Comparative study of clinical examination and MRI in relation to arthroscopy in Ligamnentous and meniscal knee injuries

Abstract

Objective: To determine sensitivity, specificity and accuracy of clinical examination and MRI in detecting ligamentous and meniscal knee injuries in relation to arthroscopy. Material and methods: It was a prospective, study conducted on 30 patients who presented to the department of Orthopaedics, with suspected ligamentous/ meniscal knee injuries, and underwent detailed clinical examination followed by MRI and arthroscopy of the knee. Patients with injuries less than 2 weeks, degenerative lesions of the knee and patients with contraindications to MRI were excluded. Results: Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of clinical examination for anterior cruciate ligament injuries was 91.6, 83.3, 95.6 71.4 and 90 percent respectively and of MRI was 95.8, 66.6, 92, 80 and 90 percent respectively. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of clinical examination for medial meniscal injuries was 61.5, 88.2, 80, 75 and 76.6 percent respectively and MRI was 92.3, 94.1, 92.3, 94.1 and 93.3 percent respectively. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of clinical examination for lateral meniscal injuries was 50, 95.8, 75, 88.5 and 86.6 percent respectively and of MRI was 83.3, 95.8, 83.3, 95.8 and 93.3 percent respectively. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of both clinical examination and MRI for posterior cruciate ligament injuries was 100 percent. Conclusion: In cases of suspected ACL injuries, carefully performed clinical examination can give equally reliable diagnosis as MRI. MRI is more sensitive than clinical examination in diagnosing meniscal injuries and reduces number of missed tears. Negative MRI scans in meniscal injuries is useful in ruling out an injury thus minimizing the number of unnecessary arthroscopies.