伴发关节软骨损伤对半月板撕裂体格检查试验诊断性能的影响
简介
一项纳入186膝的队列研究对比关节镜探查结果发现，合并关节软骨损伤（ICRS≥2级）几乎不影响McMurray试验诊断半月板撕裂的效能（内侧P=0.667，外侧P=0.064）。然而内侧关节线压痛在合并内侧间室软骨损伤时诊断价值显著下降（OR=0.10，P=0.027），提示此类患者查体结果需谨慎解读。
英文摘要
BACKGROUND: Meniscal tears are common knee injuries that frequently coexist with articular cartilage damage. Although physical examination remains essential for clinical diagnosis, the diagnostic performance of meniscal tests may be influenced by concomitant cartilage injury. PURPOSE: To investigate whether articular cartilage injury affects the diagnostic performance of the McMurray test and joint line tenderness for meniscal tears, including traumatic and degenerative lesions. STUDY DESIGN: Cohort Study (Diagnosis); Level of evidence, 3. METHODS: A total of 186 knees from 179 consecutive patients who underwent an arthroscopic evaluation were retrospectively analyzed. Physical examination findings, including the McMurray test and joint line tenderness, were compared with arthroscopically confirmed meniscal tears. Articular cartilage injury was defined as an International Cartilage Repair Society grade ≥2. The diagnostic performance was evaluated in knees with and without concomitant cartilage injury. Logistic regression analysis was used to evaluate interactions between physical examination findings and cartilage status. RESULTS: Medial meniscal tears were identified in 91 knees and lateral meniscal tears in 86 knees, including 9 knees with combined tears. Articular cartilage injury was present in 109 knees, including 18 without meniscal tears. Cartilage injury was associated with older age (P < .001), patellar ballottement (P = .019), and medial joint line tenderness (P = .022). In the overall cohort, joint line tenderness showed high sensitivity for medial and lateral meniscal tears (80.2% and 73.3%, respectively), whereas the McMurray test showed high specificity (91.4% and 91.2%, respectively). Similar diagnostic patterns were observed in knees without concomitant cartilage injury. In adjusted analyses, the McMurray test was not significantly affected by cartilage injury in either compartment (medial, P = .667; lateral, P = .064). However, medial joint line tenderness showed significantly reduced diagnostic performance in the presence of medial compartment cartilage injury (odds ratio [OR], 0.10; P = .027). CONCLUSION: The diagnostic performance of the McMurray test for meniscal tears appears largely preserved regardless of concomitant articular cartilage injury. However, medial joint line tenderness may demonstrate a reduced diagnostic performance in the presence of medial compartment cartilage injury, suggesting that palpation-based findings should be interpreted with caution.