Accuracy of clinical diagnosis in patients undergoing knee arthroscopy

Abstract

A retrospective analysis of patients who underwent knee arthroscopy was undertaken to determine the accuracy of clinical diagnosis when compared with arthroscopic findings, and to see whether any specific pathologies were difficult to diagnose. The preoperative diagnosis was compared with the operative findings and the accuracy, sensitivity and specificity of the clinical diagnosis calculated. Six hundred ninety-eight patients were included. The overall accuracy, sensitivity and specificity of clinical diagnosis was 99%, 70% and 99%, respectively. Ninety percent of patients underwent a beneficial procedure, while 10% had a normal knee diagnosed at operation. Medial meniscal tear was the hardest pathology to diagnose with accuracy, sensitivity and specificity rates of 82%, 92% and 79%, respectively. Clinical examination remains an accurate method of assessing whether patients would benefit from an arthroscopy, although the correct diagnosis may not be determined preoperatively, particularly if pain was located in the medial tibio-femoral joint.

Indications requiring preoperative magnetic resonance imaging before knee arthroscopy

“…Specificity for the anterior horn of the lateral meniscus was 80.8% and for the posterior horn 82.3%. For clinical evidence of lateral meniscus damage, similar high sensitivity of 54–92% and specificity of 90–96% were seen [ 4 , 5 , 8 ]. That shows that there is no information gain for meniscal tears with a preoperative MRI from a non-specialized radiology unit in addition to a thorough clinical examination.…”

“…Specificity for the anterior horn of the medial meniscus was 93.1% and for the posterior horn 46.2%. However, with clinical examination, sensitivity of 50–92% and specificity of 55.6–97% for medial meniscal pathologies have previously been reported [ 4 , 5 ]…”

“…Specificity for the anterior horn of the medial meniscus was 93.1% and for the posterior horn 46.2%. However, with clinical examination, sensitivity of 50–92% and specificity of 55.6–97% for medial meniscal pathologies have previously been reported [ 4 , 5 , 8 , 25 ]. For determination of lateral meniscal lesions by standardized MRI, sensitivity of 35–100% and specificity of 89–100% were reported [ 4 , 6 , 9 ].…”

Multi‐echo GRE imaging of knee cartilage

“…Disruption of the orientation of collagen fibers and alteration of the water‐proteoglycan environment lead to changes in tissue biomechanics and can potentially hasten progression into osteoarthritis (OA) . Arthroscopy, with its high specificity and sensitivity, is considered the gold diagnostic standard; however, it does not provide macromolecular information about collagen and proteoglycan status …”

“…3,4 Arthroscopy, with its high specificity and sensitivity, is considered the gold diagnostic standard; however, it does not provide macromolecular information about collagen and proteoglycan status. 5 Advanced magnetic resonance imaging (MRI) techniques for detecting cartilage damage include T 2 mapping, T 1 rho mapping, delayed gadolinium-enhanced MRI of cartilage (dGEMRIC), sodium imaging, and diffusion tensor imaging (DTI). [6][7][8] T 2 mapping is used to infer information about the water content and collagen network in cartilage.…”