Francisco Xará-Leite1,2, André Vinha3, Cristina Valente4,5, Renato Andrade4,5,6, João Espregueira-Mendes7,8,9,10,11. 1. Orthopaedics Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal. 2. Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal. 3. Orthopaedics Department, Cova da Beira University Hospital Centre, Covilhã, Portugal. 4. Clínica Espregueira-FIFA Medical Centre of Excellence, Porto, Portugal. 5. Dom Henrique Research Centre, Porto, Portugal. 6. Porto Biomechanics Laboratory (LABIOMEP), Faculty of Sports, University of Porto, Porto, Portugal. 7. Clínica Espregueira-FIFA Medical Centre of Excellence, Porto, Portugal. espregueira@dhresearchcentre.com. 8. School of Medicine, Minho University, Braga, Portugal. espregueira@dhresearchcentre.com. 9. Dom Henrique Research Centre, Porto, Portugal. espregueira@dhresearchcentre.com. 10. ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal. espregueira@dhresearchcentre.com. 11. 3B's Research Group-Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Barco, Guimarães, Portugal. espregueira@dhresearchcentre.com.
Abstract
PURPOSE: The purpose of this study was to analyze the diagnostic accuracy of magnetic resonance imaging (MRI) to detect and grade the severity of patellofemoral (PF) cartilage injuries. METHODS: A systematic review was conducted on PubMed, EMBASE and Cochrane Library databases (up to July 1st 2022) to search for studies that reported the diagnostic accuracy of MRI to detect and grade PF cartilage injuries as compared to diagnostic arthroscopy. Risk of bias was judged using the QUADAS-2 tool. Quantitative syntheses were performed to calculate the diagnostic accuracy metric-sensitivity, specificity, positive likelihood (LR+) and negative likelihood (LR-) ratios, diagnostic odds ratio (DOR)-and presented as median with 25% and 75% percentiles. The summary receiver operating characteristic (SROC) curves were also calculated. Diagnostic accuracy metrics were calculated for all PF cartilage injuries and then sub-grouped by patellar and trochlear lesions. Diagnostic accuracy was also calculated according to the grading of cartilage injuries. RESULTS: Forty-five studies were included for qualitative analyses and forty studies were included for quantitative synthesis. A total of 3534 participants with a weighted mean age of 38.1 years were included. Diagnostic accuracy was generally high: sensitivity (0.8, 0.6-1.0), specificity (0.9, 0.8-1.0), LR+ (6.4, 3.1-15.3), LR- (0.3, 0.2-0.4) and DOR (21.3, 9.9-121.1). The area under the curve (AUC) of the SROC was 0.9. The diagnostic accuracy was slightly higher for patellar (sensitivity 0.8, specificity 0.8, LR+ 5.3, LR- 0.2, DOR 28.8) than for trochlear lesions (sensitivity 0.7, specificity 0.9, LR+ 5.5, LR- 0.4, DOR 14.3). The sensitivity was generally higher when grading advanced (vs. early or intermediate) cartilage injuries of the patella. CONCLUSION: The MRI is able to diagnose PF cartilage injuries with reasonably high diagnostic accuracy (as compared to arthroscopy). Clinicians can rely on MRI to reliably diagnose PF cartilage injuries (with some limitations) which will play an important role in deciding for surgical or non-operative treatment. LEVEL OF EVIDENCE: Level III.
PURPOSE: The purpose of this study was to analyze the diagnostic accuracy of magnetic resonance imaging (MRI) to detect and grade the severity of patellofemoral (PF) cartilage injuries. METHODS: A systematic review was conducted on PubMed, EMBASE and Cochrane Library databases (up to July 1st 2022) to search for studies that reported the diagnostic accuracy of MRI to detect and grade PF cartilage injuries as compared to diagnostic arthroscopy. Risk of bias was judged using the QUADAS-2 tool. Quantitative syntheses were performed to calculate the diagnostic accuracy metric-sensitivity, specificity, positive likelihood (LR+) and negative likelihood (LR-) ratios, diagnostic odds ratio (DOR)-and presented as median with 25% and 75% percentiles. The summary receiver operating characteristic (SROC) curves were also calculated. Diagnostic accuracy metrics were calculated for all PF cartilage injuries and then sub-grouped by patellar and trochlear lesions. Diagnostic accuracy was also calculated according to the grading of cartilage injuries. RESULTS: Forty-five studies were included for qualitative analyses and forty studies were included for quantitative synthesis. A total of 3534 participants with a weighted mean age of 38.1 years were included. Diagnostic accuracy was generally high: sensitivity (0.8, 0.6-1.0), specificity (0.9, 0.8-1.0), LR+ (6.4, 3.1-15.3), LR- (0.3, 0.2-0.4) and DOR (21.3, 9.9-121.1). The area under the curve (AUC) of the SROC was 0.9. The diagnostic accuracy was slightly higher for patellar (sensitivity 0.8, specificity 0.8, LR+ 5.3, LR- 0.2, DOR 28.8) than for trochlear lesions (sensitivity 0.7, specificity 0.9, LR+ 5.5, LR- 0.4, DOR 14.3). The sensitivity was generally higher when grading advanced (vs. early or intermediate) cartilage injuries of the patella. CONCLUSION: The MRI is able to diagnose PF cartilage injuries with reasonably high diagnostic accuracy (as compared to arthroscopy). Clinicians can rely on MRI to reliably diagnose PF cartilage injuries (with some limitations) which will play an important role in deciding for surgical or non-operative treatment. LEVEL OF EVIDENCE: Level III.
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