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ultrasonography ; MPFL injuries ; traumatic patellar dislocation ; osteochondral fracture
Abstract:
IntroductionInjuries following traumatic patellar dislocation (TPD) - osteochondral fractures or/and injuries of the medial patellar ligamentous restraints may constitute an indication for the surgical treatment. Ultrasonography (USG) appears a diagnostic tool that allows to estimate precisely the range and severity of the injuries accompanying TPD.Objectives1. Characteristics of the ultrasonographic patterns of the articular cartilage and soft tissue injuries accompanying TPD,2. Evaluation of the sensitivity, specificity, and predictive value of the ultrasonography in the diagnosis of the injuries accompanying TPD,3. Comparison of the accuracy and predictive value of the ultrasonography and plain X ray examination in the diagnosis of the injuries accompanying TPD.Material and methods56 patients (35 boys and 21 girls, 31 left and 51 right knees) aged 14,5 on average were treated surgically for TPD between 2004 and 2011. Prior to surgery, all patients underwent US examination. Indications for surgical treatment were based on the results of clinical and US findings and included the osteochondral fracture or complete MPFL injury. Intraoperatively the accuracy and the predictive value of the US examination in the detection of injuries accompanying TPD and requiring surgical treatment were verified.ResultsThe patognomonic US patterns of the injuries accompanying TPD were defined.In ; the diagnosis of the presence of the osteochondral fracture ultrasonography proved the sensitivity 95 %, the specificity 90 %, PPV 95 %, NPV 90 %, accuracy – 0,93. In the diagnosis of the medial patellar ligamentous restraints injuries ultrasonography proved the sensitivity 100 %, the specificity 100 %, PPV 100 %, NPV 100%, accuracy - 1. In the diagnosis of the partial thickness articular cartilage injuries ultrasonography proved the sensitivity 65 %, the specificity 100 %, PPV 100 %, NPV 76%, accuracy – 0,79.Ultrasonography appeared to be significantly more accurate and predictive in the assessment of the injuries accompanying TPD in comparison to plain X ray examination.ConclusionsUltrasonographic examination is highly accurate and predictive in the diagnosis of the extent of TPD concomitant injuries.Applying the USG in the diagnostic algorithm in TPD allows to establish more detailed diagnosis in comparison to results obtained using plain X ray examination only.