Relevancy and reproducibility of magnetic resonance imaging (MRI) interpretation in multiple-ligament injuries and dislocations of the knee

Barbier, Olivier; Galaud, B.; Descamps, Stéphane; Boisrenoult, Philippe; Leray, Emmanuelle; Lustig, Sébastien; Bonnevialle, P.; Laffargue, P.; Paillot, J; Rosset, Philippe; Neyret, Philippe; Saragaglia, D.; Lapra, C

doi:10.1016/j.otsr.2012.11.016

Cited by 11 publications

(21 citation statements)

References 19 publications

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“…Similar results were found by Halinen et al [ 11 ], and Kosy et al [ 12 ]. In terms of reproducibility, Barbier et al [ 13 ] demonstrated that MRI lacks precision and reproducibility, and the diagnosis should be integrated with clinical exam and stress X-rays. It has been also reported that MRI was inferior to clinical examination [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

The accuracy of MRI in diagnosing and classifying acute traumatic multiple ligament knee injuries

Liu

Hou

Zhan

et al. 2022

BMC Musculoskelet Disord

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Background Magnetic resonance imaging (MRI) is widely used for the evaluation of knee injuries, however, the accuracy of MRI in classifying multiple ligament knee injuries (MLKIs) remains unknown. This study aimed to investigate the accuracy of MRI in diagnosing and classifying acute traumatic MLKIs, we hypothesize that MRI had high accuracy in detecting and classifying MLKIs. Methods The clinical data of 97 patients who were diagnosed with acute traumatic MLKIs and managed by multi-ligament reconstruction between 2012 and 2020 were retrospectively reviewed. The MR images were read by two experienced radiologists and results were compared with intraoperative findings, which were considered as the reference for the identification of injured structures. The value of MRI in detecting injuries of anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), lateral collateral ligament (LCL), and meniscus was evaluated by calculating the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and kappa coefficients analysis. The value of MRI in classifying MLKIs was evaluated by calculating the agreement between MRI and intraoperative findings. Results For detecting the specific injured structures in MLKIs, MRI had high sensitivity (90.7% for ACL, 90.4% for PCL, and moderate specificity (63.6% for ACL, 50% for PCL) in detecting cruciate ligament injuries, moderate sensitivity (79.1% for MCL, 55.6% for LCL) and specificity (46.7% for MCL, 68.4% for LCL) in detecting collateral ligament injuries, fair sensitivity (61.5%) and low specificity (39.4%) in the diagnosis of injuries to the meniscus. For classifying the MIKIs, MRI had a moderate agreement with intraoperative findings in classifying KD-V (kappa value = 0.57), poor agreement in the KD-I (kappa value = 0.39) and KD-IIIM (kappa value = 0.31), meaningless in the KD-II and KD-IIIL (kappa value < 0). The overall agreement between MRI and intraoperative findings in classifying MLKIs was poor (kappa value = 0.23). Conclusions MRI is valuable in early detection and diagnosis of acute MLKIs, however, the accuracy of MRI in classifying MLKIs is limited. The management of MLKIs should be based on intraoperative findings, physical examinations, and comprehensive imaging results.

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Section: Introductionmentioning

confidence: 99%

The accuracy of MRI in diagnosing and classifying acute traumatic multiple ligament knee injuries

Liu

Hou

Zhan

et al. 2022

BMC Musculoskelet Disord

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“…Even though the first studies that analyzed MRI accuracy in dislocated knees found very good sensitivity and specificity for most of the studied structures, 5,16,23,26,30 with a PPV greater than 90% for all the major ligaments (ACL, PCL, PLC, MCL, and patellar tendon), 26 those findings were not replicated in subsequent studies. 1,3,10 The small sample size of these initial studies, 5,16,23,26,30 together with incomplete comprehension of the anatomy of the knee at the time, could explain their overestimation of the diagnostic accuracy of MRI to identify MLKIs. Some of these studies did not include all types of MLKIs, 5,30 recorded incomplete data, 26 and lacked statistical power 23,26,30 to reach firm conclusions.…”

Section: Discussionmentioning

confidence: 99%

“…The American Journal of Sports Medicine 2023;51(2):429-436 DOI: 10.1177/03635465221145697 Ó 2023 The Author(s) examination is usually difficult to make because of pain and swelling, 3,10,16 stress radiography 1,9,13 and MRI are essential to establish an accurate diagnosis. 1,10,27 MRI is considered the gold standard for the diagnosis of ligament, meniscal, and chondral lesions of the knee, 7 but not many studies have investigated the accuracy of MRI in identifying injury patterns in MLKIs. y Initial studies found good accuracy of MRI in assessing MLKIs.…”

Section: Because a Clinical Diagnosis Based On Anmentioning

confidence: 99%

Accuracy of Magnetic Resonance Imaging in the Diagnosis of Multiple Ligament Knee Injuries: A Multicenter Study of 178 Patients

et al. 2023

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Background: Magnetic resonance imaging (MRI) has shown limited diagnostic accuracy for multiple ligament knee injuries (MLKIs), especially posterolateral corner (PLC) injuries. Hypothesis: The diagnostic accuracy of MRI for MLKIs will only be moderate for some knee structures. Patient-related factors and injury patterns could modify the diagnostic accuracy of MRI. Study Design: Cohort study; Level of evidence, 3. Methods: All patients with MLKIs surgically treated between January 2014 and December 2020 in the centers participating in the study were reviewed. We recorded sex, age, mechanism of injury, time from injury to MRI, and vascular and neurological associated lesions. Lesions to the anterior cruciate ligament (ACL), posterior cruciate ligament, medial collateral ligament, lateral collateral ligament (LCL), popliteus tendon, popliteofibular ligament, iliotibial band, biceps tendon, medial and lateral meniscus, and articular cartilage from MRI reports and surgical records were also collected. The sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy, diagnostic odds ratio, positive and negative likelihood ratio, and intraclass correlation coefficient of MRI were calculated for each knee structure. With logistic regression, associations between patient and injury characteristics and MRI accuracy were assessed. Results: A total of 178 patients (127 male; mean age, 33.1 years) were included. High-energy trauma was the most common mechanism of injury (50.6%), followed by sports trauma (38.8%) and low-energy trauma (8.4%). The ACL was the structure with the best diagnostic accuracy, diagnostic odds ratio, and positive predictive value (94.4%, 113.2, and 96.8%, respectively). PLC structures displayed the worst diagnostic accuracy among knee ligaments (popliteus tendon: 76.2%; LCL: 80.3%) and diagnostic odds ratio (popliteus tendon: 9.9; LCL: 17.0; popliteofibular ligament: 17.5). MRI was more reliable in detecting the absence of meniscal and chondral lesions than in identifying them. Logistic regression found that the diagnostic accuracy was affected by the Schenck classification, with higher Schenck grades having worse diagnostic accuracy for peripheral structures (iliotibial band, popliteus tendon, and biceps tendon) and improved diagnostic accuracy for the ACL and posterior cruciate ligament. Conclusion: The diagnostic accuracy of MRI for MLKIs largely varied among knee structures, with many of them at risk of a misdiagnosis, especially PLC, meniscal, and chondral lesions. The severity of MLKIs lowered the diagnostic accuracy of MRI for peripheral structures.

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“…Second, this study did not assess the inter-observer reliability for assessing MRI findings and this might increase the accuracy of MRI because inter-observer agreement for MRI findings for soft tissue disruption has been reported to be low. 36 Finally, this study included acute (<4 weeks after injury) and chronic (>4 weeks after injury) injuries, which may not reflect the true accuracy of the MRI. 30…”

Section: Discussionmentioning

confidence: 99%

Efficiency of magnetic resonance imaging for diagnosing unstable ligament injuries around the thumb metacarpophalangeal joint: A comparison to arthroscopy

Shin

Kim

et al. 2020

J Orthop Surg (Hong Kong)

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Purpose: This study aimed to assess the accuracy of MRI in identifying ulnar collateral ligament (UCL), radial collateral ligament (RCL), and volar plate (VP) injuries of the metacarpophalangeal joint (MCPJ) of the thumb by comparing with diagnostic arthroscopy. Methods: A total of 56 consecutive patients (56 thumbs) who underwent arthroscopy of MCPJ of thumb were enrolled. MRI findings reviewed by consensus reading of two blinded radiologists were compared with arthroscopic examination. Statistical data, including sensitivity, specificity, accuracy, were analyzed. Additionally, the performance characteristics between 3.0-tesla (39 thumbs) and 1.5-tesla (17 thumbs) MRI and acute (≤4 weeks after injury) and chronic (>4 weeks) injuries were compared. Results: Of the 56 thumbs, 38 thumbs (67.9%) showed complete correspondence between MRI and arthroscopic findings. The sensitivity, specificity and accuracy of MRI for detecting UCL injuries were 78.8%, 87.0%, and 82.1%, respectively. The sensitivity, specificity and accuracy of MRI for detecting RCL injuries were 85.7%, 91.4%, and 85.7%, respectively. The sensitivity, specificity, and accuracy of MRI for detecting VP injuries were 89.5%, 89.2%, and 81.0%, respectively. 3.0-tesla MRI showed higher correspondence with arthroscopic observation (76.9%) than 1.5-tesla MRI (47.1%) (p = 0.028). For acute injuries, 78.4% showed complete correspondence between MRI and arthroscopic findings, whereas 47.4% with chronic injuries revealed complete agreement (p = 0.019). Conclusion: Overall, MRI is moderately effective in evaluating ligamentous lesions around MCPJ of thumb, but MRI is more sensitive in diagnosing acute injuries. Furthermore, 3.0-tesla MRI can provide results with better accuracy for diagnosing ligamentous lesions around MCPJ of thumb. However, the sensitivity and the specificity are not applicable to all ligament injuries, but only the severe one which would agree for surgical options.

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Relevancy and reproducibility of magnetic resonance imaging (MRI) interpretation in multiple-ligament injuries and dislocations of the knee

Abstract: Level IV, prospective case-control study.

Cited by 11 publications

References 19 publications

The accuracy of MRI in diagnosing and classifying acute traumatic multiple ligament knee injuries

The accuracy of MRI in diagnosing and classifying acute traumatic multiple ligament knee injuries

Accuracy of Magnetic Resonance Imaging in the Diagnosis of Multiple Ligament Knee Injuries: A Multicenter Study of 178 Patients

Efficiency of magnetic resonance imaging for diagnosing unstable ligament injuries around the thumb metacarpophalangeal joint: A comparison to arthroscopy

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