Skip to main content
Log in

3D-MRI combined with signal-to-noise ratio measurement can improve the diagnostic accuracy and sensitivity in evaluating meniscal healing status after meniscal repair

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

Abstract

Purpose

This study compared the diagnostic accuracy of second-look arthroscopy, clinical assessment, and magnetic resonance imaging (MRI) in evaluating meniscal healing following repair. To explore the application of 3D-MRI sequences with signal-to-noise ratio (SNR) measurements and the analysis of sensitivity and accuracy in evaluating meniscal healing status after meniscal repair.

Methods

This study included 75 patients (75 menisci; mean age, 25.4 ± 6.6 years) who underwent arthroscopic meniscal repair (medial menisci, 45; and lateral menisci, 29). Follow-up evaluation included clinical assessment, magnetic resonance imaging (MRI), and second-look arthroscopy (mean follow-up, 10.2 ± 3.4 months). The criteria defined for unhealed menisci were: on arthroscopy, presence of cleft; on clinical assessment, presence of joint-line tenderness, swelling, locking, or positive McMurray test; on MRI, grade III signal intensity at the site of repair. Finally, the SNR on 3D-MRI of the healed and the unhealed groups were compared.

Results

On second-look arthroscopy, 68 (90.7%) menisci were found to be completely healed. With the arthroscopic healing rate as the standard, the clinical healing rate was 69.3% (63 menisci) [sensitivity, 85.7%; specificity, 75.0%; accuracy, 76.0%; positive predictive value (PPV), 26.1%; negative predictive value (NPV), 98.1%]. Similarly, the sensitivity, specificity, accuracy, PPV and NPV, respectively, for MRI in four sequences were as follows: 2D-T2W-Sag: 71.4, 79.4, 78.7, 26.3, and 96.4%; 2D-T2W-Cor: 71.4, 82.4, 81.3, 29.4, and 96.6%; 3D-PDW-Sag: 100.0, 50.0, 54.7, 17.1, and 100.0%; 3D-PDW-Cor: 100.0, 58.8, 62.7, 20.0, and 100.0%. The mean SNRs of the healed group (3D-PDW-Sag, 66.7 ± 11.9; 3D-PDW-Cor, 63.9 ± 12.4) were significantly lesser than that of the unhealed group (3D-PDW-Sag, 89.2 ± 9.6; 3D-PDW-Cor, 82.2 ± 18.5) (P < 0.05). Identifying grade 3 meniscal damage on 3D-PDW images prior to applying the different SNR cut-off points revealed SNR values 80 in the sagittal plane and 70 in the coronal plane as having better diagnostic accuracy and sensitivity. The clinical relevance of the study was that 3D-MRI combined with SNR measurement may be a noninvasive and accurate method of assessment clinically, and a reliable alternative to second-look arthroscopy.

Level of evidence

III.

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

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

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

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Ahn JH, Wang JH, Yoo JC (2004) Arthroscopic all-inside suture repair of medial meniscus lesion in anterior cruciate ligament–deficient knees: results of second-look arthroscopies in 39 cases. Arthroscopy 20(9):936–945

    Article  PubMed  Google Scholar 

  2. Applegate GR, Flannigan BD, Tolin BS et al (1993) MR diagnosis of recurrent tears in the knee: value of intraarticular contrast material. Am J Roentgenol 161(4):821–825

    Article  CAS  Google Scholar 

  3. Arnoczky SP, Cooper TG, Stadelmaier DM et al (1994) Magnetic resonance signals in healing menisci: an experimental study in dogs. Arthroscopy 10(5):552–557

    Article  PubMed  CAS  Google Scholar 

  4. Barrett GR, Field MH, Treacy SH et al (1998) Clinical results of meniscus repair in patients 40 years and older. Arthroscopy 14(8):824–829

    Article  PubMed  CAS  Google Scholar 

  5. Brittberg M, Winalski CS (2003) Evaluation of cartilage injuries and repair. J Bone Jt Surg Am 85-A(Suppl 2):58–69

    Article  Google Scholar 

  6. Bronstein R, Kirk P, Hurley J (1992) The usefulness of MRI in evaluating menisci after meniscus repair. Orthopedics 15(2):149–152

    PubMed  CAS  Google Scholar 

  7. Cheung LP, Li KC, Hollett MD et al (1997) Meniscal tears of the knee: accuracy of detection with fast spin-echo MR imaging and arthroscopic correlation in 293 patients. Radiology 203(2):508–512

    Article  PubMed  CAS  Google Scholar 

  8. De Smet AA, Tuite MJ, Norris MA et al (1994) MR diagnosis of meniscal tears: analysis of causes of errors. Am J Roentgenol 163(6):1419–1423

    Article  Google Scholar 

  9. Deutsch AL, Mink JH, Fox JM et al (1990) Peripheral meniscal tears: MR findings after conservative treatment or arthroscopic repair. Radiology 176(2):485–488

    Article  PubMed  CAS  Google Scholar 

  10. Disler DG, Kattapuram SV, Chew FS et al (1993) Meniscal tears of the knee: preliminary comparison of three-dimensional MR reconstruction with two-dimensional MR imaging and arthroscopy. Am J Roentgenol 160(2):343–345

    Article  CAS  Google Scholar 

  11. Eggli S, Wegmuller H, Kosina J et al (1995) Long-term results of arthroscopic meniscal repair. an analysis of isolated tears. Am J Sports Med 23(6):715–720

    Article  PubMed  CAS  Google Scholar 

  12. Farley TE, Howell SM, Love KF et al (1991) Meniscal tears: MR and arthrographic findings after arthroscopic repair. Radiology 180(2):517–522

    Article  PubMed  CAS  Google Scholar 

  13. Gold GE, Han E, Stainsby J et al (2004) Musculoskeletal MRI at 3.0 T: relaxation times and image contrast. Am J Roentgenol 183(2):343–351

    Article  Google Scholar 

  14. Hoffelner T, Resch H, Forstner R et al (2011) Arthroscopic all-inside meniscal repair—does the meniscus heal? A clinical and radiological follow-up examination to verify meniscal healing using a 3-T MRI. Skelet Radiol 40(2):181–187

    Article  Google Scholar 

  15. Horibe S, Shino K, Maeda A et al (1996) Results of isolated meniscal repair evaluated by second-look arthroscopy. Arthroscopy 12(2):150–155

    Article  PubMed  CAS  Google Scholar 

  16. Horibe S, Shino K, Nakata K et al (1995) Second-look arthroscopy after meniscal repair. Review of 132 menisci repaired by an arthroscopic inside-out technique. J Bone Jt Surg Br 77(2):245–249

    Article  CAS  Google Scholar 

  17. Jiang D, Ao YF, Miao Y, Zheng ZZ, Yu JK (2013) Signal characteristics of magnetic resonance imaging after meniscus repair by FasT-Fix and meniscus arrows. Chin J Minim Invasive Surg 11:1021–1025

    Google Scholar 

  18. Jung JY, Jee WH, Park MY et al (2012) Meniscal tear configurations: categorization with 3D isotropic turbo spin-echo MRI compared with conventional MRI at 3 T. Am J Roentgenol 198(2):W173–W180

    Article  Google Scholar 

  19. Jung JY, Yoon YC, Choi SH et al (2009) Three-dimensional isotropic shoulder MR arthrography: comparison with two-dimensional MR arthrography for the diagnosis of labral lesions at 3.0 T. Radiology 250(2):498–505

    Article  PubMed  Google Scholar 

  20. Kececi B, Bicer EK, Arkun R et al (2015) The value of magnetic resonance arthrography in the evaluation of repaired menisci. Eur J Orthop Surg Traumatol 25(1):173–179

    Article  PubMed  Google Scholar 

  21. Kijowski R, Davis KW, Woods MA et al (2009) Knee joint: comprehensive assessment with 3D isotropic resolution fast spin-echo MR imaging—diagnostic performance compared with that of conventional MR imaging at 3.0 T. Radiology 252(2):486–495

    Article  PubMed  Google Scholar 

  22. Klimkiewicz JJ, Shaffer B (2002) Meniscal surgery 2002 update: indications and techniques for resection, repair, regeneration, and replacement. Arthroscopy 18(9 Suppl 2):14–25

    Article  PubMed  Google Scholar 

  23. Koukoulias N, Papastergiou S, Kazakos K et al (2007) Mid-term clinical results of medial meniscus repair with the meniscus arrow in the unstable knee. Knee Surg Sports Traumatol Arthrosc 15(2):138–143

    Article  PubMed  Google Scholar 

  24. Kruger N, McNally E, Al-Ali S et al (2016) Three-dimensional reconstructed magnetic resonance scans: accuracy in identifying and defining knee meniscal tears. World J Orthop 7(11):731–737(

    Article  PubMed  PubMed Central  Google Scholar 

  25. Laible C, Stein DA, Kiridly DN (2013) Meniscal repair. J Am Acad Orthop Surg 21(4):204–213

    Article  PubMed  Google Scholar 

  26. Lim PS, Schweitzer ME, Bhatia M et al (1999) Repeat tear of postoperative meniscus: potential MR imaging signs. Radiology 210(1):183–188

    Article  PubMed  CAS  Google Scholar 

  27. Logan M, Watts M, Owen J et al (2009) Meniscal repair in the elite athlete: results of 45 repairs with a minimum 5-year follow-up. Am J Sports Med 37(6):1131–1134

    Article  PubMed  Google Scholar 

  28. Magee T (2014) Accuracy of 3-Tesla MR and MR arthrography in diagnosis of meniscal retear in the post-operative knee. Skeletal Radiol 43(8):1057–1064

    Article  PubMed  Google Scholar 

  29. Majeed H, Karuppiah S, Sigamoney KV et al (2015) All-inside meniscal repair surgery: factors affecting the outcome. J Orthop Traumatol 16(3):245–249

    Article  PubMed  PubMed Central  Google Scholar 

  30. Miao Y, Yu JK, Ao YF et al (2011) Diagnostic values of 3 methods for evaluating meniscal healing status after meniscal repair: comparison among second-look arthroscopy, clinical assessment, and magnetic resonance imaging. Am J Sports Med 39(4):735–742

    Article  PubMed  Google Scholar 

  31. Muellner T, Egkher A, Nikolic A et al (1999) Open meniscal repair: clinical and magnetic resonance imaging findings after twelve years. Am J Sports Med 27(1):16–20

    Article  PubMed  CAS  Google Scholar 

  32. Ohishi T, Takahashi M, Abe M et al (2005) The use of axial reconstructed images from three-dimensional MRI datasets for morphological diagnosis of meniscal tears of the knee. Arch Orthop Trauma Surg 125(9):622–627

    Article  PubMed  Google Scholar 

  33. Popescu D, Sastre S, Garcia AI et al (2015) MR-arthrography assessment after repair of chronic meniscal tears. Knee Surg Sports Traumatol Arthrosc 23(1):171–177

    Article  PubMed  Google Scholar 

  34. Pujol N, Tardy N, Boisrenoult P et al (2013) Magnetic resonance imaging is not suitable for interpretation of meniscal status ten years after arthroscopic repair. Int Orthop 37(12):2371–2376

    Article  PubMed  PubMed Central  Google Scholar 

  35. Rockborn P, Messner K (2000) Long-term results of meniscus repair and meniscectomy: a 13-year functional and radiographic follow-up study. Knee Surg Sports Traumatol Arthrosc 8(1):2–10

    Article  PubMed  CAS  Google Scholar 

  36. Sciulli RL, Boutin RD, Brown RR et al (1999) Evaluation of the postoperative meniscus of the knee: a study comparing conventional arthrography, conventional MR imaging, MR arthrography with iodinated contrast material, and MR arthrography with gadolinium-based contrast material. Skelet Radiol 28(9):508–514

    Article  CAS  Google Scholar 

  37. Sharifah MI et al (2015) Accuracy of MRI in the diagnosis of meniscal tears in patients with chronic ACL tears. Knee Surg Sports Traumatol Arthrosc 23(3):826–830

    Article  PubMed  CAS  Google Scholar 

  38. Steenbrugge F, Verdonk R, Verstraete K (2002) Long-term assessment of arthroscopic meniscus repair: a 13-year follow-up study. Knee 9(3):181–187

    Article  PubMed  Google Scholar 

  39. Stoller DW, Martin C, Crues JR et al (1987) Meniscal tears: pathologic correlation with MR imaging. Radiology 163(3):731–735

    Article  PubMed  CAS  Google Scholar 

  40. Stone RG, Frewin PR, Gonzales S (1990) Long-term assessment of arthroscopic meniscus repair: a two- to six-year follow-up study. Arthroscopy 6(2):73–78

    Article  PubMed  CAS  Google Scholar 

  41. Tachibana Y, Sakaguchi K, Goto T et al (2010) Repair integrity evaluated by second-look arthroscopy after arthroscopic meniscal repair with the FasT-Fix during anterior cruciate ligament reconstruction. Am J Sports Med 38(5):965–971

    Article  PubMed  Google Scholar 

  42. Vives MJ, Homesley D, Ciccotti MG et al (2003) Evaluation of recurring meniscal tears with gadolinium-enhanced magnetic resonance imaging: a randomized, prospective study. Am J Sports Med 31(6):868–873

    Article  PubMed  Google Scholar 

  43. Wang JT, Liu YJ, Wang JL et al (2014) Arthroscopic repair of meniscus injury with Fast-fix under local anesthesia. Zhongguo Gu Shang 27(8):683–685

    PubMed  Google Scholar 

  44. White LM, Schweitzer ME, Weishaupt D et al (2002) Diagnosis of recurrent meniscal tears: prospective evaluation of conventional MR imaging, indirect MR arthrography, and direct MR arthrography. Radiology 222(2):421–429

    Article  PubMed  Google Scholar 

  45. Xu C, Zhao J (2015) A meta-analysis comparing meniscal repair with meniscectomy in the treatment of meniscal tears: the more meniscus, the better outcome? Knee Surg Sports Traumatol Arthrosc 23(1):164–170

    Article  PubMed  Google Scholar 

Download references

Funding

Not applicable.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Weiping Li.

Ethics declarations

Conflict of interest

The authors declared that they have no conflicts of interest to this work.

Ethical approval

This study was approved by the Sun Yat-sen Memorial Hospital, Sun Yat-sen University.

Informed consent

Written informed consent was obtained from all participants.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Song, B., Tan, W., Xu, Y. et al. 3D-MRI combined with signal-to-noise ratio measurement can improve the diagnostic accuracy and sensitivity in evaluating meniscal healing status after meniscal repair. Knee Surg Sports Traumatol Arthrosc 27, 177–188 (2019). https://doi.org/10.1007/s00167-018-5018-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-018-5018-z

Keywords

Navigation