Clinical, MRI and Arthroscopic Correlation in Internal Derangement of Knee

Abstract

Background The traumatic or degenerative internal derangement of the knee requires certain investigations for the establishment of diagnosis, in addition to clinical history and a thorough physical examination. The use of arthrography and arthroscopy improves the accuracy of the diagnosis. MRI scanning of the knee joint has often been regarded as the noninvasive alternative to diagnostic arthroscopy. Objective The purpose of the study was to correlate clinical and low field MRI findings with arthroscopy in internal derangement of the knee. Methods Forty one patients with suspected internal derangement of the knee were subjected to MR examination followed by arthroscopy. Clinical criteria used were history, mode of injury, Mc Murray’s, Apley’s grinding, Thessaly’s test for meniscal injury. Drawer test was considered to be essential for clinical diagnosis of cruciate ligament injury. MRI of the knee was performed in low field open magnet (0.35T, Magnetom C, Seimens). Arthroscopy was done within two months of MR examination and was considered gold standard for the internal derangement of the knee. Results The sensitivity, specificity, diagnostic accuracy of clinical examination were 96.1%, 33.3% and 73.1% respectively for medial meniscal tear; 38.4%, 96.4% and 78.1% respectively for lateral meniscal tear. The sensitivity, specificity, diagnostic accuracy of MRI were 92.3%,100% and 95.1% for medial meniscal tear; 84.6%96.4% and 92.6% respectively for lateral meniscal tear. ConclusionClinical examination showed higher sensitivity for medial meniscal tear compared to MRI, however with low specificity and diagnostic accuracy. Low field MRI showed high sensitivity, specificity, diagnostic accuracy for meniscal and cruciate ligament injury, in addition to associated derangement like articular cartilage damage, synovial thickening.DOI: http://dx.doi.org/10.3126/kumj.v9i3.6300 Kathmandu Univ Med J 2011;9(3):174-8

Correlation of Clinical Examination, MRI and Arthroscopy Findings in Menisco-Cruciate Injuries of the Knee: A Prospective Diagnostic Study

“…In our study for medial meniscus tears, sensitivity, specificity, positive predictive value, negative predictive value and accuracy of clinical examination with respect to arthroscopy were 76.5%, 68.6%, 54.2%, 85.7% and 71.2%, respectively quite similar to the studies (21,22), whereas other studies report a sensitivity of 86% -96% (4,21,23), specificity of 33% -87% (4,21,22), accuracy of 73% -96% (4,7,8,22,23)whereas data for positive predictive value and negative predictive value are limited with 95% and 90%, respec-tively23. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of MRI with respect to arthroscopy were 88.2%, 62.8%, 53.6%, 91.7% and 71.2%, respectively similar to studies by (21,24).…”

Diagnostic accuracy of magnetic resonance imaging in detecting anterior cruciate ligament injuries

“…7 It is a reliable method to confirm the clinical diagnosis and may even reveal the ligament tears which may be missed by arthroscopy. [8][9] Ligament tears can be accurately assessed with MRI, but distinguishing partial tears from ruptures of the ACL can be challenging. Determining the extent of a partial tear is often extremely difficult to accurately assess.…”

Cartilage Delamination Flap Mimicking a Torn Medial Meniscus

“…Although other authors have noted less success (Sharma et al found clinical accuracy of 73–78% compared to MRI accuracy of 92–95%, [21]); on the whole the accuracy of clinical examination remains high and should not be neglected in favour of MRI.…”