A STUDY ON CLINICAL EVALUATION, MRI & ARTHROSCOPY IN CRUCIATE LIGAMENT & MENISCAL INJURIES

Abstract

BACKGROUND: This study is to determine the importance of Clinical Examination, MRI and Arthroscopy findings of one over the other respectively, in assessing meniscal & ligament injury of knee joint. Knee joint is one of the most commonly injured joints because of its anatomical structure, its exposures to external forces and the functional demands placed on it. In the last four decades advances in understanding and treatment of knee instability have progressed at a rapid rate. Historically several investigations have shown that clinical diagnosis is approximately 70% accurate in diagnosing knee pathology. STUDY DESIGN: This is an objective study in which, patients with complaints of pain and instability of knee attending to the Department of Orthopaedics, Malla Reddy Hospital (MRH) attached to Malla Reddy Institute of Medical Sciences (MRIMS), Surarum, Hyderabad, were studied. More than 200 patients who have reported to the outpatient department between 1 st January 2012 and 31 st August 2012, of which 50 patients underwent clinical examination, MRI and Arthroscopic evaluation. RESULTS: All the 10 cases of isolated ACL injury and one case of only PCL injury, one case of both ACL & PCL injury, there was equal correlation between Clinical, MRI & Arthroscopy. Two PCL and bicruciate ligaments were diagnosed clinically, MRI and Arthroscopy. In both meniscal and cruciate ligament injuries 32 cases were diagnosed by clinical examination, out of which Arthroscopically 26 were diagnosed and 28 were diagnosed by MRI. In isolated meniscal injured there were five diagnosed on arthroscopy, eight on clinical examination & four on MRI. Five were misdiagnosed clinically but on arthroscopy had no tear. CONCLUSION: From our study we concluded that, for isolated ACL and PCL injuries Clinical, MRI and Arthroscopy are almost equal in diagnosing the condition. For Meniscal injuries the sensitivity was 88% and specificity was 97% by clinical examination, sensitivity was 93.5%, specificity was 93% by MRI, sensitivity was 100% and specificity was 100% for Arthroscopy. In both Meniscal and Cruciate Ligament specificity was 100% and sensitivity was 90% by clinical examination, specificity was 98% and sensitivity was 93 % for MRI, sensitivity was 100% and specificity was 100% for Arthroscopy. Therefore Arthroscopy is best indicator of Cruciate Ligament as well as Meniscal injuries.