Correlation of clinical, radiological and arthroscopic findings of meniscal and anterior cruciate ligament injuries of knee

Abstract

Background: Orthopaedic surgeons commonly see soft tissue injuries of the knee including meniscal and ligament injuries. In the past diagnosis of these injuries was based on accurate clinical examination alone as plain radiographs were unable to detect these soft tissue injuries. Clinical examination alone produced false diagnosis rates between 40-85%. Aim of the study was to correlate clinical, radiological and arthroscopic findings of meniscal and anterior cruciate ligament injuries of knee. Methods: A Prospective observational study was conducted for a period of two year and all patients admitted to Manipal hospital who were scheduled to undergo arthroscopic surgery of the knee for either meniscal or ACL injury based on clinical and Magnetic Resonance Imaging (MRI) findings were included in the study. Results: 65 patients were studied comparing clinical examination, MRI with arthroscopy and were analyzed. Clinical examination showed sensitivity, specificity, Positive Predictive value (PPV), Negative Predictive value (NPV), accuracy of 76.47%,48.65%, 52.50%, 93.72%, 60% respectively for medial meniscus tear, 84.62%, 100%, 100%, 96.30%, 96.92% respectively for lateral meniscus tear and 76.47%, 87.50%, 68.42%, 91.30%, 84.62% respectively for Anterior Cruciate Ligament (ACL) tear. MRI findings showed sensitivity, specificity PPV, NPV, accuracy of 92.86%, 81.08%, 78.79%, 93.75%, 86.1% respectively for medial meniscus, 92.31%, 100%, 100%, 98.11%, 98.46% respectively for lateral meniscus tear, 82.35%, 91.67%, 77.78%, 93.62%, 89.23% respectively for ACL tear. Conclusion: Clinical tests to detect ACL and lateral meniscus injuries have a high degree of correlation when compared to arthroscopy and MRI. Clinical tests to detect medial meniscus injuries have a lower degree of correlation compared to MRI and arthroscopy.