Akmese征作为秘鲁医疗机构中内侧半月板后根部撕裂诊断方法的准确性
简介
一项针对201例拟行关节镜手术患者的前瞻性诊断研究显示，Akmese征诊断内侧半月板后根撕裂的敏感性为85.7%、特异性98.8%，观察者间一致性良好。该体征可作为术前辅助检查手段提高后根撕裂的筛查效率，但不宜替代MRI或关节镜确认。
英文摘要
BACKGROUND: Medial meniscus injuries are the most prevalent knee injuries, frequently causing pain, instability, and orthopaedic surgeries. Although several clinical tests are used for meniscal pathology, most were developed for general meniscal lesions rather than specifically for medial meniscus posterior root tears (MMPRT). Evidence on root-specific physical examination signs remains limited. Recently, the Akmese manoeuvre has been introduced as a non-invasive diagnostic tool, assessing pain or tenderness during physical examination. This study aimed to determine the accuracy of the Akmese sign for the clinical diagnosis of MMPRT. METHODS: This prospective cohort diagnostic study included patients aged 18 to 55 years scheduled for arthroscopic surgery following a clinical diagnosis of medial meniscus injury between January 2022 and July 2023. Diagnostic performance metrics, including sensitivity, specificity, positive and negative predictive values (PPV, NPV), and likelihood ratios (LR+, LR-), were calculated, using arthroscopy as the reference standard. The interobserver reliability of the Akmese manoeuvre was assessed using the kappa coefficient. RESULTS: A total of 201 individuals met the eligibility criteria, with a mean age of 38.4 ± 9.8 years. The Akmese sign was positive in 26 patients, and MMPRT was confirmed by arthroscopy in 28 patients. The Akmese sign demonstrated a sensitivity of 85.7%, specificity of 98.8%, PPV of 92.3%, NPV of 97.7%, LR+ of 74.1, and a LR- of 0.15. CONCLUSION: In this selected surgical population, the Akmese manoeuvre showed promising diagnostic performance and very good interobserver reliability for identifying MMPRT. The sign may be useful as an adjunctive clinical tool to support preoperative suspicion, targeted MRI review, and surgical planning, but it should not be considered a replacement for MRI or arthroscopic assessment.