Clinical Application Of High Frequency Ultrasound In Evaluating Posteromedial Corner Injury Of Kneejoint

Part One:The clinical application of high frequency ultrasound in evaluating posteromedial corner of normal knee jointObjective:To investigate the anatomical structure of the tendon and ligament of the posteromedial corner of the knee joint and its ultrasonic manifestations under stress and rest conditions.To improve the understanding of the posteromedial corner of the knee joint.Materials and methods:1.High frequency ultrasound examination was performed on 15 normal volunteers(30 knee joints).The structure of MCL,POL and SMT was observed.The ultrasonic scanning skills and ultrasonographic features of the posteromedial corner of the normal knee joint were summarized.2.The valgus stress test of MCL in these normal volunteers was performed and compared with resting state.Results:1.The MCL was normally thin and high echo,and the normal POL was thinner and high echo,and the normal SMT showed a wide and hypoechoic band.The length and thickness of the left and right ligaments of the 15 volunteers in the control group were not statistically significant(About MCL length compared t=0.837,p=0.417,about MCL thickness compared t=-0.939,p=0.364;About POL length compared t=0.598,p=0.640,about POL thickness compared t=-0.367,p=0.719;About SMT 1ength compared t=0.598,p=0.560,about SMT thickness compared t=-0.572,p=0.576).According to the data obtained from the 15 normal volunteers(30 knees in all),the 95%confidence interval(CI)of the MCL length was estimated to be(10.212,10.714)cm and 95%CI of the MCL thickness(0.173,0.188)cm.The 95%CI of POL length and thickness in normal adults was(4.752,5.067)cm and(0.119,0.131)cm respectively.The 95%Cl of the length and thickness of the SMT in normal adults was(4.263,4.504)cm and(0.409,0.433)cm respectively.2.There was no statistical difference in the length and thickness of the MCL between the stress group and the static group in 15 normal volunteers during the valgus stress test(the length and thickness of stress group compared with statics group at the value of t were 1.937 and-0.565,the values of p were 0.063 and 0.576.).Conclusion:High-frequency ultrasound can clearly show the shape and morphology of the important ligaments of PMC.part two:The clinical application research of high frequency ultrasound in diagnosis of posteromedial corner injury of knee jointObjective:To analyze the ultrasonographic features of posteromedial ligament injury of knee joint,evaluate the clinical value of ultrasonography in the diagnosis of posteromedial corner injury,and explore the significance of stress test in the diagnosis of posteromedial corner injury of knee joint.Materials and methods:1.Twenty patients who suspected the injury of PMC were examined by high frequency ultrasound,and the ultrasonic manifestations of the injured ligaments of PMC were summarized.To evaluate the clinical value of ultrasound in the diagnosis of PMC injury according to the results of operation,MRI diagnosis and follow-up ultrasonography.2.Stress test was performed in patients with PMC injury and compared with resting state.Results:1.Ultrasound images of PMC injury showed the reduction of ligament echo,the discontinuity of echo,and the irregular low or no echo area around the ligament.Ultrasonography was used to diagnose 15 cases of PMC ligament contusion(including 6 cases of MCL contusion,5 cases of POL contusion,4 cases of SMT contusion),10 cases of partial ligament tear(including 7 cases of MCL,2 cases of POL,1 case of SMT),7 cases of complete tear(including 4 cases of MCL,3 cases of POL,0 cases of SMT).All the diagnosis results were confirmed by operation or ultrasound follow-up.Compared with the 95%confidence interval of normal MCL,POL and SMT obtained in the first part,the length and thickness of ligaments in the injured group were larger than the upper limit of the corresponding confidence interval.The length and thickness of ligaments in the injured group were significantly different from those in the control group(the t values of MCL length and thickness were 4.594 and 16.452 respectively,p were both less than 0.001;the t values of POL length and thickness were 3.706 and 3.331 respectively,p were 0.005 and 0.009,and the t values of SMT length and thickness were both 2.828,the p values were both 0.047).2.The length of the injured MCL in the valgus stress group were significantly different from those in the rest group(the t values were 15.811,21.920 and 15.145 in the contusion,partial tear and complete tear groups,respectively,p were all less than 0.001),but there was no significant difference in the thickness(Compared with the stress group,the length t values of the contusion,partial and complete tearing MCL groups were 0.415,0.420 and 0.243,respectively,p were 0.695,0.689 and 0.824).Conclusion:High-frequency ultrasound can provide scientific basis for clinical diagnosis of knee joint PMC injury quickly and accurately,especially suitable for bilateral comparative evaluation and dynamic stress observation,which is worthy of wide clinical application.