Advertisement

Accuracy of MRI in the diagnosis of meniscal tears in patients with chronic ACL tears

  • M. I. A. SharifahEmail author
  • C. L. Lee
  • A. Suraya
  • A. Johan
  • A. F. S. K. Syed
  • S. P. Tan
Knee

Abstract

Purpose

This study was conducted to evaluate the accuracy of magnetic resonance imaging (MRI) in diagnosing meniscal tears in patients with anterior cruciate ligament (ACL) tears and to determine the frequency of missed meniscal tears on MRI.

Methods

This prospective comparative study was conducted from 2009 to 2012. Patients with ACL injuries who underwent knee arthroscopy and MRI were included in the study. Two radiologists who were blinded to the clinical history and arthroscopic findings reviewed the pre-arthroscopic MR images. The presence and type of meniscal tears on MRI and arthroscopy were recorded. Arthroscopic findings were used as the reference standard. The accuracy, sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of MRI in the evaluation of meniscal tears were calculated.

Results

A total of 65 patients (66 knees) were included. The sensitivity, specificity, accuracy, PPV, and NPV for the MRI diagnosis of lateral meniscal tears in our patients were 83, 97, 92, 96, and 90 %, respectively, whereas those for medial meniscus tears were 82, 92, 88, 82, and 88 %, respectively. There were five false-negative diagnoses of medial meniscus tears and four false-negative diagnoses of lateral meniscus tears. The majority of missed meniscus tears on MRI affected the peripheral posterior horns.

Conclusion

The sensitivity for diagnosing a meniscal tear was significantly higher when the tear involved more than one-third of the meniscus or the anterior horn. The sensitivity was significantly lower for tears located in the posterior horn and for vertically oriented tears. Therefore, special attention should be given to the peripheral posterior horns of the meniscus, which are common sites of injury that could be easily missed on MRI. The high NPVs obtained in this study suggest that MRI is a valuable tool prior to arthroscopy.

Level of evidence

IV.

Keywords

Anterior cruciate ligament Meniscus tear Arthroscopy Magnetic resonance imaging 

References

  1. 1.
    Ahn JH, Lee YS, Yoo JC, Chang MJ, Park SJ, Pae YR (2010) Results of arthroscopic all-inside repair for lateral meniscus root tear in patients undergoing concomitant anterior cruciate ligament reconstruction. Arthroscopy 26(1):67–75CrossRefPubMedGoogle Scholar
  2. 2.
    Bellabarba C, Bush-Joseph CA, Bach BR Jr (1997) Patterns of meniscal injury in the anterior cruciate-deficient knee: a review of the literature. Am J Orthop (Belle Mead NJ) 26(1):18–23Google Scholar
  3. 3.
    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 Arthrosc 3(3):130–134CrossRefPubMedGoogle Scholar
  4. 4.
    De Smet AA, Mukherjee R (2008) Clinical, MRI, and arthroscopic findings associated with failure to diagnose a lateral meniscal tear on knee MRI. AJR Am J Roentgenol 190(1):22–26CrossRefPubMedGoogle Scholar
  5. 5.
    Esmaili Jah AA, Keyhani S, Zarei R, Moghaddam AK (2005) Accuracy of MRI in comparison with clinical and arthroscopic findings in ligamentous and meniscal injuries of the knee. Acta Orthop Belg 71(2):189–196PubMedGoogle Scholar
  6. 6.
    Fowler PJ, Regan WD (1987) The patient with symptomatic chronic anterior cruciate ligament insufficiency. Results of minimal arthroscopic surgery and rehabilitation. Am J Sports Med 15(4):321–325CrossRefPubMedGoogle Scholar
  7. 7.
    Indelicato PA, Bittar ES (1985) A perspective of lesions associated with ACL insufficiency of the knee. A review of 100 cases. Clin Orthop Relat Res 198:77–80PubMedGoogle Scholar
  8. 8.
    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(3):402–406CrossRefPubMedGoogle Scholar
  9. 9.
    Kilcoyne KG, Dickens JF, Haniuk E, Cameron KL, Owens BD (2012) Epidemiology of meniscal injury associated with ACL tears in young athletes. Orthopedics 35(3):208–212CrossRefPubMedGoogle Scholar
  10. 10.
    Konan S, Haddad FS (2010) Outcomes of meniscal preservation using all-inside meniscus repair devices. Clin Orthop Relat Res 468:1209–1213CrossRefPubMedCentralPubMedGoogle Scholar
  11. 11.
    Naranje S, Mittal R, Nag H, Sharma R (2008) Arthroscopic and magnetic resonance imaging evaluation of meniscus lesions in the chronic anterior cruciate ligament-deficient knee. Arthroscopy 24(9):1045–1051CrossRefPubMedGoogle Scholar
  12. 12.
    Nikolaou VS, Chronopoulos E, Savvidou C, Plessas S, Giannoudis P, Efstathopoulos N, Papachristou G (2008) MRI efficacy in diagnosing internal lesions of the knee: a retrospective analysis. J Trauma Manag Outcomes 2(1):4CrossRefPubMedCentralPubMedGoogle Scholar
  13. 13.
    Noyes FR, Mooar PA, Matthews DS, Butler DL (1983) The symptomatic anterior cruciate-deficient knee. Part I: the long-term functional disability in athletically active individuals. J Bone Joint Surg Am 65(2):154–162PubMedGoogle Scholar
  14. 14.
    Shaver JC, Johnson DL (2008) Unlocking the ‘pivot shift’ in ACL surgery: medial meniscus evaluation and treatment. Orthopedics 31(12). pii: orthosupersite.com/view.asp?rID=34714Google Scholar
  15. 15.
    Stoller DW (2007) Magnetic resonance imaging in orthopaedics and sports medicine. 3rd edn. Lippincott Williams, pp 363–364Google Scholar
  16. 16.
    Takayama K, Matsushita T, Matsumoto T, Kubo S, Kurosaka M, Kuroda R (2011) The double ACL sign: an unusual bucket-handle tear of medial meniscus. Knee Surg Sports Traumatol Arthrosc 19(8):1343–1346CrossRefPubMedGoogle Scholar
  17. 17.
    Thompson WO, Fu FH (1993) The meniscus in the cruciate-deficient knee. Clin Sports Med 12(4):771–796PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • M. I. A. Sharifah
    • 1
    • 5
    Email author
  • C. L. Lee
    • 1
    • 2
  • A. Suraya
    • 1
  • A. Johan
    • 3
  • A. F. S. K. Syed
    • 3
  • S. P. Tan
    • 1
    • 4
  1. 1.Department of RadiologyUniversity Kebangsaan MalaysiaKuala LumpurMalaysia
  2. 2.Sabah Women and Children HospitalKota KinabaluMalaysia
  3. 3.Department of OrthopaedicsUniversity Kebangsaan MalaysiaKuala LumpurMalaysia
  4. 4.Sime Darby Medical CentreSubang JayaMalaysia
  5. 5.Department of RadiologyUniversity Kebangsaan Malaysia Medical CentreCheras, Kuala LumpurMalaysia

Personalised recommendations