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Comparison of clinical, MRI and arthroscopic assessments of chronic ACL injuries, meniscal tears and cartilage defects

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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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Authors and Affiliations

  1. Department of Surgical Sciences (DISC), Orthopaedic and Traumatologic Clinic, University of Genoa, Padiglione 40, IRCCS AOU San Martino - IST, Largo Rosanna Benzi 10, 16132, Genoa, Italy

    L. Felli, M. Formica, A. Zanirato & M. Alessio-Mazzola

  2. Radiology Unit, University of Genoa, IRCCS AOU San Martino - IST, Largo Rosanna Benzi 10, 16132, Genoa, Italy

    G. Garlaschi & A. Muda

  3. Department of Experimental Medicine (DIMES), Institute of Anatomy, University of Genoa, IRCCS AOU San Martino - IST, Largo Rosanna Benzi 10, 16132, Genoa, Italy

    A. Tagliafico

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  1. L. Felli
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Correspondence to M. Alessio-Mazzola.

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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

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