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Comparison of Accuracy in Expert Clinical Examination Versus Magnetic Resonance Imaging and Arthroscopic Exam in Diagnosis of Meniscal Tear

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Comparison of Accuracy in Expert Clinical Examination Versus Magnetic Resonance Imaging and Arthroscopic Exam in Diagnosis of Meniscal Tear Hindawi Advances in Orthopedics Volume 2020, Article ID 1895852, 5 pages https://doi.org/10.1155/2020/1895852 Research Article Comparison of Accuracy in Expert Clinical Examination versus Magnetic Resonance Imaging and Arthroscopic Exam in Diagnosis of Meniscal Tear Seyed Ali Hashemi,1 Mohammad Reza Ranjbar,1 Mohammad Tahami,1 Reza Shahriarirad ,2,3 and Amirhossein Erfani 2,3 1Research Center for Bone and Joint Diseases, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran 2Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran 3%oracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Correspondence should be addressed to Reza Shahriarirad; [email protected] Received 6 February 2020; Revised 14 April 2020; Accepted 27 April 2020; Published 8 May 2020 Academic Editor: Benjamin Blondel Copyright © 2020 Seyed Ali Hashemi et al. +is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Many clinical tests and diagnostic studies have been developed to increase the clinician’s ability to accurately diagnose disorders of the knee. Torn menisci or ligamentous structures within the knee cause significant pain and disability and thus require expeditious management. +is study was conducted to evaluate the accuracy of clinical examination in comparison with MRI examination and with the help of arthroscopic examination as the gold standard in the diagnosis of meniscal tears. Method. All of the arthroscopic surgery candidates, presenting symptoms of meniscal or cruciate ligament lesions, referring to Namazi and Chamran hospitals, Shiraz, Iran, were included in this study. Clinical examination (including McMurray test, Apley test, and 20 +essaly test) was performed before the arthroscopy, and the results were recorded in special forms. Magnetic resonance imaging (MRI) results were also added. +en, arthroscopy was performed, declaring the definite diagnosis, and the results were compared to the results obtained from both tests and MRI. Statistical analysis was performed using SPSS software. Results. 86 patients with a mean age of 27 years old, including 63 (73%) male and 23 (27%) female, were studied. 57 (66%), 19 (22%), and 10 (12%) injuries were caused by sports, twisting, or trauma, respectively. Arthroscopic results showed 32 meniscal tears, of which 28 (87%) and 4 (13%) were in medial and lateral menisci, respectively, including 10 bucket handle, 17 longitudinal, and 5 of other types (transverse, oblique, radial) of injuries. Comparing MRI results to arthroscopic results, we had 2 false-positive and 2 false-negative cases. 62 cases of McMurray test results were accurate; 15 and 9 cases were reported false positive and false negative, respectively. 60 cases of Apley test results were accurate; 16 and 10 cases were reported false positive and false negative, respectively. 78 cases of +essaly test results were accurate; 5 and 3 cases were reported false positive and false negative, re- spectively. Comparing +essaly test results to McMurray and Apley showed statistical significance (P < 0:05). Comparing +essaly test results to MRI showed no statistical significance (P � 0:151), while comparing McMurray and Apley test results to MRI showed statistical significance (P < 0:01). Conclusion. Clinical examination, performed by an experienced examiner, can have equal or even more diagnostic accuracy compared to MRI to evaluate meniscal lesions. In this study, the +essaly test has been approved as a reliable clinical test in the diagnosis of meniscal tears. 1. Introduction and diagnostic studies have been conducted to increase the ability of physicians to correctly diagnose knee problems Diagnosis of acute knee injuries has long been one of the [1–3]. Since ruptured meniscus or ligamentous structures in issues discussed in orthopaedic sources. Many clinical trials the knee cause significant pain and disability, these lesions 2 Advances in Orthopedics require prompt and accurate treatment and management. injury and who had a clinical complaint were treated with Due to the devastating consequences of meniscus injuries in arthroscopy, regardless of the MRI result. Also, patients who patients, especially for those injured during exercise, timely had imaging results in favor of meniscus injury with normal and accurate diagnosis of these injuries is essential [4]. physical examination who underwent arthroscopy were +e necessity of surgery after meniscus injury is sig- included in the study. Eventually, 86 patients were enrolled nificantly determined by initial physical examination along in our study. All cases that had a history of knee surgery, with other diagnostic tests. A comprehensive examination knee arthroscopy, repair of ligaments or meniscus, or history should include a full description of the injury, palpation of of meniscectomy, either in total or partial, were excluded the injury site, and a selection of specific tests. Athletes with from the study. meniscus tears usually describe a pop-like sound when Examinations were performed with competence by an redirecting in a sprint, such as twisting the heel of the foot experienced orthopaedic surgeon, with no knowledge of the with or without colliding with another player [5]. patients’ MRI results, before performing arthroscopy. All Joint line tenderness and effusion are also manifestations performed clinical examinations and the patient charac- of meniscal injury. Palpation of the knee along the axis may teristics were entered in prepared specific forms for this have indefinite results in predicting meniscus ruptures with purpose. Eventually, MRI results were added. +e tests used an acute ACL injury, with a specificity of 34.5% and sen- in this study included the McMurray test, the Apley test, and sitivity of 44.9% based on internal axis palpation and a the 20-degree +essaly test. +en, the MRI images of each specificity of 49.1% and sensitivity of 57.6% for external axis patient were examined by a qualified diagnostic radiologist palpation. In cases where the ACL is unaffected, tenderness expert and their results were reported. Finally, arthroscopy along the joint line more accurately (77%) identifies was performed by an experienced and qualified orthopaedic meniscal ruptures [5]. surgeon and with the help of his assistants; results were +e main tests required to treat patients with symptoms recorded as a definitive diagnosis; comparing the results with so far include palpation of the joint border, McMurray test, the results obtained from the tests and MRI, true positives Apley grind test, and +essaly test [6, 7]. and negatives and false positives and false negatives were Arthroscopy is the gold standard of diagnosis in trau- obtained. matic injuries to the knee joint. Arthroscopy, although Statistical analysis was performed using SPSS (version highly accurate, is an invasive and expensive intervention 18; SPSS Inc., Chicago, IL, USA) and McNemar and chi- that requires hospitalization and general or regional anes- square (X2) tests. +e findings of this study were evaluated thesia, but it can also impose complications on an open using descriptive statistics and sensitivity, specificity, ac- surgery, such as infections, neurological and vascular in- curacy, positive predictive value (PPV), and negative pre- juries, and injury to the intra-articular elements of the knee dictive value (NPV). +e chi-square and McNemar tests, [8, 9]. With 1,200 knee arthroscopies a year and rising, a each based on their use, were used to compare the findings of noninvasive diagnostic tool that requires no intra-articular the tests and MRI. Finally, the results of the comparison with approach could minimize the potential risks of arthroscopy P value less than 0.05 were considered statistically and reduce the numbers of needed arthroscopies [10]. Al- significant. though the diagnostic significance of a physical examination by an experienced clinician has been evaluated in various 3. Results studies [10, 11], further studies are justified for whether or not it could be favored over other diagnostic methods. In this study, 86 patients were enrolled with a mean age of 27 +erefore, this study was conducted to evaluate the accuracy years (range: 15 to 45 years). Table 1 demonstrates the of clinical examination in comparison with MRI examina- frequency and location, along with the types of injury tion and with the arthroscopic examination as the gold findings by arthroscopy in our study. standard in the diagnosis of meniscal tears. Arthroscopic results revealed 32 cases of meniscus rup- ture, of which 28 (87%) were medial meniscus injuries and 4 2. Materials and Methods (13%) were lateral meniscus injuries. Of these, 23 (72%) were male and 9 (28%) were female, with 13 (41%) cases of left knee +is cross-sectional descriptive study was performed on all injuries and 19 (59%) cases of right knee injury. Arthroscopy patients who referred to Shahid Chamran and Namazi also showed a wide range of injuries including 10 bucket hospitals of Shiraz with any signs of trauma to the meniscus handle injuries, 17 longitudinal injuries, and 5 other types or cruciate ligament, whether due to accidents or athletic including transverse, oblique, and radiated or radial injuries. trauma, and who were candidates for arthroscopic surgery. Concerning the MRI imaging protocols and comparing
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