Abstract
Purpose
The aim of this study was to compare the accuracy of clinical examination to that of MRI evaluated by two independent radiologists for the diagnosis of meniscal tears and chronic anterior cruciate ligament injuries and to assess the MRI accuracy in the diagnosis of cartilage defects.
Methods
Seventy-six consecutive patients with suspected intra-articular knee pathology were prospectively evaluated by objective examination, 1.5 T MRI, re-examined by trained radiologist and arthroscopy. Accuracy, sensitivity, specificity, positive predictive value and negative predictive value were calculated. Agreement analysis with kappa (К) coefficient values was performed for meniscal and ACL tears.
Results
No differences were found between diagnostic accuracy of clinical examination, the first and second MRI reports in diagnosis of medial meniscus (84 vs 96 vs 97 %) and anterior cruciate ligament injuries (93 vs 78 vs 89 %). For the lateral meniscal tears, the accuracy of the second radiologist was significantly higher than those of the first (96 vs 75 %; p < 0.01) and clinical examination (96 vs 86 %; p = 0.02). High diagnostic values were obtained for the diagnosis of full-thickness chondral defects with sensitivity of 100 %, specificity of 95 % and accuracy of 95 %.
Conclusion
Clinical and MRI evaluations have no differences in the diagnosis of medial meniscus and anterior cruciate ligament injuries. A trained radiologist obtained better sensitivity, specificity and accuracy in the diagnosis of lateral meniscus. 1.5 T MRI does not represent the technique of choice in the evaluation of chondral defect but demonstrated high diagnostic accuracy for detection of full-thickness chondral defects.
Level of evidence
Diagnostic prospective study, Level II.
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References
Munk B, Madsen F, Lundorf E et al (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
Dufka F, Lansdown DA, Zhang AL, Allen CR, Ma CB, Feeley BT (2016) Accuracy of MRI evaluation of meniscus tears in the setting of ACL injuries. Knee 23(3):460–464
Nam TS, Kim MK, Ahn JH (2014) Efficacy of magnetic resonance imaging evaluation for meniscal tear in acute anterior cruciate ligament injuries. Arthroscopy 30:475–482
Lundeberg M, Odensten M, Thuomas KA, Messner K (1996) The diagnostic validity of magnetic resonance imaging in acute knee injuries with hemarthrosis. A single-blinded evaluation in 69 patients using high-field MRI. Int J Sports Med 17(3):218–222
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
Speziali A, Placella G, Tei MM, Georgoulis A, Cerulli G (2016) Diagnostic value of the clinical investigation in acute meniscal tears combined with anterior cruciate ligament injury using arthroscopic findings as golden standard. Musculoskelet Surg 100:31–35
Rose NE, Gold SM (1996) Comparison of accuracy between clinical examination and magnetic resonance imaging in the diagnosis of meniscal and anterior cruciate ligament tears. Arthroscopy 12(4):398–405
Gillies H, Seligson D (1979) Precision in the diagnosis of meniscal lesions: a comparison of clinical evaluation, arthrography, and arthroscopy. J Bone Joint Surg Am 61:343–346
Simonsen O, Jensen J, Mouritsen P, Lauritzen J (1984) The accuracy of clinical examination of injury of the knee joint. Injury 16:96–101
Ciuffreda P, Lelario M, Milillo P, Vinci R, Coppolino F, Stoppino LP, Genovese EA, Macarini L (2013) Mechanism of traumatic knee injuries and MRI findings. Musculoskelet Surg 97(Suppl 2):S127–S135
Kocabey Y, Tetik O, Isbell WM, Atay A, Johnson DL (2004) The value of clinical examination versus magnetic resonance imaging in the diagnosis of meniscal tears and anterior cruciate ligament rupture. Arthroscopy 20(7):696–700
Mackenzie R, Keene GS, Lomas DJ, Dixon AK (1995) Errors at knee magnetic resonance imaging: true or false? Br J Radiol 68(814):1045–1051
Van Dyck P, Vanhoenacker FM, Lambrecht V, Wouters K, Gielen JL, Dossche L, Parizel PM (2013) Prospective comparison of 1.5 and 3.0-T MRI for evaluating the knee menisci and ACL. J Bone Joint Surg Am 95(10):916–924
Rayan F, Bhonsle S, Shukla D (2009) Clinical, MRI, and arthroscopic correlation in meniscal and anterior cruciate ligament injuries. Int Orthop 33:129–132
Crues JV, Mink J, Levy TL, Lotysch M, Stoller DW (1987) Meniscal tears of the knee: accuracy of MR imaging. Radiology 164:445–448
Chan WP, Fritz RC, Steinbach LS, Wu CY, Genant HK, Cannon WD (1994) The knee: internal derangements. In: Chan WP, Lang P, Genant HK (eds) MRI of the musculoskeletal system. W.B. Saunders, Philadelphia, pp 263–306
Van Dyck P, De Smet E, Veryser J, Lambrecht V, Gielen JL, Vanhoenacker FM et al (2012) Partial tear of the anterior cruciate ligament of the knee: injury patterns on MR imaging. Knee Surg Sports Traumatol Arthrosc 20:256–261
Kosaka M, Nakase J, Toratani T, Ohashi Y, Kitaoka K, Yamada H, Komura K, Nakamura S (2013) Oblique coronal and oblique sagittal MRI for diagnosis of anterior cruciate ligament tears and evaluation of anterior cruciate ligament remnant tissue. Knee 21(1):54–57
Crain EH, Fithian DC, Paxton EW, Luetzow WF (2005) Variation in anterior cruciate ligament scar pattern: does the scar pattern affect anterior laxity in anterior cruciate ligament-deficient knees? Arthroscopy 21:19–24
Sonin AH, Pensy RA, Mulligan ME, Hatem S (2002) Grading articular cartilage of the knee using fast spin-echo proton density-weighted MR imaging without fat suppression. AJR Am J Roentgenol 179(5):1159–1166
Van den Borne MP, Raijmakers NJ, Vanlauwe J, Victor J, de Jong SN, Bellemans J, Saris DB, International Cartilage Repair Society (2007) International Cartilage Repair Society (ICRS) and Oswestry macroscopic cartilage evaluation scores validated for use in Autologous Chondrocyte Implantation (ACI) and microfracture. Osteoarthritis Cartilage 15(12):1397–1402
Thomas S, Pullagura M, Robinson E, Cohen A, Banaskiewicz 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
Godlee F (2009) Less medicine is more. BMJ. doi:10.1136/bmj.b2561
Kim S, Bosque J, Meehan JP, Jamali A, Marder R (2011) Increase in outpatient knee arthroscopy in the United States: a comparison of National Surveys of Ambulatory Surgery, 1996 and 2006. J Bone Joint Surg Am 93(11):994–1000
Kemp MA, Lang K, Dahill M, Williams JL (2010) Investigating meniscal symptoms in patients with knee osteoarthritis—is MRI an unnecessary investigation? Knee 18(4):252–523
Lelario M, Ciuffreda P, Lupo P, Bristogiannis C, Vinci R, Stoppino LP, De Filippo M, Macarini L (2013) Financial impact of radiological reports on medical-legal evaluation of compensation for meniscal lesions. Musculoskelet Surg 97(Suppl 2):S137–S144
Bari A, Kashikar S, Iakhkar B, Ahsan M (2014) Evaluation of MRI versus arthroscopy in anterior cruciate ligament and meniscal injuries. J Clin Diagn Res 8(12):RC14–RC18
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(1):49–52
Heron C (1996) MRI—meniscal pitfalls. Knee 3(1–2):68–69
De Smet AA, Nathan DH, Graf BK, Haaland BA, Fine JP (2008) Clinical and MRI findings associated with false-positive knee MR diagnoses of medial meniscal tears. AJR Am J Roentgenol 191:93–99
Mackenzie R, Keene GS, Lomas DJ, Dixon AK (1995) Errors at knee magnetic resonance imaging: true or false? Br J Radiol 68:1045–1051
De Smet AA, Graf BK (1994) Meniscal tears missed on MR imaging: relationship to meniscal tear patterns and anterior cruciate ligament tears. AJR Am J Roentgenol 162(4):905–911
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):22–26
Alessio-Mazzola M, Formica M, Coviello M, Basso M, Felli L (2016) Conservative treatment of meniscal tears in anterior cruciate ligament reconstruction. Knee. doi:10.1016/j.knee.2015.08.003
Magee T, Shapiro M, Williams D (2002) MR accuracy and arthroscopic incidence of meniscal radial tears. Skeletal Radiol 31:686–689
Yu JS, Cosgarea AJ, Kaeding CC, Wilson D (1997) Meniscal flounce MR imaging. Radiology 203:513–515
Lee BY, Jee WH, Kim JM, Kim BS, Choi KH (2000) Incidence and significance of demonstrating the meniscofemoral ligament on MRI. Br J Radiol 73(867):271–274
Hodler J, Haghighi P, Pathria MN, Trudell D, Resnick D (2002) Meniscal changes in the elderly: correlation of MR imaging and histologic findings. Radiology 184:221–225
LaPrade RF, Burnett QM, Veenstra MA, Hodgman CG (1994) The prevalence of abnormal magnetic resonance imaging findings in asymptomatic knees. With correlation of magnetic resonance imaging to arthroscopic findings in symptomatic knees. Am J Sports Med 22(6):739–745
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):189–196
Zantop T, Brucker PU, Vidal A, Zelle BA, Fu FH (2007) Intra-articular rupture pattern of the ACL. Clin Orthop Relat Res 454:48–53
Friemert YB, Oberländer W, Schwarz HJ, Häberle W, Bähren H, Danz Gerngroß 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
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
Van Dyck P, Kenis C, Vanhoenacker FM, Lambrecht V, Wouters K, Gielen JL, Dossche L, Parizel PM (2014) Comparison of 1.5- and 3-T MR imaging for evaluating the articular cartilage of the knee. Knee Surg Sports Traumatol Arthrosc 22:1376–1384
Evangelopoulos DS, Huesler M, Ahmad SS, Aghayev E, Neukamp M, Röder C, Exadaktylos A, Bonel H, Kohl S (2015) Mapping tibiofemoral gonarthrosis: an MRI analysis of non-traumatic knee cartilage defects. Br J Radiol 88(1052):20140542. doi:10.1259/bjr.20140542
Sharifah M, Lee CL, Suraya A, Johan A, Syed A, Tan S (2015) Accuracy of MRI in the diagnosis of meniscal tears in patients with chronic ACL tears. Knee Surg Sports Traumatol Arthrosc 23:826–830
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):1045–1051
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Felli, L., Garlaschi, G., Muda, A. et al. Comparison of clinical, MRI and arthroscopic assessments of chronic ACL injuries, meniscal tears and cartilage defects. Musculoskelet Surg 100, 231–238 (2016). https://doi.org/10.1007/s12306-016-0427-y
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DOI: https://doi.org/10.1007/s12306-016-0427-y