Sensitivity and Specificity of MRI in Diagnosing Concomitant Meniscal Injuries With Pediatric and Adolescent Acute ACL Tears

Abstract

Background: Preoperative diagnosis of concomitant meniscal tears in pediatric and adolescent patients with acute anterior cruciate ligament (ACL) deficiency is challenging. Purpose: To investigate the diagnostic performance of magnetic resonance imaging (MRI) in detecting meniscal injuries for pediatric and adolescent patients with acute ACL tears. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: The authors retrospectively identified patients aged ≤18 years who underwent acute ACL reconstruction between 2006 and 2018 at 2 tertiary academic hospitals. The primary outcomes were arthroscopically confirmed medial, lateral, or any (defined as medial and/or lateral) meniscal tears. To control for chronically deficient knees, patients must have received their MRI study within 4 weeks of injury and must have undergone surgery no more than 8 weeks after their MRI study. Preoperative MRI reports were compared with the gold standard of arthroscopically confirmed tears to calculate sensitivity, specificity, positive predictive value, and negative predictive value. In a secondary analysis, patients were stratified by age into 2 groups (≤13 or ≥14 years), body mass index-for-age data from the Centers for Disease Control were used to classify patients as obese or nonobese, and differences between sensitivity and specificity proportions were analyzed using chi-square test for homogeneity. Results: Overall, 406 patients with a mean age of 15.4 years (range, 10-18 years) were identified. The sensitivity, specificity, positive predictive value, and negative predictive value were as follows: for lateral meniscal (LM) tears, 51.0%, 86.5%, 78.3%, and 65.0%; for medial meniscal tears, 83.2%, 80.6%, 62.3%, and 92.5%; and for any meniscal tear, 75.0%, 72.1%, 81.5%, and 63.8%, respectively. In the stratified analysis, MRI was less specific for the following diagnoses: any meniscal tear in patients aged ≤13 years ( P = .048) and LM tears in obese patients ( P = .020). Conclusion: The diagnostic ability of MRI to predict meniscal injuries present at acute ACL reconstruction was moderate. Performance was poorest at the lateral meniscus, where MRI failed to detect 97 tears that were found arthroscopically. Specificity was significantly lower in younger patients for any meniscal tear and in obese patients for LM tears.

Analysis of Discordant Findings between 3T Magnetic Resonance Imaging and Arthroscopic Evaluation of the Knee Meniscus

“…Our results are in agreement with previous studies reporting poorer performance of MRI to predict meniscal injuries present at acute ACL reconstruction [4,24]. In our study, meniscal tears were more likely to be missed on MRI in ACL-deficient knees compared to ACL-intact knees (13 vs. 9, respectively).…”

Tibial Spine Avulsion Fractures in Paediatric Patients: A Systematic Review and Meta-Analysis of Surgical Management

“…Kocher et al found MRI had a sensitivity of 71% in partial ACL ruptures in adolescents [ 51 ]. In a larger cohort study in 2022, Dawkins et al reported MRI scanning had moderate diagnostic ability to predict meniscal injuries with associated ACL ruptures in adolescents [ 52 ]. The performance was particularly poor with lateral meniscal tears (51% sensitivity).…”

“…It appears true that, when ACL or meniscal injuries are present in isolation, MRI is highly sensitive and specific, but the diagnostic accuracy declines in cases where concomitant injuries are present [ 53 ]. The sensitivity declines to around 50–75% [ 52 , 54 , 55 , 56 ]. This could have significant implications for management.…”

Association of Knee Pain in Long Standing and Sitting among University Teachers

“…Bag of frozen corn might be substituted. Applying a little amount of oil to the area before applying the ice pack may help prevent it from adhering to the skin 15 Applying oil to an afflicted region that has recently been wounded or sutured is not a good idea. Instead, place a plastic bag over the area and cover it with the bag to avoid it becoming wet.…”