Diagnostic Performance of Clinical Examination and Selective Magnetic Resonance Imaging in the Evaluation of Intraarticular Knee Disorders in Children and Adolescents

Abstract

To determine the diagnostic performances of clinical examination and selective magnetic resonance imaging in the evaluation of intraarticular knee disorders in children and adolescents we compared them with arthroscopic findings in a consecutive series of pediatric patients (< or = 16 years old). Stratification effects by patient age and magnetic resonance imaging center were examined. There were 139 lesions diagnosed clinically, 128 diagnosed by magnetic resonance imaging, and 135 diagnosed arthroscopically. There was no significant difference between clinical examination and magnetic resonance imaging with respect to agreement with arthroscopic findings (clinical examination, 70.3%; magnetic resonance imaging, 73.7%), overall sensitivity (clinical examination, 71.2%; magnetic resonance imaging, 72.0%), and overall specificity (clinical examination, 91.5%; magnetic resonance imaging, 93.5%). Stratified analysis by diagnosis revealed significant differences only for sensitivity of lateral discoid meniscus (clinical examination, 88.9%; magnetic resonance imaging, 38.9%) and specificity of medial meniscal tears (clinical examination, 80.7%; magnetic resonance imaging, 92.0%). For magnetic resonance imaging, children younger than 12 years old had significantly lower overall sensitivity (61.7% versus 78.2%) and lower specificity (90.2% versus 95.5%) compared with children 12 to 16 years old. There was no significant effect of magnetic resonance imaging center. In conclusion, selective magnetic resonance imaging does not provide enhanced diagnostic utility over clinical examination, particularly in children, and should be used judiciously in cases where the clinical diagnosis is uncertain and magnetic resonance imaging input will alter the treatment plan.

The Condylar Cutoff Sign: Quantifying Lateral Femoral Condylar Hypoplasia in a Complete Discoid Meniscus

“…We cannot determine from this study whether the condylar cutoff sign will be useful for diagnosis of incomplete discoid meniscus. Additionally, the difficulty in diagnosing pediatric and adolescent knee problems has been described [11,13]. Kocher et al [11] suggested selective MRI does not provide enhanced diagnostic utility over clinical examination, particularly in children.…”

Performance-based functional outcome for children 12 years or younger following anterior cruciate ligament injury: a two to nine-year follow-up study

“…Inclusion criteria in the present study were ACL rupture before turning the age of 13 years, and a minimum of two years from the ACL injury or ACL reconstruction to the follow-up examination. Additional inclusion criteria were intrasubstance ACL rupture confirmed by magnetic resonance imaging (MRI), clinical examination by one experienced orthopaedic surgeon (LE) and an instrumented Lachman test (a side to side difference in anterior tibiofemoral laxity of 3 mm or more, using maximum manual force measured with a knee arthrometer (KT-1000, Med-Metric, San Diego, California, USA)) [29,34,53]. Exclusion criteria were ACL avulsion injury, posterior cruciate ligament injury or intraarticular fractures.…”

A Survey of Injuries to the Anterior Cruciate Ligament Among Makkah Population, Saudi Arabia: Prevalence and Observations on Injury Mechanism.

“…[5] the diagnostic accuracy of acute knee injuries in younger patients is not as much as that in adults [9,10,11] .The expanded difficulty in correctly diagnosing acute knee injuries in kids has been proposed to be partly because the naturally more prominent laxity in the knees of children, [10] and the decreased sensitivity and specific city of magnetic resonance imaging (MRI)may likewise play a role. [9] Advances in imaging study and expanded the awareness of ACL injuries in this populace will probably enhance diagnostic accuracy later on [12] .The combination of injury history, clinical examination, and imaging specially MRi is recommended to optimize the diagnostic accuracy of ACL injuries in skeletally immature people [11,13] .…”