Evaluating the diagnostic value of ultrasound in meniscal injury detection: current evidence and future directions

Meniscal injuries are a common cause of knee dysfunction and healthcare utilization, with magnetic resonance imaging (MRI) being the diagnostic gold standard. However, MRI's cost, limited accessibility, and contraindications of MRI have prompted interest in ultrasound (US) as a more affordable, portable, and radiation-free alternative. This review aimed to synthesize the current evidence on the diagnostic accuracy of US for meniscal tears and to define its role alongside MRI and arthroscopy in clinical practice.

We conducted a systematic review following the PRISMA guidelines, searching PubMed from January 2020 to March 2025 for English-language studies of adult patients (>18 years) undergoing US assessment of suspected meniscal injuries. Eligible studies used MRI or surgical (arthroscopic or open) findings as reference standards. Two reviewers independently screened the titles, abstracts, and full texts, extracted the study characteristics and diagnostic metrics, and tabulated the results.

Six studies comprising 499 participants met the inclusion criteria. US sensitivity for detecting meniscal tears ranged from 63% to 92.9%, and specificity from 63.6% to100%, with higher performance for medial than for lateral tears. Point-of-care US in emergency settings demonstrated sensitivities up to 92.9% and specificities up to 88.9%. Community-based US yielded specificity ≥97% for medial tears.

US exhibits clinically acceptable diagnostic accuracy for meniscal injury, particularly when high-frequency probes and experienced operators are used. However, future research should focus on large-scale standardized trials to refine scanning protocols, quantify learning curves, and develop guidelines for integrating US into meniscal injury trajectories.