Comparison of Clinical Examination, MRI and Arthroscopy Findings in Internal Derangement of the Knee: A Cross-Sectional Study

Abstract

Introduction: Walking is one of the prime actions carried out by our body and the knee joint plays a crucial role in its normal functioning. Owing to its anatomical structure and the functional demands, injuries involving the menisci and cruciate ligaments of knee joint are one of the most frequently encountered problems by an Orthopaedic surgeon. There are different modalities for diagnosing knee joint injuries. A cross-sectional study was done to compare clinical examination and MRI findings with arthroscopy findings of the knee joint. Aim: To study and compare MRI and arthroscopic findings of meniscal injuries and cruciate ligament injuries. Also to compare findings of clinical examination with that of MRI and arthroscopic findings of meniscal and cruciate ligament injuries. Materials and Methods: A one-year hospital based crosssectional study in which all 90 patients admitted were scheduled to undergo arthroscopic surgery of the knee following clinical and radiological evaluation. Findings of MRI and clinical examination were compared with that of arthroscopy findings, which are treated as gold standard, and the analysis was done. Results: MRI vs. arthroscopy findings: Sensitivity of anterior cruciate ligament, medial and lateral meniscus was 100%, 70% and 72% and the specificity was 90%, 78% and 70% respectively. The accuracy of anterior cruciate ligament, medial and lateral meniscus are as follows 95%, 76% and 71%. The positive predictive value was 93%, 67% and 62%. Clinical examination vs. arthroscopy findings: Sensitivity of anterior cruciate ligament, medial and lateral meniscus was 100%, 82% and 67% respectively. The specificity was 95%, 78% and 70%. The accuracy of anterior cruciate ligament, medial and lateral meniscus are as follows 98%, 80% and 69%. The positive predictive value was 96%, 70% and 60%. Conclusion: Following the study, if MRI is positive for anterior cruciate ligament tear then the chances of finding the same on arthroscopy are very high. For medial and lateral meniscus, chances of identifying a normal meniscus are higher than that of detecting a pathological meniscus. Clinical examination was effective in single lesion injuries. In multiple injuries, the false positive results were more.For menisci, negative predictive value is higher than the positive predictive value which means that the chances of detecting a normal knee are higher than detecting a lesion.

Keywords

• anterior cruciate ligament tear
• haemarthrosis
• knee injury
• knee joint
• meniscal injury