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MRI-negative bucket-handle tears of the lateral meniscus in athletes: a case series
Michael Makdissi1, Karl O Eriksson, Hayden G Morris
1Centre for Health, Exercise and Sports Medicine, University of Melbourne, 3054 Melbourne, Australia. m.makdissi@pgrad.unimelb.edu.au
Abstract:
Magnetic resonance imaging (MRI) is the most widely used non-invasive test for assessing intra-articular injuries of the knee. It has been suggested that a negative MRI can be useful in avoiding the need for diagnostic arthroscopy in cases where clinical examination is equivocal. However, the sensitivity and specificity of MRI is not 100%, particularly for tears of the lateral meniscus. Furthermore, a false negative MRI scan may result in premature return to play in athletes, resulting in increased risk of further damage to a torn meniscus. To illustrate this issue, we present a case series of eight elite athletes who all presented with mechanical knee symptoms and where MRI scans revealed no significant intra-articular pathology. Five of the athletes were allowed to return to sport on the basis of a negative MRI. All patients were subsequently found to have a bucket-handle tear of their lateral meniscus at arthroscopy. Two independent, experienced musculoskeletal radiologists were asked to review the MRI films without being given any clinical history of the cases. Although injuries to the popliteus tendon were noted in two of the athletes who had sustained a recent acute injury to their knee, no meniscal tears were identified. Thus arthroscopy remains the gold standard for the assessment and management of high-demand patients with a clinical suspicion of meniscal pathology.
Insights
A negative MRI scan may miss lateral meniscus tears in athletes, leading to further injury. Arthroscopy remains the gold standard for diagnosing knee injuries when clinical suspicion is high.
Area of Science:
- Orthopedics
- Radiology
- Sports Medicine
Background:
- Magnetic resonance imaging (MRI) is a common non-invasive tool for knee injuries.
- A negative MRI is sometimes used to avoid arthroscopy for equivocal knee injuries.
- However, MRI has limitations in detecting certain knee injuries, like lateral meniscus tears.
Purpose of the Study:
- To evaluate the accuracy of MRI in diagnosing knee injuries in elite athletes.
- To highlight the risks associated with relying solely on MRI for return-to-play decisions.
- To emphasize the role of arthroscopy in managing suspected meniscal pathology.
Main Methods:
- A case series of eight elite athletes with mechanical knee symptoms and negative MRI scans was reviewed.
- Athletes' MRI findings were re-evaluated by independent radiologists.
- All athletes eventually underwent arthroscopy for diagnosis and treatment.
Main Results:
- Five athletes with negative MRIs returned to sport but were later diagnosed with lateral meniscus bucket-handle tears via arthroscopy.
- Radiologists reviewing the MRIs, even without clinical history, did not identify meniscal tears.
- Popliteus tendon injuries were noted in two cases with acute knee trauma.
Conclusions:
- MRI may have insufficient sensitivity and specificity for detecting lateral meniscus tears in elite athletes.
- False-negative MRI results can lead to premature return to play and increased risk of further meniscal damage.
- Arthroscopy remains the definitive diagnostic and management tool for high-demand athletes with suspected meniscal pathology.
