Clinical Assessment Versus MRI Diagnosis of Meniscus Tears

Abstract

Clinical Scenario: Common injuries in high-level and recreational athletes, nonathletes, and the elderly are medial and lateral meniscus tears. Diagnosis of meniscus tears is done with clinical exam, magnetic resonance imaging (MRI), and arthroscopy. The gold standard is arthroscopy, but accuracy of a clinical exam versus MRI diagnosis of meniscus tears is in question. A clinician's ability to detect a meniscus tear is beneficial to the patient from a timing standpoint. The process of obtaining an MRI and results could be lengthy, but if the meniscus tear is accurately diagnosed clinically, the patient could be suspended from athletics or specific job duties to prevent further injury. In addition, rehabilitation could be initiated immediately, resulting in better outcomes for the patient. The ability to diagnose a meniscus tear clinically could initiate the rehabilitation process much sooner than waiting for MRI testing and results. Beginning the rehabilitation phase earlier may lead to faster postoperative rehabilitation and better patient outcomes. Clinical detection of a meniscus tear will facilitate possible suspension, early treatment, and rehabilitation recommendations, but the MRI will provide more specific information about the injury, including type and location of tear. Thus, surgical decisions such as operative versus nonoperative or meniscectomy versus repair would be based on MRI results. Focused Clinical Question: Is a clinical exam as accurate as an MRI scan for diagnosing meniscus tears?

An Up-to-Date Review of the Meniscus Literature: A Systematic Summary of Systematic Reviews and Meta-analyses

“…Brady and Weiss 18 systematically reviewed 5 studies and concluded that clinical examination was moderately accurate for diagnosing medial (sensitivity, range 85%-94%; specificity, range 56%-75%) and lateral (sensitivity, range 66%-99%; specificity, range 66%-99%) meniscal tears compared with MRI. Hing et al 57 concluded that (1) the McMurray test had high specificity but low sensitivity and (2) the modified McMurray test may be more accurate than the traditional McMurray test, although the studies included in their review were of low methodological quality.…”

“…111,129 Several studies demonstrated that MRI was accurate for diagnosing meniscal tears, 20,107,108,121,124 but physical examination was only moderately accurate at best. 17,18,31,32,123 Meniscal tears are commonly found at the time of ACL reconstruction, especially when ACL reconstruction has been delayed by 6 months or more and after recurrent instability episodes. 89,99,130 Furthermore, APM done at the time of ACL reconstruction is a risk factor for developing osteoarthritis in the future.…”

Post-traumatic knee osteoarthritis; the role of inflammation and hemarthrosis on disease progression

“…From history-taking in patients with an meniscal injury, the determinants aged over 40 years, being unable to continue the activity and bearing weight after injury, are associated with a meniscal tear in multivariate logistic regression analysis ( 61 ). However, clinical examination was only moderately accurate in diagnosing medial (sensitivity 85–94%, specificity 56–75%) and lateral (sensitivity 66–99%, specificity 66–99%) meniscal injury compared with MRI, according to a systemic review by Brady and Weiss ( 62 ).…”

Effective Treatment of an Apparent Meniscal Injury Using the Mulligan Concept

“…13 The clinical criteria used for the diagnosis in the CAT were: pain, locking, joint line tenderness, giving way, and a positive McMurray Test. 13 The patient in this case demonstrated all of these criteria. Additionally, the patient demonstrated joint line swelling and a positive Thessaly Test at 20°.…”