Abstract
BackgroundPreoperative magnetic resonance imaging (MRI) has internationally been proven to reduce unnecessary knee arthroscopies and assist with surgical planning. This has the advantage of avoiding unnecessary surgery and the associated anaesthetic risk, as well as reducing costs. No data were found in the recently published literature assessing the accuracy of MRI interpretation of knee ligament injury in the public sector locally.ObjectivesThis pilot study aimed to determine the accuracy of MRI in detecting non-osseous knee injury in a resource-limited tertiary-level academic hospital in Pretoria, South Africa, compared to the gold standard arthroscopy findings.MethodThis was an exploratory retrospective analysis of 39 patients who had MRI and arthroscopy at Steve Biko Academic Hospital (SBAH). True positive, true negative, false positive and false negative results were extrapolated from findings in both modalities and translated into sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for each structure.ResultsNegative predictive values were recorded as 97%, 81%, 90% and 100% (anterior cruciate ligament [ACL], medial meniscus [MM], lateral meniscus [LM] and posterior cruciate ligament [PCL], respectively), which were comparative to recently published international literature. The PPV results were lower than those previously evaluated at 55%, 58%, 55% and not applicable. The sensitivities and specificities of the ligaments were 83%, 58%, 83% and not applicable; and 87%, 81%, 70% and not applicable, respectively.ConclusionMagnetic resonance imaging was found to be sensitive and specific, with a high NPV noted in all structures evaluated. Negative results can therefore be used to avoid unnecessary surgery to the benefit of the patient and state. The study reiterates that high accuracy can be obtained from MRI on a 1.5-tesla non-dedicated scanner, with interpretation by generalist radiologists.
Highlights
The knee joint is primarily a hinge joint; its flexibility allows for a wide range of further movements, but at the expense of stability.[1]
Thereafter, the results were classified into true positive (TP), true negative (TN), false positive (FP) and false negative (FN) results
TN, FP and FN results were recorded for each ligament per patient, and respective sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated
Summary
The knee joint is primarily a hinge joint; its flexibility allows for a wide range of further movements, but at the expense of stability.[1]. The modality is unparalleled in the evaluation of non-osseous knee structure derangement, being well suited for high-resolution assessment of the musculoskeletal (MSK) system, including muscle, tendon, ligament and occult bone injuries.[9,10,11] Arthroscopy is considered the gold standard in terms of http://www.sajr.org.za. Preoperative magnetic resonance imaging (MRI) has internationally been proven to reduce unnecessary knee arthroscopies and assist with surgical planning. This has the advantage of avoiding unnecessary surgery and the associated anaesthetic risk, as well as reducing costs. No data were found in the recently published literature assessing the accuracy of MRI interpretation of knee ligament injury in the public sector locally
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