Assessment of meniscal extrusion with ultrasonography: a systematic review and meta-analysis.

Autor: Boksh K; Department of Biomedical Engineering, University of Birmingham, Birmingham, UK. khalis_boksh@hotmail.co.uk.; Leicester Academic Knee Unit, University Hospitals of Leicester NHS Trust, Leicester, UK. khalis_boksh@hotmail.co.uk., Shepherd DET; Department of Biomedical Engineering, University of Birmingham, Birmingham, UK., Espino DM; Department of Biomedical Engineering, University of Birmingham, Birmingham, UK., Shepherd J; Leicester Academic Knee Unit, University Hospitals of Leicester NHS Trust, Leicester, UK., Ghosh A; Leicester Academic Knee Unit, University Hospitals of Leicester NHS Trust, Leicester, UK., Aujla R; Leicester Academic Knee Unit, University Hospitals of Leicester NHS Trust, Leicester, UK., Boutefnouchet T; Department of Biomedical Engineering, University of Birmingham, Birmingham, UK.; Department of Trauma & Orthopaedics, University Hospitals of Birmingham NHS Trust, Birmingham, UK.
Jazyk: angličtina
Zdroj: Knee surgery & related research [Knee Surg Relat Res] 2024 Oct 28; Vol. 36 (1), pp. 33. Date of Electronic Publication: 2024 Oct 28.
DOI: 10.1186/s43019-024-00236-3
Abstrakt: Background: Magnetic resonance imaging (MRI) is the imaging of choice for meniscal extrusion (ME). However, they may underappreciate the load-dependent changes of the meniscus. There is growing evidence that weight-bearing ultrasound (WB US) is more suitable, particularly in revealing occult extrusion. We therefore perform a systematic review and meta-analysis on the validity and reliability of US in diagnosing extrusion. Furthermore, we explored whether it detects differences in extrusion between loaded and unloaded positions and those with pathological (osteoarthritis and meniscal injury) and healthy knees.
Methods: The Cochrane Controlled Register of Trials, PubMed, Medline, and Embase were used to perform a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. Data pertaining to intra- and interrater reliability of US in measuring meniscal extrusion (ME), its correlation with magnetic resonance imaging (MRI), and head-to-head comparison of potential factors to influence ME were included [loading versus unloading position; osteoarthritis (OA) or pathological menisci (PM) versus healthy knees; mild versus moderate-severe knee OA]. Pooled data were analyzed by random or fixed-effects models.
Results: A total of 31 studies were included. Intraclass correlation coefficients (ICC) for intra- and interrater reliability were minimum 0.94 and 0.91, respectively. The correlation between US and MRI was (r = 0.76). US detected ME to be greater in the loaded position in all knees (healthy, p < 0.00001; OA, p < 0.00001; PM, p = 0.02). In all positions, US detected greater extrusion in OA (p < 0.0003) and PM knees (p = 0.006) compared with healthy controls. Furthermore, US revealed greater extrusion in moderate-severe OA knees (p < 0.00001).
Conclusions: This systematic review suggests ultrasonography can play an important role in the measurement of meniscal extrusion, with results comparable to that of MRI. However, to what extent it can differentiate between physiological and pathological extrusion requires further investigation, with an absolute cutoff value yet to be determined. Nevertheless, it is an appropriate investigation to track the progression of disease in those with meniscal pathologies or osteoarthritis. Furthermore, it is a feasible investigation to evaluate the meniscal function following surgery.
Level of Evidence: IV, Systematic review of level III-IV evidence.
(© 2024. The Author(s).)
Databáze: MEDLINE
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