Prospective study correlating accuracy of clinical examination,0912 519 25 27magnetic resonance imaging and arthroscopy in meniscal and anterior cruciate ligament injuries of the knee

Abstract

Background and objectives: The objectives of this study were to assess the accuracy of clinical tests for diagnosing meniscal (Thessaly, joint line tenderness and Mcmurray test) and anterior cruciate ligament (Lachman, Anterior Drawer and Pivot Shift test) injuries. Compare and correlate clinical and magnetic resonance imaging finding with arthroscopic confirmation, arthroscopy is regarded as gold standard for diagnosis. Methods: A prospective study conducted from October 2014 to October 2016. Participants included 79 patients who underwent knee arthroscopy for different indications in Erbil teaching hospital. Clinical diagnosis was established by orthopedic surgeons using clinical tests for meniscal and anterior cruciate ligament injuries. Magnetic resonance imaging was requested for confirmation. This was followed by arthroscopy for making the final diagnosis. Results: The Lachman test showed high accuracy (92.4%) to determine anterior cruciate ligament rupture. The accuracy of anterior drawer test was 70.8% and for pivot shift test was 68.3%. The Thessaly test showed high accuracy for medial (91.1%) and lateral (89.5%) meniscus tear.The joint line tenderness showed accuracy for medial (84.8%) and lateral (89.7%) meniscus tear and the McMurray test showed accuracy for medial (72.1) and for lateral (81%) meniscus tear. Validity of the clinical tests was compared to the results got from magnetic resonance imaging and arthroscopy. Accuracy of clinical diagnosis versus magnetic resonance imaging diagnosis for medial (91% vs. 89%) and lateral (89% vs. 86%) meniscal lesions was almost identical. Accuracy of clinical diagnosis compared with the accuracy of magnetic resonance imaging diagnosis for anterior cruciate ligament injuries was slightly higher (92.4% vs. 87.3%). Conclusions: The most accurate test for assessing anterior cruciate ligament rapture is Lachman test and for meniscal tear is Thessaly test with Joint line tenderness. Proper clinical examination is as accurate as magnetic resonance imaging in diagnosing meniscal injuries but for anterior cruciate ligament injuries; proper clinical examination has a better diagnostic accuracy in comparison to magnetic resonance imaging diagnosis.