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Predicted probability of meniscus tears: comparing history and physical examination with MRI
1Department of Radiology, First Affiliated Hospital of Xian Jiao Tong University, Xian, China.
Background:
The indication for surgical treatment of a meniscal lesion should not only rely on magnetic resonance imaging (MRI) findings, but also on a detailed history and a thorough clinical examination. However, various intra-articular lesions may often produce similar symptoms. So, what kinds of symptoms are more associated with a meniscal tear? Is MRI worth doing?
Objective:
The aims of this study were to identify sensitive and specific clinical tests and elements of patients' history with a high predictive value, and to assess the combined diagnostic accuracy of sensitive and specific clinical tests and elements of patients' history with MRI.
Methods:
Data from 281 consecutive knee arthroscopies to investigate and treat suspected internal knee pathologies were retrospectively collected between March 2009 and April 2010. The study group consisted of 262 knees. Statistically significant factors in the clinical diagnosis of meniscal tears were screened by a chi-square test. Logistic regression analysis was used to determine which factors associated with meniscal tears found during arthroscopy. The diagnostic values of MRI and the sensitive and specific clinical tests and elements of patients' history with high predictive value for meniscal tears were calculated.
Results:
The overall diagnostic value of MRI for meniscal tears was: accuracy, 88.8%; sensitivity, 95.7%; specificity, 75.8%; positive predictive value (PPV), 88.2%; and negative predictive value (NPV), 90.4%. Giving way, locking and McMurray's test were independent diagnostic factors with a predicted correct percentage of 80.0% (p <0.05) for the diagnosis of meniscal tears found during arthroscopy. Locking, McMurray's test and MRI increased the predicted correct percentage of meniscal tears found during arthroscopy to 91.6% (p <0.05). For the diagnosis of meniscal tears found during arthroscopy, giving way, locking and McMurray's test had the following values for accuracy (49.2, 60.9, 76), sensitivity (43.5, 55.2, 75.8), specificity (84, 96, 76.9), PPV (94.4, 98.8, 95.1) and NPV (19.4, 25.8, 35.1). Combining MRI, the diagnostic values of giving way, locking, and McMurray's test were: accuracy, 88.3,89.9,89.4; sensitivity, 95.7,97.4,97.4; specificity, 74.2,75.8,74.2; PPV, 87.5,88.4,87.7; and NPV, 90.2,94,93.9.
Conclusions:
Giving way, locking and McMurray's test are independent clinical diagnostic factors for the diagnosis of meniscal tears. MRI has higher accuracy, sensitivity and NPV for the diagnosis of meniscal tears than giving way, locking and McMurray's test. The combination of giving way, locking, McMurray's test and MRI for confirmation is typical for a meniscal lesion diagnosis. Based on these findings, MRI should be used in a standard manner to detect meniscal tears found during arthroscopy.
Insights
Clinical examination findings like giving way, locking, and McMurray's test are key for diagnosing meniscal tears. Magnetic resonance imaging (MRI) offers superior accuracy and should be standard for detecting these knee injuries.
Area of Science:
- Orthopedic Surgery
- Diagnostic Imaging
- Sports Medicine
Background:
- Surgical treatment for meniscal lesions requires more than MRI; clinical history and examination are crucial.
- Differentiating meniscal tears from other intra-articular pathologies based on symptoms can be challenging.
Purpose of the Study:
- Identify sensitive and specific clinical factors with high predictive value for meniscal tears.
- Evaluate the combined diagnostic accuracy of clinical findings and MRI for meniscal tears.
Main Methods:
- Retrospective analysis of 262 knee arthroscopies for suspected internal knee pathologies.
- Statistical screening of clinical factors using chi-square tests and logistic regression.
- Calculation of diagnostic values for MRI, clinical tests, and their combinations.
Main Results:
- MRI demonstrated high diagnostic accuracy (88.8%), sensitivity (95.7%), and negative predictive value (90.4%) for meniscal tears.
- Giving way, locking, and McMurray's test were independent predictors of meniscal tears, with accuracy up to 76%.
- Combining clinical findings with MRI significantly improved diagnostic accuracy to 91.6%.
Conclusions:
- Giving way, locking, and McMurray's test are valuable independent clinical indicators for meniscal tears.
- MRI surpasses individual clinical tests in accuracy, sensitivity, and NPV for meniscal tear diagnosis.
- A combined approach using clinical assessment (giving way, locking, McMurray's test) and MRI is recommended for definitive meniscal lesion diagnosis.
