Abstract
Purpose: This study evaluated the diagnostic accuracy of physical examination and magnetic resonance imaging (MRI) in knee injuries. Methods: Ninety-six patients at a regional hospital were included in the study. Each participant underwent a physical examination in which menisci and ACL were evaluated. Knee joint MRI was collected from each patient. Physical examination and MRI scans were then compared with knee arthroscopy findings as a golden standard for meniscal and ligamentous lesions. The data were analyzed and specificity and sensitivity were calculated and correlated on receiver operating characteristics (ROC) curves. Results: Knee arthroscopy diagnosed 32 total ACL ruptures, 45 medial meniscus and 17 lateral meniscus lesions. Three patients were diagnosed with bilateral meniscal lesions. The highest sensitivities were the McMurray test (87.5%) for medial meniscus (MM) and the Thessaly test (70%) for lateral meniscus (LM). The most sensitive ACL test was Lachman (84.5%), whereas, the pivot shift and Lelli tests were the most specific (98.5%). MRI was highly sensitive for MM (96%) with specificity of 52%. MRI showed lower sensitivity (70%) and higher specificity (85.5%) for LM. The specificity of MRI for ACL rupture was 92%, with sensitivity only 75%. Conclusion: McMurray and Apley tests for meniscal lesions seem the most appropriate in daily practice. A combination of lever signs, pivot shifts (PSs) and Lachman tests showed the best sensitivity and specificity in detecting ACL deficiency, and was superior to MRI.
Highlights
The knee joint is one of the most common joints subjected to injuries
65 patients were diagnosed with meniscal tears: 45 with medial meniscus, 17 with lateral meniscus and 3 patients with bilateral meniscal lesions
anterior cruciate ligament (ACL) injuries were diagnosed in 42 patients, out of which 32 suffered from total tear and 10 patients presented subtotal injuries
Summary
Due to its localization and function, it is of vital importance to working ability, daily tasks and recreational and professional sports. Damage to tissues such as menisci, ligaments or hyaline cartilage can lead to irreversible osteoarthritic changes of the joint [1,2]. Quick and accurate diagnosis of intraarticular lesions, which is necessary for selecting adequate treatment, is of great importance [3]. An abundance of mechanisms can lead to knee joint failure, which is one of the factors that makes diagnosis difficult [4,5,6]. Delay in introducing proper treatment has a great effect on hyaline cartilage
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