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Diagnostic accuracy of MRI for meniscal tear patterns in ACL-deficient knees: comparison with arthroscopic findings
Artit Boonrod1, Arunnit Boonrod2, Watcharapong Wongsawiang1
1Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.
Background And Objectives:
Anterior cruciate ligament (ACL) injuries are frequently associated with meniscal tears. MRI diagnostic performance varies by tear pattern and location and may be influenced by imaging timing and reader variability. This study evaluated pattern-specific MRI accuracy compared with arthroscopic findings and assessed the impact of timing and inter-reader reliability.
Methods:
This retrospective study included consecutive patients undergoing ACL reconstruction with confirmed complete ACL tears and available preoperative MRI. Meniscal tears were classified as horizontal, vertical, radial, complex, and bucket-handle. Arthroscopy served as the reference standard. Diagnostic metrics, inter-reader agreement (κ), and time intervals between injury, MRI, and surgery were analyzed.
Results:
A total of 143 patients were included. Medial meniscal tears were present in 81 patients (56.6%) and lateral tears in 69 (48.3%). MRI accuracy was 71.3% for medial tears (sensitivity 86.4%, specificity 51.6%) and 72.0% for lateral tears (sensitivity 88.4%, specificity 56.8%). Bucket handle tear patterns showed the highest inter-reader reliability (κ = 0.78), while radial tears demonstrated the lowest inter-reader reliability (κ = 0.16). In adjusted analyses, neither meniscal location nor any injury-MRI, MRI-surgery, or injury-surgery interval was significantly associated with diagnostic performance (all p ≥ 0.38).
Conclusions:
MRI shows moderate accuracy and fair-to-substantial reliability for meniscal tears in ACL-deficient knees, with the best performance in bucket-handle tear patterns. The greatest inter-reader variability was observed for radial tears. Although no significant association between timing intervals and diagnostic performance was identified, timing-related findings should be interpreted cautiously because of potential measurement error and the retrospective design.
Registration:
The study registration was not performed due to the retrospective design.
Insights
Magnetic resonance imaging (MRI) demonstrates moderate accuracy for diagnosing meniscal tears in knees with anterior cruciate ligament (ACL) injuries. Reliability is highest for bucket-handle tears but lowest for radial tears, with timing intervals not significantly impacting performance.
Area of Science:
- Orthopedic Surgery
- Radiology
- Sports Medicine
Background:
- Anterior cruciate ligament (ACL) injuries often coexist with meniscal tears.
- MRI diagnostic accuracy for meniscal tears can be affected by tear patterns, imaging timing, and reader interpretation.
- Understanding these factors is crucial for effective clinical management.
Purpose of the Study:
- To evaluate the pattern-specific accuracy of MRI for meniscal tears in ACL-deficient knees.
- To assess the impact of timing intervals (injury-MRI, MRI-surgery, injury-surgery) on diagnostic performance.
- To determine inter-reader reliability for different meniscal tear patterns.
Main Methods:
- Retrospective analysis of 143 patients with confirmed ACL tears and preoperative MRI.
- Meniscal tears classified into horizontal, vertical, radial, complex, and bucket-handle patterns.
- Arthroscopy served as the reference standard; diagnostic metrics and inter-reader agreement (κ) were analyzed.
Main Results:
- MRI accuracy for medial meniscal tears was 71.3% (sensitivity 86.4%, specificity 51.6%) and for lateral tears was 72.0% (sensitivity 88.4%, specificity 56.8%).
- Bucket-handle tears showed the highest inter-reader reliability (κ=0.78), while radial tears had the lowest (κ=0.16).
- No significant association was found between timing intervals and MRI diagnostic performance (p≥0.38).
Conclusions:
- MRI offers moderate accuracy and fair-to-substantial reliability for detecting meniscal tears in ACL-deficient knees.
- Diagnostic performance is best for bucket-handle tears, with the highest variability seen in radial tears.
- While timing intervals did not significantly affect performance in this retrospective study, caution is advised due to potential measurement error.