Diagnosis Of Medial Meniscal Tears Research Articles

Mcmurray Test for Diagnosis of the Meniscal Tears

Aim: Meniscal tears are the most common injury of the knee. Tears of medial meniscus are seen more frequently as compared to lateral meniscus. Most often tears result from sports injuries where there is a twisting motion on the partially flexed, weight-bearing knee. As majority of our population resides in peripheries where access to arthroscopy and imaging modalities is difficult so we need a clinical test for evaluation of medial meniscal tears. And then this technique can be opted in our practice for early diagnosis of meniscal tears in order to take proper management for reducing morbidity of these particular patient, if its diagnostic accuracy comes out to high. Objective: To determine the diagnostic accuracy of McMurray test in diagnosing medial meniscal tears, taking arthroscopy as gold standard. Materials and Methods: This Cross-sectional validation study was carried out in Orthopedic Department of Medical Teaching Institute Lady Reading Hospital Peshawar from July 2021 to June 2023.In this study a total of 149 patients were observed. McMurray test was performed by the a single and same consultant and was looked for medial meniscal tear (present/absent).After this arthroscopy was done in each patient by the consultant orthopedic surgeon who has examined the patient and presence or absence of medial meniscal tear was noted. McMurray test results were compared with arthroscopy result. Results: In this study mean age was 30 years with SD ± 11.35. Eighty five percent patients were male and 15% patients were female. Diagnostic accuracy of MacMurray Test findings taking arthroscopy as gold standard was analyzed as the sensitivity was 76.55%, specificity was 75%, Positive predictive value was 99.10%, Negative predictive value was 8.10%. So, the overall diagnostic accuracy was 76.51%. Practical Implication: As in our setups majority of population resides in peripheries where access to arthroscopy and magnetic resonance imaging is difficult so there is a need of clinical test for diagnosing medial meniscal tears. And this technique can be opted in routine practice for early diagnosis of medial meniscal tears in order to take proper management for reducing morbidity of these particular patients after determining the sensitivity and specificity of the test. Conclusion: This study concludes that the McMurray test had sensitivity 76.55%, specificity 75%, Positive predictive value 99.10%, Negative predictive value 8.10% and the diagnostic accuracy 76.51% in diagnosis of meniscal tear keeping knee arthroscopy as gold standard. Keywords: Arthroscopy, Knee, McMurray test, Meniscal tear, Magnetic resonance imaging.

Associations between meniscal tears and various degrees of osteoarthritis among dogs undergoing TPLO for cranial cruciate ligament rupture

ObjectiveThe aim of this study was to evaluate the association between meniscal lesions and severity of osteoarthritis (OA) among dogs that underwent Tibial Plateau Leveling Osteotomy (TPLO) for stabilization of cranial cruciate ligament rupture (CrCLR) at the University of Tennessee in 2011–2017.ResultsThere were a total of 252 meniscal tears. Factors associated with diagnosis of medial meniscal tears (MMT) in dogs were severe OA in comparison to no OA (3.8 OR, 2.0–8.0 95% CI, 0.001 p-value), sporting and mixed breed group compared to other breed (3.6 OR, 1.7–7.6 95% CI, 0.004 p-value; 3.2 OR, 1.6–6.6 95% CI, 0.019 p-value, respectively), increasing age (1.1 OR, 1.0-1.2 95% CI, 0.018 p-value), complete CrCLR compared to partial (3.3 OR, 2.1-5.0 95% CI, < 0.001 p-value), and arthrotomy compared to arthroscopy (2.2 OR, 1.4–3.1 95% CI, 0.002 p-value). The factors that did not have significance in predicting MMT were weight, sex, lameness period, and side affected.

Accuracy of needle arthroscopy for the diagnosis of medial meniscal tears in dogs with cranial cruciate ligament rupture.

To determine the accuracy of needle arthroscopy (NA) for the diagnosis of medial meniscal tears in dogs with cranial cruciate ligament rupture (CCLR). Prospective clinical trial. Twenty-six client-owned dogs. Dogs with CCLR and scheduled to undergo tibial plateau leveling osteotomy were recruited for the study. Needle arthroscopy was performed by an experienced surgeon; the same dog subsequently underwent standard arthroscopy (SA) by another experienced surgeon who was blinded to the NA findings. The SA arthroscopy findings were used as the gold standard. Arthroscopy time, visibility of the menisci, ability to probe the menisci, and the presence of meniscal tears were recorded for both arthroscopies. The degree of lameness before and after NA was subjectively quantified. The sensitivity and specificity to diagnose medial meniscal tears with NA was 95% and 100%, respectively. Visibility of the menisci was lower (P < .01), probing of the lateral meniscus was harder (P=.0017), and procedure time was shorter (P=.073) with NA when compared to SA. The lameness scores did not differ before and after NA (P=.25). Needle arthroscopy could be performed rapidly with low morbidity, and had high accuracy for detecting medial meniscal tears in dogs with CCLR. Needle arthroscopy is a promising minimally invasive technique for diagnosing medial meniscal tears in dogs with CCLR.

Accuracy of standard MRI sequences for meniscal tears and grading of chondral lesions in the knee, relative to knee arthroscopy: A prospective study of 719 cases

Introduction: Musculoskeletal magnetic resonance imaging (MRI) is commonly used for diagnosis and research, but its accuracy remains unproven and its clinical usefulness is questionable. The goal of this study was to compare the accuracy of knee MRI with clinical assessment for diagnosing meniscal tears, and to determine the accuracy of MRI for grading chondral lesions, relative to knee arthroscopy. Methods: Physically active patients presenting with acute / sub-acute onset of mechanical symptoms, in the absence of grade 2-3 ligament injury or true locking, that had been preventing them from taking part in their usual physical activity for at least 4 weeks, and with clinical findings that warranted a knee arthroscopy, had both a knee arthroscopy and an MRI performed. Patients were over the age of 18 years, fit for general anaesthetic, with no contraindications for arthroscopy or MRI, and prepared to undergo both. A standard knee arthroscopy was performed and the intra-operative findings were compared with those of the MRI, using the International Chondral Research Society (ICRS) grading for chondral damage, and the presence or absence of a meniscal tear. All MRIs were performed on either a 1.5T or 3.0T MRI machine, using standard sequences. Results: 719 patients were recruited over a period of 6.5 years. Their average age was 52 years (standard deviation, SD 5.2), the male:female ratio was 493:226. Kappa scores with standard errors (SE) for agreement between MRI and knee arthroscopy were 0.41 (SE 0.1) for medial meniscal tears, and 0.44 (SE 0.1) for lateral meniscal tears. For the grade of chondral damage, the Kappa scores with SE values were 0.09 (0.1), 0.17 (0.1), and 0.22 (0.07) for anterior, medial and lateral compartments respectively. Using areas under the receiver operating characteristic curves, we found clinical assessment was more accurate than MRI for diagnosis of lateral meniscal tears (P<0.001), and of similar accuracy for the diagnosis of medial meniscal tears (P=0.12). Discussion: MRI had relatively poor correlation with arthroscopic findings for grading chondral damage and was less accurate than clinical assessment for the diagnosis of lateral meniscal tears. Other research has suggested that MRI is overused in clinical practice and may increase the number of knee arthroscopies performed. Up to 40% of patients diagnosed with a meniscal tear on MRI had no meniscal tear at arthroscopy. Insufficient accuracy will undermine the validity of any research in which this imaging modality has a primary role in the study methodology. Conflict of interest declaration: My co-authors and I acknowledge that we have no conflict of interest of relevance to the submission of this abstract.

A STUDY IN INDIAN POPULATION CORRELATING THE DIAGNOSTIC ACCURACY OF CLINICAL EXAMINATION AND MRI IN ACL AND MENISCUS INJURIES

In the modern era of medicine, magnetic resonance imaging (MRI) has become an indispensable part in diagnosing knee injuries.Due to an increased dependence and reliance on MRI,clinical findings are often ignored and this leads to a neglect in diagnosing ligament injury. Considering a highly variable result in clinical findings &amp; less studies being performed in Indian population we did an agreement study comparing the role of clinical examination,MRI findings and diagnostic arthroscopy in the diagnosis of traumatic chronic anterior cruciate ligament &amp; meniscal injuries in our tertiary care hospital. In our prospective study we included 267 patients with anterior cruciate ligament, medial meniscus and lateral meniscus injuries.First these patients were examined clinically,then subjected to an MRI scan and arthroscopic surgery.Here we report a superior sensitivity and specificity of clinical examination in comparison to MRI scan for diagnosis of medial meniscal tears. For the diagnosis of anterior cruciate ligament (ACL) and lateral meniscus injury the results were found to be aequivocal.We recommend that when suspected clinically, a normal MRI should not be considered as a sufficient evidence to defer an arthroscopy in knee injury patient.

Accuracy of standard magnetic resonance imaging sequences for meniscal and chondral lesions versus knee arthroscopy. A prospective case-controlled study of 719 cases.

Magnetic resonance imaging (MRI) is commonly used for diagnosis and as a research tool, but its accuracy is questionable. The goal of this study was to compare the accuracy of knee MRI with clinical assessment for diagnosing meniscal tears, and to determine the accuracy of MRI for grading chondral lesions, relative to arthroscopy. Physically active patients presenting with mechanical symptoms warranting a knee arthroscopy and satisfying the inclusion criteria, had both a knee arthroscopy and MRI performed. Arthroscopic findings were compared with those of MRI, using the International Chondral Research Society grading for chondral damage, and the presence or absence of a meniscal tear. A total of 719 patients were recruited over a period of 6.5 years, average age 52 years (standard deviation, SD 5.2), male:female=493:226. Kappa scores with standard errors (SE) for agreement between MRI and knee arthroscopy were 0.41 (SE 0.1) for medial meniscal tears, and 0.44 (SE 0.1) for lateral meniscal tears. For the grade of chondral damage, the Kappa scores with SE values were 0.09 (0.1), 0.17 (0.1), and 0.22 (0.07) for anterior, medial and lateral compartments, respectively. Using areas under the receiver operating characteristic curves, we found clinical assessment was more accurate than MRI for diagnosis of lateral meniscal tears (P < 0.001), and of similar accuracy for the diagnosis of medial meniscal tears (P=0.12). MRI has relatively poor correlation with arthroscopic findings for grading the chondral damage and was less accurate than clinical assessment for the diagnosis of lateral meniscal tears.

Clinical, magnetic resonance imaging and arthroscopic findings in diagnosis of meniscal tears: a prospective study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; In developing countries like India the need for cost conscious medical practice has a major role in the economy of the country. The extensive use of costly investigative modalities puts huge burden on the patient needing proper medical care. This study is undertaken to assess the role of different diagnostic tools like clinical diagnosis, magnetic resonance imaging (MRI) and arthroscopy in diagnosis of meniscal tears.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A prospective study was conducted among 90 individuals with knee injuries due to various causes attending orthopaedic department of The Oxford Medical College and research centre, Bangalore from October 2018 to May 2019. All patients aged 18 to 60 years with history of knee injury who underwent clinical examination, radiographic examination, MRI and arthroscopy. The data was entered in MS Excel and analysed using SPSS.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The study consisted of patients aged between 18-60 years (mean age 32.5 years). Out of which 59 were male and 31 were female. There were 54 patients with suspect diagnosis of medial meniscal tear and 36 with lateral meniscal tear. The difference in diagnostic values between the clinical andMRI findings in diagnosing the medial and lateral meniscal injuries were minimal.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Ligament injuries of knee are more common with sports injuries and high velocity trauma. A well-trained surgeon can be more reliable than MRI in diagnosing the ligament injuries. Since MRI is expensive, it can be skipped and used only in more doubtful and complex knee injuries.&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

Accuracy of 3-Tesla Magnetic Resonance Imaging for the Diagnosis of Intra-articular Knee Injuries in Children and Teenagers

Magnetic resonance imaging (MRI) is a commonly used tool for the diagnosis of intra-articular knee pathologies. Although many studies have reported the accuracy of MRI in the adult population, fewer studies have investigated these tests in younger patients. Furthermore, these studies have shown a higher variability in both the sensitivity and the specificity of MRI for these knee injuries in this age group. Advancements in MRI technology, such as the 3-Tesla (3T) MRI magnet, have shown promising results for musculoskeletal injury diagnosis in adults. This study aims to evaluate 3 T MRI for the diagnosis of intra-articular knee pathologies in a pediatric and adolescent patient population. The records of 116 patients (119 knees) under the age of 20 years who underwent 3 T MRI studies of the knee and subsequent knee arthroscopy were reviewed retrospectively. The MRI report from the musculoskeletal radiology staff, the interpretation from the staff orthopedic surgeon, and the operative note dictations were compared, with a focus on meniscus and anterior cruciate ligament (ACL) pathologies. Seventeen orthopedic staff reads were not obtainable. Arthroscopy was used as the gold standard for diagnosis. The average age at MRI exam was 16.0 years and at surgery was 16.2 years. Using the musculoskeletal radiologist interpretation, the sensitivity and the specificity of 3 T MRI were 81.0% and 90.9% for medial meniscus injuries, 68.8% and 93% for lateral meniscus injuries, and 97.9% and 98.6% for ACL injuries, respectively. The orthopedic surgeon's interpretation of 3 T MRI had a sensitivity and specificity of 75.7% and 92.4% for medial meniscus injuries, 69.8% and 98.3% for lateral meniscus injuries, and 100% and 98.6% for ACL injuries, respectively. Posterior horn tears had the greatest discrepancies. When performed on pediatric and adolescent patients, newer 3 T MRI studies have excellent accuracy for diagnosing ACL tears. These studies also show a higher accuracy for the diagnosis of medial meniscal tears than lateral meniscal tears. Diagnostic study--Level 2.

Knee sonography as a diagnostic test for medial meniscal tears in young patients

To prospectively evaluate whether age of patient affects diagnostic accuracy of sonography and magnetic resonance imaging (MRI) in the diagnosis of medial meniscal tears. We prospectively evaluated 74 consecutive patients (54 males and 20 females), in two different groups [group A (37 patients ≤ 30 years; mean age: 23.5 ± 5 years) and group B (37 patients > 30 years; mean age: 43.5 ± 9.35 years)] with clinical suspicion of medial meniscal tear. After inclusion, patients underwent ultrasonography and then MRI for signs of tearing. The ultrasonographic and MRI findings were compared with arthroscopic findings, which served as a gold standard for accurate detection of meniscal tearing. The sensitivity, specificity, positive and negative predictive values and accuracy of ultrasonography in detecting medial meniscal tears in group A were 100, 88.9, 96.5, 100, 97.3% and in group B were 83.3, 71.4, 92.6, 50, 81.1%, respectively. The sensitivity, specificity, positive and negative predictive values and accuracy of MRI in group A were 100, 88.9, 96.5, 100, 97.3% and in group B were 96.7, 85.7, 96.7, 85.7, 94.6%, respectively. Given the fact that the sensitivity and specificity of the results of knee sonography matched that of MRI in patients who were 30 years old or less, we suggest ultrasonography as an effective initial investigation for tears of medial meniscus in this group of patients. Patients with negative ultrasonographic findings will need no further investigation. Diagnostic studies-investigating a diagnostic test, Level II.

Internal Knee Derangement Assessed with 3-minute Three-dimensional Isovoxel True FISP MR Sequence: Preliminary Study

To prospectively evaluate the accuracy of magnetic resonance (MR) imaging of the knee performed by using a three-dimensional (3D) isovoxel sequence involving an acquisition time of approximately 3 minutes, with surgery as the reference standard. The study was institutional review board approved. Written informed consent was obtained from all patients. Thirty knees of 29 patients (14 women, 15 men; mean age, 41 years) were prospectively examined by using a 3D isovoxel true fast imaging with steady-state precession (FISP) sequence with water excitation and secondary multiplanar reformations. All patients underwent arthroscopy within 12 days after true FISP MR imaging. Two blinded readers evaluated the MR images. Accuracy for detection of cartilage defects and anterior cruciate ligament (ACL) and meniscal tears, interobserver agreement, and intermethod agreement were calculated. Overall sensitivity, specificity, and accuracy of isovoxel true FISP imaging for the diagnosis of cartilage defects were 45%, 83%, and 76%, respectively, for reader 1 and 63%, 82%, and 83%, respectively, for reader 2. Averaged (for readers 1 and 2) sensitivity, specificity, and accuracy of isovoxel true FISP imaging were, respectively, 80%, 95%, and 90% for diagnosis of ACL tear; 100%, 82%, and 90% for diagnosis of medial meniscal tear; and 83%, 83%, and 83% for diagnosis of lateral meniscal tear. The standard MR sequences used at the authors' institution had overall sensitivities, specificities, and accuracies of 39%, 83%, and 71%, respectively, for reader 1 and 37%, 85%, and 76%, respectively, for reader 2. Averaged sensitivity, specificity, and accuracy of the standard MR sequences were, respectively, 70%, 100%, and 90% for diagnosis of ACL tear; 96%, 77%, and 85% for diagnosis of medial meniscal tear; and 83%, 77%, and 78% for diagnosis of lateral meniscal tear. The diagnostic performance of knee MR imaging performed by using a 3D water excitation isovoxel true FISP sequence and an imaging time of approximately 3 minutes is comparable to the diagnostic performance of the MR sequences used as standards at the authors' institution.

Osteonecrosis of the knee following arthroscopic meniscectomy in patients over 50-years old

We reviewed eight patients over 50-years old, with an initial diagnosis of medial meniscal tear confirmed with magnetic resonance imaging (MRI) and with no evidence of osteonecrosis. After arthroscopic meniscectomy, all patients had recurrent aggravated knee pain and reevaluation with MRI showed images compatible with osteonecrosis. The average age was 65 years (range 54 to 75 years). The mean time from MRI to surgery was 8 weeks (range 1 to 28 weeks). In five patients a total meniscectomy, and in three a partial meniscectomy with recontouring of the meniscus were performed. Surgical treatment was initially successful, but all eight patients returned to our office with recurrent aggravated pain in the treated knee. Reevaluation with MRI, at an average of 18 weeks postoperatively, found abnormalities at the medial condyle consistent with osteonecrosis. The purpose of this study is to report a potentially serious outcome after arthroscopic meniscectomy in patients over 50-years old.

The Diagnostic Validity of Magnetic Resonance Imaging in Acute Knee Injuries With Hemarthrosis: A Single-Blinded Evaluation in 69 Patients Using High-Field MRI Before Arthroscopy

Sixty-nine patients with traumatic knee hemarthrosis were evaluated an average of 3 days after trauma by high field (1.5T) magnetic resonance imaging (MRI) using sagittal T1, T2-weighted and coronal 3D-gradient echo images. All knees were arthroscopically examined shortly afterwards. The diagnostic validity of MRI for intraarticular pathology was determined using arthroscopy as golden standard. All patients had pathological findings on arthroscopy. The injuries were sports-related in 77% of the cases. MRI was highly sensitive (86%) and specific (92%) for diagnosis of anterior cruciate ligament tears. Diagnosis of medial meniscal tears showed a 74% sensitivity and 66% specificity. MRI detected lateral meniscal tears in 50% with an 84% specificity. As such, MRI missed 10 significant meniscus ruptures requiring surgical treatment. The sensitivity for partial or total medial collateral ligament tears was 56%, the specificity 93%. Rupture of the medial retinaculum in cases with patellar dislocation or significant damage of articular cartilage were only detected by MRI in a few cases (27% and 20% sensitivity, respectively). MRIs low diagnostic validity for intraarticular pathology with hemarthrosis may be attributed to the shifting paramagnetic properties of the blood remains and catabolic processes in meniscal and chondral tissues during the hemoglobin degradation process. Accordingly, MRI, with the technique used, could neither replace arthroscopy in the diagnosis and screening of acute knee injuries, nor select patients with need for immediate arthroscopic meniscal surgery.

Prospective evaluation of the McMurray test.

The accuracy and interexaminer reliability of the McMurray test for the diagnosis of meniscal tears were compared with arthroscopic findings in a prospective study of 104 consecutive patients awaiting elective arthroscopy. The only significant McMurray sign found to correlate with meniscal injury was a "thud" elicited on the medial joint line with a medial meniscal tear (P = 0.05) that had a fair interexaminer reliability (kappa = 0.35). The sensitivity of a medial thud was 16%, and the specificity was 98% with a positive predictive value of 83%. Examiner experience had little effect on the accuracy of diagnosis of medial meniscal tears. This study supports the continued but limited emphasis on the McMurray test in the clinical diagnosis of meniscal tears.