Magnetic resonance imaging can increase the diagnostic accuracy in symptomatic meniscal repair patients

Abstract

Purpose The purpose of this study was to evaluate meniscal repair healing in symptomatic patients through combined clinical assessment, magnetic resonance imaging (MRI) and re-arthroscopy. This study investigated the diagnostic accuracy of MRI and clinical assessment in determining failed meniscal repair in symptomatic meniscal repair patients, as verified by re-arthroscopy. Methods Eighty patients were included. All had undergone a primary meniscal repair followed by an MRI and re-arthroscopy due to clinical symptoms of a meniscal lesion. A validated semi-quantitative scoring system was employed for identifying MRI-diagnosed healing failure. The clinical assessment was divided into joint swelling, joint-line tenderness, locking and a positive McMurray's test. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of MRI and positive clinical findings were calculated using second-look arthroscopy as a standard. ResultsThe MRI results showed healing of 22 (27.5%) of the menisci and 58 (72.5%) unhealed menisci, whereas secondlook arthroscopy identified 15 (19%) healed menisci and 65 (81%) unhealed menisci. The isolated MRI findings were 0.85, 0.8, 0.95 and 0.55 for sensitivity, specificity, PPV and NPV, respectively. The PPVs of the clinical assessments were 0.78, 0.85 and 0.94, with one, two and three clinical findings, respectively. A grade 3 MRI combined with joint-line tenderness presented a PPV of 0.98. Conclusion A supplementary MRI will increase diagnostic accuracy when fewer than three clinical findings are present in a symptomatic meniscal repair patient. The clinical relevance of this finding is that MRI contributes to enhancing the diagnostic accuracy of an unhealed meniscal repair when there are limited clinical signs of meniscal pathology. Level of evidence III.

Association Between MRI Signal Intensity of the Repaired Lateral Meniscus and Residual Anterolateral Knee Laxity After ACL Reconstruction

“…Similarly, PDW MRIs may have detected the healing process of the repaired LM in patients who underwent anatomic ACLR. Because previous MRI reports included patients who underwent isolated meniscus repair, 10 , 31 , 43 these studies imply that T2W sequences would be preferable for detecting insufficient healing of the isolated meniscal repair. However, the current study was related to the concomitant lateral meniscal tear with ACL tear: the diagnostic performance to detect incomplete healing of focal LM posterior horn tear concomitant with an ACL tear may be superior on PDW compared with T2W sequences.…”

“…Previous data indicated that the increased signal density of repaired LM on MRI scans corresponded to the incomplete healing of meniscal tissue confirmed by second-look arthroscopy. 10 , 31 , 43 , 49 Based on current data, the increased SI of repaired LM has the potential to explain why the repaired meniscal tissue failed to heal and restore its function to stabilize the ALLx after lateral meniscal repair. At the same time, the current data could not exclude the possibility of the other direction: the residual ALLx provokes the nonhealing or delayed healing of the repaired LM.…”

“…Based on this previous work, we speculated that the repaired LM in patients with ACLR may fail to heal and restore its function to stabilize the ALLx. Several studies have indicated that the signal intensity (SI) of the repaired LM on magnetic resonance imaging (MRI) is a diagnostic indicator of meniscal healing 10 , 31 , 43 , 49 ; however, at this point, there is little evidence related to how the SI of the repaired LM is associated with residual ALLx after ACLR. In addition, we reported in another study that the SI of the hamstring graft used in ACLR was affected significantly by patient age, 7 wherein younger patients demonstrated higher SI in the intra-articular part of the graft compared with older patients.…”

Higher healing rate after meniscal repair with concomitant ACL reconstruction for tears located in vascular zone 1 compared to zone 2: a systematic review and meta-analysis

“…The accuracy of clinical outcomes to assess whether a meniscus is healed is known to be poor [11, 19]. The presence of tibiofemoral joint symptoms does not always distinguish between healed and unhealed meniscal lesions, and is not directly related to biological healing of the meniscus [17].…”

“…To assess healing, most studies look at clinical outcomes after meniscal repair, such as Patient Reported Outcome Measures (PROMs) or clinical tests, or imaging modalities such as MR imaging. The sensitivity, specificity and accuracy of clinical outcomes and different imaging modalities to determine biologically complete healing remains limited [11, 16, 17, 19, 27]. The most reliable technique to evaluate complete meniscal healing is second‐look arthroscopy [17].…”