外侧半月板过度活动的临床预测因素及过度活动性外侧半月板综合征评分的构建
简介
这项回顾性诊断预测模型研究纳入482例接受膝关节镜手术的患者（外侧半月板过度活动156例、无过度活动的结构性外侧半月板撕裂171例、关节镜对照155例），以关节镜下后角可复现的前向移位超过外侧胫骨平台中点（>50%）定义外侧半月板过度活动。独立预测因素包括间歇性交锁（aOR 4.78）、过屈痛（aOR 4.21）、旋转不稳定感（aOR 3.74）、后外侧疼痛…
英文摘要
PURPOSE: To identify independent preoperative predictors of arthroscopically confirmed lateral meniscal hypermobility and to develop and internally validate the Hypermobile Lateral Meniscus Syndrome Score (HLMSS). METHODS: A retrospective diagnostic prediction model study included 482 patients undergoing knee arthroscopy: 156 with lateral meniscal hypermobility, 171 with structural lateral meniscal tears without hypermobility and 155 arthroscopic controls. Lateral meniscal hypermobility was defined arthroscopically as reproducible anterior translation of the posterior horn beyond the midpoint (>50%) of the lateral tibial plateau. Preoperative clinical and magnetic resonance imaging (MRI) variables were evaluated as candidate predictors. Independent predictors were identified using multivariable logistic regression, and the HLMSS was derived from regression coefficients. Internal validation was performed using 1000 bootstrap resamples. Discrimination, calibration and clinical utility were assessed. RESULTS: The cohort included 482 patients (mean age, 31.8 ± 9.4 years; 62.4% male). Mean age was 28.9 ± 8.1 years in the hypermobility group, 34.7 ± 10.2 years in the structural tear group, and 31.8 ± 8.7 years in controls; 64.7%, 60.8% and 61.9% were male, respectively. Independent predictors of lateral meniscal hypermobility were intermittent locking (adjusted odds ratio [aOR], 4.78), hyperflexion pain (aOR, 4.21), rotational instability sensation (aOR, 3.74), posterolateral pain (aOR, 3.12) and popliteomeniscal fascicle abnormality on MRI (aOR, 2.68). The HLMSS demonstrated an area under the curve (AUC) of 0.91 (95% confidence interval [CI], 0.88-0.94) and an optimism-corrected AUC of 0.89. At ≥7 points, sensitivity was 86.5% and specificity was 84.8%. In the restricted comparison with structural lateral meniscal tears, the AUC was 0.84 (95% CI, 0.80-0.88). CONCLUSION: The HLMSS demonstrated good to excellent discrimination for identifying arthroscopically confirmed lateral meniscal hypermobility using preoperative clinical and MRI findings. External validation in consecutive symptomatic populations is required before routine clinical implementation. LEVEL OF EVIDENCE: Level III, retrospective diagnostic cohort study.