Complete tear of the lateral meniscus posterior root is associated with meniscal extrusion in anterior cruciate ligament deficient knees (original) (raw)
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Eastern Journal Of Medicine, 2019
The aim of this study was to determine the accuracy of MRI in meniscus and cruciate ligament (CL) pathologies. Another aim of the study was to determine the accuracy of MRI in the determination of meniscus tears in cases with and without ACL tear. The study included 96 patients who were applied for meniscus and/or CL injury and examined by MRI between 2015-2018.The meniscus and CL were examined by MRI for findings of tears. The arthroscopy results were accepted as the gold standard and compared with the MRI results. The sensitivity, specificity, PPV, NPV, accuracy of MRI were calculated in the determination of meniscus and CL tears. The patients were also separated into 2 groups as those with ACL tear and without ACL tear. MRI accuracy in meniscus tear was compared between the 2 groups. The sensitivity, specificity, PPV, NPV and accuracy rates of MRI in the evaluation of the medial meniscus tears were 93.5%, 88.8%, 97.3%, 76.1% and 92.7% respectively. These values were 64.8%, 94.9%, 88.8%, 81.1% and 83.3% for the lateral meniscus (LM), 55.5%, 81.6%, 64.5%, 75.3% and 71.8% for ACL and 100%, 98.9%, 66.6%, 100% and 98.9% for posterior cruciate ligament. In the determination of LM tears, the specificity of MRI was significantly lower in the group with ACL tear (p=0.021).No statistically significant difference was found in respect of the other values. MRI has lower accuracy rates for ACL tear than for the meniscus. There was no significant difference in the accuracy of the MRI of meniscus tears between the groups with and without ACL tear.
IOSR Journals , 2019
Background: The knee joint is a common site of injury due to trauma, repetitive activities, and sports activities.Clinical diagnosis, encompassing an accurate history, thorough examination and interpretation of investigations, is an art all doctors are expected to master during their career. A number of previous studies have examined the accuracy of clinical diagnosis in traumatic meniscal or ligamentous injuries of the knee. Multiple imaging modalities are currently used to evaluate pathologic conditions of the knee. Magnetic resonance imaging has a better soft tissue contrast and multi planar slice capability which has revolutionized and has become the ideal modality for imaging complex anatomy of the knee joint.Arthroscopy considered to be the 'gold standard' investigative method. Which can be used in its dual mode, either as diagnostic and/or as therapeutic tool.Aim of the study was to correlate clinical, radiological and arthroscopic findings of meniscal and anterior cruciate ligament injuries of knee. Materials and methods:This is a prospective study involving 30 patients with history of knee injuries who have admitted in Department of Orthopedics, Narayana medical college was conducted for a period of two year and were scheduled to undergo arthroscopic surgery of the knee for either meniscal or ACL injury based on clinical and Magnetic Resonance Imaging (MRI) findings were included in the study. Results:30 patients were studied comparing clinical examination, MRI with arthroscopy and were analyzed. Clinical examination showed sensitivity, specificity, Positive Predictive value (PPV), Negative Predictive value (NPV), accuracy of 68.1%,62.5%,83.3%,41.6%,66.6%respectively for medial meniscustear,75%,83.3%,75.0%,83.3%,80% respectively for lateral meniscus tear and 91.3%,85.7%,95.4%,75.0%,90.0%, respectively for Anterior Cruciate Ligament (ACL) tear. MRI findings showed sensitivity, specificity PPV, NPV, accuracy of 68.1%, 75.0%, 88.2%,46.1%,70.0% respectively for medial meniscus, 50.0%,83.3%,66.6%,71.4%,70.0% respectively for lateral meniscus tear, 78.2%,85.7%,94.7%,54.5%,and 80.0% respectively for ACL tear. Conclusion: Clinical tests to detect ACL and lateral meniscus injuries have a high degree of correlation when compared to arthroscopy and MRI. Clinical tests to detect medial meniscus injuries have a lower degree of correlation compared to MRI and arthroscopy.
IOSR Journals , 2019
Background :The knee joint is a common site of injury due to trauma, repetitive activities, and sports activities.Clinical diagnosis, encompassing an accurate history, thorough examination and interpretation of investigations, is an art all doctors are expected to master during their career. A number of previous studies have examined the accuracy of clinical diagnosis in traumatic meniscal or ligamentous injuries of the knee. Multiple imaging modalities are currently used to evaluate pathologic conditions of the knee. Magnetic resonance imaging has a better soft tissue contrast and multi planar slice capability which has revolutionized and has become the ideal modality for imaging complex anatomy of the knee joint.Arthroscopy considered to be the 'gold standard' investigative method. Which can be used in its dual mode, either as diagnostic and/or as therapeutic tool.Aim of the study was to correlate clinical, radiological and arthroscopic findings of meniscal and anterior cruciate ligament injuries of knee. Materials and methods :This is a prospective study involving 30 patients with history of knee injuries who have admitted in Department of Orthopaedics, Narayana medical college was conducted for a period of two year and were scheduled to undergo arthroscopic surgery of the knee for either meniscal or ACL injury based on clinical and Magnetic Resonance Imaging (MRI) findings were included in the study. Results :: 30 patients were studied comparing clinical examination, MRI with arthroscopy and were analyzed. Clinical examination showed sensitivity, specificity, Positive Predictive value (PPV), Negative Predictive value (NPV), accuracy of 68.1%,62.5%,83.3%,41.6%,66.6%respectively for medial meniscus tear,75%,83.3%,75.0%,83.3%,80% respectively for lateral meniscus tear and 91.3%,85.7%,95.4%,75.0%,90.0%, respectively for Anterior Cruciate Ligament (ACL) tear. MRI findings showed sensitivity, specificity PPV, NPV, accuracy of 68.1%,75.0%,88.2%,46.1%,70.0% respectively for medial meniscus, 50.0%,83.3%,66.6%,71.4%,70.0% respectively for lateral meniscus tear, 78.2%,85.7%,94.7%,54.5%,80.0% respectively for ACL tear. Conclusion: Clinical tests to detect ACL and lateral meniscus injuries have a high degree of correlation when compared to arthroscopy and MRI. Clinical tests to detect medial meniscus injuries have a lower degree of correlation compared to MRI and arthroscopy.
International Journal of Research Publications, 2021
Objective: Anterior Cruciate Ligament (ACL) tear can decrease quality of life especially in athlete. The physical athletic activities are external factors for ACL tear. There are also internal factor and one them is anatomical factor. Therefore, it is necessary to determine the knee morphometric risk factor profile for ACL tear. Materials and Methods: This is a descriptive observational retrospective study with case-control design. The study data consisted of the patient's medical records and knee joint MRI study results which were collected through consecutive sampling. Morphometric variable measurements in the form of Notch Width (NW), Notch Width Index (NWI),-angle, Q-angle (Quadricep angle) and Medial Tibial Posterior Slope (MTPS) were assessed by two assessors. Afterwards, the mean value of each variable was determined. Results: In ACL tear group, the mean±SD value for NW, NWI, Alpha angle, Q-angle and MTPS was 2.02±0.21, 0.27±0,02, 37.97±4.69, 11.06±3.21, and 9.24±2.73, respectively, while in non-ACL tear group the mean±SD value was 1.97±0.23, 0.29±0.02, 35.59±4.52, 12.03±4.08 and 7.70±3.53, respectively. Conclusion: The mean NWI and Q-angle values in ACL tear group were smaller than in non-ACL tear group. The mean NW, Alpha angle, and MTPS values in ACL group were greater than in non-ACL tear group.
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
Orthopaedic Journal of Sports Medicine, 2022
Background: Preoperative diagnosis of concomitant meniscal tears in pediatric and adolescent patients with acute anterior cruciate ligament (ACL) deficiency is challenging. Purpose: To investigate the diagnostic performance of magnetic resonance imaging (MRI) in detecting meniscal injuries for pediatric and adolescent patients with acute ACL tears. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: The authors retrospectively identified patients aged ≤18 years who underwent acute ACL reconstruction between 2006 and 2018 at 2 tertiary academic hospitals. The primary outcomes were arthroscopically confirmed medial, lateral, or any (defined as medial and/or lateral) meniscal tears. To control for chronically deficient knees, patients must have received their MRI study within 4 weeks of injury and must have undergone surgery no more than 8 weeks after their MRI study. Preoperative MRI reports were compared with the gold standard of arthroscopically confirmed tears to...
2019
Introduction: MRI is a noninvasive, radiation free modality with a good ability to evaluate soft tissues. About 28% of populations among all population visits in hospital have complained with knee pain. There may be many causes such as infections, trauma, degenerative joint conditions, inflammatory conditions, and congenital lesions. Commonly injured ligament in knee is Anterior cruciate ligament (ACL) which is usually associated with Meniscal injures. In the body knee is important weight bearing joint of the body that provides mobility and stability during physical activity as well as balance while standing. Knee injuries like Traumatic injuries are frequently encountered both in general practice and in the hospital setting. Knee injury is offen caused by sports activities and may lead to severe pain and disability. Aim: The main aim of this study is to MRI evaluation in the knee injuries related to anterior cruciate ligament compared to arthroscopy. Material and methods: In this study 40 patients were included who were visiting to CCM hospital with suspected ACL injury. From all the patients detail history and clinical provisional diagnosis were taken. All the patients were taken for MRI examination followed by arthroscopy. Patients with injury of ACL and meniscal injuries were included in this study. MRI was analysis with the standard imaging planes of the knee were evaluated with each ACL bundle being classified as intact, partially torn, or completely torn. Result: In this study 40 patients were included with suspected ACL injuries, which are associated with pain, limitation of movement, and swelling of the knee joint. According to ACL tear seen in MRI 30 patients shows partial and 10 patients shows complete ACL tear whereas Arthroscopy shows 12 patients with partial and 28 patients shows complete tear. According to the associated injuries re-sampling the type of meniscal injuries,in comparing to MRI and Arthroscopy the incidence of medial meniscus tear was 26 and lateral meniscus tear was 14 in MRI and meniscus tear was 25 and lateral meniscus tear was 15 in Arthroscopy. Conclusion: MRI is commonly used diagnostic arthroscopy in most settings, and is considered an effective screening tool in most patients. MRI findings before arthroscopy help in the management of meniscal and ligament injuries. MRI has also been proved as cost effective.
American Journal of Sports Medicine, 2019
Background: Combined Anterior Cruciate Ligament (ACL) and Anterolateral ligament (ALL) reconstruction is associated with improved clinical outcomes compared to isolated intraarticular reconstruction but the indications are not precisely defined. It may be the case that patients with proven anterolateral injury on pre-operative imaging are most likely to benefit but the accuracy of MRI is not known. Hypothesis/Purpose: To evaluate the correlation between MRI findings and intra-operative anterolateral compartment exploration in acute ACL injured knees. The study hypothesis was that a positive correlation would be identified between imaging and surgical findings for injuries to the ALL/capsule and the iliotibial band and that pre-operative MRI would be associated with high sensitivity, specificity and accuracy for these parameters. Study Design: Case Series Methods: Between January 2016 to May 2016 patients presenting with an acute ACL injury were considered for study eligibility. A sample size calculation determined the numbers enrolled. Included patients underwent 1.5T MRI and this was evaluated by three investigators who attributed a Ferretti grade of injury to the anterolateral structures. At the time of ACL reconstruction, a lateral exploration was undertaken and macroscopic injuries were identified, classified and repaired. An evaluation of correlation between MRI and surgical exploration findings was performed. Results: patients participated in the study. 96% had an ALL/capsule injury. The sensitivity, specificity and accuracy of MRI in the evaluation of ALL/capsule injury, when using surgical exploration as a gold standard were 88%, 100% and 88.5% respectively. For evaluation of iliotibial band injury these values were 62.5%, 40% and 50%. The percentage agreement between MRI and surgical findings for ALL/capsule injury was 88% but only 65% for the ITB. The sensitivity and specificity of MRI for complete or partial tear of ALL and capsule were 78.6 and 41.7 respectively. The k test for correlation between surgical and MRI findigs was 0.27 for ITB abnormalities, 0.47 for ALL/capsule abnormalities, 0.23 for ALL/capsule determination of partial or complete tear and 0.49 for ALL/capsule determination of anterior or posterior tear. The overall percentage agreement between MRI and the classification based on surgical findings was only 53% and the Altman classification of kappa was fair. This suggests that whilst the classification is useful for description of surgical findings the grade cannot be reliably established from MRI, at least with the parameters used in the current study Conclusion: Surgical exploration demonstrates that injuries occur to the anterolateral structures in almost all acute ACL injured knees. Pre-operative MRI is highly sensitive, specific and accurate, for detection of abnormalities of the ALL/capsule and shows a high percentage of agreement with surgical findings. In contrast MRI has low sensitivity, specificity, and accuracy for the diagnosis of ITB injury. The agreement between MRI and surgical exploration with respect to ITB abnormality and determination of whether ALL/capsular tears were partial or complete was only fair.
Arthroscopy-the Journal of Arthroscopic and Related Surgery, 2008
We performed this prospective study to evaluate the incidence of meniscus tears arthroscopically and the effectiveness of magnetic resonance imaging (MRI) in detecting these lesions in patients with chronic anterior cruciate ligament (ACL)-deficient knees. Methods: We reviewed 50 patients (46 male and 4 female ) with a mean age of 27 years (range, 18 to 48 years) who underwent ACL reconstruction for chronic ACL tears. Injuries were classified as chronic because arthroscopy was performed after more than 6 weeks of injury. All 50 patients had clinical and MRI evaluation followed by knee arthroscopy. The MRI and arthroscopic findings were then analyzed by a single independent reviewer. The presence of meniscus tears and their morphologic types and locations were analyzed. The sensitivity, specificity, positive predictive value, and negative predictive value of MRI were calculated. Results: On arthroscopy, a medial meniscus tear was found in 18 patients (36%), a lateral meniscus tear was found in 11 patients (22%), both menisci were torn in 8 patients (16%), and no meniscus lesion was found in 13 patients (26%). The most common morphologic type of tear seen in the medial meniscus was "complex" (n ϭ 11 [42%]), and that in the lateral meniscus was "longitudinal" (n ϭ 10 [53%]). The posterior horn of the meniscus was the most common tear site. The overall sensitivity, specificity, positive predictive value, and negative predictive value for detecting meniscus tears in chronic ACL-deficient knees on MRI were 90%, 89%, 87%, 93%, respectively. Conclusions: We conclude from our study that in chronic ACL-deficient patients, the prevalence of posterior horn medial meniscus tears seems to be high. Anterior horn tears and radial and horizontal patterns of meniscus tears seem to be rare in chronic ACL deficiency. MRI correlates well with arthroscopy and has high negative predictive values. Level of Evidence: Level I, prognostic prospective study.