Diagnosis of knee injuries: comparison of the physical examination and magnetic resonance imaging with the findings from arthroscopy

Abstract

ObjectivesTo ascertain the sensitivity, specificity, accuracy and concordance of the physical examination (PE) and magnetic resonance imaging (MRI) in comparison with arthroscopy, in diagnosing knee injuries.MethodsProspective study on 72 patients, with evaluation and comparison of PE, MRI and arthroscopic findings, to determine the concordance, accuracy, sensitivity and specificity.ResultsPE showed sensitivity of 75.00%, specificity of 62.50% and accuracy of 69.44% for medial meniscal (MM) lesions, while it showed sensitivity of 47.82%, specificity of 93.87% and accuracy of 79.16% for lateral meniscal (LM) lesions. For anterior cruciate ligament (ACL) injuries, PE showed sensitivity of 88.67%, specificity of 94.73% and accuracy of 90.27%. For MM lesions, MRI showed sensitivity of 92.50%, specificity of 62.50% and accuracy of 69.44%, while for LM injuries, it showed sensitivity of 65.00%, specificity of 88.46% and accuracy of 81.94%. For ACL injuries, MRI showed sensitivity of 86.79%, specificity of 73.68% and accuracy of 83.33%. For ACL injuries, the best concordance was with PE, while for MM and LM lesions, it was with MRI (p < 0.001).ConclusionsMeniscal and ligament injuries can be diagnosed through careful physical examination, while requests for MRI are reserved for complex or doubtful cases. PE and MRI used together have high sensitivity for ACL and MM lesions, while for LM lesions the specificity is higher.Level of evidence II – Development of diagnostic criteria on consecutive patients (with universally applied reference “gold” standard).

Evaluation of clinical tests and magnetic resonance imaging for knee meniscal injuries: correlation with video arthroscopy

“…Recently, Orlando et al 11 concluded that the association between physical examination and MRI has a high sensitivity for ACL lesions and MMT, but for MT the specificity is greater.…”

Use of MRI by radiologists and orthopaedic surgeons to detect intra-articular injuries of the knee

“…These results correspond to the lower end of what has been published. 14 , 17 , 22 , 25 , 26 One should consider that neither one team nor the other had previous access to each patient's clinical information. Several studies have already addressed the importance of physical examination in increasing the likelihood for a diagnosis, or on diagnosis establishment per se .…”

Magnetic Resonance Imaging in the Diagnosis of Traumatic Injuries Knee Joint

“…МРТ чувствительна и специфична для диагностики повреждений внутренних структур коленного сустава [12,13]. В нашем исследовании разрывы медиального мениска наблюдали чаще, чем дру-гие повреждения (78,6% случаев).…”

“…de Souza Leão и соавт. (92,5%) [13]. Но по данным других авторов, МРТ показала низкие резуль таты в диагностике разрыва латерального мениска (65,0%) [14].…”