Accuracy of Magnetic Resonance Imaging in the Diagnosis of Multiple Ligament Knee Injuries: A Multicenter Study of 178 Patients.

Autor:	Sanchez-Munoz E; Knee Unit, Department of Traumatology and Orthopaedic Surgery, Toledo University Hospital, Toledo, Spain., Lozano Hernanz B; Knee Unit, Department of Traumatology and Orthopaedic Surgery, Toledo University Hospital, Toledo, Spain., Zijl JAC; Department of Orthopaedic Surgery, St Antonius Hospital, Utrecht, the Netherlands., Passarelli Tirico LE; Institute of Orthopedics and Traumatology, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil., Angelini FJ; Institute of Orthopedics and Traumatology, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil., Verdonk PCM; Orthopedic Center Antwerp, AZ Monica Hospital, Antwerp, Belgium; MoRe Foundation, Antwerp, Belgium., Vuylsteke K; MoRe Foundation, Antwerp, Belgium., Andrade R; Clínica Espregueira, Porto, Portugal; Dom Henrique Research Centre, Porto, Portugal; Porto Biomechanics Laboratory, Faculty of Sport, University of Porto, Porto, Portugal., Espregueira-Mendes J; Clínica Espregueira, Porto, Portugal; Dom Henrique Research Centre, Porto, Portugal; School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; 3B's Research Group [Biomaterials, Biodegradables and Biomimetics], University of Minho, Guimarães, Portugal., Valente C; Clínica Espregueira, Porto, Portugal; Dom Henrique Research Centre, Porto, Portugal., Figueroa F; Clinica Alemana, Faculty of Medicine, Universidad del Desarrollo, Santiago, Chile; Hospital Sotero del Rio, Santiago, Chile., Figueroa D; Clinica Alemana, Faculty of Medicine, Universidad del Desarrollo, Santiago, Chile., Maestro Fernández A; School of Medicine, University of Oviedo, Oviedo, Spain; Begoña Hospital, Gijón, Spain.; Investigation performed at Toledo University Hospital, Toledo, Spain.
Jazyk:	angličtina
Zdroj:	The American journal of sports medicine [Am J Sports Med] 2023 Feb; Vol. 51 (2), pp. 429-436. Date of Electronic Publication: 2023 Jan 10.
DOI:	10.1177/03635465221145697
Abstrakt:	Background: Magnetic resonance imaging (MRI) has shown limited diagnostic accuracy for multiple ligament knee injuries (MLKIs), especially posterolateral corner (PLC) injuries. Hypothesis: The diagnostic accuracy of MRI for MLKIs will only be moderate for some knee structures. Patient-related factors and injury patterns could modify the diagnostic accuracy of MRI. Study Design: Cohort study; Level of evidence, 3. Methods: All patients with MLKIs surgically treated between January 2014 and December 2020 in the centers participating in the study were reviewed. We recorded sex, age, mechanism of injury, time from injury to MRI, and vascular and neurological associated lesions. Lesions to the anterior cruciate ligament (ACL), posterior cruciate ligament, medial collateral ligament, lateral collateral ligament (LCL), popliteus tendon, popliteofibular ligament, iliotibial band, biceps tendon, medial and lateral meniscus, and articular cartilage from MRI reports and surgical records were also collected. The sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy, diagnostic odds ratio, positive and negative likelihood ratio, and intraclass correlation coefficient of MRI were calculated for each knee structure. With logistic regression, associations between patient and injury characteristics and MRI accuracy were assessed. Results: A total of 178 patients (127 male; mean age, 33.1 years) were included. High-energy trauma was the most common mechanism of injury (50.6%), followed by sports trauma (38.8%) and low-energy trauma (8.4%). The ACL was the structure with the best diagnostic accuracy, diagnostic odds ratio, and positive predictive value (94.4%, 113.2, and 96.8%, respectively). PLC structures displayed the worst diagnostic accuracy among knee ligaments (popliteus tendon: 76.2%; LCL: 80.3%) and diagnostic odds ratio (popliteus tendon: 9.9; LCL: 17.0; popliteofibular ligament: 17.5). MRI was more reliable in detecting the absence of meniscal and chondral lesions than in identifying them. Logistic regression found that the diagnostic accuracy was affected by the Schenck classification, with higher Schenck grades having worse diagnostic accuracy for peripheral structures (iliotibial band, popliteus tendon, and biceps tendon) and improved diagnostic accuracy for the ACL and posterior cruciate ligament. Conclusion: The diagnostic accuracy of MRI for MLKIs largely varied among knee structures, with many of them at risk of a misdiagnosis, especially PLC, meniscal, and chondral lesions. The severity of MLKIs lowered the diagnostic accuracy of MRI for peripheral structures.
Databáze:	MEDLINE
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