Mri Can Prevent Unnecessary Arthroscopy

Carmichael, I. W.; MacLeod, A. M.; Travlos, J.

doi:10.1302/0301-620x.79b4.0790624

Cited by 8 publications

(4 citation statements)

References 3 publications

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“…However, there were high values for specificity and for the negative prediction value (all higher than 97%) so that the MRI shows great importance as a method of exclusion. This was also the opinion of Hodel and Carmichael in their studies [4, 13]. The sensitivity for the evaluation of chondral lesions varies from 15% [22] to 96% [17] in the literature.…”

Section: Discussionsupporting

confidence: 61%

Diagnosis of chondral lesions of the knee joint: can MRI replace arthroscopy?

Friemert

Oberländer

Schwarz

et al. 2004

Knee Surgery, Sports Traumatology, Arthroscopy

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The role of magnetic resonance tomography (MRI) for the diagnosis of chondral lesions of the knee joint is still unclear. The sensitivity of the method ranges from 15% to 96%. The scope of our daily experiences showed that there were considerable deviations between the tomographical and arthroscopical results, which vary from the results of experimental studies. Therefore we have conducted a prospective study to investigate the question of how MRI can replace arthroscopy (ASC) in the diagnosis of cartilage damages in the scope of daily routine. All 195 patients included in this study received a magnetic resonance tomography followed by an arthroscopy. A clear diagnosis of supposition had to be determined before the magnetic resonance tomography. The patients were divided into 3 Groups. Group A (n=86) received a standard Military Hospital Ulm (MH) MRI--sagittal STIR TSE and PD TSE, coronal and transversal T2 FFE (TR=660 ms, TE=18 ms, FA=30 degrees, 512 matrix). In addition, one sub-Group, AK (n=21) was examined with a special cartilage sequence of the cartilage fs T1 W FFE. Neither patients in Group AK nor in Group A as a whole received any contrast medium. Group B (n=88) was examined with an alternate MRI protocol (Radiological Joint Practice, Neu-Ulm--sagittal T1 SE, T2 SE and T2 FLASH (TR=608 ms, TE=18 ms, FA=20 degrees, 256 matrix), coronal PD fs), employing gadolinium as a contrast medium. 156 cartilage lesions were found arthroscopically. In Group A the sensitivity was 33%, the specificity 99%, and the positive and negative prediction values 75% and 98% respectively. Group B reached a sensitivity of 53% and a specificity of 98%. The positive prediction value was 48% and the negative was 98%. Group AK showed a sensitivity of 38% and specificity of 98%; the positive and negative prediction values came to 50% and 97% respectively. In conclusion, our results indicate that the MRI examination techniques recommended in the literature at present are not able to replace the ASC for the diagnosis of cartilage damages of the knee joint. In view of the high specificity (97%-99%) and the high negative prediction value (97%-98%), MRI is suitable for the exclusion of cartilage lesions. For a negative MRI associated with a cartilage injury, a cautious attitude towards an operative cartilage treatment is therefore justified. Because the MRI can not replace the ASC for diagnostic of cartilage damage, the ASC still has to be seen as the method of choice for the evaluation of cartilage damage.

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Section: Discussionsupporting

confidence: 61%

Diagnosis of chondral lesions of the knee joint: can MRI replace arthroscopy?

Friemert

Oberländer

Schwarz

et al. 2004

Knee Surgery, Sports Traumatology, Arthroscopy

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“…Magnetic resonance imaging (MRI) is frequently used in the diagnosis of anterior cruciate ligament (ACL) and meniscal injuries. Since its introduction in the 1980s, Lee et al [10] and many others have demonstrated its value as a non‐invasive and accurate diagnostic tool [5, 6, 8]. However, further publications by Rose et al [14] and others [4, 11] highlight the value of an adequate history and clinical examination.…”

Section: Introductionmentioning

confidence: 99%

The value of magnetic resonance imaging in our current management of ACL and meniscal injuries

Thomas

Pullagura

Robinson

et al. 2007

Knee Surg Sports Traumatol Arthrosc

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Magnetic resonance imaging (MRI) is frequently used in the diagnosis of anterior cruciate ligament (ACL) and meniscal injuries. The aim of this retrospective study was to determine the reliability and value of MRI in our management of ACL and meniscal tears. 138 patients who had undergone a MRI to confirm or refute the clinical diagnosis of an ACL or meniscal tear were identified. Those who had subsequently undergone arthroscopy were selected. MRI findings and clinical diagnosis were compared with those at arthroscopy. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy of clinical diagnosis and MRI were then calculated. The overall accuracy for MRI was 91, 68 and 86% for detecting ACL, medial meniscal and lateral meniscal tears, respectively. Accuracy for clinical diagnosis was 90 and 64% for ACL and meniscal tears, respectively. In contrast to other series, our results indicate a lower accuracy of MRI in detecting pathology, especially of the ACL and medial meniscus. We noted a low sensitivity, specificity and positive predictive value but a high negative predictive value rendering MRI most useful as a negative diagnostic tool. We suggest that where symptoms and clinical findings support one of these diagnoses and arthroscopic therapeutic intervention is contemplated, that MRI scanning is not always beneficial. Our current practice of requesting scans to routinely confirm the diagnosis should be altered. Unnecessary MRI scanning increases the financial burden and delays patient treatment.

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“…MR imaging is a valuable non‐invasive and reasonably accurate diagnostic tool [3, 4, 11, 22]. Recent literature on MRI accuracy for knee injuries differs widely in their conclusions (Table 4) [27, 29, 32].…”

Section: Discussionmentioning

confidence: 99%

“…The accuracy of magnetic resonance (MR) imaging in knee sports injuries has been reported to be variable [2, 3, 6, 11, 17, 28, 29, 31, 32]. As suggested by Thomas et al [32] MR imaging might not be helpful where history and clinical findings are suggestive of an injury and when therapeutic intervention had already been planned.…”

Section: Introductionmentioning

confidence: 99%