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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

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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

Doctor Nicolas LEFEVRE, Doctor Yoann BOHU, Doctor Shahnaz KLOUCHE , Doctor Serge HERMAN. - 29 mars 2014.

Conflicts of interest: the author or authors have no conflicts of interest concerning the data published in this article.


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