A Speziali1,2, G Placella3, M M Tei3, A Georgoulis4, G Cerulli5,6. 1. Institute of Translational Research for Musculoskeletal System 'Nicola Cerulli', A.Einstein 12, 52100, Arezzo, Italy. andrea.speziali@gmail.com. 2. Institute of Orthopedic and Traumatology, Catholic University, 'Agostino Gemelli' Hospital, Rome, Italy. andrea.speziali@gmail.com. 3. Institute of Translational Research for Musculoskeletal System 'Nicola Cerulli', A.Einstein 12, 52100, Arezzo, Italy. 4. Department of Orthopedic Surgery, Orthopaedic Sports Medicine Center, University of Ioannina, Ioannina, Greece. 5. Institute of Translational Research for Musculoskeletal System 'Nicola Cerulli', A.Einstein 12, 52100, Arezzo, Italy. g_cerulli@tin.it. 6. Institute of Orthopedic and Traumatology, Catholic University, 'Agostino Gemelli' Hospital, Rome, Italy. g_cerulli@tin.it.
Abstract
INTRODUCTION: The main purpose of our study was to evaluate the accuracy of clinical investigation for meniscal tears associated with ACL injuries. We hypothesized that combined ACL injury can decrease the accuracy of clinical examination in acute onset. MATERIALS AND METHODS: One hundred and thirty-seven patients with a mean age of 28.5 years (from 12 to 55) were prospectively examined for acute combined ACL and meniscal injuries, between March and November 2012 at our department. For meniscal tears, clinical examination was performed using McMurray test, Apley test and medial and lateral joint line tenderness. The diagnoses of ACL tear were made using Lachman test, jerk test and pivot-shift test, anterior drawer test and KT-2000 side-to-side difference. Each patient was examined using X-ray and MRI. All the patients underwent arthroscopic surgery performed by the same surgeon within 6 weeks after the injury. Finally, using the arthroscopic findings as gold standard, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of clinical investigation and MRI were evaluated. RESULTS: The specificity of clinical investigation was 63.5 and 46.0 % and the sensitivity was 74.4 and 77.3 % for the medial meniscus and the lateral meniscus, respectively. Overall, the accuracy of the clinical investigation was 70.3 % for the MM and 65.5 % for the lateral meniscus. The accuracy of MRI investigation was 76.4 and 69.5 % for medial and lateral meniscus, respectively. DISCUSSION: In combined acute ACL injury and meniscal tears, we have found a decreased accuracy of the clinical investigation. The remnants of the torn ACL and the synovitis increased the rate of false positives, and it could simulate meniscal tears. However, clinical investigation can provide sufficient information for the treatment decision and MRI can be avoided as a routine diagnostic tool. LEVEL OF EVIDENCE: Level II, prospective study.
INTRODUCTION: The main purpose of our study was to evaluate the accuracy of clinical investigation for meniscal tears associated with ACL injuries. We hypothesized that combined ACL injury can decrease the accuracy of clinical examination in acute onset. MATERIALS AND METHODS: One hundred and thirty-seven patients with a mean age of 28.5 years (from 12 to 55) were prospectively examined for acute combined ACL and meniscal injuries, between March and November 2012 at our department. For meniscal tears, clinical examination was performed using McMurray test, Apley test and medial and lateral joint line tenderness. The diagnoses of ACL tear were made using Lachman test, jerk test and pivot-shift test, anterior drawer test and KT-2000 side-to-side difference. Each patient was examined using X-ray and MRI. All the patients underwent arthroscopic surgery performed by the same surgeon within 6 weeks after the injury. Finally, using the arthroscopic findings as gold standard, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of clinical investigation and MRI were evaluated. RESULTS: The specificity of clinical investigation was 63.5 and 46.0 % and the sensitivity was 74.4 and 77.3 % for the medial meniscus and the lateral meniscus, respectively. Overall, the accuracy of the clinical investigation was 70.3 % for the MM and 65.5 % for the lateral meniscus. The accuracy of MRI investigation was 76.4 and 69.5 % for medial and lateral meniscus, respectively. DISCUSSION: In combined acute ACL injury and meniscal tears, we have found a decreased accuracy of the clinical investigation. The remnants of the torn ACL and the synovitis increased the rate of false positives, and it could simulate meniscal tears. However, clinical investigation can provide sufficient information for the treatment decision and MRI can be avoided as a routine diagnostic tool. LEVEL OF EVIDENCE: Level II, prospective study.
Authors: Stephen Bridgman; Paula J Richards; Gayle Walley; Gilbert MacKenzie; Darren Clement; Ian McCall; David Griffiths; Nicola Maffulli Journal: Arthroscopy Date: 2007-11 Impact factor: 4.772
Authors: G di Vico; R Simonetta; G Correra; K Corona; L Proietti; B J Morris; S Cerciello Journal: Arch Orthop Trauma Surg Date: 2022-08-04 Impact factor: 2.928