CC-BY-NC-ND 4.0 · Joints 2017; 05(03): 164-167
DOI: 10.1055/s-0037-1605583
Original Article
Georg Thieme Verlag KG Stuttgart · New York

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

P. Antinolfi1, R. Crisitiani2, F. Manfreda2, S. Bruè3, V. Sarakatsianos4, G. Placella5, M. Bartoli5, A. Caraffa1, 2
  • 1Division of Orthopedics and Trauma Surgery, S. Maria della Misericordia Hospital, Perugia, Italy
  • 2Department of Orthopedics and Traumatology, University of Perugia, Italy
  • 3International Orthopedics and Traumatology Institute, Arezzo, Italy
  • 4Capio Artro Clinic/Stockholm Sports Trauma Research Center, Stockholm, Sweden
  • 5Department of Othopaedics, U. Cattolica del Sacro Cuore, Gemelli Ospital, Rome, Italy
Further Information

Publication History

Publication Date:
24 August 2017 (eFirst)

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.