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

Las Jamal  Hwazi; Dedawan  Namiq; Idris  Jerjis

doi:10.56056/amj.2017.31

Authors

Las Jamal Hwazi M.B.Ch.B C.A.B.M.S (Ortho)
Dedawan Namiq M.B.CH.B F.K.B.M.S (Ortho)
Idris Jerjis M.B.Ch.B, F.I.C.M.F (Radiology)

DOI:

https://doi.org/10.56056/amj.2017.31

Keywords:

Anterior Cruciate Ligament, Clinical Examination, Magnetic Resonance Imaging, Meniscus, Knee Arthroscopy

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.

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References

Magee T, Shapiro M, Williams D. MR accuracy and arthroscopic incidence of meniscal radial tears. Skeletal radiology. 2002;31(12):686-9.

Feller JA, Webster KE. Clinical value of magnetic resonance imaging of the knee. ANZ journal of surgery. 2001;71(9):5347.

Miller MD, Thompson SR. Miller›s Review of Orthopaedics. Seventh ed: Elsevier Health Sciences; 2016. 339-52 p.

Hegedus EJ, Cook C, Hasselblad V, Goode A, Mccrory DC. Physical examination tests for assessing a torn meniscus in the knee: a systematic review with meta-analysis. journal of orthopaedic & sports physical therapy. 2007;37(9):541-50.

Malanga GA, Andrus S, Nadler SF, McLean J. Physical examination of the knee: a review of the original test description and scientific validity of common orthopedic tests. Archives of physical medicine and rehabilitation. 2003;84(4):592-603. 6.Karachalios T, Hantes M, Zibis AH, Zachos V, Karantanas AH, Malizos KN. Diagnostic accuracy of a new clinical test (the Thessaly test) for early detection of meniscal tears. The Journal of Bone & Joint Surgery. 2005;87(5):955-62.

Benjaminse A, Gokeler A, van der Schans CP. Clinical diagnosis of an anterior cruciate ligament rupture: a meta-analysis. Journal of Orthopaedic & Sports Physical Therapy. 2006;36(5):267-88. 8.Lieberman JR. AAOS comprehensive orthopaedic review: American academy of orthopaedic surgeons; 2009.

Mandelbaum BR, Finerman GA, Reicher MA, Hartzman S, Bassett LW, Gold RH, et al. Magnetic resonance imaging as a tool for evaluation of traumatic knee injuries: anatomical and pathoanatomical correlations. The American journal of sports medicine. 1986;14(5):361-70. 10.Reicher MA, Rauschning W, Gold R, Bassett L, Lufkin R, Glen Jr W. High-resolution magnetic resonance imaging of the knee joint: normal anatomy. American journal of roentgenology. 1985;145(5):895-902.

Mink JH, Levy T, Crues 3rd J. Tears of the anterior cruciate ligament and menisci of the knee: MR imaging evaluation. Radiology. 1988;167(3):769-74.

Rayan F, Bhonsle S, Shukla DD. Clinical, MRI, and arthroscopic correlation in meniscal and anterior cruciate ligament injuries. International orthopaedics. 2009;33(1):129-32.

Huysse WC, Verstraete KL, Verdonk PC, Verdonk R, editors. Meniscus imaging. Seminars in Musculoskeletal radiology; 2008: © Thieme Medical Publishers.

Anderson MW. MR imaging of the meniscus. Radiologic Clinics of North America. 2002;40(5):1081-94.

Quinn SF, Brown TF. Meniscal tears diagnosed with MR imaging versus arthroscopy: how reliable a standard is arthroscopy? Radiology. 1991;181(3):843-7.

Gökalp G, Nas O, Demirag B, Yazici Z, Savci G. Contribution of thin-slice (1 mm) axial proton density MR images for identification and classification of meniscal tears: correlative study with arthroscopy. The British journal of radiology. 2014.

Araki Y, Yamamoto H, Nakamura H, TsukaguchiI. MR diagnosis of discoid lateral menisci of the knee. European journal of radiology. 1994;18(2):92- 5.

Rohren EM, Kosarek FJ, Helms CA. Discoid lateral meniscus and the frequency of meniscal tears. Skeletal radiology. 2001;30(6):316-20.

Miller MD, Thompson SR, Hart J. Review of orthopaedics: Elsevier Health Sciences; 2012. 20.Canale ST, Beaty JH. Campbell›s operative orthopaedics. Twelfth ed: Elsevier Health Sciences; 2016. 136-7 p.

Marshall S. Combined arthroscopic-open repair of meniscal injuries. Surgery and Arthroscopy of the Knee: Springer; 1988. p. 317-27.

Metcalf RW. Symposium on arthroscopic knee surgery: Saunders; 1982.

Eren OT. The accuracy of joint line tenderness by physical examination in the diagnosis of meniscal tears. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2003;19(8):850-4.

Lucie RS, Wiedel JD, Messner DG. The acute pivot shift: clinical correlation. The American journal of sports medicine. 1984;12(3):189-91.

Bomberg BC, McGinty JB. Acute hemarthrosis of the knee: indications for diagnostic arthroscopy. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 1990;6(3):221-5.

Torg JS, Conrad W, Kalen V. Clinical I diagnosis of anterior cruciate ligament instability in the athlete. The American journal of sports medicine. 1976;4(2):84-93.

Mitsou A, Vallianatos P. Clinical diagnosis of ruptures of the anterior cruciate ligament: a comparison between the Lachman test and the anterior drawer sign. Injury. 1988;19(6):427-8.

Bach JR BR, Warren RF, Wickiewicz TL. The pivot shift phenomenon: results and description of a modified clinical test for anterior cruciate ligament insufficiency. The American journal of sports medicine. 1988;16(6):571-6.

Steinbrück K, Wiehmann J. Examination of the knee joint. The value of clinical findings in arthroscopic control. Zeitschrift fur Orthopadie und ihre Grenzgebiete. 1987;126(3):289-95.

Scholten R, Opstelten W, van der Plas CG, Bijl D, Deville W, Bouter LM. Accuracy of physical diagnostic tests for assessing ruptures of the anterior cruciate ligament: a meta-analysis. Journal of family practice. 2003;52(9):689-96.

Kocabey Y, Tetik O, Isbell WM, Atay ÖA, Johnson DL. The value of clinical examination versus magnetic resonance imaging in the diagnosis of meniscal tears and anterior cruciate ligament rupture. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2004;20(7):696- 700.

Severino NR, Camargo O, Aihara T, Cury R, Oliveira V, Vaz C, et al. Comparação entre a ressonância magnética e a artroscopia no diagnóstico das lesões do joelho. Rev Bras Ortop. 1997;32(4):275-8.

Yousef WJ, Thiele ES, Scuisato DL. Correlação diagnóstica da ressonância magnética com artroscopia nas lesões intra-articulares do joelho. Rev bras ortop. 1999;34(6):375-80.

Navali AM, Bazavar M, Mohseni MA, Safari B, Tabrizi A. Arthroscopic evaluation of the accuracy of clinical examination versus MRI in diagnosing meniscus tears and cruciate ligament ruptures. Archives of Iranian medicine. 2013;16(4):229.

Ercin E, Kaya I, Sungur I, Demirbas E, Ugras AA, Cetinus EM. History, clinical findings, magnetic resonance imaging, and arthroscopic correlation in meniscal lesions. Knee surgery, sports traumatology, arthroscopy. 2012;20(5):851-6.