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

Abstract

Background: The aim of this study was to examine the correlation of the clinical examination, MRI and arthroscopic findings in cruciate ligaments and meniscal injuries of knee and to evaluate the accuracy of clinical examination and MRI with the gold standard arthroscopy. Methods: A prospective diagnostic double-blind study was conducted on 104 consecutive patients admitted to the outdoor/casualty with trauma to the knee complaining of knee pain/locking/ instability, from August 2012 to June 2014. All the patients were subjected to clinical examination, MRI scanning and diagnostic arthroscopy. Variables like sensitivity, specificity, positive predictive value, negative predictive value and accuracy of clinical examination and MRI against arthroscopy were evaluated. Results: The sensitivity, specificity and accuracy of clinical examination for anterior cruciate ligament tears were 94.7%, 71.4% and 88.5% and for MRI were 94.7%, 78.6% and 90.4%, respectively; for posterior cruciate ligament tears 100%, 100% and 100% for clinical examination and for MRI 80%, 97.9% and 96.2%, respectively. These values for medial meniscus tears were 76.5%, 68.6% and 71.2% for clinical examination and 88.2%, 62.8% and 71.2% respectively for MRI. For lateral meniscus tears, 40%, 94.6% and 78.8% for clinical examination and 46.7%, 89.2% and 76.9% respectively for MRI. Conclusions: A skillfully performed clinical examination establishes a diagnosis on which an arthroscopic procedure can be planned, reserving MRI scans for patients where the clinical examination fails to establish a diagnosis or cannot be performed. Decision to use MRI should be based on the criteria that it would confirm, expand the diagnosis or change diagnosis in such a way that alters the proposed treatment.

The Validation of Clinical Examination and MRI as a Diagnostic Tool for Cruciate Ligaments and Meniscus Injuries of the Knee Against Diagnostic Arthroscopy

“…[11]. Previous studies showed these values ranges as for sensitivity 41-100% [2,3,11,14,15], specificity 72-100% [2,10,11,14,15], PPV 34-100% [2,14], NPV 90-100% [2,14], and accuracy 68-100% [2,3,11,14,16]. Our results of MRI for diagnosing the lateral meniscus injuries were as per the findings of the literature.…”

Role of Magnetic Resonance Imaging in Evaluation of Anterior Cruciate Ligament Injuries

“…Thus, a complete ACL tear was seen on MRI in 10 patients (50%) and partial tear identified also in 10 patients (50%) but in arthroscopy, a complete tear was in 14 patients (70%) and partial tear was in 6 patients (30%).This means that 4 cases with complete ACL tear was diagnosed as partial tear by MRI. Panigrahi et al (11) reported, when he studied MRI of 76 patients of ACL tear against arthroscopy, the sensitivity, specificity, PPV, NPV and accuracy were 94.7%, 78.6%, 92.3%, 84.6% and 90.4%, respectively and 4 cases with complete ACL tears were missed on MRI and detected as partial tear of ACL In our study, we have correlated the MRI finding with arthroscopy in 20 patients, we compared the finding of ACL injury in MRI with arthroscopy regarding type of injury (partial and complete), we found that sensitivity and specificity were (90%, 70%) respectively in partial ACL injury. And the sensitivity, specificity in complete ACL injury were (78.4%, 100%)respectively, which was near to the study done by Behairy et al (12) who reported that the sensitivity of MRI was 77.8% and specificity was 100 %.…”

Office-Based Small Bore Needle Arthroscopy of the Knee

“…To diagnose a complete anterior cruciate ligament (ACL) tear, studies show MRI to have sensitivity, specificity, accuracy and negative predictive value (NPV) of 90.9, 84.6, 88.6, and 84.6% respectively [1,2]. Furthermore, the sensitivity, specificity, accuracy, and NPV of MRI to detect medial meniscus pathology was 100, 52.6, 64 and 100%, respectively, while detection of lateral meniscus pathology was 55.6, 83.3, 75.8 and 83.3%, respectively [1,2]. MRI's objective measures of test performance are not perfect by any means, leading experts to question its overall reliability [3], while also seeking a superior method.…”