磁共振检查下内侧半月板损伤人群膝关节骨性解剖值与半月板突出值及软骨损伤程度的关系

The Relationship between the Knee Joint Bony Anatomy Value, Meniscal Protrusion Value and Cartilage Damage Degree in People with Medial Meniscal Injury under Magnetic Resonance Imaging

摘要: 目的：探讨磁共振(MRI)检查下内侧半月板损伤人群中的膝关节骨性解剖值与半月板突出值及软骨损伤程度之间的关系。方法：选取2021年1月至2023年6月于安徽医科大学第一附属医院运动创伤与关节镜外科行膝关节镜探查的184例诊断内侧半月板损伤病例的MRI检查结果以及病程特点进行回顾性分析，观测膝关节镜下内侧间室软骨损伤等级及半月板损伤模式。结果：根据患者住院期间提供的相关资料、本院影像科膝关节磁共振资料以及关节镜探查结果，对184名患者进行分组。半月板突出组120例，无突出组64例；磁共振冠状位发现髁间窝骨赘组50例，未发现骨赘组134例；磁共振冠状位A型髁间窝组112例，U型髁间窝组67例，W型髁间窝组5例；关节镜下诊断内侧半月板根部撕裂组17例，非内侧半月板根部撕裂组167例；关节镜下诊断内侧半月板复合裂组83例，非复合裂组101例；关节镜膝下诊断内侧间室严重软骨损伤组(III度及以上) 80例，轻度软骨损伤组(II度及以下) 104例；膝关节外伤分组55例，非外伤分组129例；急性损伤分组71例，慢性损伤分组113例。结论：膝关节髁间窝出现骨赘对于评估膝关节内侧半月板各部位的突出程度及软骨损伤程度具有较高的参考价值。髁间窝形态分型中A型髁间窝较U型髁间窝内侧半月板后角突出值显著增加。髁间窝宽度/深度比值及髁间窝宽度/髁间距比值较与内侧半月板后角突出值及软骨损伤等级呈负相关，和半月板前角、体部突出值无显著关系。内侧半月板后根撕裂对于评估膝关节内侧半月板体部及后角部突出具有较高的参考价值。慢性膝关节病程以及较高的体重指数与不同部位的MME值及膝关节软骨损伤等级呈正相关。非膝关节外伤史组内侧半月板体部突出值更高。

Abstract: Objective: This study aimed to investigate the correlation between bony anatomy values of the knee joint, meniscal protrusion values, and the degree of cartilage damage in individuals with medial meniscus injuries as assessed by magnetic resonance imaging (MRI). Method: A retrospective analysis was conducted on the MRI results and disease course characteristics of 184 cases of medial meniscus injury diagnosed by arthroscopic knee exploration in the Department of Sports and Arthroscopic Surgery of the First Affiliated Hospital of Anhui Medical University from January 2021 to June 2023. The grade of cartilage injury in the medial compartment and the pattern of meniscus injury under knee arthroscopy were observed. Results: Based on the information provided by patients during hospitalization, knee magnetic resonance data from our hospital’s imaging department, and arthroscopy results, a total of 184 patients were categorized into various groups. Among them, there were 120 cases in the meniscus protrusion group and 64 cases in the non-protrusion group. In coronal magnetic resonance imaging, there were 50 cases in the intercondylar notch osteophyte group and 134 cases in the no osteophyte group. Additionally, there were 112 cases in the A-shaped intercondylar notch group, 67 cases in the U-shaped group, and 5 cases in the W-shaped group. Arthroscopy revealed 17 cases in the medial meniscal root tear group and 167 cases in the non-medial meniscal root tear group. Furthermore, 83 cases were diagnosed with medial meniscus compound tear, while 101 cases were in the non-compound tear group. Arthroscopic knee surgery identified 80 cases with severe cartilage damage (Grade III and above) in the medial compartment, and 104 cases with mild cartilage damage (Grade II and below). Moreover, there were 55 cases in the knee joint trauma group and 129 cases in the non-trauma group. The patients were also divided into subgroups based on acute injury (71 cases) and chronic injury (113 cases). Conclusion: The presence of osteophytes in the intercondylar fossa of the knee joint is highly indicative for assessing the degree of protrusion and cartilage damage in various areas of the medial meniscus. In the morphological classification of the intercondylar notch, the protrusion of the posterior horn of the medial meniscus is significantly greater in the A-type notch compared to the U-shaped notch. The ratios of intercondylar notch width/depth and intercondylar notch width/condylar distance are inversely correlated with the protrusion of the posterior horn of the medial meniscus and the severity of cartilage damage, but not significantly related to the protrusion of the anterior horn and body of the meniscus. A posterior root tear in the medial meniscus is valuable for evaluating the protrusion of the body and posterior corner of the medial meniscus in the knee joint. The duration of chronic knee joint disease and higher body mass index are positively associated with the MME values in different parts and the grade of knee cartilage damage. The protrusion of the medial meniscus body is higher in the group without a history of knee trauma compared to the group with a trauma history.