Comparison of Clinical Examination, MRI and Arthroscopy in the Diagnosis of Knee Problems Meniscal and Anterior Cruciat Ligament Tear

Abstract

Purpose: Clinical examination, magnetic resonance imaging (MRI) and arthroscopy are used commonly in the diagnosis of knee problems. To evaluate the diagnostic accuracy of MRI and clinical examination, the arthroscopic findings of the cases were compared with their clinical examination and MRI findings. Material and
Method: Between August 1995 and December 1997, arthroscopy surgery was performed on 129 patients (133 knees) who presented to our clinics with knee problems. Before the operation all the patients had a detailed clinical examination and MRI of the knees.
Results: When compared with arthroscopic findings, the sensitivity, specificity and accuracy values of clinical examination for medial meniscus were 91.3%, 71.8%, 81.9% and for lateral meniscus 64.2%, 93.2%, 90.2% and for anterior cruciate ligament 80%, 96.6% and 94.7%, respectively. When we compared MRI findings with arthroscopy in the first study which the MRI was evaluated by a general radiologist, sensitivity, specificity and accuracy values for medial meniscus were 80%, 72.7%, 78.2% and for lateral meniscus 70%, 92.9%, 89.4% and for anterior cruciate ligament 76.9%, 95.8% and 93.3%, respectively. When the same study was performed blindly by a radiologist who (experienced in) musculoskeletal radiology the sensitivity, specificity and accuracy values for medial meniscus were 94.4%, 86.9%, 90.9% and for lateral meniscus 89.4%, 87.9%, 94.4% and for anterior cruciate ligament 92.3%, 98.3% and 97.7%, respectively.
Discussion: Careful clinical examination can detect the majority of knee problems and an MRI evaluated by an experienced musculoskeletal radiologist can spare patients from unnecessary and expensive arthroscopic intervention.