前交叉韧带周围脂肪垫水肿在关节镜确诊的ACL断裂中的时间依赖性诊断价值：一项比较性MRI研究
简介
该回顾性研究纳入188例关节镜确诊ACL完全断裂患者，系统评估胫骨前移、PCL角、十字韧带周围脂肪垫（PFP）水肿等6项MRI继发征象的诊断效能。结果显示PFP水肿总体特异度达100%，伤后13周内敏感度提升至85%，且特异度保持100%。PFP水肿是ACL断裂高度特异的时效性继发征象，可在原发征象不明确时辅助诊断并推测损伤时间。
英文摘要
BACKGROUND: To evaluate temporal changes in pericruciate fat pad (PFP) edema as a secondary MRI sign of anterior cruciate ligament (ACL) rupture and to determine the diagnostic performance of secondary MRI findings in patients undergoing ACL reconstruction. METHODS: This retrospective study included 188 patients who underwent primary arthroscopic ACL reconstruction with arthroscopically confirmed total ACL rupture. Six secondary MRI findings (anterior tibial translation, ACL-lateral tibial plateau angle, posterior cruciate ligament (PCL) angle, PCL line sign, PCL buckling, and PFP edema) were assessed using predefined criteria. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated. Intra- and inter-observer reliability were evaluated using intraclass correlation coefficients and Cohen's kappa. ROC analysis assessed the diagnostic performance of PFP edema relative to injury to MRI interval. RESULTS: All secondary findings were significantly associated with ACL rupture (p < 0.001). Overall sensitivity and specificity of PFP edema were 65.4% and 100%, respectively. With a 13-week injury-to-MRI cutoff, sensitivity increased to 85% while specificity and PPV remained 100% (NPV 78%). Other findings showed good diagnostic performance, including anterior tibial translation >5 mm (79.8%/92.5%), ACL-lateral tibial plateau angle <45°(88.8%/91.5%), PCL angle <107° (84.6%/94.5%), PCL line sign (70.2%/91.0%), and PCL buckling (72.3%/86.5%). CONCLUSION: PFP edema is a highly specific and time-dependent secondary MRI sign of ACL rupture, particularly within 13 weeks after injury, and may aid in diagnosis and estimation of injury chronicity when primary findings are inconclusive.