The accuracy of MRI in diagnosing and classifying acute traumatic multiple ligament knee injuries

Abstract

Background Magnetic resonance imaging (MRI) is widely used for the evaluation of knee injuries, however, the accuracy of MRI in classifying multiple ligament knee injuries (MLKIs) remains unknown. This study aimed to investigate the accuracy of MRI in diagnosing and classifying acute traumatic MLKIs, we hypothesize that MRI had high accuracy in detecting and classifying MLKIs. Methods The clinical data of 97 patients who were diagnosed with acute traumatic MLKIs and managed by multi-ligament reconstruction between 2012 and 2020 were retrospectively reviewed. The MR images were read by two experienced radiologists and results were compared with intraoperative findings, which were considered as the reference for the identification of injured structures. The value of MRI in detecting injuries of anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), lateral collateral ligament (LCL), and meniscus was evaluated by calculating the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and kappa coefficients analysis. The value of MRI in classifying MLKIs was evaluated by calculating the agreement between MRI and intraoperative findings. Results For detecting the specific injured structures in MLKIs, MRI had high sensitivity (90.7% for ACL, 90.4% for PCL, and moderate specificity (63.6% for ACL, 50% for PCL) in detecting cruciate ligament injuries, moderate sensitivity (79.1% for MCL, 55.6% for LCL) and specificity (46.7% for MCL, 68.4% for LCL) in detecting collateral ligament injuries, fair sensitivity (61.5%) and low specificity (39.4%) in the diagnosis of injuries to the meniscus. For classifying the MIKIs, MRI had a moderate agreement with intraoperative findings in classifying KD-V (kappa value = 0.57), poor agreement in the KD-I (kappa value = 0.39) and KD-IIIM (kappa value = 0.31), meaningless in the KD-II and KD-IIIL (kappa value < 0). The overall agreement between MRI and intraoperative findings in classifying MLKIs was poor (kappa value = 0.23). Conclusions MRI is valuable in early detection and diagnosis of acute MLKIs, however, the accuracy of MRI in classifying MLKIs is limited. The management of MLKIs should be based on intraoperative findings, physical examinations, and comprehensive imaging results.

Bioanalytical evaluation of wound depth and musculoskeletal injuries: Synergizing focused assessment with sonography for trauma with computed tomography/magnetic resonance imaging in orthopaedic trauma care

“…According to our research, MRI demonstrated superior performance in assessing complex musculoskeletal injuries compared to CT and FAST in terms of sensitivity, specificity, PPV, NPV and overall accuracy. These results are consistent with those who emphasized the superiority of MRI in this regard 23,24 …”

Diagnosis and treatment strategies of the multiligament injured knee: a scoping review

“…This can often lead to diagnosis of MLKI being missed acutely and presenting in the chronic setting 66. Although the use of MRI is widely advocated, literature assessing the sensitivity and specificity of MRI in patients with MLKI is limited 67–73. Original data regarding the value of MRI are of levels II-III evidence 56 67 70 73 74.…”

Comparing the findings of clinical examination versus magnetic resonance imaging for the diagnosis of ligamentous injuries of knee in rural area

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“…MRI was found to have high sensitivity (90.7%) and moderate specificity (63.6%) in the diagnosis of injuries to the ACL; high sensitivity (90.4%) and moderate specificity (50%) in the diagnosis of injuries to the PCL. 7 Siddiqui et al showed there were only marginal differences in sensitivity and specificity of clinical examination and MRI in diagnosis of lateral meniscal and ACL injury.…”