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Tibial spino-meniscal clearance: A reproducible MRI-derived measurement associated with hypermobile lateral meniscus
Camilo Helito1, Francisco Endara Urresta2, Carlos Peñaherrera-Carrillo3
1Universidad de Sao Paulo Sao Paulo Brazil.
Purpose:
To evaluate whether tibial spino-meniscal clearance (TSMC), a magnetic resonance imaging (MRI)-derived imaging measurement, is associated with arthroscopically confirmed hypermobile lateral meniscus (HML), and to assess the reproducibility of this measurement.
Methods:
A combined retrospective-prospective diagnostic accuracy study was conducted including 164 patients who underwent knee MRI followed by arthroscopy within six months. TSMC was measured on sagittal MRI as the shortest distance between the apex of the lateral tibial spine and the inner margin of the posterior horn of the lateral meniscus. Three blinded observers independently performed measurements to assess intra- and interobserver reliability using intraclass correlation coefficients (ICCs). Diagnostic performance was evaluated using receiver operating characteristic (ROC) analysis, and multivariable logistic regression was used to examine the association between TSMC and HML.
Results:
Mean TSMC values were lower in patients with arthroscopically confirmed HML compared with controls. The measurement demonstrated excellent intra- and interobserver reliability. ROC analysis showed good discriminatory performance for identifying HML, and TSMC remained independently associated with hypermobility after adjustment for demographic and anatomical variables.
Conclusion:
TSMC is a reproducible MRI-derived imaging measurement associated with HML. While these findings suggest that TSMC may assist in preoperative suspicion of lateral meniscal instability, further external validation is required before routine clinical application.
Level Of Evidence:
Level III.
Insights
Tibial spino-meniscal clearance (TSMC) is a reliable MRI measurement linked to hypermobile lateral meniscus (HML). This imaging technique shows promise for identifying lateral meniscal instability before surgery.
Area of Science:
- Orthopedic imaging
- Knee biomechanics
- Diagnostic accuracy studies
Background:
- Hypermobile lateral meniscus (HML) can cause knee pain and instability.
- Accurate preoperative diagnosis of HML is crucial for effective treatment.
- Current diagnostic methods may have limitations in detecting HML.
Purpose of the Study:
- To determine if tibial spino-meniscal clearance (TSMC), an MRI measurement, correlates with arthroscopically confirmed HML.
- To assess the reliability and reproducibility of TSMC measurements.
- To evaluate TSMC's diagnostic performance in identifying HML.
Main Methods:
- A diagnostic accuracy study included 164 patients undergoing knee MRI and arthroscopy.
- TSMC was measured on sagittal MRI as the distance between the tibial spine and lateral meniscus.
- Intra- and interobserver reliability were assessed using ICCs; diagnostic performance was evaluated via ROC analysis.
Main Results:
- Mean TSMC values were significantly lower in patients with HML compared to controls.
- TSMC demonstrated excellent intra- and interobserver reliability.
- ROC analysis indicated good discriminatory performance for HML; TSMC was independently associated with hypermobility.
Conclusions:
- TSMC is a reproducible MRI measurement associated with HML.
- TSMC may aid in the preoperative suspicion of lateral meniscal instability.
- Further external validation is needed for routine clinical use of TSMC.
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