Diagnosis Of Knee Injuries Research Articles

Bioimpedance Measurement of Knee Injuries Using Bipolar Electrode Configuration.

Currently, there is no suitable solution for the point-of-care diagnosis of knee injuries. A potential portable and low-cost technique for accessing and monitoring knee injuries is bioimpedance measurement. This study validated the feasibility of the bipolar electrode configuration for knee bioimpedance measurement with two electrodes placed on a fixed pair of knee acupuncture locations called Xiyan. Then, the study collected 76 valid samples to investigate the relationship between bioimpedance and knee injuries, among whom 39 patients have unilateral knee injuries, and 37 individuals have healthy knees. The self-contrast results indicated that knee injuries caused a reduction of bioimpedance of the knee by about 5% on average, which was detectable at around 100 kHz (p ≈ 0.001). Furthermore, the results analyzed by principal component analysis and support vector machines show that the detection sensitivity can reach 87.18% using the leave-one-out cross-validation. We also proposed a low-cost and portable bioimpedance measurement device that meets the needs for measuring knee joint bioimpedance.

Role of MRI in diagnosis of knee injuries in footballers

MRI findings are essential to diagnose the severity of ligament tears in knee injuries in footballers. By using Magnetic Imaging Resonance we can accurately make diagnose and can determine the extent of damage to tissues and ligaments by grading them according to injuries. Objective: The main objective of this study is to determine the MRI findings in patients of knee injuries in football players. MethodS: A multicenter descriptive study conducted at University of Lahore Teaching hospital and National hospital during 4 months period. All symptomatic football players of both genders and age ranging from 16-40 year are included in this study. Our calculated sample size is 80. 1.5T MRI machine used for scans. All images were Proton density and T2 weighted images. Results: This study includes 80 footballers complaining knee pain. Mean age of all subjects was 31.4 +, - 5.7 year. Among 80 patients who had knee injuries, 56 patients (70%) had ACL injuries, 14 patients (17.5%) had PCL injuries, 14 patients (17.5%) had LCL injuries, 8 patients (10%) had MCL injuries, 24 patients (30%) had LM injuries, and 31 patients (38.8%) had MM injuries. Conclusion: MRI is useful imaging modality for the detection of soft tissue injuries most commonly sports injuries. It gives more accurate and detailed information of ligaments and muscle tears than any other modalities. In our study most common injuries that are detected by MRI are ACL tear, bucket handle tear of medial meniscus and MCL injuries. PCL injuries are less common than ACL injuries.

Accuracy of magnetic resonance imaging in diagnosis of knee injuries

Introduction: Apart from clinical examination multiple modalities (conventional radiography, MRI and arthroscopy) are currently used to evaluate knee injuries. This study is intended to compare the sensitivity and specificity of MRI in correlation of arthroscopy in diagnosing of knee injuries. Material & Methods: This is a prospective study involving 51 patients with history of knee injuries who were admitted in the Department of Orthopaedics, in a tertiary care hospital of Kolkata between April 2013 and June 2014. MRI of the knee joint was done for all these patients either before or after admission. The patients were then subjected to diagnostic and therapeutic arthroscopy. Statistical analysis was used to calculate the sensitivity, specificity, positive predictive value and the negative predictive value, in order to assess the reliability of the MRI results.Results: The sensitivity and specificity of MRI with respect to arthroscopy in anterior cruciate ligament tear is 87.5% and 66.6%.Positive predictive value is 87.5%. Negative predictive value is 66.6%.Accuracy is 81.82%. The sensitivity and specificity of MRI with respect to arthroscopy in medial meniscal tears is 85.7% and 70.8% respectively. Positive predictive value is 63%; Negative predictive value is 89.4%; Accuracy is 76.3%. Conclusion: The present study supports that MRI is helpful in diagnosing medial meniscal and anterior cruciate ligament injuries. The negative predictive value of a MRI was found to be high for all structures of the knee joint and hence a MRI can be used to exclude a pathology, thus sparing patients from expensive and unnecessary surgery.

Where does magnetic resonance imaging stand in the diagnosis of knee injuries?

Background:The aim of this study was to determine the diagnostic value of magnetic resonance imaging (MRI) in the diagnosis of knee injuries.Materials and Methods:Ninety-eight consecutive patients were enrolled in the study. In all patients, MRI and arthroscopy were performed and the results were compared.Results:MRI was most sensitive in the detection of medial meniscus injuries, and the highest specificity and negative predictive value (NPV) were found in the detection of posterior cruciate ligament injuries.Conclusion:MRI is a valuable tool, and according to its high NPV, normal MRI can prevent unnecessary arthroscopic interventions.

Comparative analyses of diagnostic methods in knee injuries

Objective: This study is analyzing the role and significance of the three diagnostic methods (clinical diagnosis, magnetic resonance imaging (MRI) and arthroscopy), in establishing accurate diagnosis in knee injuries. The goal is to determine the diagnostic accuracy of each diagnostic method, using arthroscopy as gold standard. Material and Methods: We examined 70 patients with knee injuries. Clinical diagnosis was established using patient's history and positive clinical tests for meniscal lesions, ACL injury and articular cartilage lesions. All patients underwent MRI on a 1.5 T magnet for MRI diagnosis. This was followed by arthroscopy for making the final diagnosis. Results: We analyzed the results of clinical tests for meniscal, ligamentous and articular cartilage injuries of the patients in both groups. Validity of the clinical tests was compared to the results got from MRI and arthroscopy. Accuracy of clinical diagnosis versus MRI diagnosis for medial(69.6% vs. 68.5%) and lateral (84% vs. 82.6%) meniscal lesions was almost identical. Accuracy of clinical diagnosis compared with the accuracy of MRI diagnosis for ACL injuries was higher (91.3% vs. 81.4%). Accuracy (85.5% vs. 72.8%) of clinical diagnosis versus MRI diagnosis for articular cartilage lesions was better. Conclusion: Affirmation of clinical diagnosis in this study is a result of usage of standard clinical signs and tests which are fundamental in establishing clinical diagnosis of knee injuries. MRI is a diagnostic method which enriches the diagnostic process. Arthroscopy is defined as superior diagnostic method, also a gold standard for comparison of the other two diagnostic methods.

Diagnosis of knee injuries: comparison of the physical examination and magnetic resonance imaging with the findings from arthroscopy

ObjectivesTo ascertain the sensitivity, specificity, accuracy and concordance of the physical examination (PE) and magnetic resonance imaging (MRI) in comparison with arthroscopy, in diagnosing knee injuries. MethodsProspective study on 72 patients, with evaluation and comparison of PE, MRI and arthroscopic findings, to determine the concordance, accuracy, sensitivity and specificity. ResultsPE showed sensitivity of 75.00%, specificity of 62.50% and accuracy of 69.44% for medial meniscal (MM) lesions, while it showed sensitivity of 47.82%, specificity of 93.87% and accuracy of 79.16% for lateral meniscal (LM) lesions. For anterior cruciate ligament (ACL) injuries, PE showed sensitivity of 88.67%, specificity of 94.73% and accuracy of 90.27%. For MM lesions, MRI showed sensitivity of 92.50%, specificity of 62.50% and accuracy of 69.44%, while for LM injuries, it showed sensitivity of 65.00%, specificity of 88.46% and accuracy of 81.94%. For ACL injuries, MRI showed sensitivity of 86.79%, specificity of 73.68% and accuracy of 83.33%. For ACL injuries, the best concordance was with PE, while for MM and LM lesions, it was with MRI (p<0.001). ConclusionsMeniscal and ligament injuries can be diagnosed through careful physical examination, while requests for MRI are reserved for complex or doubtful cases. PE and MRI used together have high sensitivity for ACL and MM lesions, while for LM lesions the specificity is higher.Level of evidence II – Development of diagnostic criteria on consecutive patients (with universally applied reference “gold” standard).

Optimization of Ultrasound Examination in Diagnosis of Knee Injuries

Comparative assessment of arthroscopic and ultrasound examination data were performed in 393 patients (400 knee joints). For the perfection of diagnosis quality a principle of “feedback” (cooperation) between examiners was used. Basing on the analysis of the achieved results the reasons for sonographic and ultrasound results (objective and subjective) incompatibility were determined and real diagnostic value of ultrasound examination was estimated for every intraarticular knee structure separately.

Optimization of Ultrasound Examination in Diagnosis of Knee Injuries

Comparative assessment of arthroscopic and ultrasound examination data were performed in 393 patients (400 knee joints). For the perfection of diagnosis quality a principle of “feedback” (cooperation) between examiners was used. Basing on the analysis of the achieved results the reasons for sonographic and ultrasound results (objective and subjective) incompatibility were determined and real diagnostic value of ultrasound examination was estimated for every intraarticular knee structure separately.

Assessing the benefit of multidisciplinary assessment centre in a military population sustaining knee injury

ObjectiveTo evaluate the benefit of multidisciplinary assessment centres in the diagnosis of knee injury in military populations and assess the role of MRI as gold standard in the diagnosis of knee injury. DesignRetrospective epidemiological study. Setting122 servicemen attending the Multidisciplinary Injury Assessment Clinic (MIAC) at Redford Barracks, Edinburgh between January 2008 and January 2010. ResultsThe most common of these injuries were to the medial meniscus (30.3%), osteochondral defects (28.7%) and anterior cruciate ligament (25.4%). 45.6% of patient sustained injury to more than one structure.23% of the 122 servicemen were deemed fully fit for military duty following treatment; 41 (34%) were classed as partially fit, with 31 (25.4%) deemed not medically fit at the end of period of assessment. The MIAC team were both more sensitive and specific at picking up all forms of structural knee injury with the exception of meniscal injuries, where the MIAC was more sensitive (0.76 vs. 0.74) but less specific (0.53 vs. 0.62). MRI was shown to have a sensitivity of between 0.68 and 0.96 when compared against arthroscopy. Its specificity was poorest for picking up osteochondral defects (0.39). DiscussionThe MIAC diagnosis of knee injuries was shown to be more effective than that of non-specalised GPs. MIAC also had a good degree of clinical accuracy when compared to MRI. MRI was shown to be an effective investigation, although not 100% sensitive and specific, and was poor at picking up osteochondral defects. It is recommended that the use of systems such as MIAC be expanded in the civilian community and be used in conjunction with MRI for maximal diagnostic efficiency.

ARTHROSCOPIC DETERMINATION OF ACCURACY OF CLINICAL EXAMINATION IN INJURIES WITH INTERNAL DERANGEMENT OF KNEE

Abstract Background: For the diagnosis of knee injuries some investigations along with detailed history and clinical examination such as arthrography and arthroscopy are required, which increase the authenticity of diagnosis. Objective: To determine diagnostic accuracy of pre-operative clinical diagnosis with arthroscopic diagno-sis in internal derangement of knee. Methods: This was a Comparative cross sectional study. Conducted at Department of Orthopaedic Sur-gery and Traumatology (DOST) Unit - 1, King Edward Medical University, Mayo Hospital Lahore. Total 45 patients having symptomatic knee injuries, were inclu-ded in this study. After taking informed consent from these patients, a clinical diagnosis of medial meniscus tear (MMT), lateral meniscus tear (LMT), anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament(MCL) and lateral collateral ligament (LCL) injury of knee was made, confirmation with magnetic resonance imaging (MRI) was done and those patients having positive clinical and MRI findings of above mentioned injuries arthro-scopy was carried out and then findings of both clini-cal examination and arthroscopy were compared to find out the diagnostic accuracy of clinical examinat-ion. Data was analyzed with the help of SPSS version 20. Results: Mean age of all 45 patients was 29.51 ± 8.72 years. Minimum and maximum age of patients was 18 and 48 years respectively. Clinical examination is 70.83% sensitive and 19.05% specific for medial meniscus tear. Clinical examination has 50% Positive predictive value and 36.36% Negative predictive value. For the diagnosis of Lateral Meniscal tear, clini-cal examination is 16.67% sensitive and 89.47% speci-fic. While clinical examination has 20% positive pre-dictive value and 87.5% negative predictive value. For ACL rupture diagnosis clinical examination is 72.73% sensitive and 66.67% specific. While clinical examina-tion has 85.71% positive predictive value and 47.06% negative predictive value. Conclusion: Results of this study clearly revealed that diagnostic accuracy of clinical examination for the diagnosis of internal derangement of knee shows vari-ability. Clinical examination findings have high sensi-tivity for diagnosis of MMT and ACL injuries while it shows very low sensitivity for LMT. While specificity of clinical examination for diagnosing LMT and ACL was high but for MMT was low. Key Words: Arthroscopy, Clinical Examination, Internal derangement, Knee.

An analysis on MRI diagnosis of knee injury in 38 patients

Objective To explore the diagnostic value of magnetic resonance ( MR ) for knee injury.Methods 38 patients who had signs of knee injury on clinical examination and underwent MR examinations during the period of 2011 to 2012 were included in this study.The findings of MR imaging were analyzed.Results MR clearly showed the injuries of the knees,including knee meniscus injury,ligament injuries,bone contusion,fractures,joint effusion,and soft tissue swelling,with characteristic appearance in imaging.It had a higher diagnostic reliability and accuracy rate,with a combination of history of knee injury.Conclusions MRI has greater values and clinical significance in the diagnosis of knee injury. Key words: Knee; Injury; Magnetic resonance

Oblique meniscomeniscal ligament: a potential pitfall in the diagnosis of knee injury

The purpose of the Journal of the Belgian Society of Radiology is the publication of articles dealing with diagnostic and interventional radiology, related imaging techniques, allied sciences, and continuing education

Management of Knee Injuries in the Accident and Emergency Department

Knee injuries are frequently seen in the accident and emergency (A&E) department. A prospective study was carried out to investigate the reliability of the initial diagnosis of knee injuries made in the A&E department. All patients (n = 425) who presented at the A&E Department of the Red Cross Hospital in the Hague, the Netherlands, in 1996 with a knee injury were clinically examined and an X-ray was obtained. The patients were reviewed in the outpatient clinic after 4 days and then at 6 weeks. At these times, patients were referred to the orthopedic outpatient clinic for further investigation and treatment as indicated. After 5 years, a final evaluation was undertaken. After 6 weeks, the subsequent diagnosis was found to differ from the initial one in 6% of cases. This finding had no further consequences with regard to prognosis. After 5 years, all patients were approached by telephone. In total, 94% of the patients were contacted and of these, three patients (1%) had been re-referred to the orthopedic outpatient clinic. The final diagnosis of these three patients was different to the initial diagnosis. Of these patients, one needed an arthroscopy, the other two received conservative treatment. The study found that 1% of knee injuries were misdiagnosed at the A&E department. It is therefore beneficial to review patients with knee injuries in the outpatient clinic after 4 days.

Assessment and Diagnosis of Knee Injuries: The value of an experienced physiotherapist

Summary A range of titles now reflects emerging roles in physiotherapy: clinical specialists, extended scope practitioners, and more recently consultant therapists. While each role is essentially different, what people in these roles have in common is experience. There is a move to cut down patient waiting times both for operations and for orthopaedic consultant outpatient appointments. An experienced physiotherapist with additional skills would help achieve a reduction in patient waiting times, being able to triage patients for either conservative treatment or a consultant appointment. This study investigates physiotherapists' diagnostic accuracy of acute knee injuries and answers the question: ‘Can a physiotherapist manage the diagnosis of patients presenting with an acute knee injury safely and effectively?’ This is a prospective study investigating the agreement between physiotherapists' clinical diagnoses and arthroscopic diagnosis of the knee. Fifty consecutive new patients referred to one consultant's acute knee clinic were recruited into the study. Assessment was by a consultant knee surgeon and two experienced physiotherapists in random order. An initial diagnosis was then made. This was compared to final diagnosis, which was mainly based on arthroscopic findings and special investigations. The results show that experienced physiotherapists are able to diagnose acute knee injuries with a high rate of accuracy, sensitivity and specificity. A range of titles now reflects emerging roles in physiotherapy: clinical specialists, extended scope practitioners, and more recently consultant therapists. While each role is essentially different, what people in these roles have in common is experience. There is a move to cut down patient waiting times both for operations and for orthopaedic consultant outpatient appointments. An experienced physiotherapist with additional skills would help achieve a reduction in patient waiting times, being able to triage patients for either conservative treatment or a consultant appointment. This study investigates physiotherapists' diagnostic accuracy of acute knee injuries and answers the question: ‘Can a physiotherapist manage the diagnosis of patients presenting with an acute knee injury safely and effectively?’ This is a prospective study investigating the agreement between physiotherapists' clinical diagnoses and arthroscopic diagnosis of the knee. Fifty consecutive new patients referred to one consultant's acute knee clinic were recruited into the study. Assessment was by a consultant knee surgeon and two experienced physiotherapists in random order. An initial diagnosis was then made. This was compared to final diagnosis, which was mainly based on arthroscopic findings and special investigations. The results show that experienced physiotherapists are able to diagnose acute knee injuries with a high rate of accuracy, sensitivity and specificity.

IMAGING OF SKELETAL AND SOFT TISSUE INJURIES IN AND AROUND THE KNEE

This article addresses the place of MR imaging in the diagnosis of knee injuries. MR imaging of subtle fractures and bone contusions is described with emphasis placed on those types of fractures frequently associated with specific patterns of soft tissue injury. Soft tissue injuries are divided into ligamentous, meniscal, and muscular; each is discussed separately. The MR imaging appearance of these lesions is explained.

Magnetic resonance imaging in the diagnosis of knee injuries

Of all the magnetic resonance examinations performed for studying musculoskeletal disease, magnetic resonance imaging (MRI) of the knee is the most frequently requested examination. It has replaced knee arthrography in the vast majority of clinical situations. MRI of the knee is currently the diagnostic procedure of choice for the diagnosis of injuries to the menisci, ligaments, and tendons as well as bone bruises and occult fractures in the knee. This review article discusses the technical aspects of performing the MRI examination of the knee. It also discusses the magnetic resonance criteria for diagnosing meniscus tears, ligament and tendon disruptions, and bone bruises.

The diagnosis of knee injuries in Casualty—a prospective study

A prospective study of all knee injuries seen at a Casualty Department was organized. A clinical diagnosis was made in each case, based on standardized criteria, and the subsequent progress followed. Meniscal tears tended to be over-diagnosed clinically. Many injuries thus classified settled in three to four weeks without further sequelae. Conversely, complete ligament tears were under-diagnosed and in particular these tended to be missed in the presence of a haemarthrosis. Examination under anaesthesia is recommended if there is any doubt concerning ligamentous stability and all unexplained haemarthroses should have early examination under anaesthesia and arthroscopy. Among those injuries initially regarded as less serious e.g. traumatic synovitis, no serious pathology subsequently emerged.