Dynamic Magnetic Resonance Imaging Protocol: An Effective and Useful Tool to Assess Discoid Lateral Meniscus Instability in Children.

IF 1.4 3区 医学 Q3 ORTHOPEDICS
Journal of Pediatric Orthopaedics Pub Date : 2024-10-01 Epub Date: 2024-06-11 DOI:10.1097/BPO.0000000000002747
Nicolas Cance, Aymeric Rouchaud, Aygulph Chousta, Antoine Josse, Michael James Dan, Franck Chotel
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引用次数: 0

Abstract

Objectives: One of the most common symptoms in cases of discoid lateral meniscus (DLM) in children is a "snapping" knee. The clock in extension, followed by a pop in flexion, perceived by the clinician, reflects the meniscal displacement caused by the peripheral meniscocapsular detachment. Standard magnetic resonance imaging (MRI) results in a 40% false-negative rate for detecting this instability. The hypothesis was that a dynamic MRI protocol could reduce the false negative rate and improve the efficiency of the MRI in detecting the direction of instability.

Methods: Eight DLM knees (8 patients) with snapping knees (grade 2 of Lyon's classification) were included in this monocentric prospective preliminary study in a referral center of pediatric orthopaedic surgery. Every patient underwent a dynamic MRI protocol with both T2-Fat-Sat sagittal and coronal slices, performed "after the clock" and again "after the pop" in a knee with standard 20 degrees of flexion during acquisition. All the MRI data were correlated with an arthroscopic description of the peripheral tear of the DLM according to Ahn's classification to assess for diagnostic accuracy.

Results: The standard MRI protocol resulted in a false-negative rate of 50% for detecting the direction of instability. The dynamic MRI protocol allowed the identification of, and classification of the meniscal instability, meniscal shift, and meniscocapsular tear in 8 of 8 patients (0% false-negative rate), perfectly correlated with arthroscopic findings.

Conclusion: This preliminary series, although short, allowed us to understand all the types of movements and lesions associated with the child's discoid meniscus. The detailed case analysis showed a strong benefit of such a protocol for planning the surgical suture procedure. The functionality and reliability of the dynamic MRI protocol is a good and method relatively simple method which does not require specific equipment, minimizing any additional cost compared with standard MRI.

Level of evidence: Level IV.

动态磁共振成像协议:评估儿童盘状外侧半月板不稳定性的有效实用工具。
目的:儿童盘状外侧半月板(DLM)病例中最常见的症状之一是膝关节 "折断"。临床医生感觉到伸膝时 "咔嚓 "一声,屈膝时 "啪嗒 "一声,这反映了外周半月板脱落导致的半月板移位。标准磁共振成像(MRI)在检测这种不稳定性时,假阴性率高达 40%。假设动态核磁共振成像方案可降低假阴性率,并提高核磁共振成像检测不稳定性方向的效率:方法:在一家儿科骨科转诊中心进行的这项单中心前瞻性初步研究中,纳入了 8 名患有膝关节折叠(里昂分类 2 级)的 DLM 膝关节(8 名患者)。每位患者都接受了T2-Fat-Sat矢状切片和冠状切片动态核磁共振成像方案,在采集过程中膝关节标准屈曲20度,"计时后 "和 "弹响后 "再次进行。所有核磁共振成像数据都与根据安氏分类法对 DLM 周围撕裂的关节镜描述相关联,以评估诊断的准确性:结果:标准磁共振成像方案在检测失稳方向方面的假阴性率为 50%。动态核磁共振成像方案可对8例患者中的8例进行半月板失稳、半月板移位和半月板囊撕裂的识别和分类(假阴性率为0%),与关节镜检查结果完全吻合:这个初步系列虽然很短,但让我们了解了与儿童盘状半月板相关的所有运动和病变类型。详细的病例分析表明,这种方案对规划手术缝合程序大有裨益。动态核磁共振成像方案的功能性和可靠性很好,方法相对简单,不需要特殊设备,与标准核磁共振成像相比,可最大限度地减少额外费用:证据等级:IV 级。
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来源期刊
CiteScore
3.30
自引率
17.60%
发文量
512
审稿时长
6 months
期刊介绍: ​Journal of Pediatric Orthopaedics is a leading journal that focuses specifically on traumatic injuries to give you hands-on on coverage of a fast-growing field. You''ll get articles that cover everything from the nature of injury to the effects of new drug therapies; everything from recommendations for more effective surgical approaches to the latest laboratory findings.
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