MRI preferable to diagnostic arthroscopy in knee joint injuries a double-blind comparison of 47 patients (original) (raw)
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Mri and Arthroscopy- Co-Relation in Meniscal and Ligamentous Knee Injuries
Journal of Evolution of Medical and Dental Sciences, 2018
BACKGROUND MRI use for primary diagnosis of traumatic knee intra-articular lesion. The purpose of this investigation was to correlate MR and arthroscopic findings in a setup of knee injury. MATERIALS AND METHODS A descriptive study of 111 patients who underwent MRI for the diagnosis of soft tissue injury in knee over a period of last 2 years in GMC Hospital, Nagpur. A combination of T1-and T2-weighted sequences is most commonly used. RESULTS Commonest lesion detected in our study was ACL tear followed by meniscal tear. These lesions were further collaborated with arthroscopic finding and further treatment was done in GMC Hospital, Nagpur. Sensitivity, specificity, positive predictive value and negative predictive value was calculated of MRI with respect to Arthroscopy.
Knee injuries: correlation of MRI with arthroscopic findings
Journal of Patan Academy of Health Sciences
Introduction: Knee injuries are common among active adults. Achieving a correct clinical diagnosis is often difficult in acute presentations. Knee arthroscopy is considered the gold standard in diagnosing post-traumatic intra-articular lesions, but it is an invasive procedure requiring a certain degree of expertise. Magnetic Resonance Imaging (MRI) is a non-invasive, sensitive diagnostic tool for knee injuries. This study aims to correlate the findings of MRI with arthroscopy of the knee. Method: This Prospective Observational Study was done at Shree Birendra Hospital, Kathmandu, Nepal from 13 Feb 2016 to 13 Jun 2016. The sensitivity, specificity, and accuracy of MRI findings in ligamentous, meniscal, and osteochondral injuries of the knee were analyzed using arthroscopic findings as standard. Result: Fifty-two patients (35 male and 17 female), mean age 35.4 years were included in the study. The accuracy of MRI for anterior cruciate ligament (ACL), posterior cruciate ligament (PCL),...
Archives of Trauma Research
Background: The aim of this study was to examine the correlation of the clinical examination, MRI and arthroscopic findings in cruciate ligaments and meniscal injuries of knee and to evaluate the accuracy of clinical examination and MRI with the gold standard arthroscopy. Methods: A prospective diagnostic double-blind study was conducted on 104 consecutive patients admitted to the outdoor/casualty with trauma to the knee complaining of knee pain/locking/ instability, from August 2012 to June 2014. All the patients were subjected to clinical examination, MRI scanning and diagnostic arthroscopy. Variables like sensitivity, specificity, positive predictive value, negative predictive value and accuracy of clinical examination and MRI against arthroscopy were evaluated. Results: The sensitivity, specificity and accuracy of clinical examination for anterior cruciate ligament tears were 94.7%, 71.4% and 88.5% and for MRI were 94.7%, 78.6% and 90.4%, respectively; for posterior cruciate ligament tears 100%, 100% and 100% for clinical examination and for MRI 80%, 97.9% and 96.2%, respectively. These values for medial meniscus tears were 76.5%, 68.6% and 71.2% for clinical examination and 88.2%, 62.8% and 71.2% respectively for MRI. For lateral meniscus tears, 40%, 94.6% and 78.8% for clinical examination and 46.7%, 89.2% and 76.9% respectively for MRI. Conclusions: A skillfully performed clinical examination establishes a diagnosis on which an arthroscopic procedure can be planned, reserving MRI scans for patients where the clinical examination fails to establish a diagnosis or cannot be performed. Decision to use MRI should be based on the criteria that it would confirm, expand the diagnosis or change diagnosis in such a way that alters the proposed treatment.
INTRODUCTION: Owing to its anatomical structure and functional demands, injuries involving the menisci and cruciate ligaments of the knee joints are among the most frequently encountered problems by an orthopedic surgeon. MATERIAL & METHODS: A hospital-based cross-sectional study was conducted where all patients aged 18-60 years with a history of trauma involving the knee joint admitted and posted to undergo arthroscopic surgery of the knee for either meniscal or cruciate ligament injury based on clinical and MRI findings with no fresh injury after MRI and before arthroscopy were included. All the surgeries were performed in an operation theatre under antibiotic cover. MRI findings were compared with Arthroscopic findings and the analysis was done. RESULTS&CONCLUSIONS: In present study of 45 patients, the maximum number of patients was in between 20-40 years of age. Clinical examination is equal to or better than an MRI in injuries involving Anterior Cruciate Ligament. When it comes to injuries involving the meniscus, the MRI was better than the Clinical examination.With a high NPV, it is suggested that a negative result on MRI would most probably give a normal result on arthroscopy. However, a positive result should always be correlated with the clinical examination findings before arriving at any final diagnosis.In patients involving injury to only one structure, i.e., either ACL or MM or LM, Clinical examination had better results than MRI.However, in cases with multiple injuries, it was found that MRI had better results than the clinical examination alone.
A Prospective Study of Role of MRI Evaluation in Knee Injuries in a Tertiary Care Hospital
Introduction: Knee is one of the largest and most complex joints in the body. Disease processes and injuries that disrupt ligaments, menisci, articular cartilage and other structures of the knee cause painful knee resulting in significant morbidity and disability. Number of imaging modalities are currently used to evaluate knee abnormalities including standard radiography, scintigraphy, Computed Tomography (CT), planar tomography and arthrography. . 100 patients presenting with knee injury referred from OPD (outpatient Department) & IPD (inpatient Department) of Orthopaedics to the Department of Radiology for MR imaging were included in the study, Arthroscopy was done in 39 patients and findings of arthroscopy were correlated with MRI findings. Sensitivity, specificity NPV, PPV and accuracy of MRI were calculated. Results: MR diagnosis of 100 cases was as follows: in ACL tear 50%; PCL tear 19%; MCL tear 17%; LCL tear 16%; MM tear 49%; LM tear 31%; Sensitivity, specificity, NPV, PPV and accuracy of MRI in detecting the knee injuries taking arthroscopy as gold standard are as follows ACL-100%, 90.9%, 100%, 96.5% and 97.4 %; lateral meniscus-100%, 94.5%, 100%, 50% and 94.8%; medial meniscus 90.4%, 66.7%, 85.7%, 76% and 79.5% respectively. Correlation between MRI and arthroscopic findings regarding presence and absence of posterior cruciate ligament tear was highest with sensitivity -100%, specificity-94.5%, NPV-100% and accuracy-94.8%, There were 6 false positives for meniscus tear on MR examinations accounting for low positive predictive value (72%) of MR examination. Posterior horn tears of menisci are likely to be missed on arthroscopy. Out of 6 false positive cases of meniscus tear, 4 were located predominately in the posterior horn and 2 in the anterior horn. Thus, acceptance of MRI findings as false positive is controversial. Conclusion: MRI is a useful non-invasive modality having high diagnostic accuracy, sensitivity and negative predictive value making it a very reliable screening test for diagnosis of internal derangements of knee joint. Thus, MRI saves many knees from unnecessary arthroscopies.
Role of MRI Evaluation in Knee Injuries
Journal of Evolution of Medical and Dental Sciences, 2020
BACKGROUND Knee is a major weight bearing and largest joint that provides mobility and stability during physical activities as well as balance while standing. Due to its wide range of functions it is exposed to forces beyond its physiological range, and thus bone and soft tissue of knee are at risk of injuries. We wanted to study MRI appearances of cruciate ligaments and meniscal tears in cases of knee injuries and correlate the MRI findings of knee injury with clinical observations/other radiological investigations/ arthroscopic findings. We also wanted to evaluate the sensitivity, specificity, PPV, NPV and accuracy of MRI in detecting knee injuries taking arthroscopy as gold standard (wherever performed). METHODS This prospective diagnostic descriptive study was conducted in the Department of Radiodiagnosis of Maharishi Markandeshwar Institute of Medical Sciences and Research, MMDU, Mullana, among 100 patients presenting with knee injuries referred to Department of Radiodiagnosis for MR imaging. MR scans were carried out on 1.5 tesla MR machine Achieva (by Phillips Medical System) and studies were performed with the sense extremity coil. Arthroscopic knee surgery was performed in 39 patients. MR findings were correlated with clinical and arthroscopic findings wherever possible. RESULTS MR diagnosis of 100 cases was as follows: in ACL tear 50%; PCL tear 19%; MCL tear 17%; LCL tear 16%; MM tear 49%; LM tear 31%; Sensitivity, specificity, NPV, PPV and accuracy of MRI in detecting the knee injuries taking arthroscopy as gold standard are as follows ACL-100%, 90.9%, 100%, 96.5% and 97.4 %; lateral meniscus-100%, 94.5%, 100%, 50% and 94.8%; medial meniscus 90.4%, 66.7%, 85.7%, 76% and 79.5% respectively. Correlation between MRI and arthroscopic findings regarding presence and absence of posterior cruciate ligament tear was highest with sensitivity-100%, specificity-94.5%, NPV-100% and accuracy-94.8%, There were 6 false positives for meniscus tear on MR examinations accounting for low positive predictive value (72%) of MR examination. Posterior horn tears of menisci are likely to be missed on arthroscopy. Out of 6 false positive cases of meniscus tear, 4 were located predominately in the posterior horn and 2 in the anterior horn. Thus, acceptance of MRI findings as false positive is controversial. CONCLUSIONS MRI is a useful non-invasive modality having high diagnostic accuracy, sensitivity and negative predictive value making it a very reliable screening test for diagnosis of internal derangements of knee joint. Thus, MRI saves many knees from unnecessary arthroscopies.
2021
Knee joint is the largest and complex joint of the body and also most frequently injured joint in sportsmen due to the lack of bony support. The stability of the joint is highly dependent on its supporting ligamentous structures; therefore, injuries of ligaments and menisci are extremely common. MRI has virtually replaced conventional arthrography and other modalities for the evaluation of menisci and cruciate ligaments [3]. Compared with CT scans, MRI provides superior anatomic and pathological status of soft tissues, ligaments, fibro cartilage and articular cartilage. Since the 1980’s, diagnostic arthroscopy has been used frequently to show intra-articular abnormalities with more than 95% accuracy depending on the expertise of the arthroscopist [6]. During arthroscopy, all the internal structures are visualized, the abnormality detected and treated as well. MRI has enormous impact on musculoskeletal imaging and knee is the most frequently imaged joint. It is non- invasive and does...
Comparison of Diagnostic Accuracy of Physical Examination and MRI in the Most Common Knee Injuries
Applied Sciences
Purpose: This study evaluated the diagnostic accuracy of physical examination and magnetic resonance imaging (MRI) in knee injuries. Methods: Ninety-six patients at a regional hospital were included in the study. Each participant underwent a physical examination in which menisci and ACL were evaluated. Knee joint MRI was collected from each patient. Physical examination and MRI scans were then compared with knee arthroscopy findings as a golden standard for meniscal and ligamentous lesions. The data were analyzed and specificity and sensitivity were calculated and correlated on receiver operating characteristics (ROC) curves. Results: Knee arthroscopy diagnosed 32 total ACL ruptures, 45 medial meniscus and 17 lateral meniscus lesions. Three patients were diagnosed with bilateral meniscal lesions. The highest sensitivities were the McMurray test (87.5%) for medial meniscus (MM) and the Thessaly test (70%) for lateral meniscus (LM). The most sensitive ACL test was Lachman (84.5%), whe...
International Orthopaedics, 2008
The aim of this study was to detect the accuracy of routine magnetic resonance imaging (MRI) done in different centres and its agreement with arthroscopy in meniscal and ligamentous injuries of the knee. We prospectively examined 70 patients ranging in age between 22 and 59 years. History taking, plain X-ray, clinical examination, routine MRI and arthroscopy were done for all patients. Sensitivity, specificity, accuracy, positive and negative predictive values, P value and kappa agreement measures were calculated. We found a sensitivity of 47 and 100%, specificity of 95 and 75% and accuracy of 73 and 78.5%, respectively, for the medial and lateral meniscus. A sensitivity of 77.8%, specificity of 100% and accuracy of 94% was noted for the anterior cruciate ligament (ACL). We found good kappa agreements (0.43 and 0.45) for both menisci and excellent agreement (0.84) for the ACL. MRI shows high accuracy and should be used as the primary diagnostic tool for selection of candidates for arthroscopy. Level of evidence: 4. Résumé Le but de cette étude est de détecter un examen de routine l'IRM et la bonne correspondance entre ces constatations et les constatations arthroscopiques des lésions méniscales ou des lésions ligamentaires du genou. Nous avons réalisé une étude prospective de 70 patients âgés de 22 à 59 ans avec analyse de l'histoire clinique, des radiographies, de l'examen clinique, de l'examen IRM et des constatations arthroscopiques. La sensitivité, la spécificité et l'exactitude des constatations ont été évaluées de manière statistique. Nous avons trouvé respectivement une sensitivité de 47% et 100%, une spécificité de 95% et 75% et une exactitude des constatations de 73% et 78,5%, pour les lésions du ménisque interne ou du ménisque latéral. En ce qui concerne les ligaments croisés, la sensitivité est de 77,8%, la spécificité de 100% et l'exactitude des constatations de 94% avec une bonne correspondance Kappa (0,43 et 0,45) pour les ménisques et 0,84 pour le ligament croisé antérieur. L'IRM peut donc être utilisée comme un élément tout à fait sûr et routinier concernant le diagnostic primaire des lésions miniscales ou des lésions ligamentaires chez les patients devant bénéficier d'une arthroscopie. Niveau d'évidence : 4. Abbreviations MRI magnetic resonance imaging ACL anterior cruciate ligament
Journal of Ayub Medical College, Abbottabad : JAMC
Magnetic Resonance Imaging (MRI) is frequently advised to evaluate clinically suspected cases of meniscal injuries in our setup. The objective was to determine the diagnostic accuracy of MRI in meniscal injuries of knee joint and its effectiveness in selection of patients for arthroscopy. A Cross-sectional comparative study was conducted at Radiology Department Military Hospital (MH) Rawalpindi in collaboration with Orthopaedic Department Combined Military Hospital (CMH) Rawalpindi from 31 Jan 2007 to 1 Aug 2007. Fifty-seven patients with clinical suspicion of meniscal injuries were subjected to MRI. Arthroscopy was done only in 34 patients while 23 were excluded on the basis of MRI findings. MRI findings were compared with arthroscopic findings. Medial and lateral menisci were considered separately in each case. Among 57 patients only 30 showed significant tear on MRI. Arthroscopy was done in these cases. Arthroscopy was considered on clinical grounds only in 4 patients who did not...