Relationship between Clinical, MRI, and Arthroscopic Findings: A Guide to Correct Diagnosis of Meniscal Tears

Abstract

Purpose The aim of this prospective study was to compare and correlate clinical, MRI, and arthroscopic findings in cases of suspected meniscal tears. Using arthroscopic findings as the gold standard, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of clinical investigation and MRI were evaluated to determine if is possible, after a careful examination, to bypass MRI and perform directly arthroscopy in suspected cases.

Methods A total of 80 patients with a history of knee trauma, preoperative RX, and MRI underwent arthroscopy over an 8-month period at our department. All patients had a clinical examination performed by an experienced knee surgeon. These examiners evaluated and recorded the results of three tests: medial and lateral joint line tenderness test, McMurray's test, and Apley's test. The injury was classified as a meniscal tear if there were at least two positive tests. Finally, using the arthroscopic findings as the gold standard, sensibility, specificity, accuracy, positive and negative predictive values of clinical examination, and MRI were evaluated and compared.

Results Clinical examination performed by an experienced knee surgeon reported better sensitivity (91 vs. 85%), specificity (87 vs. 75%), accuracy (90 vs. 82%), positive predictive value (94 vs. 88%), and negative predictive value (81 vs. 71%) than MRI for medial meniscal tears. These parameters showed minimal differences for lateral meniscal tears.

Conclusion Clinical examination performed by an experienced knee surgeon provided equal or better results to diagnose meniscal injuries in comparison to MRI. MRI is not necessary to confirm these lesions and should not be used as the primary diagnostic tool.

Level of Evidence Level II, prospective study.

Keywords

meniscus - tears - knee - examination - meniscal tears - MRI

• References

• 1 Aagaard H, Verdonk R. Function of the normal meniscus and consequences of meniscal resection. Scand J Med Sci Sports 1999; 9 (03) 134-140
• 2 Fox AJ, Wanivenhaus F, Burge AJ, Warren RF, Rodeo SA. The human meniscus: a review of anatomy, function, injury, and advances in treatment. Clin Anat 2015; 28 (02) 269-287
• 3 Terry GC, Tagert BE, Young MJ. Reliability of the clinical assessment in predicting the cause of internal derangements of the knee. Arthroscopy 1995; 11 (05) 568-576
• 4 Mohan BR, Gosal HS. Reliability of clinical diagnosis in meniscal tears. Int Orthop 2007; 31 (01) 57-60
• 5 Nickinson R, Darrah C, Donell S. Accuracy of clinical diagnosis in patients undergoing knee arthroscopy. Int Orthop 2010; 34 (01) 39-44
• 6 Crawford R, Walley G, Bridgman S, Maffulli N. Magnetic resonance imaging versus arthroscopy in the diagnosis of knee pathology, concentrating on meniscal lesions and ACL tears: a systematic review. Br Med Bull 2007; 84 (01) 5-23
• 7 Rubin DA, Paletta Jr GA. Current concepts and controversies in meniscal imaging. Magn Reson Imaging Clin N Am 2000; 8 (02) 243-270
• 8 Esmaili Jah AA, Keyhani S, Zarei R, Moghaddam AK. Accuracy of MRI in comparison with clinical and arthroscopic findings in ligamentous and meniscal injuries of the knee. Acta Orthop Belg 2005; 71 (02) 189-196
• 9 Scholten RJ, Devillé WL, Opstelten W, Bijl D, van der Plas CG, Bouter LM. The accuracy of physical diagnostic tests for assessing meniscal lesions of the knee: a meta-analysis. J Fam Pract 2001; 50 (11) 938-944
• 10 Hing W, White S, Reid D, Marshall R. Validity of the McMurray's Test and modified versions of the test: a systematic literature review. J Manual Manip Ther 2009; 17 (01) 22-35
• 11 Lotysch M, Mink J, Crues JV, Schwartz SA. Magnetic resonance imaging in the detection of meniscal injuries. Magn Reson Imaging 1986; 4: 185
• 12 Crues III JV, Mink J, Levy TL, Lotysch M, Stoller DW. Meniscal tears of the knee: accuracy of MR imaging. Radiology 1987; 164 (02) 445-448
• 13 Rose NE, Gold SM. A comparison of accuracy between clinical examination and magnetic resonance imaging in the diagnosis of meniscal and anterior cruciate ligament tears. Arthroscopy 1996; 12 (04) 398-405
• 14 Abdon P, Lindstrand A, Thorngren KG. Statistical evaluation of the diagnostic criteria for meniscal tears. Int Orthop 1990; 14 (04) 341-345
• 15 Rangger C, Klestil T, Kathrein A, Inderster A, Hamid L. Influence of magnetic resonance imaging on indications for arthroscopy of the knee. Clin Orthop Relat Res 1996; (330) 133-142
• 16 Morrison WB, Sanders TG. Imaging of the knee. Problem Solving in Musculoskeletal Imaging. Mosby Elsevier Inc.; 2008: 567-568
• 17 Englund M, Niu J, Guermazi A. , et al. Effect of meniscal damage on the development of frequent knee pain, aching, or stiffness. Arthritis Rheum 2007; 56 (12) 4048-4054
• 18 Link TM, Steinbach LS, Ghosh S. , et al. Osteoarthritis: MR imaging findings in different stages of disease and correlation with clinical findings. Radiology 2003; 226 (02) 373-381
• 19 Miller GK. A prospective study comparing the accuracy of the clinical diagnosis of meniscus tear with magnetic resonance imaging and its effect on clinical outcome. Arthroscopy 1996; 12 (04) 406-413
• 20 Magee T, Williams D. 3.0-T MRI of meniscal tears. Am J Roentgenol 2006; 187 (02) 371-375
• 21 Van Dyck P, Vanhoenacker FM, Lambrecht V. , et al. Prospective comparison of 1.5 and 3.0-T MRI for evaluating the knee menisci and ACL. J Bone Joint Surg Am 2013; 95 (10) 916-924
• 22 Ercin E, Kaya I, Sungur I, Demirbas E, Ugras AA, Cetinus EM. History, clinical findings, magnetic resonance imaging, and arthroscopic correlation in meniscal lesions. Knee Surg Sports Traumatol Arthrosc 2012; 20 (05) 851-856
• 23 Kocabey Y, Tetik O, Isbell WM, Atay OA, Johnson DL. The value of clinical examination versus magnetic resonance imaging in the diagnosis of meniscal tears and anterior cruciate ligament rupture. Arthroscopy 2004; 20 (07) 696-700