Status After Meniscal Repair Comparison Among Second-Look Arthroscopy, Clinical Assessment, and Magnetic Resonance Imaging
Diagnostic Values of 3 Methods for Evaluating Meniscal Healing Status After Meniscal Repair Comparison Among Second-Look Arthroscopy, Clinical Assessment, and Magnetic Resonance Imaging
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DOI：
10.1177/0363546510388930
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发表时间：
2011-04-01
影响因子：
4.8
通讯作者：
Leung, Kevin Kar Ming
中科院分区：
文献类型：
--
作者：
Miao, Yu;Yu, Jia-Kuo;Leung, Kevin Kar Ming
背景资料：评估修复后关节炎的主要诊断方法包括关节镜二次探查、临床评估和磁共振成像（MRI）。以往的研究都没有对每一个连续的病例应用所有的3种方法，也没有对它们进行任何系统的比较。目的：本研究进行了比较3种不同方法的诊断价值，试图提出建议，以评估尿道愈合的结果。研究设计：队列研究方法：81例患者，（89人），平均年龄25.4岁（标准差[SD]，7.7;范围，15-50岁），接受关节镜下髋关节修复，包括65例内侧髋关节和24例外侧髋关节。每个半月板的随访评价包括临床评估、关节镜二次探查和术后MRI，平均随访时间为25.4个月（SD，6.0;范围，17.4-48.3个月）。半月板不愈合的定义标准是任何症状，如关节线压痛，肿胀，锁定，或积极的McMurray测试的临床评估;裂缝或不稳定的第二次看关节镜检查;和3级信号强度显示在修复的网站上术后MRI.Results：77个半月板被证实完全愈合的第二次看关节镜检查，总愈合率为86.5%。临床评估发现63例患者治愈，临床治愈率为70.8%（敏感性，58.3%，特异性，75.3%，准确性，73.0%）。以二次关节镜检查为标准，计算5个序列MRI诊断关节炎的敏感性、特异性和准确性：矢状位T1：91.7%、58.4%、62.9%;矢状位质子密度（PD）：83.3%、40.3%、46.1%;矢状位T2：58.3%、89.6%、85.4%;冠状位PD：结论：二次关节镜检查是判断骨折愈合最可靠的方法。临床评估在诊断已愈合的阑尾炎方面有明显的局限性。在MRI检查中，T2加权序列的特异性和准确性明显高于PD和T1序列。不同序列的联合应用可提高诊断价值。
Background: The main diagnostic methods for evaluating repaired menisci include second-look arthroscopy, clinical assessment, and magnetic resonance imaging (MRI). None of the previous studies applied all 3 methods for each consecutive case nor made any systematic comparison among them.Purpose: This study was undertaken to compare the diagnostic values of the 3 different methods in an attempt to propose suggestions for evaluating meniscal healing results.Study Design: Cohort study (diagnosis); Level of evidence, 2.Methods: Eighty-one patients (89 menisci), with a mean age of 25.4 years (standard deviation [SD], 7.7; range, 15-50 years), underwent arthroscopic meniscal repair, including 65 medial menisci and 24 lateral menisci. Follow-up evaluation for each meniscus included clinical assessment, second-look arthroscopy, and postoperative MRI, with a mean follow-up time of 25.4 months (SD, 6.0; range, 17.4-48.3 months). Defined criteria for unhealed meniscus were any symptoms such as joint-line tenderness, swelling, locking, or positive McMurray test for clinical assessment; cleft or instability on second-look arthroscopy; and grade 3 signal intensity shown at the repaired site on postoperative MRI.Results: Seventy-seven menisci were confirmed completely healed by second-look arthroscopy, with a total healing rate of 86.5%. Clinical assessment found 63 menisci healed, with a clinical healing rate of 70.8% (sensitivity, 58.3%; specificity, 75.3%; accuracy, 73.0%). By using the second-look arthroscopy as the standard, the sensitivity, specificity, and accuracy, respectively, were calculated for MRI in 5 sequences: sagittal T1: 91.7%, 58.4%, 62.9%; sagittal proton density (PD): 83.3%, 40.3%, 46.1%; sagittal T2: 58.3%, 89.6%, 85.4%; coronal PD: 75.0%, 74.0%, 74.2%; and coronal T2: 41.7%, 98.7%, 91.0%.Conclusion: Second-look arthroscopy was the most dependable way to determine meniscal healing. Clinical assessment had obvious limitations in diagnosing healed menisci. On MRI examination, T2-weighted sequences had obviously higher specificity and accuracy, while PD and T1 had higher sensitivity. The diagnostic value could be improved by a combined application of different sequences.