The Sensitivity and Specificity of Preoperative History, Physical Examination, and Magnetic Resonance Imaging to Predict Articular Cartilage Injuries in Symptomatic Discoid Lateral Meniscus

The discoid meniscus is the most common meniscal variant. The likely etiology being congenital, the condition usually affects the lateral meniscus. Poorly vascularized, thicker and unstable, the discoid lateral meniscus (DLM) is more prone to tears due to abnormal shearing forces. Watanabe et al. (1979) classified the discoid lateral meniscus into three types: Complete, incomplete and Wrisberg type; Monllau et al. (1998) added the ring type as the fourth variant. Pain and clicks/thud are the most common presentations. Plain radiograph and magnetic resonance imaging are helpful in confirming the diagnosis. Asymptomatic DLM is best left alone. For symptomatic complete and incomplete types, partial arthroscopic saucerization is the treatment of choice leaving behind a stable rim. The Wrisberg type needs peripheral stabilization with resection of excess rim, if any. Total meniscectomy should be avoided unless inevitable. Short term results after partial meniscectomy are good.

Download Full-text

A Novel Magnetic Resonance Imaging Classification of Discoid Lateral Meniscus Based on Peripheral Attachment

The American Journal of Sports Medicine ◽

10.1177/0363546509332502 ◽

2009 ◽

Vol 37 (8) ◽

pp. 1564-1569 ◽

Cited By ~ 43

Author(s):

Jin Hwan Ahn ◽

Yong Seuk Lee ◽

Hae Chan Ha ◽

Jong Sup Shim ◽

Kyung Sub Lim

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Lateral Meniscus ◽

Discoid Lateral Meniscus ◽

Resonance Imaging ◽

Chi Square ◽

Shift Type ◽

Chi Square Test ◽

Imaging Classification

Background In the symptomatic discoid lateral meniscus, the effectiveness of preoperative magnetic resonance imaging (MRI) is not well documented. Hypothesis Magnetic resonance imaging classification will provide more information to the surgeon in choosing the appropriate treatment methods with the help of arthroscopic findings. Study design Cohort study (diagnosis); Level of evidence, 2. Methods Sixty-seven patients (82 knees) were reviewed. The preoperative MRI was checked in 76 of 82 knees. The Lysholm and Ikeuchi grading scales were evaluated. Images were analyzed from MRI, and findings were classified into 4 categories: no shift, anterocentral shift, posterocentral shift, and central shift. Tear pattern classifications were based on arthroscopic findings: horizontal tear, peripheral tear, horizontal and peripheral tear, posterolateral corner loss, and others. The correlations between MRI classification tear patterns and surgical methods were analyzed using the chi-square test or the Fisher exact test. The sensitivity, specificity, and accuracy of shift in preoperative MRI–according to the existence of peripheral tear when corroborated with arthroscopy–were also analyzed with the chi-square test. Inter- and intraobserver reliability was statistically analyzed by producing the inter- and intraclass correlation coefficient. Results The mean preoperative Lysholm score was 77.3 (range, 43-97), and the last follow-up Lysholm score had increased to 96.8 (range, 84-100; P <. 001). At last follow-up (100% follow-up), the Ikeuchi grading scale scored 48 knees as excellent, 30 as good, and 4 as fair. According to the MRI classification, 43 knees were no shift; 6, anterocentral shift; 15, posterocentral shift; and 12, central shift. Shift-type knees had a significantly larger number of peripheral tears, and repairs were performed in the shift-type knees (55%) more frequently than in the no-shift-type knees (28%). Among 82 knees, 31 were repaired simultaneously after a central partial meniscectomy. Conclusion Magnetic resonance imaging classification provides more information to surgeons in choosing the appropriate treatment methods, although the final decision regarding procedure is made during arthroscopy after thorough analysis of the tear.

Download Full-text

Should We Prefer Magnetic Resonance Imaging to Physical Examination in Meniscal Tears

The Journal of Knee Surgery ◽

10.1055/s-0039-1693449 ◽

2019 ◽

Vol 33 (12) ◽

pp. 1251-1255 ◽

Cited By ~ 1

Author(s):

Gökhun Arıcan ◽

Ahmet Özmeriç ◽

Özgür Şahin ◽

Serkan İltar ◽

Kadir Bahadır Alemdaroğlu

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Physical Examination ◽

Lateral Meniscus ◽

Meniscal Tears ◽

Resonance Imaging ◽

Predictive Values ◽

Arthroscopic Findings ◽

Meniscus Tears ◽

Joint Line Tenderness

AbstractThe aim of this study was to compare the sensitivity, specificity, accuracy, positive and negative predictive values of magnetic resonance imaging (MRI), and clinical examination in the diagnosis of meniscus tears with the findings obtained from the knee joint arthroscopy. A retrospective study was made of 452 patients who underwent knee arthroscopy due to meniscus tears between 2012 and 2017. Physical examination was performed using the Thessaly's, McMurray's, and Joint line tenderness tests (JLTT). On preoperative MRI, medial meniscal tears were observed in 292 patients, lateral meniscal tears in 96 patients, and medial and lateral meniscal tears in 64 patients. According to the arthroscopy results, 284 patients had medial meniscal tears, 108 patients had lateral meniscal tears, and 60 patients had medial and lateral meniscal tears. Sensitivity and specificity of the JLTT was determined as 93 and 86% respectively for medial meniscal tears and 94 and 89% for lateral meniscal tears. The McMurray's test was 60% sensitive, 68% specific for medial meniscal tears (MMT), and 73% sensitive and 68% specific for lateral meniscus tears (LMT). The Thessaly's test was 93% sensitive and 87% specific for medial meniscal tears; and 94% sensitive and 88% specific for LMT. Compared with the arthroscopic findings, MRI was observed to have sensitivity of 94% for MMT and 84% for LMT. For specificity, the values were 89% for MMT and 91% for LMT. Accuracy was 89% for MMT and 86% for LMT. In comparison with the arthroscopic findings, the triple test was determined to have sensitivity of 92% for MMT and 89% for LMT. The specificity was 88% for MMT and 91% for LMT. The results of this study showed that a combination of selected physical examination methods is as sensitive as MRI in the diagnosis of meniscus tears.

Download Full-text