Diagnostic accuracy of ultrasonography in the assessment of anterior knee pain

Abstract

Background Anterior knee pain (AKP) is a problematic complaint, considered to be the most frequent cause of orthopedic consultancy for knee problems. This study aimed to highlight diagnostic accuracy of ultrasonography as a fast imaging technique in assessment of patients with AKP. Methods and results A prospective study was conducted on 143 patients with clinically confirmed AKP. All patients underwent ultrasonography and MRI examinations of the knee. The diagnostic accuracy of ultrasonography compared to MRI for evaluating different findings of possible causes of AKP were analyzed using receiver operating characteristic (ROC) curve and judged by area under curve (AUC). A total of 155 knees were included in the study; 26 knees showed no abnormalities, 19 knees showed positive MRI only, and 110 knees showed positive ultrasonography and MRI. Ultrasonography and MRI reported 11 different findings of possible causes of AKP or related to it. Joint effusion was the most common finding (38%) followed by trochlear cartilage defect (20.6%) and superficial infrapatellar subcutaneous edema (20%). The overall accuracy of ultrasonography was 85.3% sensitivity and 100% specificity. The ultrasonography provided the highest sensitivity (100%) in detecting bipartite patella, followed by 91.5% for joint effusion, and 87.5% for quadriceps tendinopathy. The ROC curve analysis of overall accuracy of ultrasonography showed an AUC of 0.93. The overall Kappa agreement between ultrasonography and MRI was good (k = 0.66). Conclusion Ultrasonography can be used to make a swift screening and assessment of painful anterior knee and as an alternative to MRI when it is unavailable or contraindicated.

Utility of High-Resolution Sonography for Evaluation of Knee Joint Pathologies as a Screening Tool

“…Tendinopathy is one of the most common causes of acute knee joint pain. In this study, HRS had a sensitivity of 75% and 66.6% in detecting patellar and quadriceps tendinopathy in comparison to 84% and 87.5% reported by Basha et al 17 In this cohort, there was almost perfect agreement with a coefficient κ = 0.85 , which was noted between HRS and MRI, in detection of knee patellar tendinopathy. Likewise, there was substantial agreement with coefficient κ = 0.79 , which was noted between HRS and MRI, in detection of knee quadriceps tendinopathy.…”

Knee Pain Examined under Musculoskeletal Ultrasonography: Experience from a Community-based Rheumatology Practice – A Cross-sectional Study

“…In suspected medial plica, dynamic sonography had diagnostic accuracy, sensitivity, and specificity of 88%, 90%, and 83%, respectively [77,78]. The US is useful in detecting supra-patellar and all medial patellar plicae but not infrapatellar plicae [52]. In the present study, we defined synovial plica in over 70% of patients.…”

“…In another study, Basha et al reported US and MRI findings in anterior knee pain (AKP); joint effusion was the most common (38%), followed by trochlear cartilage defect (20.6%) and superficial infrapatellar subcutaneous edema (20%) [52]. Draghi et al demonstrated the US's sensitivity and specificity of 81.3% and 100% specificity in knee effusion [41].…”

“…The US could approximate as low as 7 to 10 ml joint effusion [53]. US is a suitable alternative to MRI in AKP [52].…”

The role of real-time elastosonography in the diagnosis of quadriceps fat pad edema

“…In previous studies with B-Mode imaging, echogenicity of the edematous QFP was recorded as hypoechoic; however, it has not been stated which tissue was used in comparison (25,26). In the current study, QFP echogenicity was either hyperechoic or isoechoic when compared with the subcutaneous adipose tissue.…”