Double anterior cruciate ligament sign: a magnetic resonance imaging performance of unstable tear of discoid lateral meniscus in adults

doi:10.3969/j.issn.2095-4344.0564

Abstract

Abstract:

BACKGROUND: Double anterior cruciate ligament sign is a imaging performance of the bucket handle tear of lateral meniscus. While, the relationship between double anterior cruciate ligament sign and the tearing type of discoid lateral meniscus is still unclear.

OBJECTIVE: To investigate the meaning and value of double anterior cruciate ligament sign on the instability of torn discoid lateral meniscus in adults.

METHODS: Clinical and imaging data of 95 cases of torn discoid lateral meniscus were retrospectively reviewed. All MRI images of the knee were observed and analyzed by two chief physicians of radiology. The incidence of double anterior cruciate ligament sign on preoperative MRI was calculated, and the relation between double anterior cruciate ligament sign and tearing type, surgical method and clinical symptoms of torn discoid lateral meniscus were analyzed.

RESULTS AND CONCLUSION: (1) Among 95 knees with torn discoid lateral meniscus, 17 knees (18%) were diagnosed as definite double anterior cruciate ligament sign. (2) The incidence of double anterior cruciate ligament sign in complete discoid lateral meniscus was 29%, which was significantly higher than that of 7% in incomplete discoid lateral meniscus (P=0.005). The incidences of longitudinal tear and peripheral tear were 35% and 41% in positive group of double anterior cruciate ligament sign, which were significantly higher than that of 9% (P=0.013) and 14% (P=0.025) in negative group. (3) The cases of preoperative click (P=0.021), extension block (P=0.003), the Visual Analogue Scale score (P=0.008) of the knee and the intraoperative meniscus suture (P=0.010) in positive group of double anterior cruciate ligament sign were significantly higher than those in the negative group, while the Lysholm score was lower than that in the negative group (P=0.020).(4) Our findings indicate that double anterior cruciate ligament sign is a MR imaging feature associated with a displaced tear of the discoid lateral meniscus in adults. Therefore, it may be a reliable indicator for evaluating the tear pattern and the operation method for adult patients with torn discoid lateral meniscus.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Menisci, Tibial, Magnetic Resonance Imaging, Tissue Engineering

CLC Number:

R318

Sun Xiao-xin, Liu Hao, Chai Hong-wei, Liang Chun-yu . Double anterior cruciate ligament sign: a magnetic resonance imaging performance of unstable tear of discoid lateral meniscus in adults[J]. Chinese Journal of Tissue Engineering Research, 2018, 22(31): 5015-5020.

Figures/Tables 2

2.2 双前交叉韧带征与患者年龄、性别、病程、外伤史以及DLM分型的关系此组95例成人DLM损伤病例中，有17例(18%)术前MRI检查符合双前交叉韧带征诊断标准(即双前交叉韧带征阳性)。χ2检验显示双前交叉韧带征的发生与年龄、性别、病程、外伤史无关(表1)。但完全型DLM病例中双前交叉韧带征的发生率(29%)明显高于不完全型(7%)，且差异有显著性意义(P=0.005)。风险分析显示前交叉韧带征的发生与完全型DLM相关(P=0.005，OR=5.733，95%CI：1.525-21.556)。此组中无Wisberg韧带型DLM。 2.3 双前交叉韧带征与患者术前症状、体征以及膝关节功能的关系此组患者均有典型DLM损伤临床症状，统计学分析显示双前交叉韧带征阳性病例中弹响和伸膝活动受限的发生率明显高于阴性组(P < 0.05)。风险评价显示前交叉韧带征与弹响(OR=3.639，95%CI：1.167-11.350，P=0.021)、伸膝受限(OR=4.976，95%CI：1.634-15.152，P=0.003)显著相关。双前交叉韧带征阳性组术前膝关节疼痛目测类比评分明显高于阴性组(P < 0.008)，而Lysholm 膝关节功能评分均明显低于阴性组(P < 0.020)。双前交叉韧带征与术前症状、体征以及膝关节功能的关系见表2。 2.4 双前交叉韧带征与DLM撕裂类型的关系在5种DLM撕裂类型中水平撕裂31例(33%)、放射状撕裂7例(8%)、纵向撕裂13例(14%)、边缘撕裂18例(19%)、复合撕裂26例(27%)。统计分析显示双前交叉韧带征阳性与阴性在不同撕裂类型中的分布差异有显著性意义(表3)。双前交叉韧带征阳性组中纵向撕裂(35%)和边缘撕裂(41%)的发生率明显高于阴性组(9%和14%)，相关分析显示双前交叉韧带征阳性病例中发生纵向撕裂(OR=5.532，95%CI：1.566-19.541，P=0.013)和边缘撕裂(OR=4.264，95%CI：1.340-13.565，P=0.025)的风险更高。而双前交叉韧带征阴性组中水平撕裂的发生率更高。 2.5 双前交叉韧带征与DLM损伤手术方式的关系此组双前交叉韧带征阳性与阴性在4种手术类型间的分布差异有显著性意义(表4)。双前交叉韧带征阳性病例半月板缝合(41%)的概率明显高于阴性病例(14%)，风险评价显示术中半月板缝合术与双前交叉韧带征显著相关(OR=4.264，95%CI：1.340-13.565，P=0.010)。而双前交叉韧带征阴性病例中单纯成形的概率更高。 "

References

[1] Bui-Mansfield LT, De Witt RM. Magnetic resonance imaging appearance of a double anterior cruciate ligament associated with a displaced tear of the lateral meniscus. J Comput Assist Tomogr. 2006; 30(2):327-332.

[2] Boody BS, Omar IM, Hill JA. Displaced medial and lateral bucket handle meniscal Tears with intact ACL and PCL. Orthopedics. 2015; 38(8):738-741.

[3] Ververidis AN, Verettas DA, Kazakos KJ, et al. Meniscal bucket handle tears: a retrospective study of arthroscopy and the relation to MRI. Knee Surg Sports Traumatol Arthrosc. 2006;14(4):343-349.

[4] Atay OA, Pekmezci M, Dorol MN, et al. Discoid meniscus: An ultrastructural study with transmission electron microscopy. Am J Sports Med. 2007;35(3):475-478.

[5] Papadopoulos A, Kirkos JM, Kapetanos GS. Histomorphologic study of discoid meniscus. Arthroscopy. 2009;25(3):262-268.

[6] Kocher MS, Klingele K, Rassman SO. Meniscal disorders: normal, discoid, and cysts. Orthop Clin North Am. 2003;34(3):329-340.

[7] Rao SK, Rao PS. Clinical, radiologic and arthroscopic assessment and treatment of bilateral discoid lateral meniscus. Knee Surg Sports Traumatol Arthrosc. 2007;15(5):597-601.

[8] 孙晓新,周伟,左淑萍,等.MRI形态学指标评价成人外侧盘状半月板损伤[J].中国组织工程研究,2017,21(7):1104-1109.

[9] 孙晓新,余家阔,张柳等.儿童症状性外侧盘状半月板患者前交叉韧带形态及信号变化的MRI影像学研究[J].中国矫形外科杂志,2014,22(7): 607-612

[10] 孙晓新,余家阔,张柳等.儿童症状性外侧盘状半月板损伤对前交叉韧带形态及信号影响的MRI影像学研究[J].中华关节外科杂志(电子版),2015,9(1):21-24.

[11] 孙晓新,周伟,左淑萍,等.成人外侧盘状半月板损伤的有效影像学指标：MRI影像学评价[J].中国组织工程研究, 2016,20(24):3535-3540

[12] Watanabe M, Takeda S, Ikeuchi H. Atlas of arthroscopy. Tokyo: Igaku Shoin, 1979:87-91.

[13] Ryu KN, Kim IS, Kim EJ, et al. MR imaging of tears of discoid lateral menisci. Am J Roentgenol. 1998;171(4):963-967.

[14] 冯锟,周洁,梁治平,等.磁共振成像对膝关节半月板桶柄样撕裂的评估作用[J].实用医学影像杂志,2015,16(4):317-319.

[15] 郑卓肇,范家栋,谢敬霞.MRI评价膝关节半月板的桶柄状撕裂[J].中华放射学杂志,2003,37(8):751-754.

[16] Vaishya R, Vijay V, Vaish A, et al. Double posterior cruciate ligament sign on magnetic resonance imaging: imaging variants, mimics, and clinical implications. J Orthop Case Rep. 2017;7(6):76-79.

[17] 姚海泉,胡智斌,林洪平.外侧半月板桶柄状撕裂低场MRI特殊征象分析[J].临床放射学杂志,2011,30(11):1662-1665.

[18] 钟世燕,伍鑫,吴晓涛,等.MRI诊断半月板桶柄状撕裂的临床应用[J].锦州医科大学学报,2017,38(3):29-31.

[19] Yoo JH, Hahn SH, Yi SR, et al. Posterior double PCL sign: a case report of unusual MRI finding of bucket-handle tear of medial meniscus. Knee Surg Sports Traumatol Arthrosc. 2007;15(11):1343-1345.

[20] 牛尚甫,骆俊.磁共振对膝关节半月板桶柄状撕裂的诊断价值[J].蚌埠医学院学报,2015,40(4):519-522.

[21] 蔡泽银,麦春华.MRI诊断膝关节半月板桶柄状撕裂[J].放射学实践,2011, 2(6):637-640.

[22] 王继琛,朱雪娥.MRI诊断膝关节半月板病变[J].中国医学影像技术,2011, 27(1):191-198.

[23] 冯磊,王敬学,王国华,等.磁共振成像评价膝关节半月板损伤[J].中国组织工程研究,2013,17(30):5545-5550.

[24] Dorsay TA, Helms CA. Bucket-handle meniscal tears of the knee: sensitivity and specificity of MRI signs. Skeletal Radiol. 2003;32(5): 266-272.

[25] Ryan RS, Marchinkow LO, Munk PL. Radiology for the surgeon: Musculoskeletal case 35 Bucket-handle tear of medial meniscus- thedouble PCL sign. Can J Surg. 2005;48(3):241-242.

[26] 龚静山,陈蓟,徐坚民,等.双前交叉韧带征:外侧半月板桶柄状撕裂MR征象[J].医学影像学杂志,2008,18(7):798-800.

[27] 彭如臣,沈秀芝,张殿平,等.膝关节半月板桶柄状撕裂的MRI诊断[J].核磁共振成像,2010,1(6):456-458.

[28] Liu C, Zheng HY, Huang Y, et al. Double PCL sign does not always indicate a bucket-hand letear of medial meniscus. Knee Surg Sports Traumatol Arthrosc. 2016;24(9):2806-2810.

[29] Takayama K, Matsushita T, Matsumoto T, et al. The double ACL sign: an unusual bucket-handle tear of medial meniscus. Knee Surg Sports Traumatol Arthrosc. 2011;19(8):1343-1346.

[30] Prasad A, Brar R, Rana S. MRI imaging of displaced meniscal tears: Report of a case highlighting new potential pitfalls of the MRI signs. Indian J Radiol Imaging. 2014;4(3):291-296.

[31] Klingele KE, Kocher MS, Hresko MT, et al. Discoid lateral meniscus: Prevalence of peripheral rim instability. J Pediatr Orthop. 2004;24(1): 79-82.

[32] Ahn JH, Lee YS, Ha HC, et al. A novel magnetic resonance imaging classification of discoid lateral meniscus based on peripheral attachment. Am J Sports Med. 2009;37(8):1564-1569.

[33] Ahn JH, Lee SH, Yoo JC, et al. Arthroscopic partial meniscectomy with repair of the peripheral tear for symptomatic discoid lateral meniscus in children: results of minimum 2 years of follow-up. Arthroscopy. 2008; 24(8):888-898.

[34] Yoo WJ, Choi IH, Chung CY, et al. Discoid lateral meniscus in children: limited knee extension and meniscal instability in the posterior segment. J Pediatr Orthop. 2008;28(5):544-548.

[35] 孙晓新,周伟,左淑萍,等.成人完全型外侧盘状半月板损伤的形态学特征及MRI评价[J].中国运动医学杂志,2016,35(9):799-803

[36] Rao SK, Rao PS. Clinical, radiologic and arthroscopic assessment and treatment of bilateral discoid lateral meniscus. Knee Surg Sports Traumatol Arthrosc. 2007;15(5):597-601.

[37] Lee SK, Yang BS, Park BM, et al. Medial meniscal root repair using curved guideand soft suture anchor. Clin Orthop Surg. 2018;10(1): 111-115.

[38] Hagino T, Ochiai S, Senga S, et al. Arthroscopic treatment of symptomatic discoid meniscus in children. Arch Orthop Trauma Surg. 2017;137(1):89-94.

[39] Ahn JH, Kim KI, Wang JH, et al. Arthroscopic repair of bucket-handle tears of the lateral meniscus. Knee Surg Sports Traumatol Arthrosc. 2015;23(1):205-210.

[40] Yamasaki S, Hashimoto Y, Takigami J, et al. Risk factors associated with knee joint degeneration after arthroscopic reshaping for juvenile discoid lateral meniscus. Am J Sports Med. 2017;45(3):570-577.