Comparing the Diagnostic Precision of Clinical Examination and MRI with Findings from Arthroscopy in Traumatic Knee Injuries with Femur or Tibia Shaft Fracture

Background: Diagnosis of knee injuries following trauma to the lower extremity is very important and needs to be carefully examined. This study aimed at comparing the diagnostic precision of clinical examination (CE) and MRI with findings from arthroscopy in traumatic knee injuries with femur or tibia shaft fracture.Methods: A cross-sectional study was conducted on ۱۶۴ patients with traumatic knee injuries with femur or tibia shaft fracture who had been referred to Imam Hossein Hospital, Shahroud, between March ۲۰۱۴ and February ۲۰۱۵. We compared CE and MRI with arthroscopic findings (gold standard) to determine the concordance, accuracy, sensitivity, and specificity of injuries to the meniscus and knee ligaments.Results: The results showed that internal mucus rupture was the most common trauma, noted in ۸۳ cases (۵۰.۶%), followed by anterior corrosion rupture, noted in ۶۵ cases (۳۹.۶%). CE sensitivity was ۶۸.۴% and specificity was ۹۶.۲% for medial meniscal (MM) injuries, while sensitivity was ۵۳.۶% and specificity was ۹۶.۴% for lateral meniscal (LM) injuries. For anterior cruciate ligament (ACL) injuries, CE showed sensitivity of ۷۷.۲% and specificity of ۹۱.۸%. For posterior cruciate ligament (PCL) injuries, CE showed sensitivity of ۵۲.۶% and specificity of ۹۸.۶%. For MM injuries, MRI showed sensitivity of ۹۲.۵% and specificity of ۸۶.۵%, while for LM injuries, it showed sensitivity of ۸۵.۰۰% and specificity of ۹۸.۶%. For ACL injuries, MRI showed sensitivity of ۸۶.۷% and specificity of ۹۳.۸%, and for PCL injuries, MRI showed sensitivity of ۸۴.۵% and specificity of ۹۸.۸. For ACL injuries, the best concordance was with CE, while for MM and LM injuries, it was with MRI (P<۰.۰۰۱).Conclusions: Meniscal and ligament injuries in traumatic knee injury can be diagnosed through careful clinical examination, while requests for MRI can be reserved for complex or doubtful cases. CE and MRI used together have high sensitivity for ACL, PCL, and MM lesions, while for LM lesions, the specificity is higher.Background: Diagnosis of knee injuries following trauma to the lower extremity is very important and needs to be carefully examined. This study aimed at comparing the diagnostic precision of clinical examination (CE) and MRI with findings from arthroscopy in traumatic knee injuries with femur or tibia shaft fracture. Methods: A cross-sectional study was conducted on ۱۶۴ patients with traumatic knee injuries with femur or tibia shaft fracture who had been referred to Imam Hossein Hospital, Shahroud, between March ۲۰۱۴ and February ۲۰۱۵. We compared CE and MRI with arthroscopic findings (gold standard) to determine the concordance, accuracy, sensitivity, and specificity of injuries to the meniscus and knee ligaments. Results: The results showed that internal mucus rupture was the most common trauma, noted in ۸۳ cases (۵۰.۶%), followed by anterior corrosion rupture, noted in ۶۵ cases (۳۹.۶%). CE sensitivity was ۶۸.۴% and specificity was ۹۶.۲% for medial meniscal (MM) injuries, while sensitivity was ۵۳.۶% and specificity was ۹۶.۴% for lateral meniscal (LM) injuries. For anterior cruciate ligament (ACL) injuries, CE showed sensitivity of ۷۷.۲% and specificity of ۹۱.۸%. For posterior cruciate ligament (PCL) injuries, CE showed sensitivity of ۵۲.۶% and specificity of ۹۸.۶%. For MM injuries, MRI showed sensitivity of ۹۲.۵% and specificity of ۸۶.۵%, while for LM injuries, it showed sensitivity of ۸۵.۰۰% and specificity of ۹۸.۶%. For ACL injuries, MRI showed sensitivity of ۸۶.۷% and specificity of ۹۳.۸%, and for PCL injuries, MRI showed sensitivity of ۸۴.۵% and specificity of ۹۸.۸. For ACL injuries, the best concordance was with CE, while for MM and LM injuries, it was with MRI (P<۰.۰۰۱). Conclusions: Meniscal and ligament injuries in traumatic knee injury can be diagnosed through careful clinical examination, while requests for MRI can be reserved for complex or doubtful cases. CE and MRI used together have high sensitivity for ACL, PCL, and MM lesions, while for LM lesions, the specificity is higher.

Keywords:

Knee Injury , Clinical Examination , MRI , Meniscus , Ligament.