Summary
A prospective study was carried out to test the sensitivity and specificity of stress radiography in detecting anterior cruciate ligament deficiency in both knees of 116 patients using the Telos device. In 47 of these a total or partial rupture of the anterior cruciate ligament was diagnosed by arthroscopy, while the ligament was intact in the remaining 69 patients. The mean difference in radiological translation between the injured and the normal knee was greater than 5 mm (p<0.001) in those with anterior cruciate deficiency, and less than 3 mm in the others. A differential displacement of up to 3 mm was considered normal. The sensitivity of the method was less than 67% and the specificity was 100%. Clinical diagnosis had a sensitivity of 70.2% and a specificity of 98.5%. Our findings suggest that, although a differential translation of more than 3 mm can be diagnostic, smaller differences do not rule out anterior cruciate deficiency.
Résumé
Les auteurs ont réalisé une étude prospective pour évaluer la sensibilité et la spécificité des radiographies en position forcée dans le diagnostic des insuffisances du ligament croisé antérieur (LCA). Une radiographie en tiroir forcé des deux genoux a d'abord été faite, en utilisant l'appareil Telos, chez 116 patients devant subir une arthroscopie unilatérale. Chez 47 de ces patients une rupture totale ou partielle du LCA a été confirmée par arthroscopie, qui a montrée un ligament intact chez les 69 autres. La différence moyenne de translation entre le genou blessé et le genou sain a été supérieure à 5 mm (p<0.001) chez les patients ayant une insuffisance du LCA et inférieure à 3 mm chez les autres (une différence de 3 mm a été considérée comme normale). La sensibilité de la méthode a été de moins de 67% et le spécificité de 100%. L'examen clinique a une sensibilité de 70.2% et une spécificité de 98.5%. Ces résultats permettent de penser que, bien qu'une translation supérieure à 3 mm puisse avoir une valeur diagnostique, une moindre différence n'exclut pas une insuffisance du ligament croisé antérieur.
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Garcés, G.L., Perdomo, E., Guerra, A. et al. Stress radiography in the diagnosis of anterior cruciate ligament deficiency. International Orthopaedics 19, 86–88 (1995). https://doi.org/10.1007/BF00179966
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DOI: https://doi.org/10.1007/BF00179966