A Multimodal Diagnostic Algorithm for Focal Knee Chondral Defects: Correlating Clinical Tests, Musculoskeletal...

Area of Science:

• Orthopedics
• Radiology
• Sports Medicine

Background:

• Focal chondral lesions of the knee are often underdiagnosed, with clinical symptoms not always reflecting structural severity.
• Accurate diagnosis is crucial for effective treatment and management of knee injuries.

Purpose of the Study:

• To evaluate the diagnostic utility of clinical examination tests and musculoskeletal ultrasound (MSK-US) for identifying high-grade chondral defects.
• To compare these diagnostic methods against MRI-based International Cartilage Repair Society (ICRS) grading.

Main Methods:

• An observational cross-sectional study involving 57 patients with mechanical knee pain and MRI-confirmed focal chondral lesions.
• Standardized clinical examination (including Wilson's and McMurray's tests), MSK-US, and MRI were performed.
• Statistical analysis included Chi-square tests, Pearson correlations, and odds ratios (OR) using Python.

Main Results:

• 87.7% of lesions were ICRS Grade 3 and 12.3% were ICRS Grade 4.
• McMurray's test showed a significant association with lesion grade (p=0.038), differentiating ICRS 3 from ICRS 4 lesions.
• MRI revealed meniscal tears in 86% of ICRS 4 lesions versus 30% of ICRS 3 lesions.

Conclusions:

• Symptom severity does not reliably differentiate between ICRS Grade 3 and Grade 4 chondral lesions.
• McMurray's test indicates combined osteochondral-meniscal involvement rather than cartilage depth alone.
• A diagnostic framework integrating clinical tests, MSK-US, and MRI aids in preoperative risk stratification for knee lesions.