“膝关节重建后前交叉韧带感染的磁共振成像结果:描述性和可靠性研究”。

Blake C Meza, Niv Marom, Harry Greditzer, Eric Bogner, Robert G Marx
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引用次数: 0

摘要

目的:前交叉韧带(ACL)重建后脓毒性关节炎是一种罕见但具有潜在破坏性的并发症。与此类感染相关的影像学发现没有很好地描述或量化。本研究的目的是描述和量化前交叉韧带重建后感染的特征性MRI表现的频率。方法:选取2010年至2018年确诊的17例病例,确认符合深部感染的既定定义,并在感染诊断后10天内进行MRI检查。两名委员会认证的肌肉骨骼放射科医生评估和评分MRI研究与一组预定的成像特征。Cohen’s kappa(±)用于确定放射科医师之间的一致程度。评估移植物类型、微生物结果和MRI结果之间的关系。结果:总感染率为0.42%,中位术后35天确诊(范围9-411)。17例感染患者中11例(64.7%)保留移植物,9例(52.9%)需要重复冲洗和清创。常见的影像学表现包括复杂的层状积液(k=0.86)、股管内积液(k=0.91)和股管吸收(k=0.83)。在大多数病例中还发现了皮下水肿和股管周围水肿。没有证据表明隧道的皮质破坏或软骨溶解。所有急性感染均表现为复杂的层状积液,而慢性病例均表现为单纯积液。没有发现指数ACL移植类型或微生物结果与MRI结果之间的关联。结论:感染前交叉韧带重建膝关节的常见影像学表现,包括积液模式、移植物隧道周围水肿和隧道吸收均接近完美。MRI可以提供ACL重建术后感染的有价值信息。证据等级:四级——流行病学观察研究。
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'Findings of Magnetic Resonance Imaging in Knee with Post-Reconstruction Infection of the ACL: A Descriptive and Reliability Study' as per instructions.

Objectives: Septic arthritis after anterior cruciate ligament (ACL) reconstruction is a rare but potentially devastating complication. The imaging findings associated with such infections are not well-described or quantified. The purpose of this study was to describe and quantify the frequency of the characteristic MRI findings of infection following ACL reconstruction.

Methods: Seventeen cases were identified from 2010 to 2018, confirmed to meet established definitions for deep infections, and had an MRI obtained within ten days of diagnosis of infection. Two board-certified musculoskeletal radiologists evaluated and scored MRI studies with a predetermined set of imaging characteristics. Cohen's kappa (±) was utilized to determine the extent of agreement between the radiologists. Associations between graft type and microbiologic results and MRI findings were assessed.

Results: The overall infection rate was 0.42%, diagnosed at a median 35 days postoperatively (range 9-411). Grafts were retained in 11 of 17 (64.7%) infected cases and 9 patients (52.9%) required repeat irrigation and debridement. Common imaging findings included complex lamellated effusions (k=0.86), fluid within the femoral tunnel (k=0.91), and femoral tunnel resorption (k=0.83). Subcutaneous edema and edema surrounding the femoral tunnel were also identified in the majority of cases. There was no evidence of cortical destruction of the tunnels or chondrolysis. All acute infections demonstrated complex lamellated effusions, whereas all simple effusions were seen in chronic cases. No associations were found between index ACL graft type or microbiologic results and MRI findings.

Conclusion: Interrater agreement for common imaging findings including effusion pattern, edema surrounding the graft tunnels and tunnel resorption was near perfect within infected ACL reconstructed knees. MRI can provide value information regarding postoperative infection after ACL reconstruction.

Level of evidence: Level IV- epidemiological observational study.

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来源期刊
CiteScore
2.90
自引率
6.20%
发文量
61
审稿时长
108 days
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