COMPARATIVE ANALYSES OF DIAGNOSTIC METHODS IN KNEE INJURIES

Roza Dzoleva-Tolevska, Anastasika Poposka, Daniela Georgieva, Zoran Bozinovski, Jasminka Nanceva, Stojan Gjoshev

Abstract


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 patients 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.

Key words: knee injuries, clinical examination, MRI, arthroscopy.


Keywords


Key words: Knee injuries, clinical examination, MRI, arthroscopy.

Full Text:

PDF

References


Solomon DH, Simel DL, Bates DW, Katz JN, Schaffer JL. The rational clinical examination. Does this patient have a torn meniscus or ligament of the knee? Value of the physical examination. JAMA. 2001;286(13):1610-20.

Abdon P, Lindstrand A, Thorngren KG. Statistical evaluation of the diagnostic criteria for meniscal tears. Int Orthop. 1990;14(4):341-5.

von Engelhardt LV, Kraft CN, Pennekamp PH, Schild HH, Schmitz A, von Falkenhausen M. The evaluation of articular cartilage lesions of the knee with a 3-Tesla magnet. Arthroscopy. 2007;23(5):496-502.

Noyes FR, Stabler CL. A system for grading articular cartilage lesions at arthroscopy. Am J Sports Med.1989;17( 4): 505-13.

Reed ME, Villacis DC, Hatch GF 3rd, et al. 3.0-tesla MRI and arthroscopy for assessment of knee articular cartilage lesions.Orthopedics. 2013;36(8):e1060-4.

Katz JW, Fingeroth RJ. The diagnostic accuracy of ruptures of the anterior cruciate ligament comparing the Lachman test, the anterior drawer sign, and the pivot shift test in acute and chronic knee injuries. Am J Sports Med. 1986;14(1):88-91.

Unay K, Akcal MA, Gokcen B, Akan K, Esenkaya I, Poyanl? O. The relationship between intra-articular meniscal, chondral, and ACL lesions: finding from 1,774 knee arthroscopy patients and evaluation by gender. Eur J OrthopSurgTraumatol. 2014;24(7):1255-62.

Kostov H, Kostova E. Comparison of clinical and arthroscopic findings in meniscal tears. Sanamed. 2014;9(1):25-30.

Yan R, Wang H, Yang Z, Ji ZH, Guo YM. Predicted probability of meniscus tears: comparing history and physical examination with MRI. Swiss Med Wkly. 2011;141:w13314.

Crawford R, Walley G, Bridgman S, Maffulli N. Magnetic resonance imaging versus arthroscopy in the diagnosis of knee pathology, concentrating on meniscal lesions and ACL tears: a systematic review. Br Med Bull. 2007;84(1):5-23.

von Engelhardt LV, Raddatz M, Bouillon B, et al.How reliable is MRI in diagnosing cartilaginous lesions in patients with first and recurrent lateral patellar dislocations?BMC Musculoskelet Disord. 2010;11:149.

Cameron ML, Briggs KK, Steadman JR. Reproducibility and reliability of the outerbridge classification for grading chondral lesions of the knee arthroscopically. Am J Sports Med. 2003;31(1):83-6.

Ghodadra N, Mall NA, Karas V,et al. Articular and meniscal pathology associated with primary anterior cruciate ligament reconstruction. J Knee Surg. 2013;26(3):185-93.

Borchers JR, Kaeding CC, Pedroza AD, et al. Intra-articular findings in primary and revision anterior cruciate ligament reconstruction surgery: a comparison of the MOON and MARS study groups. Am J Sports Med. 2011;39(9):1889-93.

Munshi M, Davidson M, MacDonald PB, Froese W, Sutherland K. The efficacy of magnetic resonance imaging in acute knee injuries. Clin J Sport Med. 2000;10(1):34-9.

Strauss EJ, Fonseca LE, Shah MR, Yorum T. Management of focal cartilage defects in the knee - Is ACI the answer? Bull NYU Hosp Jt Dis.2011;69(1):63-72.

Falah M, Nierenberg G, Soudry M, Hayden M, Volpin G.Treatment of articular cartilage lesions of the knee.Int Orthop. 2010;34(5):621-30.

Frobell RB, Roos EM, Roos HP, Ranstam J, Lohmander LS. A randomized trial of treatment for acute anterior cruciate ligament tears. N Engl J Med. 2010;363(4):331-42.

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

Rose NE, Gold SM. A comparison of accuracy between clinical examination and magnetic resonance imaging in the diagnosis of meniscal and anterior cruciate ligament tears. Arthroscopy. 1996;12(4):398-405.

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

Bohnsack M, Rühmann O, Sander-Beuermann A, Wirth CJ. Comparison of clinical examination with NMR spectroscopy in the diagnosis of meniscal lesions in daily practice. Z Orthop Ihre Grenzgeb. 1999;137(1):38-42.

Mohan BR, Gosal HS. Reliability of clinical diagnosis in meniscal tears. IntOrthop. 2007; 31(1): 57–60.

Dutka J, Skowronek M, Skowronek P, Dutka L. Arthroscopic verification of objectivity of the orthopaedic examination and magnetic resonance imaging in intra-articular knee injury. Retrospective study. Wideochir Inne Tech Malo Inwazyjne. 2012;7(1):13-8.

HardyJC.,Evangelista GT, Grana WA, Hunter RE. Accuracy of magnetic resonance imaging of the knee in the community setting. Sports Health. 2012;4(3):222-31.

Miller GK. A prospective study comparing the accuracy of the clinical diagnosis of meniscus tear with magnetic resonance imaging and its effect on clinical outcome. Arthroscopy. 1996;12(4):406-13.

Aydingöz U, Firat AK, Atay OA, Doral MN. MR imaging of meniscal bucket-handle tears: a review of signs and their relation to arthroscopic classification. Eur Radiol. 2003;13(3):618-25.

Cellar R, Sokol D, Lacko M, Stofta S, Gharaibeh A, Vasko G. Magnetic resonance imaging in the diagnosis of intra-articular lesions of the knee. Acta Chir Orthop Traumatol Cech. 2012;79(3):249-54.

Esmaili Jah AA, Keyhani S, Zarei R, Moghaddam AK. Accuracy of MRI in comparison with clinical and arthroscopic findings in ligamentous and meniscal injuries of the knee. Acta Orthop Belg. 2005;71(2):189-96.

van Eck CF, van den Bekerom MP, Fu FH, Poolman RW, Kerkhoffs GM. Methods to diagnose acute anterior cruciate ligament rupture: a meta-analysis of physical examinations with and without anaesthesia. Knee Surg Sports Traumatol Arthrosc. 2013;21(8):1895-903.

Jain DK, Amaravati R, Sharma G. Evaluation of the clinical signs of anterior cruciate ligament and meniscal injuries. Indian J Orthop. 2009;43(4):375-8.

Kim SJ, Kim HK. Reliability of the anterior drawer test, the pivot shift test, and the Lachman test. Clin Orthop Relat Res. 1995;(317):237-42.

Laoruengthana A, Jarusriwanna A. Sensitivity and specificity of magnetic resonance imaging for knee injury and clinical application for the Naresuan University Hospital. J Med Assoc Thai. 2012;95(Suppl 10):S151-7.

Gelb HJ, Glasgow SG, Sapega AA, Torg JS. Magnetic resonance imaging of knee disorders. Clinical value and cost-effectiveness in a sports medicine practice. Am J Sports Med. 1996;24(1):99-103.

Duc SR, Koch P, Schmid MR, Horger W, Hodler J, Pfirrmann CW. Diagnosis of articular cartilage abnormalities of the knee: prospective clinical evaluation of a 3D water-excitation true FISP sequence. Radiology. 2007;243(2):475-82.

Friemert B, Oberländer Y, Schwarz W,et al. Diagnosis of chondral lesions of the knee joint: can MRI replace arthroscopy? A prospective study.Knee Surg Sports Traumatol Arthrosc. 2004;12(1):58-64.

Munk B, Madsen F, Lundorf E, et al. Clinical magnetic resonance imaging and arthroscopic findings in knees: a comparative prospective study of meniscus anterior cruciate ligament and cartilage lesions. Arthroscopy. 1998;14(2):171-5.

D'Erme M, Ventura M, Di Giacomo G, Pasquali Lasagni M. Magnetic resonance and arthroscopy of the knee. A double-blind study in 40 patients. Radiol Med. 1992;84(5):553-6.

Kijowski R, Blankenbaker DG, Davis KW, Shinki K, Kaplan LD, De Smet AA. Comparison of 1.5- and 3.0-T MR imaging for evaluating the articular cartilage of the knee joint. Radiology. 2009;250(3):839-48.

Trieshmann HW Jr, Mosure JC. The impact of magnetic resonance imaging of the knee on surgical decision making. Arthroscopy. 1996;12(5):550-5.




DOI: http://dx.doi.org/10.24125/sanamed.v11i1.67

Refbacks

  • There are currently no refbacks.


Copyright (c) 2016 SANAMED

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.