Abstract
This study evaluates the diagnostic accuracy of anterior cruciate ligament (ACL) rupture using magnetic resonance imaging in the management of patients with symptomatic tibiofemoral instability. Published and unpublished databases including the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, AMED and CINAHL, as well as unpublished studies registers were searched for studies that compared the diagnostic findings of MRI to arthroscopic surgery for patients with a suspected ACL rupture in September 2010. For each study, sensitivity and specificity of complete ACL rupture were analysed as bivariate data to account for a possible negative correlation within studies, and pooled meta-analysis was performed. Fifty-three studies compared the diagnostic accuracy of MRI to arthroscopic findings for a total of 4,673 patients, 4,683 knees. Overall, the pooled sensitivity of MRI for detecting complete ACL rupture was 94.5% (95% confidence interval 0.92–0.96) and specificity of 95.3% (0.93–0.97). MRI has high accuracy for patients with complete ACL rupture. Due to the higher economic costs and increased complication risks of diagnostic arthroscopy, MRI is therefore recommended as the principal investigation following clinical examination, to diagnose ACL rupture.
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References
Tsai KJ, Chiang H, Jiang CC (2004) Magnetic resonance imaging of anterior cruciate ligament rupture. BMC Musculoskel Disord 5:1471
Winters K, Tregonning R (2005) Reliability of magnetic resonance imaging for traumatic injury of the knee. NZ Med J 118:1209
Sherman OH, Fox JM, Snyder SJ, Del Pizzo W, Friedman MJ, Ferkel RD, Lawley MJ (1986) Arthroscopy—“no-problem surgery”. An analysis of complications in two thousand six hundred and forty cases. J Bone Joint Surg 68-A:256–265
Boeree NR, Ackroyd CE (1991) Assessment of the menisci and cruciate ligaments: an audit of clinical practice. Injury 22:291–294
Klass D, Toms AP, Greenwood R, Hopgood P (2007) MR imaging of acute anterior cruciate ligament injuries. Knee 14:339–347
Boerre NR, Watkinson AF, Ackroyd CE, Johnson C (1991) Magnetic resonance imaging of meniscal and cruciate injuries of the knee. J Bone Joint Surg 73-B:452–457
Fischer SP, Fox JM, Del Pizzo W, Friedman MJ, Snyder SJ, Ferkel RD (1991) Accuracy of diagnoses from magnetic resonance imaging of the knee: a multicentre analysis of one thousand and fourteen patients. J Bone Joint Surg 73-A:2–10
Panisset JC, Duraffour H, Vasconcelos W, Colombet P, Javois C, Potel JF, Dejour D, Société française d’arthroscopie (2008) Clinical, radiological and arthroscopic analysis of the ACL tear. A prospective study of 418 cases. Rev Chir Orthop Reparatrice Appar Mot 94(8 Suppl):362–368
Casteleyn PP, Handelberg F (1996) Non-operative management of anterior cruciate ligament injuries in the general population. J Bone Joint Surg 78-B:446–451
Whiting P, Rutjes AW, Dinnes J, Reitsma J, Bossuyt PM, Kleijnen J (2004) Development and validation of methods for assessing the quality of diagnostic accuracy studies. Health Technol Assess 8(iii):1–234
Whiting PF, Weswood ME, Rutjes AW, Reitsma JB, Bossuyt PN, Kleijnen J (2006) Evaluation of QUADAS, a tool for the quality assessment of diagnostic accuracy studies. BMC Med Res Methodol 6:9
Reitsma JB, Glas AS, Rutjes AW, Scholten RJ, Bossuyt PM, Zwinderman AH (2005) Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. J Clin Epidemiol 58:982–990
McDermott MJ, Bathgate B, Gillingham BL, Hennrikus WL (1998) Correlation of MRI and arthroscopic diagnosis of knee pathology in children and adolescents. J Pediat Orthop 18:675–678
Craig JG, Go L, Blechinger J, Hearshen D, Bouffard JA, Diamond M, van Holsbeeck MT (2005) Three-tesla imaging of the knee: initial experience. Skelet Radiol 34:453–461
Ghanem I, Abou Jaoude S, Kharrat K, Dagher F (2002) Is MRI effective in detecting intraarticular abnormalities of the injured knee? J Med Libanais 50:168–174
Gelb HJ, Glasgow SG, Sapega AA, Torg JS (1996) Magnetic resonance imaging of knee disorders: clinical value and cost- effectiveness in a sports medicine practice. Am J Sport Med 24:99–103
Bergstrom R, Gillquist J, Lysholm J, Hamberg P (1984) Arthroscopy of the knee in children. J Pediat Orthop 4:542–545
Suman RK, Stother IG, Illingworth G (1984) Diagnostic arthroscopy of the knee in children. J Bone Joint Surg 66-B:535–537
Casscells SW (1980) The place of arthroscopy in the diagnosisi and treatment of internal derangement of the knee: an analysis of 1000 cases. Clin Orthop Relat Res 151:135–142
Sarimo J, Rantanen J, Heikkilä J, Helttula I, Hiltunen A, Orava S (2002) Acute traumatic hemarthrosis of the knee. Is routine arthroscopic examination necessary? A study of 320 consecutive patients. Scand J Surg 91:361–364
Adalberth T, Roos H, Lauren M, Akeson P, Sloth M, Jonsson K, Lindstrand A, Stefan Lohmander L (1997) Magnetic resonance imaging, scintigraphy, and arthroscopic evaluation of traumatic hemarthrosis of the knee. Am J Sport Med 25:231–237
Yao L, Gentili A, Petrus L, Lee JK (1995) Partial ACL rupture: an MR diagnosis? Skelet Radiol 24:247–251
Scholten RJ, Opstelten W, van der Plas CG, Bijl D, Deville WL, Bouter LM (2003) Accuracy of physical diagnostic tests for assessing ruptures of the anterior cruciate ligament: a meta-analysis. J Fam Pract 52:689–694
Moksnes H, Risberg MA (2009) Performance-based functional evaluation of non-operative and operative treatment after anterior cruciate ligament injury. Scand J Med Sci Sports 19:345–355
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
Bari V, Murad M (2003) Accuracy of magnetic resonance imaging in the knee. J Coll Physic Surg Pakistan 13:408–411
Barnett MJ (1993) MR diagnosis of internal derangement of the knee: Effect of field strength on efficacy. Am J Roentgenol 161:115–118
Barry KP, Mesgarzadeh M, Triolo J, Moyer R, Tehranzadeh J, Bonakdarpour A (1996) Accuracy of MRI patterns in evaluating anterior cruciate ligament tears. Skelet Radiol 25:365–370
Bui-Mansfield LT, Youngberg RA, Warme W, Pitcher JD, Nguyen PL (1997) Potential cost saving of MR imaging obtained before arthroscopy of the knee: Evaluation of 50 consecutive patients. Am J of Roentgenol 168:913–918
Burgaud A, Dubrana F, Brunet P, Stindel E, Ch Lefevre (2003) Role of magnetic of resonance imaging in assessment of severe knee sprain. J Traumatol Sport 20:162–166
Challen J, Tang Y, Hazratwala K, Stuckey S (2007) Accuracy of MRI diagnosis of internal derangement of the knee in a non-specialized tertiary level referral teaching hospital. Australas Radiol 51:426–431
Chung HW, Kim YH, Hong SH, Kim SS, Chung JK, Seong SC, Kang HS (2000) Indirect signs of anterior cruciate ligament injury on SPET: comparison with MRI and arthroscopy. Nucl Med Commun 21:651–658
Cook GJR, Ryan PJ, Clarke SEM, Fogelman I (1996) SPECT bone scintigraphy of anterior cruciate ligament injury. J Nucl Med 37:1353–1356
Cotton A, Delfaut E, Demondion X, Lepegue F, Boukhelifa M, Boutry N, Chastanet P, Gougeon F (2000) MR imaging of the knee at 0.2 and 1.5T: correlation with surgery. Am J Roentgenol 174:1093–1097
Duc SR, Pfirrmann CWA, Koch PP, Zanetti M, Hodler J (2008) Internal knee derangement assessed with 3-minute three-dimensional isovoxel true FISP MR sequence: preliminary study. Radiology 246:526–535
Ekelund L, Bjornebrink J, Elmqvist L-G (1991) Ultra-low-field magnetic resonance imaging of acute cruciate ligament tears. Magn Reson Imag 9:179–185
Gay SB, Chen NC, Burch JJ, Gleason TR, Sagman AM (1993) Multiplanar reconstruction in magnetic resonance evaluation of the knee: comparison with film magnetic resonance interpretation. Invest Radiol 28:142–145
Gentili A, Seeger LL, Yao L, Do HM (1994) Anterior cruciate ligament tear: indirect signs at MR imaging. Radiology 193:835–840
Glashow JL, Katz R, Schneider M, Scott WN (1989) Double-blind assessment of the value of magnetic resonance imaging in the diagnosis of anterior cruciate and meniscal lesions. J Bone Joint Surg 71-A:113–119
Gluckert K, Kladny B, Blank-Schal A, Hofmann G (1992) MRI of the knee joint with a 3-D gradient echo sequence. Equivalent to diagnostic arthroscopy? Arch Orthop Trauma Surg 112:5–14
Gul-e-khanda AkhtarW, Ahsan H, Ahmad N (2008) Assessment of menisci and ligamentous injuries of the knee on magnetic resonance imaging: Correlation with Arthroscopy. J Pakistan Med Assoc 58:537–540
Ha TPT, Li KCP, Beaulieu CF, Bergman G, Chen IY, Eller DJ, Cheung LP, Herfkens RJ (1998) Anterior cruciate ligament injury: fast spin-echo MR imaging with arthroscopic correlation in 217 examinations. Am J Roentgenol 170:1215–1219
Halbrecht JL, Jackson DW (1992) Office arthroscopy: a diagnostic alternative. Arthroscopy 8:320–326
Heron CW, Calvert PT (1992) Three-dimensional gradient-echo MR imaging of the knee: comparison with arthroscopy in 100 patients. Radiology 183:839–844
Jackson DW, Jennings LD, Maywood RM, Berger PE (1988) Magnetic resonance imaging of the knee. Am J Sports Med 16:29–38
Jung JY, Yoon YC, Kwon JW, Ahn JH, Choe BK (2009) Diagnosis of internal derangement of the knee at 3.0-T MR imaging: 3D isotropic intermediate-weighted versus 2D sequences. Radiology 253:780–787
Kelly MA, Flock TJ, Kimmel JA, Kiernan HA Jr, Singson RS, Starron RB, Feldman F (1991) MR imaging of the knee: clarification of its role. Arthroscopy 7:78–85
Kijowski R, Blankenbaker DG, Klaers JL, Shinki K, De Smet AA, Block WF (2009) Vastly undersampled isotropic projection steady-state free precession imaging of the knee: diagnostic performance compared with conventional MR. Radiology 251:185–194
Kijowski R, Davis KW, Woods MA, Lindstrom MJ, De Smet AA, Gold GE, Busse RF (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 252:486–495
Kinnunen J (1994) Diagnostic performance of low field MRI in acute knee injuries. Magn Reson Imag 12:1155–1160
Kocabey Y, Tetik O, Isbell WM, Atay OA, Johnson DL (2004) The value of clinical examination versus magnetic resonance imaging in the diagnosis of meniscal tears and anterior cruciate ligament rupture. Arthroscopy 20:696–700
Lee K, Siegel MJ, Lau DM, Hildebolt CF, Matava MJ (1999) Anterior cruciate ligament tears: MR imaging-based diagnosis in a pediatric population. Radiology 213:697–704
Lerman JE, Gray DS, Schweitzer ME, Bartolozzi A (1995) MR evaluation of the anterior cruciate ligament: value of axial images. J Comput Assist Tomograph 19:604–607
Lundberg 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 before arthroscopy. Int J Sport Med 17:218–222
Mandelbaum BR, Finerman GA, Reicher MA, Hartzman S, Bassett LW, Gold RH, Rauschning W, Dorey F (1986) Magnetic resonance imaging as a tool for evaluation of traumatic knee injuries. Anatomical and pathoanatomical correlations. Am J Sports Med 14:361–370
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
Munk PL, Hilborn MD, Vellet AD, Dumas MD, Romano CC (1997) Diagnostic equivalence of conventional and fast spin echo magnetic resonance imaging of the anterior cruciate ligament of the knee. Australas Radiol 41:238–242
Nagwa DA, Gishen P (2004) Comparison between arthroscopy and 3 dimensional double echo steady state (3D-DESS) sequences in magnetic resonance imaging in internal derangement of the knee. Saudi Med J 25:761–765
Niitsu M, Anno I, Fukubayashi T, Shimojo H, Kuno S, Akisada M (1991) Tears of cruciate ligaments and menisci: evaluation with cine MR imaging. Radiology 178:859–864
Polly DW Jr, Callaghan JJ, Sikes RA, McCabe JM, McMahon K, Savory CG (1988) The accuracy of selective magnetic resonance imaging compared with the findings of arthroscopy of the knee. J Bone Joint Surg 70-A:192–198
Rappeport ED, Wieslander SB, Stephensen S, Lausten GS, Thomsen HS (1997) MRI preferable to diagnostic arthroscopy in knee joint injuries. Acta Orthop Scand 68:277–281
Rayan F, Bhonsle S, Shukla DD (2009) Clinical, MRI, and arthroscopic correlation in meniscal and anterior cruciate ligament injuries. Int Orthop 33:129–132
Riel KA, Reinisch M, Ottl G, Hof N, Lenz M (1995) Knee joint lesions - results of magnetic resonance imaging (MRI) and arthroscopy. Endoskopie Heute 8:226–230
Sampson MJ, Jackson MP, Moran CJ, Moran R, Eustace SJ, Shine S (2008) Three Tesla MRI for the diagnosis of meniscal and anterior cruciate ligament pathology: a comparison to arthroscopic findings. Clin Radiol 63:1106–1111
Sanchis-Alfonso V, Martinez-Sanjuan V, Gastaldi-Orquin E (1993) The value of MRI in the evaluation of the ACL deficient knee and in the post-operative evaluation after ACL reconstruction. Eur JRadiol 16:126–130
Saragaglia D, Rose-Pittet L, Lebas JF, Coulomb M, Butel J (1989) Magnetic resonance imaging in studying injuries of the ligaments and menisci of the knee. 85 cases controlled by arthroscopy. Rev Chir Orthop Reparatrice Appar Mot 75:452–458
Schaefer FKW, Schaefer PJ, Brossmann J, Frahm C, Muhle C, Hilgert RE, Heller M, Jahnke T (2006) Value of fat-suppressed PD-weighted TSE-sequences for detection of anterior and posterior cruciate ligament lesions-comparison to arthroscopy. Eur J Radiol 58:411–415
Stanitski CL (1998) Correlation of arthroscopic and clinical examinations with magnetic resonance imaging findings of injured knees in children and adolescents. Am J Sport Med 26:2–6
Tung GA, Davis LM, Wiggins ME, Fadale PD (1993) Tears of the anterior cruciate ligament: primary and secondary signs at MR imaging. Radiology 188:661–667
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We thank the Sir Thomas Browne Library at the Norfolk and Norwich University Hospital for their assistance in obtaining the texts, which formed the basis of this review.
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Smith, T.O., Lewis, M., Song, F. et al. The diagnostic accuracy of anterior cruciate ligament rupture using magnetic resonance imaging: a meta-analysis. Eur J Orthop Surg Traumatol 22, 315–326 (2012). https://doi.org/10.1007/s00590-011-0829-3
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DOI: https://doi.org/10.1007/s00590-011-0829-3