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Magnetic resonance imaging is able to detect patellofemoral focal cartilage injuries: a systematic review with meta-analysis

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to analyze the diagnostic accuracy of magnetic resonance imaging (MRI) to detect and grade the severity of patellofemoral (PF) cartilage injuries.

Methods

A systematic review was conducted on PubMed, EMBASE and Cochrane Library databases (up to July 1st 2022) to search for studies that reported the diagnostic accuracy of MRI to detect and grade PF cartilage injuries as compared to diagnostic arthroscopy. Risk of bias was judged using the QUADAS-2 tool. Quantitative syntheses were performed to calculate the diagnostic accuracy metric—sensitivity, specificity, positive likelihood (LR+) and negative likelihood (LR−) ratios, diagnostic odds ratio (DOR)—and presented as median with 25% and 75% percentiles. The summary receiver operating characteristic (SROC) curves were also calculated. Diagnostic accuracy metrics were calculated for all PF cartilage injuries and then sub-grouped by patellar and trochlear lesions. Diagnostic accuracy was also calculated according to the grading of cartilage injuries.

Results

Forty-five studies were included for qualitative analyses and forty studies were included for quantitative synthesis. A total of 3534 participants with a weighted mean age of 38.1 years were included. Diagnostic accuracy was generally high: sensitivity (0.8, 0.6–1.0), specificity (0.9, 0.8–1.0), LR+ (6.4, 3.1–15.3), LR− (0.3, 0.2–0.4) and DOR (21.3, 9.9–121.1). The area under the curve (AUC) of the SROC was 0.9. The diagnostic accuracy was slightly higher for patellar (sensitivity 0.8, specificity 0.8, LR+ 5.3, LR− 0.2, DOR 28.8) than for trochlear lesions (sensitivity 0.7, specificity 0.9, LR+ 5.5, LR− 0.4, DOR 14.3). The sensitivity was generally higher when grading advanced (vs. early or intermediate) cartilage injuries of the patella.

Conclusion

The MRI is able to diagnose PF cartilage injuries with reasonably high diagnostic accuracy (as compared to arthroscopy). Clinicians can rely on MRI to reliably diagnose PF cartilage injuries (with some limitations) which will play an important role in deciding for surgical or non-operative treatment.

Level of evidence

Level III.

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Authors and Affiliations

  1. Orthopaedics Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal

    Francisco Xará-Leite

  2. Orthopaedics Department, Cova da Beira University Hospital Centre, Covilhã, Portugal

    André Vinha

  3. Clínica Espregueira-FIFA Medical Centre of Excellence, Porto, Portugal

    Cristina Valente, Renato Andrade & João Espregueira-Mendes

  4. School of Medicine, Minho University, Braga, Portugal

    João Espregueira-Mendes

  5. Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal

    Francisco Xará-Leite

  6. Dom Henrique Research Centre, Porto, Portugal

    Cristina Valente, Renato Andrade & João Espregueira-Mendes

  7. Porto Biomechanics Laboratory (LABIOMEP), Faculty of Sports, University of Porto, Porto, Portugal

    Renato Andrade

  8. ICVS/3B’s–PT Government Associate Laboratory, Braga/Guimarães, Portugal

    João Espregueira-Mendes

  9. 3B’s Research Group-Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Barco, Guimarães, Portugal

    João Espregueira-Mendes

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Contributions

All authors were involved both in the idealization of the systematic review and preparation of the manuscript. FXL and RA were involved in the databases searches and data extraction. FXL and AV performed the data collection and organization in coordination with RA and CV. CV and RA performed all data analysis and interpretation of results. FXL and AV judged the risk of bias of the studies included in the systematic review. JEM guided and provided advice during all steps of the development of the systematic review. All authors contributed to drafting and approving the final manuscript prior to submission to the peer-reviewed journal.

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Correspondence to João Espregueira-Mendes.

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Xará-Leite, F., Vinha, A., Valente, C. et al. Magnetic resonance imaging is able to detect patellofemoral focal cartilage injuries: a systematic review with meta-analysis. Knee Surg Sports Traumatol Arthrosc 31, 2469–2481 (2023). https://doi.org/10.1007/s00167-022-07203-z

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