Comparative analysis of diagnostic methods in meniscal lesions.

UNLABELLED: The aim of this study is to determine the accuracy of clinical and MRI diagnosis in comparison with arthroscopy for detection of meniscal lesions. Also, to answer if MRI diagnosis impacts on the decision of the surgeon for the choice of treatment (operative or conservative).

MATERIAL AND METHODS: We examined 70 patients with knee injuries. Clinical diagnosis was established using the case-history of the patient and positive clinical tests for meniscal injuries (McMurray and Aplay). All patients underwent MRI on a 1.5 T magnet for MRI diagnosis. This was followed by arthroscopy for final diagnosis. Clinical and MRI diagnoses were correlated with the arthroscopic diagnosis which was used as a gold standard.

RESULTS: Of 70 patients with knee injuries, 55 had a clinical diagnosis of meniscal lesions out of whom 44 patients had a medial meniscal lesion and 11 had a lateral meniscal lesion. Arthroscopy confirmed the clinical diagnosis in 32 patients (72.72%) (44 vs 32) in medial meniscal lesion, and 8 patients (72.7%) (11 vs 8) with a lateral meniscal lesion. In MRI diagnosis of 56 patients with medial meniscal lesion arthroscopy confirmed the diagnosis in 34 patients (60.7%) (56 vs 34) and pf 10 patients with lateral meniscal lesion arthroscopy confirmed the diagnosis in 6 patients (60%) (10 vs 6). The sensitivity, specificity, PPV and NPV of clinical diagnosis versus MRI for medial meniscus were (79.9% vs 79.5%); (58.1% vs 38.1%); (69.8% vs 69.6%); (69.2% vs 69.2%). The sensitivity, specificity, PPV and NPV of clinical diagnosis versus MRI for lateral meniscus were (50% vs 40%); (92.7% vs 92.7%); (63.6% vs 60%); (87.9% vs 85.5%).

CONCLUSIONS: Carefully performed clinical examination can give an equal or better diagnosis of meniscal lesions in comparison with MRI diagnosis. Any experienced orthopaedic surgeon can trust his clinical diagnosis as an indication of arthroscopy. When the clinical diagnosis is established, with no doubts due to positivity of the clinical tests, the MRI is not essential. In suspected cases where there is a dilemma, MRI is very helpful in making a decision for arthroscopy. The diagnostic accuracy of clinical and MRI diagnosis of meniscal lesions is high. Their reliability in diagnosing meniscal lesions is evident. lesion, clinical diagnosis, MRI, arthroscopy.