Diagnostic value of clinical tests and Mri for meniscal injury in patients with anterior cruciate ligament injury: Case series study

INTRODUCTION AND IMPORTANCE: Meniscal tear is one of the most common knee injuries and knee surgery procedures. It is frequently associated with an anterior cruciate ligament (ACL) injury. We conducted this study, on patients with ACL reconstruction surgeries, which were occasionally accompanied by meniscal tears, in order to determine the diagnostic value of clinical examinations for meniscal tear, both individually and in combination, in correlations to magnetic resonance imaging (MRI) scans, with the goal of improving clinical diagnosis for patients with meniscal injuries in particular, as well as meniscal injuries associated with cruciate ligament knee injuries. CASE PRESENTATION: 50 patients were thoroughly clinically examined, using Joint line tenderness, Thessaly test, McMurray's test, Apley's test followed by MRI, before their scheduled ACL reconstruction arthroscopic surgeries. The meniscal tears were then identified during the procedure, and were treated, if necessary. The data before and after the surgery was taken into calculating, with arthroscopic findings serving as the gold standard. Results: the sensitivity, specificity and accuracy of each clinical tests and MRI scans respectively were: for medial meniscus, Joint line tenderness (70%; 53,3%; 60%); McMurray's test (80%; 73,3%: 76%); Apley's test (65%; 70%; 68%); Thessaly test(70%; 76,7%; 74%); MRI (90%; 83,3%; 86%); lateral meniscus: Joint line tenderness (73%; 66,7%; 70%); McMurray's test (69,2%; 75%: 72%); Apley's test (69,2%; 70,8%; 70%); Thessaly test (73,1%; 75%; 74%); MRI (88,5%; 87,5%; 88%). However, when combining at least two positive tests into a single composite test, the diagnostic value is considerably enhanced with sensitivity, specificity and accuracy of 85%, 73,3%, 78% for medial meniscus, 92,3%, 87,5%, 90% for lateral meniscus. CLINICAL DISCUSSION: Clinical tests are essential for diagnosis of meniscal tears, although inconsistent. A composite test consisting of at least two positive tests can considerably enhance the diagnostic value, even comparable to MRI scans. However, after the clinical examination, MRI is still necessary for the diagnostic process of meniscal injuries in particular, as well as meniscal injuries associated with cruciate ligament knee injuries. CONCLUSION: The combination of clinical tests and MRI images will give a precise diagnosis as well as surgical indication for meniscus injury in patients with anterior cruciate ligament tear.