Skip to main content
SpringerLink
Log in

Reliability of magnetic resonance imaging in evaluating meniscal and cartilage injuries in anterior cruciate ligament-deficient knees

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The accuracy of magnetic resonance (MR) imaging in assessing meniscal and cartilage injuries in anterior cruciate ligament (ACL)-deficient knees as compared to arthroscopy was evaluated in the present study.

Methods

The results of all preoperative MR imaging performed within 3 months prior to the ACL reconstruction were compared against intraoperative arthroscopic findings. A total of 206 patients were identified. The location and type of meniscal injuries as well as the location and grade of the cartilage injuries were studied. The negative predictive value, positive predictive value, sensitivity, specificity and accuracy of MR imaging for these 206 cases were calculated and analysed.

Results

In patients with an ACL injury, the highest incidence of concomitant injury was that of medial meniscus tears, 124 (60.2 %), followed by lateral meniscus tears, 105 (51.0 %), and cartilage injuries, 66 (32.0 %). Twenty-three (11.2 %) patients sustained injuries to all of the previously named structures. MR imaging was most accurate in detecting medial meniscus tears (85.9 %). MR imaging for medial meniscus tears also had the highest sensitivity (88.0 %) and positive predictive value (88.7 %), while MR imaging for cartilage injuries had the largest specificity (84.1 %) and negative predictive value (87.1 %). It was least accurate in evaluating lateral meniscus tears (74.3 %). The diagnostic accuracy of medial meniscus imaging is significantly influenced by age and the presence of lateral meniscus tears, while the duration between MR imaging and surgery has greater impact on the likelihood of lateral meniscus and cartilage injuries actually being present during surgery. The majority of meniscus tears missed by MR imaging affected the posterior horn and were complex in nature. Cartilage injuries affecting the medial femoral condyle or medial patella facet were also often missed by MR imaging.

Conclusion

MR imaging remains a reliable tool for assessing meniscus tears and cartilage defects preoperatively. It is most accurate when evaluating medial meniscus tears. However, MR imaging should be used with discretion especially if there is a high index of suspicion of lateral meniscus tears.

Level of evidence

IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Arnoczky SP, Warren RF (1982) Microvasculature of the human meniscus. Am J Sports Med 10:90–95

    Article  CAS  PubMed  Google Scholar 

  2. Bredella MA, Tirman PF, Peterfy CG, Zarlingo M, Feller JF, Bost FW, Belzer JP, Wischer TK, Genant HK (1999) Accuracy of T2-weighted fast spin-echo MR imaging with fat saturation in detecting cartilage defects in the knee: comparison with arthroscopy in 130 patients. Am J Roentgenol 72:1073–1080

    Article  Google Scholar 

  3. Carmichael IW, MacLeod AM, Travlos J (1997) MRI can prevent unnecessary arthroscopy. J Bone Joint Surg Br 79:624–625

    Article  CAS  PubMed  Google Scholar 

  4. Chissell HR, Allum RL, Keightley A (1994) MRI of the knee: its cost-effective use in a district general hospital. Ann R Coll Surg Engl 76:26–29

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Cipolla M, Scala A, Gianni E, Puddu G (1995) Different patterns of meniscal tears in acute anterior cruciate ligament (ACL) ruptures and in chronic ACL-deficient knees. Classification, staging and timing of treatment. Knee Surg Sports Traumatol 3:130–134

    Article  CAS  Google Scholar 

  6. Crawford R, Walley G, Bridgman S, Maffulli N (2007) Magnetic resonance imaging versus arthroscopy in the diagnosis of knee pathology, concentrating on meniscal lesions and ACL tears: a systematic review. Br Med Bull 84:5–23

    Article  PubMed  Google Scholar 

  7. Crues JC, Mink J, Levy IL, Lotysch M, Stolter DW (1987) Meniscal tears of the knee: accuracy of MR imaging. Radiology 164:445–448

    Article  PubMed  Google Scholar 

  8. De Smet AA, Graf BK (1994) Meniscal tears missed on MR imaging: relationship to meniscal tear patterns and anterior cruciate ligament tears. Am J Roentgenol 162:905–911

    Article  Google Scholar 

  9. Disler DG, McCauley TR, Kelman CG, Fuchs MD, Ratner LM, Wirth CR, Hospodar PP (1996) Fat-suppressed three-dimensional spoiled gradient-echo MR imaging of hyaline cartilage defects in the knee: comparison with standard MR imaging and arthroscopy. Am J Roentgenol 167:127–132

    Article  CAS  Google Scholar 

  10. Eckstein F, Charles HC, Buck RJ, Kraus VB, Remmers AE, Hudelmaier M, Wirth W, Evelhoch JL (2005) Accuracy and precision of quantitative assessment of cartilage morphology by magnetic resonance imaging at 3.0T. Arthritis Rheum 52:3132–3136

    Article  PubMed  Google Scholar 

  11. Feller JA, Webster KE (2001) Clinical value of magnetic resonance imaging of the knee. ANZ J Surg 71:534–537

    Article  CAS  PubMed  Google Scholar 

  12. Feucht MJ, Bigdon S, Bode G, Salzmann GM, Dovi-Akue D, Südkamp NP, Niemeyer P (2015) Associated tears of the lateral meniscus in anterior cruciate ligament injuries: risk factors for different tear patterns. J Orthop Surg 10:34

    Article  Google Scholar 

  13. Figueroa D, Calvo R, Vaisman A, Carrasco MA, Moraga C, Delgado I (2007) Knee chondral lesions: incidence and correlation between arthroscopic and magnetic resonance findings. Arthroscopy 23:312–315

    Article  PubMed  Google Scholar 

  14. Friemert B, Oberlander Y, Schwarz W, Haberle HJ, Bahren W, Gerngross H, Danz B (2004) Diagnosis of chondral lesions of the knee joint: can MRI replace arthroscopy? A prospective study. Knee Surg Sports Traumatol Arthrosc 12:58–64

    Article  CAS  PubMed  Google Scholar 

  15. Grossman JW, De Smet AA, Shinki K (2009) Comparison of the accuracy rates of 3-T and 1.5-T MRI of the knee in the diagnosis of meniscal tear. Am J Roentgenol 193:509–514

    Article  Google Scholar 

  16. Henning CE, Clark JR, Lynch MA, Stallbaumer R, Yearout KM, Vequist SW (1988) Arthroscopic meniscus repair with a posterior incision. Instr Course Lect 137:209–221

    Google Scholar 

  17. Jee WH, McCauley TR, Kim JM (2004) Magnetic resonance diagnosis of meniscal tears in patients with acute anterior cruciate ligament tears. J Comput Assist Tomogr 28:402–406

    Article  PubMed  Google Scholar 

  18. Kawahara Y, Uetani M, Nakahara N, Doiguchi Y, Nishiguchi M, Futagawa S, Kinoshita Y, Hayashi K (1998) Fast spin-echo MR of the articular cartilage in the osteoarthritic knee. Correlation of MR and arthroscopic findings. Acta Radiol 39:120–125

    CAS  PubMed  Google Scholar 

  19. Khan HA, Ahad H, Sharma P, Bajaj P, Hassan N, Kamal Y (2015) Correlation between magnetic resonance imaging and arthroscopic findings in the knee joint. Trauma Mon 20:e18635

    PubMed  PubMed Central  Google Scholar 

  20. King D (1990) The healing of semilunar cartilages. Clin Orthop Relat Res 252:4–7

    Google Scholar 

  21. Kobayashi K, Fujimoto E, Deie M, Sumen Y, Ikuta Y, Ochi M (2004) Regional differences in the healing potential of the meniscus—an organ culture model to eliminate the influence of microvasculature and the synovium. Knee 11:271–278

    Article  PubMed  Google Scholar 

  22. Lee JK, Yao L, Phelps CT, Wirth CR, Czajka J, Lozman J (1998) Anterior cruciate ligament tears: MR imaging compared with arthroscopy and clinical tests. Radiology 166:861–864

    Article  Google Scholar 

  23. Munk B, Madsen F, Lundorf E, Staunstrup H, Schmidt SA, Bolvig L, Hellfritzsch MB, Jensen J (1998) Clinical magnetic resonance imaging and arthroscopic findings in knees: a comparative prospective study of meniscus, anterior cruciate ligament and cartilage lesions. Arthroscopy 14:171–175

    Article  CAS  PubMed  Google Scholar 

  24. Nam TS, Kim MK, Ahn JH (2014) Efficacy of magnetic resonance imaging evaluation for meniscal tears in acute anterior cruciate ligament injuries. Arthroscopy 30:475–482

    Article  PubMed  Google Scholar 

  25. Nikolic DK (1998) Lateral meniscal tears and their evolution in acute injuries of the anterior cruciate ligament of the knee. Arthroscopic analysis. Knee Surg Sports Traumatol Arthrosc 6:26–30

    Article  CAS  PubMed  Google Scholar 

  26. Oei EH, Nikken JJ, Verstijnen AC, Ginai AZ, Myriam Hunink MG (2003) MR imaging of the menisci and cruciate ligaments: a systematic review. Radiology 22:837–848

    Article  Google Scholar 

  27. Rose NE, Gold SM (1996) A comparison of accuracy between clinical examination and magnetic resonance imaging in the diagnosis of meniscal and anterior cruciate ligament tears. Arthroscopy 12:398–405

    Article  CAS  PubMed  Google Scholar 

  28. Rubin DA, Kettering JM, Towers JD, Britton CA (1998) MR imaging of knees having isolated and combined ligament injuries. Am J Roentgenol 170:1207–1213

    Article  CAS  Google Scholar 

  29. Sharifah MI, Lee CL, Suraya A, Johan A, Syed AF, Tan SP (2015) Accuracy of MRI in the diagnosis of meniscal tears in patients with chronic ACL tears. Knee Surg Sports Traumatol Arthrosc 23:826–830

    Article  CAS  PubMed  Google Scholar 

  30. Smith TO, Drew BT, Toms AP, Donell ST, Hing CB (2012) Accuracy of magnetic resonance imaging, magnetic resonance arthrography and computed tomography for the detection of chondral lesions of the knee. Knee Surg Sports Traumatol Arthrosc 20:2367–2379

    Article  PubMed  Google Scholar 

  31. Spiers AS, Meagher T, Ostlere SJ, Wilson DJ, Dodd CA (1993) Can MRI of the knee affect arthroscopic practice? A prospective study of 58 patients. J Bone Joint Surg Br 75:49–52

    CAS  PubMed  Google Scholar 

  32. Thomas S, Pullagura M, Robinson E, Cohen A, Banaszkiewicz P (2007) The value of magnetic resonance imaging in our current management of ACL and meniscal injuries. Knee Surg Sports Traumatol Arthrosc 15:533–536

    Article  CAS  PubMed  Google Scholar 

  33. Yao J, Snibbe J, Maloney M, Lerner AL (2006) Stresses and strains in the medial meniscus of an ACL deficient knee under anterior loading: a finite element analysis with image-based experimental validation. J Biomech Eng 12:135–141

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Changi General Hospital Singapore, 2 Simei Street 3, Singapore, 529889, Singapore

    Kenneth Pak Leung Wong, Audrey XinYun Han, Jeannie Leh Ying Wong & Dave Yee Han Lee

Authors
  1. Kenneth Pak Leung Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Audrey XinYun Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jeannie Leh Ying Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dave Yee Han Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kenneth Pak Leung Wong.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wong, K.P.L., Han, A.X., Wong, J.L.Y. et al. Reliability of magnetic resonance imaging in evaluating meniscal and cartilage injuries in anterior cruciate ligament-deficient knees. Knee Surg Sports Traumatol Arthrosc 25, 411–417 (2017). https://doi.org/10.1007/s00167-016-4211-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-016-4211-1

Keywords

Search

Navigation