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Background: Approx. 28% of patients presents to orthopedic OPD with complaints of knee pain. Common medical complications include an unstable knee, chronic knee pain, and post traumatic arthritis. Aim: To study the correlation between clinical, magnetic resonance imaging (MRI), and arthroscopic findings in knee injuries. Materials and Methods: Abou...
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Objective The aim of this work is to evaluate the diagnostic accuracy of 0.3T sectoral MR imaging, compared with arthroscopy, for meniscal, cruciate ligaments and chondral knee lesions. Materials and Methods We conducted a retrospective study analyzing all the consecutive knees subjected to arthroscopy at our institution between January 2014 and Ju...
Introduction:
Chronic anterior cruciate ligament (ACL) tear might be difficult to diagnose on MRI. Indirect signs might be a typical meniscal or cartilage lesion, or a spontaneous anterior drawer visualized by a decreased angle of the posterior cruciate ligament (PCL).
Presentation of case:
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Magnetic resonance imaging (MRI) is the most accurate imaging technique in the diagnosis of meniscal lesions and represents a standard tool in knee evaluation. MRI plays a critical role in influencing the treatment decision and enables information that would obviate unnecessary surgery including diagnostic arthroscopy. An accurate interpretation of...
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Citations
... MRI confirms the clinical diagnosis, and the patient can be scheduled for therapeutic arthroscopy. 16 The inferior surface of the meniscus is especially sensitive to this arthroscopic defect. As a result, accepting MRI data as false positives is debatable. ...
... MRI has high sensitivity and a low false-negative rate, so it can be used to avoid diagnostic arthroscopy. 16 As a result, we conclude that MRI is a helpful non-invasive technique with excellent diagnostic accuracy, sensitivity, and NPV, making it a very reliable screening test for internal derangements at the knee joint. In cases where arthroscopy isn't an option, such as peripheral meniscus tears and inferior surface rips, MRI can help. ...
p> Background: This study aims to compare the correlation between clinical findings and magnetic resonance imaging with arthroscopic findings in meniscal and anterior cruciate ligament (ACL) injuries.
Methods: This was a prospective study of 60 patients with ACL and meniscal injuries of the knee who were admitted between October 2020 and October 2021, who underwent clinical examination, MRI, and arthroscopy of the knee.
Results: In our study of 60 cases, there were 44 male and 16 female patients ranging from 18 to 45 years, with the majority of patients between the ages of 25 and 35. The clinical examination had a sensitivity of 88%, specificity of 100%, and accuracy of 90% for ACL, the sensitivity of 80%, specificity of 100%, and accuracy of 90% for medial meniscus, and sensitivity of 50%, specificity of 100%, and accuracy of 83.33% for lateral meniscus. Magnetic resonance imaging (MRI) had a sensitivity of 100%, specificity of 100%, and accuracy of 100% for ACL, the sensitivity of 100%, specificity of 66.67%, and accuracy of 83.33% for medial meniscus, and sensitivity of 100%, specificity of 85%, and accuracy of 90% for lateral meniscus.
Conclusions: In conclusion, the current investigation emphasizes the importance of clinical diagnosis, as the positive predictive value (PPV) for all lesions is high. An MRI provides an additional diagnostic tool for ligament and meniscal injuries of the knee. The diagnostic accuracy of all lesions was in the 90th percentile. Because the negative predictive value (NPV) for all lesions is substantial, MRI is utilized to confirm the diagnosis and rule out pathology.</p
... Our study was comparable with many similar studies. [11][12][13][14][15] MRI can detect even minute meniscal lesions including the intrasubstance degeneration, which gives high signal intensity image in MRI. ...
... Previous studies have reported a strong relation between MRI and arthroscopic findings and confirmed the value of MRI in assessing IDK. [12][13][14] Gupta et al. [12] reported that MRI is an effective modality with high sensitivity, diagnostic accuracy, and NPV. Hence, it is a very reliable screening test for diagnosing meniscal and ligament injuries. ...
... These results are similar to our observations. Puri et al. [13] reported that MRI has a significant role when clinical signs and symptoms are inconclusive, which will be more beneficial in avoiding unnecessary arthroscopic surgery. Esmaili Jah et al. [14] concluded that a well-performed repeated physical examination can sometimes be as good as MRI. ...
Introduction: Complete evaluation of knee injury includes detailed clinical examination, radiological evaluation, and arthroscopy. Objective: The objective of this study was to compare the effectiveness of clinical, magnetic resonance imaging (MRI), and arthroscopic findings in meniscal and cruciate ligament injuries. Patients and Methods: A cross-sectional study of 40 post knee injury symptomatic patients aged 20–40 years. Clinical and MR imaging findings were compared with arthroscopic findings (considering arthroscopy as the gold standard diagnostic test). The specificity, sensitivity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were calculated and compared. Results: The specificity, sensitivity, PPV, NPV, accuracy of clinical examination, and MRI were similar for anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) injuries. The diagnostic accuracy of clinical examination and MRI were 82.5% and 90%, respectively, and 95% and 92.5% for medial meniscal and lateral meniscal injuries, respectively, and 97.5% and 100% for ACL and PCL injuries, respectively. Conclusion: The diagnostic accuracy of clinical examination is similar to MRI for ligament injuries and marginally lower for meniscal injuries. MRI is useful to clarify clinical diagnosis in clinical cases of meniscal and cruciate ligament injuries that are doubtful.
... Spolehlivost MRI při diagnostice poranění měkkého kolene je v literatuře podrobně studována (1,2,7,8,9,14,16,17,18,20,21). Žádná z citovaných prací však nehodnotí tak rozsáhlý soubor dat, jako naše práce. ...
... Singh et al. (18) hodnotili v souboru 173 pacientů na 0,5 T přístroji poranění LCA. Jednalo se pouze o pacienty po recentním traumatu. ...
... Myslíme si, že je důležitá jednotná terminologie a spolupráce radiologem. K podobným závěrům dospěl i Subhash (18). Rovněž porovnává kliniku, MRI a ASK, a to na souboru 30 pacientů. ...
PURPOSE OF THE STUDY Our retrospective study presents the comparison of the preoperative magnetic resonance imaging of the knee joint - MRI - and the arthroscopic finding - ASC. Its aim is to find out how a positive or a negative finding of MRI corresponds with the operative finding and how much the experience of radiologist contributes to the conformity. MATERIAL AND METHODS The MRI findings of knee joints treated surgically at two departments in 2013 and 2014 were assessed. The MRI was performed in a total of 470 patients who subsequently underwent an arthroscopic surgery. A conformity or a non-conformity in anterior, posterior horn and complete rupture of both menisci and in partial or complete tear of anterior cruciate ligament - LCA was searched for. The sensitivity, specificity and accuracy of MRI were established. The difference between experienced and less experienced radiologists was evaluated. The analysis of the radiology report, surgical protocol of ASC and medical history in the documentation was performed. The cartilage was not subject to evaluation. The finding of Grade 1 meniscus tear on MRI was evaluated as negative. Grade 2 and Grade 3 were evaluated as positive. RESULTS Comparison of the preoperative MRI and the arthroscopic finding 1. The group with MRI reported 3 % of diagnostic arthroscopies. The control group without MRI (551 ASC) reported 15 % diagnostic arthroscopies. 2. Low sensitivity of MRI (0.67) in negative findings of ASC. It concerned 7 cases in which a pathological finding was identified on a MRI scan, but not by ASC. In two cases the repeated arthroscopy confirmed that a pathology inside the knee joint was overlooked by the arthroscopist. In the remaining five cases, the clinical finding improved without a repeated surgery. 3. High sensitivity of MRI is shown in the most frequent finding - posterior horn of medial meniscus (0.94). 4. Lower sensitivity (0.76) in partial and (0.83) in complete ACL tear. It increases to 0.93 if partial and complete tear are put together. Both MRI and ASC detect the pathology of ligament, but do not agree in terms of terminology. 5. Lower sensitivity (0.78) was seen in posterior horn of lateral meniscus, most likely due to its complicated anatomy. 6. Specificity of complete tear of medial meniscus tear is 0.99. Lower specificity in the posterior horn of medial meniscus (0.81) shows a higher number of positive MRI findings in negative ASC findings. Some posterior horn tear can be overlooked by an inexperienced surgeon. The MRD findings need to be studied. 7. High specificity (0.99) was described in negative findings. In three cases only, the surgeon discovered a pathological finding, not revealed by MRI scan. It always concerned a tear within the posterior horn of the medial meniscus. 8. Specificity (0.88, 0.93 or 0.86, respectively) in partial, complete and all ACL damages in total. 9. We concluded that contributing to the degree of agreement between MRI and ASC is also the experience of a radiologist. The most experienced radiologist evaluated 190 of 470 MRI scans, the remaining twelve radiologists assessed 280 scans. The posterior horn of the medial meniscus - sensitivity or specificity evaluated by an experienced radiologist (0.98 and 0.88, respectively) and inexperienced radiologist (0.91 and 0.79). The specificity and sensitivity in complete ACL tears - by experienced radiologist (0.91 and 0.94, respectively) and inexperienced radiologist (0.81 and 0.90, respectively). The test accuracy of the experienced radiologist in evaluating the most frequent injuries of soft knee structures was by 9-10 % higher than of the inexperienced radiologist. DISCUSSION The results obtained by the other authors show that the sensitivity and specificity range from 0.6 to 0.9. They agree that the MRI is unsuitable for assessing the cartilage. We confirm that the results are worse when evaluating the posterior horn of the lateral meniscus. We have also proven that the radiologist s experience does play an important role. It can be the reason for a high degree of difference between the results of various authors. Some of them give preference to a clinical examination or a diagnostic arthroscopy instead of the MRI. At our department, MRI is indicated if we are convinced it can help with the indication or where it will suggest what to focus on during the surgery. CONCLUSIONS A preoperative MRI scan can prevent an unnecessary arthroscopy. It displays structures to the surgeon which shall be reviewed in detail during the surgery. We recommend paying attention to Grade 2 MRI findings, positive MRI findings on the posterior horn of medial meniscus and to MRI findings on partial ACL tears. Such menisci and ligaments shall be carefully reviewed. Clinical preoperative examination and cooperation between the surgeon, the "arthroscopist", and the radiologist is essential. The experience of the radiologist also plays a role when evaluating the MRI scan. We have introduced MRI ward rounds. Key words: MRI, knee joint, knee arthroscopy, sensitivity, specificity, accuracy.
... In a study done by Claus Muhle et.al 66 in 2013, study of diagnosis of ACL and meniscal injuries: MR imaging of knee flexion versus extension compared to arthroscopy the diagnosis of meniscal injuries, however, was not superior at both flexion positions compared to commonly performed examinations at knee extension. . The accurcy of MRI in detecting cruciate ligament tears was between 80-96% against 82-93% for clinical examination. ...
Objective:
This study aimed to assess the meniscus and cruciate ligament lesions of the knee using magnetic resonance imaging (MRI) and to investigate the correlation between clinical and MRI diagnoses.
Patients and methods:
Herein, we reviewed the electronic medical records of 240 patients who underwent knee MRI. The images were evaluated and then the clinical and MRI diagnoses were compared.
Results:
Of the 240 patients, 66% were male and the mean age was 40.6 ± 15.5 years (range, 2-79 years). Knee pain alone was the most common presenting symptom (50.64%) followed by pain after trauma (47.92%). Majority of the knee lesions were medial meniscus (MM) lesions (63%) followed by osteoarthritis (48%) and ACL lesions (35%). The majority of the MM and ACL lesions were tears (54.6% and 69.41%, respectively) followed by degeneration (33.55% and 17.65%, respectively). However, the MM lesions were predominantly observed in the posterior horn (Odds ratio [OR], 152; 95% confidence interval (CI), 21.550-1072.113; P < 0.001). The ACL lesions were significantly more common in men than in women (OR, 0.355; 95% CI, 0.191-0.661; P = 0.001), and altered signal intensity on T2- and proton density-weighted images was the most common sign (P < 0.001). A strong compatibility was observed between the clinical and MRI diagnoses (Kappa = 0.141; P < 0.001).
Conclusion:
MM and ACL lesions are the most common injuries of the knee, which can be diagnosed by physical examination in most cases. Further confirmation by MRI should be reserved for doubtful cases only.
