Indications requiring preoperative magnetic resonance imaging before knee arthroscopy

Abstract

IntroductionKnee arthroscopy knee is gold standard in diagnosis and simultaneous treatment of knee disorders. But most patients undergo magnetic resonance imaging (MRI) before arthroscopy, although MRI results are not always consistent with arthroscopic findings. This raises the question in which suspected diagnoses MRI really has influence on diagnosis and consecutive surgical therapy.Material and methodsPreoperative MRI of 330 patients with knee disorders were compared with arthroscopic findings. The MRI were performed by 23 radiologists without specialization in musculoskeletal diagnostics. Specificity, sensitivity, negative/positive predictive value and accuracy of MRI were calculated in comparison to arthroscopic findings.ResultsWe found sensitivity/specificity of 58%/93% for anterior horn, 94%/46% for posterior horn of medial meniscus and 71%/81% for anterior and 62%/82% for posterior horn of lateral meniscus. Related to anterior cruciate ligament injuries we showed sensitivity/specificity of 82%/91% for grade 0 + I and 72%/96% for grade II + III. For Cartilage damage sensitivity/specificity of 98%/7% for grade I-, 89%/29% for grade II-, 96%/38% for grade III- and 96%/69% for grade IV-lesions were revealed.ConclusionsThe MRI should not be used as routine diagnostic tool for knee pain. No relevant information for meniscal lesions and anterior cruciate ligament ruptures has been gained with MRI from non-specialized outside imaging centres.The MRI should not be used as routine diagnostic tool for knee pain. No relevant information for meniscal lesions and anterior cruciate ligament ruptures has been gained with MRI from non-specialized outside imaging centres.

The diagnostic accuracy of magnetic resonance imaging for anterior cruciate ligament injury in comparison to arthroscopy: a meta-analysis

“…Arthroscopy allows direct visualization of all intra-articular structures and thus provides a high level of accuracy for both diagnosis and treatment, which makes arthroscopy the gold standard for evaluation of internal disorders and other lesions of the knee 7 . However, arthroscopy constitutes a relatively expensive and invasive examination 8 .…”

Meniscus tear surgery and meniscus replacement

“…Chambers et al 13 compared the MRI meniscal images with arthroscopy, finding that MRI scanning was 90.5% sensitive, 89.5% specific and 90.1% accurate. Roßbach et al 14 found sensitivity/specificity of 58/93% for anterior horn, 94/46% for posterior horn of medial meniscus and 71/81% for anterior and 62/82% for posterior horn of lateral meniscus. The specificity of conventional MRI can be improved by employing at least two T2-weighted sequences, but this still leaves a shortfall in sensitivity and if MRI is contraindicated, computed tomography arthrography seems a promising alternative.…”

Concurrent use of oblique sagittal and oblique coronal MRI: does it enhance the specificity and the accuracy of diagnosing complete and partial ACL tears?

“…Magnetic resonance imaging (MRI) of knee joints aids in the detection of the site and degree ACL injury [3]. However, arthroscopy remains the gold standard for assessment of internal derangement of the knee joint with the limitation of being an expensive and invasive procedure [4]. The ACL possesses a unique diagonal course extending from the inner surface of the lateral femoral condyle and attaching to a fossa in front and lateral to the anterior tibial spine [5].…”