Accuracy of clinical diagnosis in meniscal tears

Introduction: Meniscal injuries of the knee are common indications for arthroscopic knee surgery. Most of the meniscal tears can be diagnosed by clinical evaluation alone. This study aims to test the accuracy of the commonly performed tests for meniscal tears in our set up. Method: This was a prospective observational study of 32 symptomatic knees that underwent clinical evaluation followed by arthroscopy. The sensitivity, specificity and diagnostic accuracy of three clinical tests (McMurray’s test, Apley’s compression test and Joint line tenderness) were calculated against arthroscopic findings. Result: Among clinical tests, maximum sensitivity (94.44%) was with Joint Line Tenderness for Medial Meniscus Tear (MMT) and minimum (54.54%) with Apley’s Compression Test for Lateral meniscus Tear (LMT). Specificity was maximum (90.48%) with Joint Line Tenderness for LMT and minimum (64.28%) with Apley’s Compression Test for MMT. Diagnostic accuracy was maximum (90.6%) with McMurray’s test for LMT and minimum (75%) with Apley’s Compression Test for MMT and LMT. Conclusion: All three clinical tests (McMurray’s, Apley’s compression and Joint line tenderness) were found reliable for diagnosing meniscus tears. Joint Line Tenderness had the best diagnostic accuracy followed by McMurray’s test.

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

The 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.

Do Clinical Correlates of Knee Osteoarthritis Predict Outcome of Intraarticular Steroid Injections?

Objective.To determine whether clinical correlates of knee osteoarthritis (OA) affect the outcome of intraarticular steroid injections (IASI) in symptomatic knee OA.Methods.Men and women aged ≥ 40 years with painful knee OA who participated in an open-label trial of IASI completed questionnaires and clinical examination. The Outcome Measures in Rheumatology (OMERACT)–Osteoarthritis Research Society International (OARSI) criteria were used to assess response to therapy in the short term (within 2 weeks). Among those who initially responded, those whose pain had not returned to within 20% of the baseline Knee Injury and Osteoarthritis Outcome Score pain score at 6 months were characterized as longer-term responders. Log-binomial regression was used to examine factors associated with outcome.Results.One hundred ninety-nine participants were included, of whom 146 (73.4%) were short-term and 40 (20.1%) longer-term responders. Compared to short-term nonresponders, participants with these characteristics were more likely to be short-term responders: medial joint line tenderness [relative risk (RR) 1.42, 95% CI 1.10–1.82], medial and lateral joint line tenderness (RR 1.38, 95% CI 1.03–1.84), patellofemoral tenderness (RR 1.27, 95% CI 1.04–1.55), anserine tenderness (RR 1.27, 95% CI 1.06–1.52), and a belief that treatment would be effective [RR/unit increase (range 0–10) = 1.05 (1.01–1.09)]. Aspiration of joint fluid (RR 0.79, 95% CI 0.66–0.95) and previous ligament/meniscus injury (RR 0.63, 95% CI 0.44–0.91) were associated with a reduced risk of being a short-term responder. Compared to initial nonresponders and those whose pain recurred within 6 months, participants with a higher number of pain sites [RR/unit increase (range 0–10) = 0.83, 95% CI 0.72–0.97], chronic widespread pain (RR 0.32, 95% CI 0.10–0.98), perceived chronicity of disease [RR/unit increase (range 0–10) = 0.86, 95% CI 0.78–0.94], and a higher depression score [RR/unit increase (range 0–21) = 0.89, 95% CI 0.81–0.99] were less likely to be longer-term responders.Conclusion.Among patients with symptomatic knee OA, tenderness around the knee was associated with better short-term outcome of IASI. However, clinical-related factors did not predict longer-term response, while those with chronic widespread pain and depressive symptoms were less likely to obtain longer-term benefits.

Preoperative Diagnosis and Treatment Outcomes of Incarcerated Inferiorly Displaced Flap Tear of the Medial Meniscus: Comparison between Flap Tears with and without Incarcerated Fragment

The purpose of this study was to compare preoperative variables and postoperative outcomes between flap tears with and without incarceration of inferiorly displaced fragments of medial meniscus and find distinct features of incarcerated flap tear of medial meniscus to improve preoperative diagnosis. 79 patients who underwent partial meniscectomy for flap tear of medial meniscus were classified into two groups: group U, usual flap tear without incarcerated fragment; group I, flap tear with incarcerated inferiorly displaced fragment. Patient characteristics and preoperative variables including duration of symptom aggravation were investigated. A comprehensive physical examination including joint line tenderness was performed. Magnetic resonance imaging (MRI) examination was carried out on all patients. Clinical assessments were performed with functional scores including visual analogue scale (VAS), and radiologic evaluation was conducted. Preoperative values and postoperative outcomes measured at the minimum follow-up duration of 2 years were compared between the groups. The groups did not differ significantly regarding postoperative outcomes by functional and radiological evaluations (p>0.05). In making preoperative diagnosis, sensitivity of diagnosis based solely on MR images was significantly lower in group I (68.8%) than that in group U (90.5%) (p=0.040). The following clinical features differed significantly between the groups: Patients in group I had higher scores in preoperative VAS (group U = 6.6; group I = 7.7) (p=0.011) and shorter duration of symptom aggravation (group U = 13.8 weeks; group I = 3.9 weeks) (p<0.001). Joint line tenderness was positive more distinctly in group I (100%) than in group U (74.6%). If displaced flap tear was properly resected, improved outcomes did not differ regardless of incarceration of flap tear. In diagnosing incarcerated inferiorly displaced flap tear, sensitivity of diagnosis based solely on MR images could be low. Distinguishing clinical findings would be helpful in obtaining a more appropriate diagnosis.

Intra articular hyaluronic acid versus intra articular triamcinolone hexacetonide in primary osteoarthritis of knee: a comparative study

Background: Osteoarthritis (OA) is a painful, chronic disease with widespread burden on patients, communities, social and health care systems. Intraarticular (IA) Hyaluronic acid (HA) and corticosteroids are established treatments for OA knee. However, concerns exist regarding effect, duration, safety, effectiveness across population and heterogeneity. Aim of the study is to compare the efficacy and safety of IA HA with THA in the treatment of primary osteoarthritis knee.Methods: A descriptive cross-sectional study was done among 30 patients. One group (n=15) received IA THA 20mg/2mL on day 0 and other group (n=15) received IA HA 20mg/2 mL on day 0, 7 and 14 under aseptic precautions. The efficacy assessment using VAS for overall pain, joint line tenderness and 15m walking time in seconds were recorded. Side effects if any were noted.Results: Comparing both treatments IA THA provided superior short-term pain relief. But HA showed sustained benefit up to six months.Conclusions: OA being a chronic disease process, we need a drug which has a long-lasting effect. Additive effect of HA and THA can be considered for better efficacy.