| Objective:To explore the value of the first time MRI examination,which evaluates the efficacy of Anterior cruciate ligament(ACL)reconstruction operation.Method:Collected 101 patients,who met standard after had ACL reconstruction operation during the year 2016-09 to the year 2017-08 in our hospital,aged from 18 to 60 years old,with an average age of 41.5 years old.All patients received a related examination of clinical stability of the knee joint,which is according to the subjective assessment of Lysholom score,including:(1)knee joint function evaluation,scored by Lysholm;(2)Lachman test;(3)Anterior drawer test(ADT);(4)Pivot-shift test,the patients are divided into two groups of stable and unstable groups.All patients underwent MRI examination for the first time 3 months after ACL reconstruction operation.The collected image data was read by two highly qualified diagnostic radiographers who were not aware of the clinical examination results,based on the standard and marked the location of the femoral and tibial tunnels respectively,and measured the angle of the corresponding tunnel.Using two independent samples t test stability results with MR image contrast clinical examination on the connection between the tibial and femoral tunnel perspective,analyzing the difference of MR abnormal incidence according to the bone tunnel position of stable and unstable group,P < 0.05 the difference been known as statistically significant;SPSS21.0 software was used to draw the ROC curve to determine the threshold value of the knee joint instability and calculate the area under the curve.Result:There were 101 cases of knee ligament rupture diagnosed by arthroscopic surgery and intraoperative confirmed anterior cruciate ligament rupture.The subjective assessment of joint function was scored by Lysholom.There were 80 patients in the post operation stability group,21 in the unstable group,and 80 patientsgot 65-95 scores with an average of 88.4 scores.The results of the two orthopedic surgeons were checked by consistency(Kappa=0.767,P<0.01).Among the patients who underwent ACL reconstruction surgery,the probability of occurrence of abnormal bone tunnel location in the two groups of clinical knee instability and stable groups was 85.71%(18/21)and 16.25%(13/80)respectively.According to the Statistical Analysis,P=0.003,Both have significant statistical differences;Incidence rates of sagittal and coronal angle abnormalities in the tibial tunnel were :76.19%(16/21)?13.75%(11/80)and 90.47%(19/21)?11.25%(9/80);Incidence rates of sagittal and coronal angle abnormalities in the femoral tunnel were :85.71%(18/21)? 14.77%(13/80)and 71.43%(15/21)? 23.75%(19/80),Statistical analysis with independent sample t-test showed statistically significant differences in the angles of the four groups of bone tunnels P<0.005.The area under the maximum curve of the stability of the knee joint in the coronal and sagittal positions of the tibia tunnel,the coronal position of the femur tunnel,and the sagittal position are: 0.893 and 0.855?0.748 and 0.789,thresholds are:29.6°and 61.3°?29.85°and 61.3°.Conclusion:1.The study showed that the first MRI examination of the 3 months after the reconstruction was important for the early judgment of the stability of the knee joint by observing the position of the bone tunnel and measuring the angle of the bone tunnel.The sensitivity and specificity of the tibial coronal and sagittal positions were:81.8%?91.0% and 81.7%?81.9%;The sensitivity and specificity of the femur coronal and sagittal positions:72.7%?81.8% and 81.8%?72.7%.2.The first MRI examination provides effective basis for postoperative evaluation of early adjustment of rehabilitation training and whether two operation are needed. |
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