title: Reliability of magnetic resonance imaging in evaluating meniscal and cartilage injuries in anterior cruciate ligament-deficient knees.
abstract: OBJECTIVE
  The accuracy of magnetic resonance (MR) imaging in assessing meniscal and cartilage injuries in anterior cruciate ligament (ACL)-deficient knees as compared to arthroscopy was evaluated in the present study.
  
  
  METHODS
  The results of all preoperative MR imaging performed within 3 months prior to the ACL reconstruction were compared against intraoperative arthroscopic findings. A total of 206 patients were identified. The location and type of meniscal injuries as well as the location and grade of the cartilage injuries were studied. The negative predictive value, positive predictive value, sensitivity, specificity and accuracy of MR imaging for these 206 cases were calculated and analysed.
  
  
  RESULTS
  In patients with an ACL injury, the highest incidence of concomitant injury was that of medial meniscus tears, 124 (60.2 %), followed by lateral meniscus tears, 105 (51.0 %), and cartilage injuries, 66 (32.0 %). Twenty-three (11.2 %) patients sustained injuries to all of the previously named structures. MR imaging was most accurate in detecting medial meniscus tears (85.9 %). MR imaging for medial meniscus tears also had the highest sensitivity (88.0 %) and positive predictive value (88.7 %), while MR imaging for cartilage injuries had the largest specificity (84.1 %) and negative predictive value (87.1 %). It was least accurate in evaluating lateral meniscus tears (74.3 %). The diagnostic accuracy of medial meniscus imaging is significantly influenced by age and the presence of lateral meniscus tears, while the duration between MR imaging and surgery has greater impact on the likelihood of lateral meniscus and cartilage injuries actually being present during surgery. The majority of meniscus tears missed by MR imaging affected the posterior horn and were complex in nature. Cartilage injuries affecting the medial femoral condyle or medial patella facet were also often missed by MR imaging.
  
  
  CONCLUSIONS
  MR imaging remains a reliable tool for assessing meniscus tears and cartilage defects preoperatively. It is most accurate when evaluating medial meniscus tears. However, MR imaging should be used with discretion especially if there is a high index of suspicion of lateral meniscus tears.
  
  
  METHODS
  IV.
authors.affiliation: Changi General Hospital Singapore, 2 Simei Street 3, Singapore, 529889, Singapore. kwpltkl@yahoo.com.
authors.forename: Kenneth Pak Leung
authors.initials: KP
authors.lastname: Wong
authors.affiliation: Changi General Hospital Singapore, 2 Simei Street 3, Singapore, 529889, Singapore.
authors.forename: Audrey XinYun
authors.initials: AX
authors.lastname: Han
authors.affiliation: Changi General Hospital Singapore, 2 Simei Street 3, Singapore, 529889, Singapore.
authors.forename: Jeannie Leh Ying
authors.initials: JL
authors.lastname: Wong
authors.affiliation: Changi General Hospital Singapore, 2 Simei Street 3, Singapore, 529889, Singapore.
authors.forename: Dave Yee Han
authors.initials: DY
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries / Q000175:diagnosis*; D005260:Female; D006801:Humans; D015994:Incidence; D007718:Knee Injuries / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D000070600:Tibial Meniscus Injuries / Q000175:diagnosis*; D055815:Young Adult
keywords: ACL; Accuracy; Anterior cruciate ligament; Arthroscopy; Cartilage; MRI; Magnetic resonance imaging; Meniscus