Download PDF
J Knee Surg 2020; 33(12): 1251-1255
DOI: 10.1055/s-0039-1693449
Original Article

Should We Prefer Magnetic Resonance Imaging to Physical Examination in Meniscal Tears

Gökhun Arıcan 
1   Department of Orthopaedics, Ankara Training and Research Hospital, Ankara, Turkey
,
Ahmet Özmeriç
1   Department of Orthopaedics, Ankara Training and Research Hospital, Ankara, Turkey
,
Özgür Şahin
1   Department of Orthopaedics, Ankara Training and Research Hospital, Ankara, Turkey
,
Serkan İltar
2   Department of Orthopaedics, University of Health Sciences (UHS), Ankara Training and Research Hospital, Ankara, Turkey
,
Kadir Bahadır Alemdaroğlu
2   Department of Orthopaedics, University of Health Sciences (UHS), Ankara Training and Research Hospital, Ankara, Turkey
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

The aim of this study was to compare the sensitivity, specificity, accuracy, positive and negative predictive values of magnetic resonance imaging (MRI), and clinical examination in the diagnosis of meniscus tears with the findings obtained from the knee joint arthroscopy. A retrospective study was made of 452 patients who underwent knee arthroscopy due to meniscus tears between 2012 and 2017. Physical examination was performed using the Thessaly's, McMurray's, and Joint line tenderness tests (JLTT). On preoperative MRI, medial meniscal tears were observed in 292 patients, lateral meniscal tears in 96 patients, and medial and lateral meniscal tears in 64 patients. According to the arthroscopy results, 284 patients had medial meniscal tears, 108 patients had lateral meniscal tears, and 60 patients had medial and lateral meniscal tears. Sensitivity and specificity of the JLTT was determined as 93 and 86% respectively for medial meniscal tears and 94 and 89% for lateral meniscal tears. The McMurray's test was 60% sensitive, 68% specific for medial meniscal tears (MMT), and 73% sensitive and 68% specific for lateral meniscus tears (LMT). The Thessaly's test was 93% sensitive and 87% specific for medial meniscal tears; and 94% sensitive and 88% specific for LMT. Compared with the arthroscopic findings, MRI was observed to have sensitivity of 94% for MMT and 84% for LMT. For specificity, the values were 89% for MMT and 91% for LMT. Accuracy was 89% for MMT and 86% for LMT. In comparison with the arthroscopic findings, the triple test was determined to have sensitivity of 92% for MMT and 89% for LMT. The specificity was 88% for MMT and 91% for LMT. The results of this study showed that a combination of selected physical examination methods is as sensitive as MRI in the diagnosis of meniscus tears.

Keywords

meniscal tears - McMurray's test - JLTT - Thessaly's test


Publication History

Received: 28 October 2018

Accepted: 19 May 2019

Article published online:
09 July 2019

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Saavedra MÁ, Navarro-Zarza JE, Villaseñor-Ovies P. et al. Clinical anatomy of the knee. Reumatol Clin 2012; 8 (Suppl. 02) 39-45
    CrossrefPubMedGoogle Scholar
  • 2 Bhagia S, Xing S, Weinik M. Meniscal Injury: Background, Pathophysiology, Epidemiology. Medscape; 2014. . Accessed June 7, 2019 at: https://emedicine.medscape.com/article/308054-overview
    Google Scholar
  • 3 Englund M, Guermazi A, Gale D. et al. Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med 2008; 359 (11) 1108-1115
    CrossrefPubMedGoogle Scholar
  • 4 McNally EG. Magnetic resonance imaging of the knee Is accurate and helps in making therapeutic decisions. BMJ 2002; 325 (7356): 115-116
    CrossrefPubMedGoogle Scholar
  • 5 Fox MG. MR imaging of the meniscus: review, current trends, and clinical implications. Magn Reson Imaging Clin N Am 2007; 15 (01) 103-123
    CrossrefPubMedGoogle Scholar
  • 6 Ryzewicz M, Peterson B, Siparsky PN, Bartz RL. The diagnosis of meniscus tears: the role of MRI and clinical examination. Clin Orthop Relat Res 2007; 455 (455) 123-133
    CrossrefPubMedGoogle Scholar
  • 7 Nguyen JC, De Smet AA, Graf BK, Rosas HG. MR imaging-based diagnosis and classification of meniscal tears. Radiographics 2014; 34 (04) 981-999
    CrossrefPubMedGoogle Scholar
  • 8 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
    CrossrefPubMedGoogle Scholar
  • 9 Thomas S, Pullagura M, Robinson E, Cohen A, Banaszkiewicz P. The value of magnetic resonance imaging in our current management of ACL and meniscal injuries. Knee Surg Sports Traumatol Arthrosc 2007; 15 (05) 533-536
    CrossrefPubMedGoogle Scholar
  • 10 Behairy NH, Dorgham MA, Khaled SA. Accuracy of routine magnetic resonance imaging in meniscal and ligamentous injuries of the knee: comparison with arthroscopy. Int Orthop 2009; 33 (04) 961-967
    CrossrefPubMedGoogle Scholar
  • 11 Chambers S. et al. The accuracy of magnetic resonance imaging in detecting meniscal pathology. J R Nav Med Serv 2012; 100 (02) 157-160
    PubMedGoogle Scholar
  • 12 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
    CrossrefPubMedGoogle Scholar
  • 13 Muhle C, Ahn JM, Dieke C. Diagnosis of ACL and meniscal injuries: MR imaging of knee flexion versus extension compared to arthroscopy. Springerplus 2013; 2 (01) 213
    CrossrefPubMedGoogle Scholar
  • 14 Fischer SP, Fox JM, Del Pizzo W, Friedman MJ, Snyder SJ, Ferkel RD. Accuracy of diagnoses from magnetic resonance imaging of the knee. a multi-center analysis of one thousand and fourteen patients. J Bone Joint Surg Am 1991; 73 (01) 2-10
    CrossrefPubMedGoogle Scholar
  • 15 Muellner T, Weinstabl R, Schabus R, Vécsei V, Kainberger F. The diagnosis of meniscal tears in athletes. a comparison of clinical and magnetic resonance imaging investigations. Am J Sports Med 1997; 25 (01) 7-12
    CrossrefPubMedGoogle Scholar
  • 16 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
    CrossrefPubMedGoogle Scholar
  • 17 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
    CrossrefPubMedGoogle Scholar
  • 18 Strobel M, Stedtfeld H-W. Evaluation of the femoropatellar joint, In: diagnostic evaluation of the knee. Heidelberg, Berlin: Springer; 1990
    CrossrefGoogle Scholar
  • 19 Drosos GI, Pozo JL. The causes and mechanisms of meniscal injuries in the sporting and non-sporting environment in an unselected population. Knee 2004; 11 (02) 143-149
    CrossrefPubMedGoogle Scholar
  • 20 Greis PE, Bardana DD, Holmstrom MC, Burks RT. Meniscal injury: I. Basic science and evaluation. J Am Acad Orthop Surg 2002; 10 (03) 168-176
    CrossrefPubMedGoogle Scholar
  • 21 Evans PJ, Bell GD, Frank C. Prospective evaluation of the McMurray test. Am J Sports Med 1993; 21 (04) 604-608
    CrossrefPubMedGoogle Scholar
  • 22 Hattam P, Smeatham A. Special tests in musculoskeletal examination: an evidence-based guide for clinicians. China: Elsevier; 2010
    Google Scholar
  • 23 Lotysch M. et al. Magnetic resonance imaging in the detection of meniscal injuries. Magn Reson Imaging 1986; 4 (02) 185
    CrossrefPubMedGoogle Scholar
  • 24 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
    CrossrefPubMedGoogle Scholar
  • 25 Tandoğan R, Alparslan M. Diz Cerrahisi. Haberal Vakfı; Ankara: 1999: 5-18
    Google Scholar
  • 26 Urquhart M. et al. Meniscal injuries in the adult. Orthopaedic Sports Medicine: Principles and Practice 2002; 2: 1669-1673
    PubMedGoogle Scholar
  • 27 Quinn SF, Brown TF. Meniscal tears diagnosed with MR imaging versus arthroscopy: how reliable a standard is arthroscopy?. Radiology 1991; 181 (03) 843-847
    CrossrefPubMedGoogle Scholar
  • 28 Justice WW, Quinn SF. Error patterns in the MR imaging evaluation of menisci of the knee. Radiology 1995; 196 (03) 617-621
    CrossrefPubMedGoogle Scholar
  • 29 Spiers AS, Meagher T, Ostlere SJ, Wilson DJ, Dodd CA. Can MRI of the knee affect arthroscopic practice? a prospective study of 58 patients. J Bone Joint Surg Br 1993; 75 (01) 49-52
    CrossrefPubMedGoogle Scholar
  • 30 Boden SD, Davis DO, Dina TS. et al. A prospective and blinded investigation of magnetic resonance imaging of the knee. abnormal findings in asymptomatic subjects. Clin Orthop Relat Res 1992; (282) 177-185
    PubMedGoogle Scholar
  • 31 Cheung LP, Li KC, Hollett MD, Bergman AG, Herfkens RJ. Meniscal tears of the knee: accuracy of detection with fast spin-echo MR imaging and arthroscopic correlation in 293 patients. Radiology 1997; 203 (02) 508-512
    CrossrefPubMedGoogle Scholar
  • 32 Mesgarzadeh M, Moyer R, Leder DS. et al. MR imaging of the knee: expanded classification and pitfalls to interpretation of meniscal tears. Radiographics 1993; 13 (03) 489-500
    CrossrefPubMedGoogle Scholar
  • 33 Barnett MJ. MR diagnosis of internal derangements of the knee: effect of field strength on efficacy. AJR Am J Roentgenol 1993; 161 (01) 115-118
    CrossrefPubMedGoogle Scholar
  • 34 Fowler PJ, Lubliner JA. The predictive value of five clinical signs in the evaluation of meniscal pathology. Arthroscopy 1989; 5 (03) 184-186
    CrossrefPubMedGoogle Scholar
  • 35 Barry OC, Smith H, McManus F, MacAuley P. Clinical assessment of suspected meniscal tears. Ir J Med Sci 1983; 152 (04) 149-151
    CrossrefPubMedGoogle Scholar
  • 36 Anderson AF, Lipscomb AB. Clinical diagnosis of meniscal tears. description of a new manipulative test. Am J Sports Med 1986; 14 (04) 291-293
    CrossrefPubMedGoogle Scholar
  • 37 Shakespeare DT, Rigby HS. The bucket-handle tear of the meniscus. a clinical and arthrographic study. J Bone Joint Surg Br 1983; 65 (04) 383-387
    CrossrefPubMedGoogle Scholar
  • 38 Harrison BK, Abell BE, Gibson TW. The Thessaly test for detection of meniscal tears: validation of a new physical examination technique for primary care medicine. Clin J Sport Med 2009; 19 (01) 9-12
    CrossrefPubMedGoogle Scholar
  • 39 Mohan BR, Gosal HS. Reliability of clinical diagnosis in meniscal tears. Int Orthop 2007; 31 (01) 57-60
    CrossrefPubMedGoogle Scholar
  • 40 Khanda GE, Akhtar W, Ahsan H, Ahmad N. Assessment of menisci and ligamentous injuries of the knee on magnetic resonance imaging: correlation with arthroscopy. J Pak Med Assoc 2008; 58 (10) 537-540
    PubMedGoogle Scholar
  • 41 Liodakis E, Hankemeier S, Jagodzinski M, Meller R, Krettek C, Brand J. The role of preoperative MRI in knee arthroscopy: a retrospective analysis of 2,000 patients. Knee Surg Sports Traumatol Arthrosc 2009; 17 (09) 1102-1106
    CrossrefPubMedGoogle Scholar
  • 42 Dixon AK. Magnetic resonance imaging of meniscal tears of the knee. J Bone Joint Surg Br 1996; 78 (02) 174-176
    CrossrefPubMedGoogle Scholar
  • 43 Majewski M, Susanne H, Klaus S. Epidemiology of athletic knee injuries: a 10-year study. Knee 2006; 13 (03) 184-188
    CrossrefPubMedGoogle Scholar
  • 44 Watanabe AT, Carter BC, Teitelbaum GP, Bradley Jr WG. Common pitfalls in magnetic resonance imaging of the knee. J Bone Joint Surg Am 1989; 71 (06) 857-862
    CrossrefPubMedGoogle Scholar