Accuracy Of Clinical Examination, Magnetic Resonance Imaging, And Arthroscopy In Diagnosing Meniscal And Anterior Cruciate Ligament Injuries

Abstract

Background: Accurate diagnosis of knee injuries is critically dependent on thorough patient history and detailed clinical examination. Meniscal and ligamentous injuries within the knee are frequently assessed using magnetic resonance imaging (MRI), which serves as an adjunct diagnostic tool. This study aimed to evaluate the precision of clinical tests in diagnosing meniscal (Thessaly, joint line tenderness, and McMurray tests) and anterior cruciate ligament (ACL) (Lachman, Anterior Drawer (ADT), and Pivot Shift tests (PST)) injuries and to compare these findings with MRI and arthroscopic results, the latter of which is considered the diagnostic gold standard.

Material and methods: This study was done prospectively from October (Year) to October (Year). The study included a total of 79 individuals who had knee arthroscopy for different reasons at Erbil Teaching Hospital. Orthopedic doctors conducted clinical assessments using specialized techniques to evaluate meniscal and ACL damage. MRI was used to validate these clinical symptoms, then followed by arthroscopy to obtain the definitive diagnosis.

Results: The Lachman test demonstrated high diagnostic accuracy (92.4%) in identifying ACL ruptures. Similarly, the Thessaly test was highly accurate for detecting tears in the medial (91.1%) and lateral (89.5%) menisci. Joint line tenderness (JLT) achieved an accuracy of 84.8% for medial and 89.7% for lateral meniscus tears. The validity of these clinical tests was benchmarked against MRI findings and arthroscopic confirmation. The accuracy of clinical diagnoses for medial and lateral meniscal lesions was comparable to MRI (91% vs. 89% and 89% vs. 86%, respectively). Clinical diagnosis of ACL injuries also showed superior accuracy compared to MRI (92.4% vs. 87.3%).

Conclusions: Among the clinical tests evaluated, the Lachman test was the most precise for diagnosing ACL ruptures, and the Thessaly test, coupled with JLT, was the most reliable for identifying meniscal tears. Clinical examinations proved as accurate as MRI in diagnosing meniscal injuries, and even more so for ACL injuries, highlighting the effectiveness of careful clinical assessment in the diagnostic process.