Diagnostic value of ultrasound in the discoid lateral meniscus of the knee / 中国骨伤

OBJECTIVE@#Based on the anatomical differences between discoid lateral meniscus(DLM) and normal lateral meniscus (NLM), this study aims to setting up the ultrasound examination parameters to distinguish DLM and NLM and explore the diagnostic value of these parameters on DLM.@*METHODS@#According to the inclusion, exclusion and matching criteria, 66 DLM patients(DLM group) and 132 NLM patients with other knee joint diseases(NLM group), hospitalized from October 2019 to June 2020, were included in this study. There were 18 males and 48 females in the DLM group, ranging in age from 3 to 60 years old, with a mean of (36.9±12.1) years old;36 males and 96 females in the NLM group, ranging in age from 3 to 60 years old, with a mean of (40.0±12.2) years old. Philips high frequency(3.0 to 12.0 MHz) linear array ultrasound probe was used to examine the lateral meniscus of all patients in two groups. Nine parameters including the thickness, width and the included angle of the anterior angle, body and posterior angle respectively in the lateral meniscus were measured. The included angke is formed by the chords of the upper and lower curved surfaces of the meniscus at the free edge. The independent t test was used to analyze the difference of the measured parameters between the DLM group and the NLM group. The receiver operating characteristic(ROC) curve was used to evaluate the cut-off value of each parameter for diagnosing DLM and the corresponding sensitivity, specificity, positive predictive value, negative predictive value, and area under the ROC curve(AUC).@*RESULTS@#The above 9 ultrasound measurement parameters between the DLM group and the NLM group had significant statistical differences(P<0.001). The ROC curve analysis method evaluated the cut-off value and diagnostic capabilities of these nine ultrasound parameters for DLM. The results showed that the cut-off value of the included angle of anterior part, body and posterior part were 25.85°, 24.85° and 29.15 °, respectively;and the sensitivity, specificity, negative predictive value, positive predictive value and AUC were significantly higher than other parameters, which were 88%, 91%, 79%, 95%, 0.94;89%, 94%, 82%, 97%, 0.96; 92%, 97%, 86%, 98%, 0.97, respectively.@*CONCLUSION@#Ultrasound diagnosis of DLM is feasible and reliable. The diagnostic ability of the included angle of the anterior part, body and posterior part in the lateral meniscus measured by ultrasound to diagnose DLM are significantly better than other ultrasound measurement parameters, and the sensitivity and specificity of those parameters are close to MRI. Therefore, ultrasound can be used as a reliable method for preliminary diagnosis of DLM.

Correlación entre hallazgos clínicos, de resonancia magnética y artroscópicos en el diagnóstico de rupturas meniscales / Relationship between clinical, MRI, and arthroscopic findings in meniscal tears

Objetivo: Evaluar y comparar la sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo y exactitud global de la exploración física y la resonancia magnética en el diagnóstico de rupturas meniscales, considerando los hallazgos artroscópicos como estándar de oro.Materiales y métodos: Se realizó un estudio de tipo prueba diagnóstica comparando la exploración física por un especialista y los hallazgos de resonancia magnética para el diagnóstico de lesiones meniscales en 140 pacientes, tomando como estándar de oro la artroscopia diagnóstica.Resultados: La exploración física tuvo una mayor especificidad que la resonancia magnética, con diferencia entre exploración física y resonancia magnética de 87.5% vs 42.4% y de 82.2% vs 33.3% en pruebas diagnósticas para menisco lateral y medial, respectivamente. Así mismo, se encontró una exactitud global mayor, con 82.2% vs. 63.3% para menisco lateral y 84.4% vs. 70% para menisco medial.Conclusión: La resonancia magnética en la presencia de una sospecha clínica alta de lesión de menisco es, en algunos casos, innecesaria para el diagnóstico de lesiones de menisco, y se debe reservar para ocasiones en las que los hallazgos clínicos no son concluyentes.Tipo de estudio: Prueba diagnóstica. Nivel de evidencia: II

Introduction: The aim of this study is to compare the accuracy of clinical examination and MRI in diagnosing meniscal tears, with diagnostic arthroscopy as the gold standard.Material and methods: In this study, designed as a diagnostic test, 140 patients underwent clinical examination by a specialist followed by MRI, and the results were compared to the presence or absence of meniscal tears during diagnostic arthroscopy.Results: The accuracy of clinical examination was 82.2% for lateral meniscal tears and 84.4% for medial meniscal tears. The accuracy of MRI was 63.3% for lateral meniscal tears and 70% for medial meniscal tears.Conclusion: MRI can, in some cases, be unnecessary when there is a positive clinical examination for meniscal tears and should be reserved for cases when clinical examination is not conclusive. Study type: Diagnostic test. Level of evidence: II

Avaliação da previsibilidade da sutura de menisco através da ressonância magnética / Predictability of meniscal suture by magnetic resonance imaging

The prediction of meniscus reparability is quite useful for surgeons to optimize surgical planning. The main objective of this study was to evaluate the ability of magnetic resonance imaging (MRI) to predict the suture of meniscal lesions. This was an unicentric retrospective study that included 104 patients who underwent knee joint ligament reconstruction and / or arthroscopy for the treatment of meniscal injury at knee joint level. The MRI images of the meniscus were evaluated and later the arthroscopic findings were used as the gold standard. After the operative procedure, the cases were allocated into two groups according to the necessity of meniscus suture: Sutured Group "MSu" (n = 58) and Non sutured Group "MNSu" (n = 150). Considering the lesion detection capacity in the medial meniscus, the sensitivity, specificity and accuracy of MR were 85.3%, 63.9% and 77.9%, respectively. The positive predictive value (PPV) was 81.7% and the negative predictive value (NPV) was 69.7%. The agreement between MRI and arthroscopy was moderate. For the lateral meniscus, sensitivity, specificity and accuracy of MRI were 80.6%, 89.0% and 86.5%, respectively, with PPV of 75.7% and NPV of 91.5% and a substantial agreement. Regarding suture predictability, the sensitivity, specificity and accuracy were respectively 60.3%, 66.7% and 64.9% with PPV of 41.2% and NPV of 81.3%, with weak agreement. According to the arthroscopy, the 58 meniscal lesions of the MSu group were more frequent in the posterior horn, had the longitudinal pattern and were located in the red-red vascular zone. In our study, MRI was not a good predictor of meniscal suture, although it is an useful tool for the diagnosis of medial and lateral meniscal lesions

Interposition of the Posterior Cruciate Ligament into the Medial Compartment of the Knee Joint on Coronal Magnetic Resonance Imaging

OBJECTIVE: The purpose of our study was to evaluate the overall prevalence and clinical significance of interposition of the posterior cruciate ligament (PCL) into the medial compartment of the knee joint in coronal magnetic resonance imaging (MRI). MATERIALS AND METHODS: We retrospectively reviewed 317 consecutive patients referred for knee MRI at our institution between October 2009 and December 2009. Interposition of the PCL into the medial compartment of the knee joint on proton coronal MRI was evaluated dichotomously (i.e., present or absent). We analyzed the interposition according to its prevalence as well as its relationship with right-left sidedness, gender, age, and disease categories (osteoarthritis, anterior cruciate ligament tear, and medial meniscus tear). RESULTS: Prevalence of interposition of PCL into the medial compartment of the knee joint was 47.0% (149/317). There was no right (50.0%, 83/166) to left (43.7%, 66/151) or male (50.3%, 87/173) to female (43.1%, 62/144) differences in the prevalence. There was no significant association between the prevalence and age, or the disease categories. CONCLUSION: Interposition of the PCL into the medial compartment of the knee joint is observed in almost half of patients on proton coronal MRI of the knee. Its presence is not associated with any particular factors including knee pathology and may be regarded as a normal MR finding.

Diagnostic accuracy of magnetic resonance imaging in meniscal injuries of knee joint and its role in selection of patients for arthroscopy

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 show significant tear on MRI. MRI showed Medial Meniscus [MM] injury in 23 patients and Lateral Meniscus [LM] injury in 10 patients. Arthroscopy confirmed MM injury in 17 patients and LM injury in 7 patients. MRI missed two MM and one LM injuries. This showed that MRI has sensitivity of 89.4% and specificity of 62% in diagnosing injuries of MM, while sensitivity of 87% and specificity of 88% in diagnosing injuries of LM. Diagnostic accuracy of MRI in MM and LM injuries was 76.4% and 88.2% respectively. MRI is accurate in diagnosing meniscal injuries of knee joint and is effective in selection of patients for arthroscopy

diagnostic value of sonography in bucket h and le tear of meniscus and complete MCL tear compared with arthroscopy

The concept of evaluating the musculoskeletal system with ultrasound was initially introduced in the late 1970s. For evaluating meniscal tears, which are a common injury in traumatic events of knee, linear probes with high resolution have been used. In this study, we compared the results of sonography with arthroscopy in diagnosing bucket h and le tear of meniscus and MCL tear. 218 clinically symptomatic knee joints with clinical indication of arthroscopy were examined by sonography in a referral sport medicine center. The patients eventually had arthroscopic exam. The results were compared, and statistically analyzed using Fisher's exact. In this study, of 218 patient who had arthroscopy and sonography, the sensitivity and specificity of sonography in meniscal tear were 68.1% and 100%, respectively. 34 patients had bucket h and le tear of the posterior horn of the medial meniscus on sonography; six cases [17.6%] of which had abnormally small posterior horns of medial meniscus [in favor of meniscal tear] but in 60 patients with other types of meniscal tear, sonography revealed tear in 58 [96.6%][P < 0.0001]. Six patients had complete MCL tear in arthroscopy, while in sonography 4 complete MCL tears were shown. Sensitivity of ultrasound in diagnosing complete MCL tear was 66.6% and specificity of 98%. Ultrasound is easily applicable in evaluation of knee derangement: however, for bucket h and le tears it has limited application. For MCL tears, sonography seems an accurate method. Ultrasonography is rapid, low-cost and non-invasive examination

Discoid medical meniscus varied presentation of 3 knees

Discoid medial meniscus is a rarity. We present 2 cases, one with bilateral discoid medial menisci, and the other with both medial and lateral discoid menisci in the same knee. The radiological, MRI and arthroscopic findings in these knees and their association with various synovial plicae have been described. Both patients had good results after arthroscopic subtotal meniscectomy