The diagnostic accuracy of anterior cruciate ligament rupture using magnetic resonance imaging: a meta-analysis

Abstract

This study evaluates the diagnostic accuracy of anterior cruciate ligament (ACL) rupture using magnetic resonance imaging in the management of patients with symptomatic tibiofemoral instability. Published and unpublished databases including the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, AMED and CINAHL, as well as unpublished studies registers were searched for studies that compared the diagnostic findings of MRI to arthroscopic surgery for patients with a suspected ACL rupture in September 2010. For each study, sensitivity and specificity of complete ACL rupture were analysed as bivariate data to account for a possible negative correlation within studies, and pooled meta-analysis was performed. Fifty-three studies compared the diagnostic accuracy of MRI to arthroscopic findings for a total of 4,673 patients, 4,683 knees. Overall, the pooled sensitivity of MRI for detecting complete ACL rupture was 94.5% (95% confidence interval 0.92-0.96) and specificity of 95.3% (0.93-0.97). MRI has high accuracy for patients with complete ACL rupture. Due to the higher economic costs and increased complication risks of diagnostic arthroscopy, MRI is therefore recommended as the principal investigation following clinical examination, to diagnose ACL rupture.

Magnetic resonance tomography of the knee joint

“…Several review articles on low-field versus high-field MRI of the extremities agree that low-field strength MRI systems provide the ability to diagnose substantial pathologies within the ligaments and menisci of the knee [3,9,19]. This is in accordance with our findings.…”

“…One was published in 2003, one in 2011, and two in 2012. Two included both low-and high-field MRT studies [2,9], and the other two [10,11] had used a minimum field strength of 1.5 T as an inclusion criteria.…”

“…Smith et al [9] evaluated the diagnostic accuracy of anterior cruciate ligament (ACL) rupture using all-strength MRI by performing a pooled meta-analysis. They included 53 articles of which 16 had already been referred to by Oei et al [2].…”

“…Data were extracted from two high-quality meta-analyses dealing with the diagnostic accuracy of MRI in knee injuries related to the menisci and the cruciate ligaments [2,9]. Table 3 details the number and content of included articles, publication period of included articles, inclusion criteria, and results with regard to differences in diagnostic performance between low-and high-field MRI .…”

Diagnostic accuracy of magnetic resonance imaging in detecting anterior cruciate ligament injuries

“…Due to the higher economic costs and increased complication risks of diagnostic arthroscopy, MRI is therefore recommended as the principal investigation following clinical examination, to diagnose ACL rupture. 17 However, there are still controversies. According to Liodakis et al 18 the MRI scans are not routinely necessary as an indication for knee arthroscopy as clinical examination and plain radiograph are sufficient.…”