| ObjectiveTo provide a new classification and typing for the diagnosis of the anterior cruciate ligament (ACL) tear, meniscal and cartilage injury in knee joint by both arthroscopy and magnetic resonance imaging (MRI). Meanwhile, to analyze the clinical, MRI and arthroscopic features of injury of ACL, meniscus and cartilage in the traumatic and degenerative knee, and to explore the value of MRI in the diagnosis of knee joint injury.ContentBased on clinical findings and referenced to the existing grading standards, to propose new or improve existing classification and typing method in the diagnosis of ACL, meniscus and cartilage damage by arthroscopy and MRI. To analyze the clinical features of traumatic and retrograde degeneration knee injury, and use the above new grading and typing methods of this study to do the diagnosis of cases. Especially, to explore the sensitivity, specificity and accuracy of MRI in the diagnosis of knee injury, considering the arthroscopic view as the gold standard.Method112cases of traumatic injuries and123cases of degenerative knee injury were collected. The clinical symptoms and physical examinations, and the signs seen in the MRI and arthroscopic surgery were analyzed. Based on morphology and signal change with reference to the existing grading criteria, ACL, meniscus and articular cartilage injury were to be graded and typed in the performance of arthroscopic and MRI, and the performance of arthroscopic and MRI was made to the comparative analysis. In addition, the clinical features of knee ACL, meniscus and articular cartilage damage were to be explored.ResultACL, meniscus and cartilage damage on MRI and arthroscopy could be divided into grade0to grade IV, while grade0represented normal grade and grade Ⅰ～Ⅳ were on behalf of damage from light to heavy. The meniscus damage could be divided into two injury type, non-degenerative injury and degenerative injury. In the 112cases of traumatic knee injury patients, arthroscopy confirmed81cases of ACL injury (the femoral side fracture accounted for70.4%),108menisci tear of88cases (grade Ⅳ accounted for59.3%) and87articular cartilage of34cases injury. Using arthroscopy as the reference standard, the overall sensitivity, specificity, and accuracy of MRI diagnosis of traumatic ACL, meniscus and articular cartilage damage were98.8%.83.8%.94.6%,84.3%.91.5%,83.9%and52.9%.99.7%.93.6%, respectively. In the123cases of knee osteoarthritis patients, the main symptoms were swelling and activities restricted, and floating patella test was positive in38.2%, patella grinding test was positive in91.9%, and39.8%of cases had loose bodies. Arthroscopy confirmed51cases of ACL degeneration injury (grade II accounted for56.8%),156meniscal degeneration injury of108cases (mixed degenerative damage type up to accounting for35.9%) and505degeneration of articular cartilage injury of123cases (the patellar damage up to20.4%). Using arthroscopic findings as the reference standard, the overall sensitivity, specificity, and accuracy of MRI diagnosis of degenerative ACL, meniscus and articular cartilage damage were70.6%.75.0%.73.2%,93.5%.63.7%.76.0%and70.1%.93.1%.77.4%, respectively.ConclusionACL, meniscus and articular cartilage damage in arthroscopy and MRI manifestations can be divided into five grades. Meniscus damage can be divided into two injury types, non-degenerative injury and degenerative injury, respectively, including5and6subtypes. In the cases of traumatic knee injury, the ACL injury is mainly on the femoral side and easy to merge the meniscus and articular cartilage damage. In the degenerative knee injury, articular cartilage injury is mainly to the patella, and the ACL injury is not very heavy, most of the meniscus degeneration belong to the mixed type, and the high incidence of medial meniscus. MRI represents a highly accurate method for identifying tears of the traumatic ACL, meniscus and cartilage damage. However, identification of degenerative damage of them remain low relatively. |
PDF Full Text Request