MRI-Based Prediction of Meniscal Tear Repairability Demonstrates Limited Accuracy and Reliability.

Area of Science:

• Orthopedics
• Radiology
• Sports Medicine

Background:

• Magnetic resonance imaging (MRI) is standard for identifying meniscal tears.
• Intraoperative assessment traditionally determines meniscal tear repairability.
• Predicting repairability preoperatively remains a clinical challenge.

Purpose of the Study:

• To evaluate a simplified MRI-based scoring system for predicting meniscal repairability.
• To compare MRI-based predictions against actual surgical procedures (meniscal repair vs. meniscectomy).
• To assess the accuracy and reliability of MRI criteria in determining meniscal tear repairability.

Main Methods:

• Retrospective review of 202 meniscal tears (2010-2018).
• Blinded, independent assessment of preoperative MRIs by two radiologists and one orthopedic surgeon.
• Scoring based on four arthroscopic criteria: proximity to junction, tear length, inner segment integrity, and thickness (>50%).

Main Results:

• Reviewer accuracy in predicting repairability ranged from 48% to 76%.
• Interobserver reliability was poor to moderate (κ = 0.07-0.43).
• Individual MRI criteria showed limited predictive value, with accuracy below 50% for most.

Conclusions:

• The simplified MRI scoring system demonstrated limited accuracy and poor interobserver reliability.
• Current MRI-based prediction is insufficient for clinical decision-making regarding meniscal repair.
• Future research should explore advanced imaging and AI to enhance preoperative assessment of meniscal repairability.