title: Diagnostic value of the clinical investigation in acute meniscal tears combined with anterior cruciate ligament injury using arthroscopic findings as golden standard.
abstract: BACKGROUND
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
  
  
  METHODS
  Level II, prospective study.
authors: Institute of Translational Research for Musculoskeletal System 'Nicola Cerulli', A.Einstein 12, 52100, Arezzo, Italy. andrea.speziali@gmail.com.|Institute of Orthopedic and Traumatology, Catholic University, 'Agostino Gemelli' Hospital, Rome, Italy. andrea.speziali@gmail.com.
authors: A
authors: A
authors: Speziali
authors: Institute of Translational Research for Musculoskeletal System 'Nicola Cerulli', A.Einstein 12, 52100, Arezzo, Italy.
authors: G
authors: G
authors: Placella
authors: Institute of Translational Research for Musculoskeletal System 'Nicola Cerulli', A.Einstein 12, 52100, Arezzo, Italy.
authors: M M
authors: MM
authors: Tei
authors: Department of Orthopedic Surgery, Orthopaedic Sports Medicine Center, University of Ioannina, Ioannina, Greece.
authors: A
authors: A
authors: Georgoulis
authors: Institute of Translational Research for Musculoskeletal System 'Nicola Cerulli', A.Einstein 12, 52100, Arezzo, Italy. g_cerulli@tin.it.|Institute of Orthopedic and Traumatology, Catholic University, 'Agostino Gemelli' Hospital, Rome, Italy. g_cerulli@tin.it.
authors: G
authors: G
authors: Cerulli
mesh_terms: D000293:Adolescent; D000328:Adult; D000070598:Anterior Cruciate Ligament Injuries / Q000175:diagnosis*; D001182:Arthroscopy; D002648:Child; D006801:Humans; D007718:Knee Injuries / Q000175:diagnosis; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D000070600:Tibial Meniscus Injuries / Q000175:diagnosis*; D055815:Young Adult
keywords: ACL injury; Arthroscopy; Clinical investigation; Combined injuries; Meniscal tears