Meniscal tears diagnosed with MR imaging versus arthroscopy: how reliable a standard is arthroscopy?

Quinn, Stephen F.; Brown, Terry

doi:10.1148/radiology.181.3.1947108

Cited by 133 publications

(67 citation statements)

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“…In the same study (30), 15 of the 32 false-negative results were due to small tears which did not warrant surgical intervention. The negative predictive value of MR in double-blind studies has been reported as ranging from 80 to 100% and in other studies as between 92 and 98%.…”

Section: Discussionmentioning

confidence: 84%

“…Some false-positive results on MR investigations may reflect this. In one study (30) with 254 consecutive patients undergoing both MR imaging and arthroscopy, the videotapes from arthroscopy were reviewed in 49 patients where there was a discrepancy between the MR and arthroscopic findings. There were 17 false-positive MR interpretations of which 9 were located in the posterior horns of the menisci, areas incompletely seen on arthroscopy, and 2 were due to differences in subjective interpretation of post surgical meniscal appearances thought not to be of clinical significance at arthroscopy.…”

Section: Discussionmentioning

confidence: 99%

“…In some institutions, diagnostic arthroscopy is not performed in the presence of a normal MR examination (22). This role for MR has been disputed (30,37,39) by some orthopaedic surgeons who favour arthroscopy. The purpose of this article is to review the current literature to examine the relative merits of arthroscopy and MR of the knee.…”

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confidence: 99%

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MR Imaging before Arthroscopy in Knee Joint Disorders?

Rappeport¹,

Mehta²,

Wieslander³

et al. 1996

Acta Radiol

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Purpose: To review the current literature examining the relative merits of arthroscopy and MR imaging of the knee.Material and Methods: Allgapers comparing MR imaging with arthroscopy published within the last 10 years according to Medline were collected and read.Results: Technology has improved considerably during recent years allowing detailed non-invasive visualization of the knee. In particular, the development of cheaper whole-body and dedicated low-field MR units has opened up for non-invasive inspection of the knee at reasonable cost. Meniscal tears can be detected with accuracy rates of around 90% and rupture of the anterior cruciate ligament with accuracy rates of around 93% compared to arthroscopy. However, arthroscopy is not the ideal gold standard, since it has weak points, e.g. peripheral meniscal tears or osteochondritis without apparent damage to the cartilage.Conclusion: Based on the overwhelming literature it seems safe to conclude that MR examinations of the knee should be performed before arthroscopy is undertaken.The knee joint is a common site for morbidity as a result of trauma or degenerative disease with resultant temporary or permanent disability characterized by pain, immobility or reduction in previous sporting activity. Symptomatology, clinical examination and conventional film studies are often insufficient for an accurate diagnosis (12,40). Supplementary diagnostic procedures are often required to determine prognosis and allow appropriate management including conservative therapy.During the 1970s and the 1980s arthroscopy of the knee joint became the gold standard in diagnosing knee disorders. The advent of MR imaging has, in most institutions, led to the virtual abandonment of arthrography as a diagnostic procedure in the knee. Over the last 10 years MR has gained worldwide acceptance as the imaging method of choice for the non-invasive evaluation of the knee (21). It provides excellent anatomical detail (Fig. 1) unobtainable by any other imaging modality (Fig. 2).A vast number of papers have been published that examine the diagnostic accuracy of MR examinations of the knee but the exact role of MR remains unclear. In some institutions, diagnostic arthroscopy is not performed in the presence of a normal MR examination (22). This role for MR has been disputed (30, 37, 39) by some orthopaedic surgeons who favour arthroscopy. The purpose of this article is to review the current literature to examine the relative merits of arthroscopy and MR of the knee.The central question in this debate is the diagnostic accuracy of the 2 procedures but other issues such as time, patient comfort, risk and cost need to be taken into account. Arthroscopy is an invasive procedure requiring anaesthesia, carrying a small risk of infection and produces variable pain and reduction in movement in the days following the procedure. MR is non-invasive without known risk to the patient. It can be uncomfortable for the patient owing to prolonged examination time or claustrophobia but such problems are r...

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

MR Imaging before Arthroscopy in Knee Joint Disorders?

Rappeport¹,

Mehta²,

Wieslander³

et al. 1996

Acta Radiol

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“…However, in the acute stage following injury, clinical tests may not be appropriate due to pain, thus an MRI is the preferred modality of investigation. It is non invasive, and considered to be highly sensitive to meniscal injuries 7,8,9 but is less so for the Anterior cruciate ligament injuries. Arthroscopy of the knee is a key hole surgery performed as a daycare procedure.…”

Section: Introductionmentioning

confidence: 99%

Correlation between MRI Findings and Arthroscopic Findings in Internal Degeneration of Knee

Islam¹,

Ailani²,

Bhattacharyya³

et al. 2017

IOSR JDMS

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“…An accurate description of a meniscal tear has become increasingly important, with the emphasis on meniscal preservation and repair, because of the long-term complications of meniscectomy that comprise degenerative changes, patient dissatisfaction, marked disability and chronic pain [4,11].…”

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confidence: 99%

Contribution of thin-slice (1 mm) axial proton density MR images for identification and classification of meniscal tears: correlative study with arthroscopy

Gökalp

Nas²,

Demirağ³

et al. 2012

BJR

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Objective: To evaluate the diagnostic efficacy of thin-slice (1 mm) axial proton density-weighted (PDW) MRI of the knee for meniscal tear detection and classification. Methods: We prospectively assessed pre-operative MR images of 58 patients (41 males, 17 females; age range 18-62 years) with arthroscopically confirmed meniscal tear. First, we evaluated the performance of the sagittal and thin-slice axial MR images for the diagnosis of meniscal tears. Second, we compared the correlation of tear types presumed from sagittal and axial MRI with arthroscopy and tear classification from axial MRI. Tears were classified on the sagittal plane and the axial plane separately. The diagnostic performance and tear classification were compared statistically with arthroscopy results, which is accepted as the standard of reference. Results: 8 of 58 patients were removed from the study group because they had complex or degenerative tears. A total of 62 tears were detected with arthroscopy in 50 patients. On the sagittal images, sensitivity and specificity values were 90.62% and 70.37%, respectively, for medial meniscus tears and 72.73% and 77.14%, respectively, for lateral meniscus tears. The corresponding values for axial images were 97.30% and 84.00%, respectively, for medial meniscus tears and 95.65% and 80.50%, respectively, for lateral meniscus tears. There was no significant difference in tear classification between the arthroscopy results and the thin-slice axial PDW MRI results (p.0.05). Conclusion: thin-slice axial PDW MRI increases the sensitivity and specificity of meniscal tear detection and especially classification, which is important for surgical procedure decisions.

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Meniscal tears diagnosed with MR imaging versus arthroscopy: how reliable a standard is arthroscopy?

Cited by 133 publications

References 0 publications

MR Imaging before Arthroscopy in Knee Joint Disorders?

MR Imaging before Arthroscopy in Knee Joint Disorders?

Correlation between MRI Findings and Arthroscopic Findings in Internal Degeneration of Knee

Contribution of thin-slice (1 mm) axial proton density MR images for identification and classification of meniscal tears: correlative study with arthroscopy

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