Evaluation of recurring meniscal tears with gadolinium-enhanced magnetic resonance imaging: a randomized, prospective study.
BACKGROUND
Magnetic resonance imaging has been shown to be of questionable accuracy in detecting recurrent meniscal tears after previous resection or repair.


OBJECTIVE
To compare the accuracy of nonenhanced magnetic resonance imaging with that of intraarticular contrast-enhanced direct magnetic resonance arthrography and intravenous contrast-enhanced indirect magnetic resonance arthrography for detection of recurrent meniscal tears.


METHODS
Prospective cohort study.


METHODS
Forty-one patients who had previous meniscal tears treated by resection or repair but who were experiencing recurrent knee symptoms were prospectively randomized into one of three groups: conventional magnetic resonance imaging, indirect arthrography, and direct arthrography. The interpretations of two musculoskeletal radiologists were compared with the findings of an arthroscopic procedure performed 2 to 14 weeks later.


RESULTS
Conventional imaging had a sensitivity of 57.9%, specificity of 80%, and overall accuracy of 62.5%. Intravenous contrast improved the sensitivity to 90.9%, specificity to 100%, and overall accuracy to 93.8%; intraarticular contrast had a sensitivity of 91.7%, specificity of 100%, and an overall accuracy of 92.9%.


CONCLUSIONS
We demonstrated an increased accuracy of intravenous or intraarticular contrast-enhanced magnetic resonance arthrography in detecting recurrent meniscal tears. Both contrast routes demonstrated similar accuracy, a finding not previously reported.
Vives
Michael J
MJ
Department of Orthopaedic Surgery. Department of Radiology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Homesley
David
D
Ciccotti
Michael G
MG
Schweitzer
Mark E
ME
D000328:Adult; D000368:Aged; D001175:Arthrography / Q000379:methods*; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008592:Menisci, Tibial / Q000473:pathology; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012680:Sensitivity and Specificity; D000070600:Tibial Meniscus Injuries
D019786:Gadolinium DTPA