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Sensitivity and specificity of bell-hammer tear as indirect sign of an anterior cruciate ligament partial rupture on magnetic resonance imaging
The main purpose of this study Was to evaluate-the usefulness of the bell-hammer sign in the diagnosis of partial tears of the anterior cruciate ligament (ACL) of the knee is MRI.
Methods A retrospective study Was Performed Including all patients underwent ACL reconstruction Who for partial or full tears from 2008 to 2009. The diagnosis of partial or full ACL tears Was based on the appearance of the ligament bundles and the quality is MRI signal. On arthroscopy, qui est regarded the gold standard contents, each bundle Was classified as normal, Partially or completely Call torn DEPENDING on the extent of the fracture and the quality of the remaining fibers. The study included 312 patients, 83 women and 229 men (mean age 33.3 ┬▒19.6 years). A diagnosis of a tear Was made ??in all patients on preoperative MRI. Arthroscopy Did not show Any normal ACL, 247/312 (79.2%) Complete tears and 65/312 (20.8%) partial tears, 50/65 (76.9%) on the anteromedial bundle (AM) and 15/65 (23.1%) the posterolateral bundle.
Results The bell-hammer sign Was found on MRI in 13/312 patients (4.5%). It Involved 9/65 (13.8%) partial tears, all in the AM bundle, and 4/247 (1.6%) Complete tears, Significantly more frequent in cases of partial rupture (P \ 0.0001). Diagnosed MRI has partial tear in 15/65 cases without the bell-hammer sign (sensitivity CI95% = 23.1 ┬▒ 10%, specificity 95% CI = 95.9 ┬▒ 2.5%) and with the bell-hammer sign in 23/65 cases (sensitivity 95% CI =35.4 ┬▒ 11%, specificity 95% CI = 93.9 ┬▒ 3%). The combination of the bell-hammer sign with conventional radiological diagnostic criteria HAS Improved performance of MRI diagnosis for partial tears but not signif- icantly (ns).
Reviews The most significant finding of the interest BELL- hammer sign in the day-to-day clinical work is to suggest partial tears on MRI. It aids making a diagnosis, goal ict lack Does not exclude partial ACL rupture.
Level of evidence Diagnostic study, Level II.
Keywords ACL reconstruction, Partial tear, MRI
Partial ACL tear
Isolated ruptures of the anterior cruciate ligament (ACL) injuries are the most frequent ligament of the knee. These breaks may be complete or partial. In partial tears, clinical diagnosis is more difficult because the clinical presentation is variable. The diagnosis, evolution in time and treatment its partial tears are still subject to much controversy. The purpose of this article is to clarify the definitions, clinical diagnosis and therapeutic strategies to these partial ACL tears. (read more ...)
Women have four to eight times more likely than men to have a ruptured anterior cruciate ligament (ACL). This risk seems more important during the pre-ovulatory phase of the menstrual cycle than during the post-ovulatory phase. The main objective of the study was to describe the distribution of ACL injuries during the menstrual cycle in a large recreational skiers population.
The main goal of this study Was to compare the results of the GNRB arthrometer To Those of Telos TM in the diagnosis of partial thickness tears of the anterior cru- ciate ligament (ACL). A prospective study Performed January- December 2011 included all patients presenting with a partial or full-thickness tears ACL without ACL recon- struction and with a healthy contralateral knee. Anterior laxity Was Measured in all patients by the Telos TM and GNRB├ĺ devices.
It is necessary to distinguish:
- The fracture lesions which are always found with certainty notion traumatic (new or old)
- Chronic lesions with onset of osteonecrosis subchondral more or less extensive, described in the literature under different terminologies (osteochondrosis, osteochondritis, osteonecrosis).
This distinction seems to us essential because etiology, radiographic appearance, treatment and prognosis of such lesions are sometimes totally different.