Comparison of Diagnostic Accuracy of Physical Examination and MRI in the Most Common Knee Injuries

Krakowski, Przemysław; Nogalski, Adam; Jurkiewicz, Andrzej; Karpiński, Robert; Maciejewski, Ryszard; Jonak, Józef

doi:10.3390/app9194102

Cited by 33 publications

(41 citation statements)

References 46 publications

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“…The accuracy of MRI for the diagnosis of meniscal tears has been reported to be 80–96% in other studies, but this depends upon the specific MRI protocols used 11–16 . Although these figures may appear impressive, clinical assessment has similar levels of accuracy at a fraction of the cost 14,17 . Our study had similar findings.…”

Section: Discussionsupporting

confidence: 79%

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Accuracy of standard magnetic resonance imaging sequences for meniscal and chondral lesions versus knee arthroscopy. A prospective case‐controlled study of 719 cases

Porter

Shadbolt

2021

ANZ Journal of Surgery

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Background Magnetic resonance imaging (MRI) is commonly used for diagnosis and as a research tool, but its accuracy is questionable. The goal of this study was to compare the accuracy of knee MRI with clinical assessment for diagnosing meniscal tears, and to determine the accuracy of MRI for grading chondral lesions, relative to arthroscopy. Methods Physically active patients presenting with mechanical symptoms warranting a knee arthroscopy and satisfying the inclusion criteria, had both a knee arthroscopy and MRI performed. Arthroscopic findings were compared with those of MRI, using the International Chondral Research Society grading for chondral damage, and the presence or absence of a meniscal tear. Results A total of 719 patients were recruited over a period of 6.5 years, average age 52 years (standard deviation, SD 5.2), male:female = 493:226. Kappa scores with standard errors (SE) for agreement between MRI and knee arthroscopy were 0.41 (SE 0.1) for medial meniscal tears, and 0.44 (SE 0.1) for lateral meniscal tears. For the grade of chondral damage, the Kappa scores with SE values were 0.09 (0.1), 0.17 (0.1), and 0.22 (0.07) for anterior, medial and lateral compartments, respectively. Using areas under the receiver operating characteristic curves, we found clinical assessment was more accurate than MRI for diagnosis of lateral meniscal tears (P < 0.001), and of similar accuracy for the diagnosis of medial meniscal tears (P = 0.12). Conclusions MRI has relatively poor correlation with arthroscopic findings for grading the chondral damage and was less accurate than clinical assessment for the diagnosis of lateral meniscal tears.

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Section: Discussionsupporting

confidence: 79%

“…Krakowski et al . evaluated the diagnostic accuracy of physical examination and MRI in knee injuries 17 . Like us, they also reported that MRI was no more accurate than physical assessment of the knee, for the diagnosis of meniscal tears, medial or lateral.…”

Section: Discussionmentioning

confidence: 78%

Accuracy of standard magnetic resonance imaging sequences for meniscal and chondral lesions versus knee arthroscopy. A prospective case‐controlled study of 719 cases

Porter

Shadbolt

2021

ANZ Journal of Surgery

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“…Femoral condyles and the medial knee compartment were found to be most commonly affected. Unfortunately, there are no specific clinical tests for the evaluation of articular cartilage, and distinguishing between chondral or meniscal lesions is impossible during physical examination [34]. For this purpose, MRI becomes the only available diagnostic modality for a routine cartilage examination [35].…”

Section: Discussionmentioning

confidence: 99%

Knee MRI Underestimates the Grade of Cartilage Lesions

et al. 2021

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Purpose: This study was conducted in order to evaluate the clinical utility of MRI in detecting cartilage lesions and its dependence on anatomical location and lesion grade. Methods: A retrospective analysis of MRI reports and arthroscopic findings was performed on 190 consecutive patients treated in one orthopaedic department. MRI protocols were prepared by 18 radiologists from 10 different MRI centers with the use of 1.5 T magnets. The image protocols were selected by reading radiologists. Four hundred and fifty-three chondral lesions in five anatomic locations were identified during this study and graded according to the ICRS classification. Sensitivity, specificity, receiver operating characteristic (ROC), and Bangdiwala’s observer agreement charts were utilized to evaluate the diagnostic performance. Results: Only approximately 30% of MRI showed an adequate cartilage status in all anatomical locations. The sensitivity ranged from 92% in healthy cartilage to 5% in grade I lesions. The specificity differed also grossly depending on the lesion grade, reaching 96.5% in grade four lesions and 38% in healthy cartilage. The medial compartment Bangdiwala’s observer agreement charts show a gross underestimation of cartilage lesions, and the area under the curve (AUC) of ROC surpasses 0.7 only in the medial femoral condyle and patella-femoral joint. Overall, the medial compartment accuracy was significantly higher than the lateral compartment. The MRI showed correspondence of its diagnostic performance with cartilage lesion severity. Conclusion: MRI underestimates the extent of cartilage injury and evaluation of cartilage defects based on MRI should be taken with caution by orthopaedic surgeons in planning surgery. Surgical planning on MRI should take cartilage lesions under consideration, even if no cartilage lesions are reported on the MRI.

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“…An early and accurate diagnosis is necessary to guide toward an efficient management of knee disorders and limit disability as well as loss of quality of life in affected individuals [ 4 , 5 ]. Yet, obtaining a valid initial knee disorder diagnosis remains a common challenge [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Higher psychological distress in patients seeking care for a knee disorder is associated with diagnostic discordance between health care providers: a secondary analysis of a diagnostic concordance study

Lowry

Bass

Vukobrat

et al. 2021

BMC Musculoskelet Disord

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Background Knee disorders are highly prevalent and may be a disabling condition. An accurate diagnosis is necessary to guide toward a rapid and efficient management of knee disorders. However, the ability to make a valid diagnosis is often complex for clinicians and evidence is mainly focused on clinician cognitive biases or errors produced during clinical reasoning. The aim of this secondary exploratory analysis is to identify patient-specific characteristics associated with diagnostic discordance between health care providers in making a diagnosis for a new knee disorder. Methods We performed a secondary analysis of a diagnostic study comparing the diagnostic ability of a physiotherapist to medical musculoskeletal specialists. Patients’ socio-demographic, psychosocial and clinical characteristics were compared between the concordant and discordant diagnostic groups. Psychosocial symptoms were evaluated using the validated Kessler 6 (K6) questionnaire. We performed multivariable logistic regressions using the Bayesian Information Criterion to identify the most probable model including patients’ characteristics associated with diagnostic discordance. Overall probability of identified variables to explain diagnostic discordance and associated odd ratios (OR) with 95% credibility intervals (95% CrI) were calculated. Results Overall, 279 participants were evaluated by a physiotherapist and medical musculoskeletal specialists. The mean age of the participants was 49.1 ± 15.8 years and 57.7% were female. The most common disorder was osteoarthritis (n = 117, 18.8% of cases were discordant). The most probable model explaining diagnostic discordance (11.13%) included having depressive symptoms, which was associated with an increased probability of diagnostic discordance (OR: 3.9; 95% CrI: 1.9 – 8.0) and having a higher number of comorbidities, which was associated with a decreased probability of diagnostic discordance (OR: 0.6; 95% CrI: 0.5 – 0.9). The depression item of the K6 questionnaire had a 99.4% chance to be included in a model explaining diagnostic discordance. Other variables taken separately had less than 50% chance to be included in a model explaining diagnostic discordance and cannot be considered significant. Conclusion Our results suggest that depressive symptoms may increase the risk of knee diagnostic discordance. Clinicians may be more likely to make diagnostic errors and should be more cautious when evaluating patients with knee disorders suffering from psychological distress.

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Comparison of Diagnostic Accuracy of Physical Examination and MRI in the Most Common Knee Injuries

Cited by 33 publications

References 46 publications

Accuracy of standard magnetic resonance imaging sequences for meniscal and chondral lesions versus knee arthroscopy. A prospective case‐controlled study of 719 cases

Accuracy of standard magnetic resonance imaging sequences for meniscal and chondral lesions versus knee arthroscopy. A prospective case‐controlled study of 719 cases

Knee MRI Underestimates the Grade of Cartilage Lesions

Higher psychological distress in patients seeking care for a knee disorder is associated with diagnostic discordance between health care providers: a secondary analysis of a diagnostic concordance study

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