title: Comparison of clinical, MRI and arthroscopic assessments of chronic ACL injuries, meniscal tears and cartilage defects.
abstract: OBJECTIVE
  The aim of this study was to compare the accuracy of clinical examination to that of MRI evaluated by two independent radiologists for the diagnosis of meniscal tears and chronic anterior cruciate ligament injuries and to assess the MRI accuracy in the diagnosis of cartilage defects.
  
  
  METHODS
  Seventy-six consecutive patients with suspected intra-articular knee pathology were prospectively evaluated by objective examination, 1.5 T MRI, re-examined by trained radiologist and arthroscopy. Accuracy, sensitivity, specificity, positive predictive value and negative predictive value were calculated. Agreement analysis with kappa (К) coefficient values was performed for meniscal and ACL tears.
  
  
  RESULTS
  No differences were found between diagnostic accuracy of clinical examination, the first and second MRI reports in diagnosis of medial meniscus (84 vs 96 vs 97 %) and anterior cruciate ligament injuries (93 vs 78 vs 89 %). For the lateral meniscal tears, the accuracy of the second radiologist was significantly higher than those of the first (96 vs 75 %; p < 0.01) and clinical examination (96 vs 86 %; p = 0.02). High diagnostic values were obtained for the diagnosis of full-thickness chondral defects with sensitivity of 100 %, specificity of 95 % and accuracy of 95 %.
  
  
  CONCLUSIONS
  Clinical and MRI evaluations have no differences in the diagnosis of medial meniscus and anterior cruciate ligament injuries. A trained radiologist obtained better sensitivity, specificity and accuracy in the diagnosis of lateral meniscus. 1.5 T MRI does not represent the technique of choice in the evaluation of chondral defect but demonstrated high diagnostic accuracy for detection of full-thickness chondral defects.
  
  
  METHODS
  Diagnostic prospective study, Level II.
authors.affiliation: Department of Surgical Sciences (DISC), Orthopaedic and Traumatologic Clinic, University of Genoa, Padiglione 40, IRCCS AOU San Martino - IST, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Felli
authors.affiliation: Radiology Unit, University of Genoa, IRCCS AOU San Martino - IST, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Garlaschi
authors.affiliation: Radiology Unit, University of Genoa, IRCCS AOU San Martino - IST, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Muda
authors.affiliation: Department of Experimental Medicine (DIMES), Institute of Anatomy, University of Genoa, IRCCS AOU San Martino - IST, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Tagliafico
authors.affiliation: Department of Surgical Sciences (DISC), Orthopaedic and Traumatologic Clinic, University of Genoa, Padiglione 40, IRCCS AOU San Martino - IST, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Formica
authors.affiliation: Department of Surgical Sciences (DISC), Orthopaedic and Traumatologic Clinic, University of Genoa, Padiglione 40, IRCCS AOU San Martino - IST, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Zanirato
authors.affiliation: Department of Surgical Sciences (DISC), Orthopaedic and Traumatologic Clinic, University of Genoa, Padiglione 40, IRCCS AOU San Martino - IST, Largo Rosanna Benzi 10, 16132, Genoa, Italy. mattia.alessio@hotmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Alessio-Mazzola
mesh_terms: D000328:Adult; D000070598:Anterior Cruciate Ligament Injuries / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D001182:Arthroscopy / Q000379:methods; D002358:Cartilage, Articular / Q000293:injuries; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D010808:Physical Examination / Q000379:methods; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D000070600:Tibial Meniscus Injuries / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome
keywords: ACL; Anterior cruciate ligament injury; Arthroscopy; Cartilage; Knee; MRI; Meniscal tears; Meniscus