title: A systematic review and meta-analysis of the diagnostic accuracy of MRI for suspected ACL and meniscal tears of the knee.
abstract: OBJECTIVE
  To determine the diagnostic accuracy of magnetic resonance imaging (MRI) and ultrasound (US) in the diagnosis of anterior cruciate ligament (ACL), medial meniscus and lateral meniscus tears in people with suspected ACL and/or meniscal tears.
  
  
  METHODS
  MEDLINE, Web of Science and the Cochrane library were searched from inception to March 2014. All prospective studies of the diagnostic accuracy of MRI or US against arthroscopy as the reference standard were included in the systematic review. Studies with a retrospective design and those with evidence of verification bias were excluded. Methodological quality of included studies was assessed using the QUADAS-2 tool. A meta-analysis of studies evaluating MRI to calculate the pooled sensitivity and specificity for each target condition was performed using a bivariate model with random effects. Sub-group and sensitivity analysis were used to examine the effect of methodological and other study variables.
  
  
  RESULTS
  There were 14 studies included in the meta-analysis of the accuracy of MRI for ACL tears, 19 studies included for medial meniscal tears and 19 studies for lateral meniscal tears. The summary estimates of sensitivity and specificity of MRI were 87 % (95 % CI 77-94 %) and 93 % (95 % CI 91-96 %), respectively, for ACL tears; 89 % (95 % CI 83-94 %) and 88 % (95 % CI 82-93 %), respectively, for medial meniscal tears; and 78 % (95 % CI 66-87 %) and 95 % (95 % CI 91-97 %), respectively, for lateral meniscal tears. Magnetic field strength had no significant effect on accuracy. Most studies had a high or unclear risk of bias. There were an insufficient number of studies that evaluated US to perform a meta-analysis.
  
  
  CONCLUSIONS
  This study provides a systematic review and meta-analysis of diagnostic accuracy studies of MRI and applies strict exclusion criteria in relation to the risk of verification bias. The risk of bias in most studies is high or unclear in relation to the reference standard. Concerns regarding the applicability of patient selection are also present in most studies.
  
  
  METHODS
  III.
authors.affiliation: Department of Orthopaedics, Royal College of Surgeons in Ireland, Dublin, Ireland. niphelan@tcd.ie.
authors.forename: Nigel
authors.initials: N
authors.lastname: Phelan
authors.affiliation: Department of Orthopaedics, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Patrick
authors.initials: P
authors.lastname: Rowland
authors.affiliation: Department of Clinical Therapies, University of Limerick, Limerick, Ireland.
authors.forename: Rose
authors.initials: R
authors.lastname: Galvin
authors.affiliation: Professorial Unit, Cappagh National Orthopaedic Hospital, Dublin, Ireland.
authors.forename: John M
authors.initials: JM
authors.lastname: O'Byrne
mesh_terms: D000293:Adolescent; D000328:Adult; D000070598:Anterior Cruciate Ligament Injuries / Q000175:diagnosis*; D001182:Arthroscopy; D005260:Female; D006801:Humans; D007719:Knee Joint; D008279:Magnetic Resonance Imaging / Q000592:standards*; D008297:Male; D008592:Menisci, Tibial / Q000473:pathology; D008875:Middle Aged; D000070600:Tibial Meniscus Injuries / Q000175:diagnosis*; D055815:Young Adult
keywords: Anterior cruciate ligament; Diagnostic test accuracy; Lateral meniscus; Magnetic resonance imaging; Medial meniscus; Ultrasonography