Diagnostic arthroscopy compared to magnetic resonance imaging in the evaluation of meniscal and ligament tears of the knee

Background: The knee joint gets injured commonly as it has less musculature anteriorly and due to external forces affecting knee movements in coronal and sagittal planes. Rotational injuries are also common at the knee. Aims and Objectives: We wanted to compare the diagnostic capabilities of magnetic resonance imaging (MRI) and diagnostic arthroscopy (DgAr) in the evaluation of anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial meniscus (MM), and lateral meniscus (LM) injuries etc., seek correlation among both MRI and DgAr knee and find the better modality. Materials and Methods: This prospective study involved 50 patients suffering from knee joint injuries in our tertiary care teaching hospital. MRI of the knee was done in knees with internal derangement; all patients went for arthroscopy under general/spinal anesthesia. Keeping DgAr as reference, MRI was compared on parameters such as sensitivity and specificity, positive and negative predictive value plus accuracy. Results: MRI had a high accuracy i.e. 91.1%, 94%, 86%, and 92% for ACL, PCL, MM, and LM, respectively. Furthermore, it had low positive predictive value (PPV) and High PPV for meniscal and cruciate injuries. Conclusion: MRI is commonly used to evaluate various structures of the knee. In cases where clinical findings favor meniscal or ACL injuries, MRI scan prior to arthroscopic examination does not offer additional advantage. We suggest early DgAr as appropriate intervention in such cases.

Protocolo de Investigación: Validación de Resonancia Magnética en Meniscopatías Comparado con Artroscopía. Pacientes de Traumatología del Hospital de Especialidades José Carrasco Arteaga. Cuenca - Ecuador. 2016-2017 / Research Protocol: Validation of Magnetic Resonance Imaging for Meniscal Injuries Compared with Arthroscopy. Trauma Patients of the Specialty Hospital José Carrasco Arteaga. Ecuador basin. 2016-2017

INTRODUCCIÓN: La resonancia magnética es un método de imagen no invasivo que valora satisfactoriamente las meniscopatías, contribuyendo significativamente a su diagnóstico y evitando la realización de artroscopias innecesarias. El objetivo es determinar la validez del estudio de RM para el diagnóstico de las meniscopatías en comparación con la artroscopía, en pacientes del servicio de traumatología del Hospital de Especialidades José Carrasco Arteaga de Cuenca-Ecuador, entre Abril 2016 y Marzo 2017. METODOLOGÍA: Es un estudio de prueba diagnóstica, y evalúa los pacientes con diagnóstico clínico de meniscopatía, tratados en el servicio de traumatología del hospital, durante el periodo Abril 2016 a Marzo 2017. Los hallazgos de la RM serán contrastados con la exploración artroscópica posterior, la información será recogida mediante un formulario. El análisis estadístico se utiliza el Chi2 para establecer asociación entre variables y tablas de doble entrada para validar pruebas diagnósticas, con nivel de seguridad del 95 %, mediante el software estadístico SPSS. RESULTADOS ESPERADOS: Existe mayor validez diagnóstica del estudio de RM para el diagnóstico de las meniscopatías, comparado con la artroscopia.(au)

INTRODUCTION: Magnetic Resonance Imaging is a noninvasive imaging method that satisfactorily evaluates meniscal injuries, significantly contributing to its diagnosis and avoiding unnecessary arthroscopies. The aim determine the validity of the MRI study for the diagnosis of meniscal injuries compared to arthroscopy in patients from the traumatology service of the Hospital of Specialties Jose Carrasco Arteaga of Cuenca - Ecuador between April 2016 and March 2017. METHODOLOGY: Validation study of a diagnostic test, evaluated the patients with clinical diagnosis of meniscal injuries, treated in the traumatology service of the hospital, period from April 2016 to March 2017. The findings of the MRI of contrasting with the exploration posterior arthroscopy, this information will be collected through a form. The statistical analysis, Chi2 used to establish an association between variables and double-entry tables to validate diagnostic tests, with a 95 % safety level, using SPSS statistical software. EXPECTED RESULTS: There is greater diagnostic validity of the MRI study for the diagnosis of meniscopathies compared to arthroscopy(au)

MRI versus clinical examination for the diagnosis of meniscal and ligamentous injuries of knee.

Objective: The purpose of this study was to correlate and meniscus tears in knee joint injuries. Material and methods: 30 cases with history of rotational injury having knee pain and recurrent swelling were subjected to study. The age range of 11-60 years who were referred to Radiology Department for MRI of knee joint following injury to the knee was included. Prior to MRI, a detailed history, clinical, and local examination was done in all the subjects. MRI was carried out on 1.5 Tesla MR Machine and the standard protocol consisted of fat-suspended PD (TE 45, TR 2800) in axial, sagittal, and coronal planes, T2W (TE 80, TR 4000) in sagittal plane and T1W (TE 11, TR 495) in sagittal plane. Results: MRI had 100% sensitvity and negitive predictive value (NPV) of diagnosing ACL tears in this study. Clinical examination had sensitivity of 88% NPV 75% in diagnosing ACL injuries as compared to arthroscopy. There was high NPV of MR examination (96%) in diagnosing meniscus tear while the PPV of MR examination was low (71%) as compared to arthroscopy. These values were low in case of clinical examination. Conclusion: Magnetic resonance imaging is useful as a pre operative diagnostic tool in selected cases where a clinical examination cannot be performed as in acute injuries or in cases where clinical examination is inconclusive. The efficacy of MRI in diagnosing a tear varies among different intra articular structures. MRI has a high accuracy in diagnosing a tear of PCL. Sensitivity for medial meniscal tear is higher as compared to lateral meniscus and high for PCL as compared to ACL. MRI has a high positive predictive value for ACL, but has a low negative predictive value. For PCL tears MRI has a high negative predictive value which indicates that with a negative result for PCL on MRI, a diagnostic arthroscopy can be avoided.

Meniscal injuries and related sports.

The studies in sports-related meniscal injuries depend on the popularity of specific sports. 276 meniscectomies from 405 arthroscopic and arthrotomied knee injuries perfourmed in Siriraj Hospital, Bangkok, from 1985 to 1990 were studies. Sports-related meniscal injuries were tabulated and compared with all other causes. The results indicated that 76% were sport-related injuries, 58.6% were medial meniscal tears while 57.1% involved right knees. Football had a 60.9% predominance of medial meniscectomy, athletics 55.6%, volleyball 42.9%, badminton 33.3% and sepak takraw 60%. Our data indicated that there were no difference in the medial versus lateral meniscal injuries associated with sports activities but there is a difference in position in athletics versus individual sports and all sports taken together. The ratio of torn menisci (peripheral : body = 2:1) and the ratio of body types (longitudinal or bucket handle : transverse or oblique = 4.6:1) in all sports taken together were significantly different compared to non-athletes.