Department of Orthopedic Surgery, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
Arch Iran Med. 2013 Apr;16(4):229-32.
Magnetic resonance imaging (MRI) of the knee joint has often been regarded as a noninvasive alternative to diagnostic arthroscopy. In day-to-day clinical practice, the MRI scan is routinely used to support the diagnosis for meniscus or ligamentous injuries prior to recommending arthroscopic examination and surgery. On the other hand, rapidly progressing medical technology sometimes obscures the importance of history and physical examination. This study aims to evaluate the accuracy of physical examination and MRI scanning in the diagnosis of knee injury, including meniscus tears and cruciate ligament ruptures.
In a cross-sectional, descriptive analytical study, 120 patients with knee injury who were candidates for arthroscopy were referred to Tabriz Shohada Hospital during a one-year period. Prior history of arthroscopy or knee surgery was considered as exclusion criteria. Before ordering an MRI and arthroscopy, a thorough physical examination of the affected knee was performed and a preliminary diagnosis made. The results of arthroscopy were considered as the definitive diagnosis, therefore the results of the physical examination and MRI were judged accordingly.
Of the 120 evaluated patients with knee injuries, there were 108 males and 12 females with a mean age of 29.13 ± 7.37 (16-54) years. For medial meniscus injuries, clinical examination had an accuracy of 85%, sensitivity of 94.8%, and specificity of 75.8%. Lateral meniscus injuries had the following results: accuracy (85%), sensitivity (70.8%) and specificity (88.5%). Clinical examination of anterior cruciate injuries had an accuracy of 95.8%, sensitivity of 98.6% and specificity of 91.7%. According to MRI results, for medial meniscus injuries there was an accuracy of 77.5%, sensitivity of 84.2%, and specificity of 71.4%. In lateral meniscus injuries, MRI had an accuracy of 85.8%, sensitivity of 56.5% and 92.8% specificity. MRI evaluation of anterior cruciate injuries was 92.5% for accuracy, 98.6% for sensitivity, and 83.3% for specificity. Both clinical examination and MRI were 100% for posterior cruciate injuries. Overall, in isolated injuries, the accuracy of clinical examination was relatively better than with complicated cases. The opposite results were seen for MRI findings in this regard.
According to our results, both physical examination and MRI scans are very sensitive and accurate in the diagnosis of knee injuries, with a mild preference for physical examination. MRI should be reserved for doubtful cases or complicated injuries.
磁共振成像（MRI）膝关节检查常被视为诊断性关节镜检查的非侵入性替代方法。在日常临床实践中，MRI 扫描通常用于支持半月板或韧带损伤的诊断，然后再建议进行关节镜检查和手术。另一方面，快速发展的医疗技术有时会掩盖病史和体格检查的重要性。本研究旨在评估体格检查和 MRI 扫描在诊断膝关节损伤（包括半月板撕裂和十字韧带断裂）中的准确性。
在一项横断面、描述性分析研究中，在为期一年的时间里，有 120 名膝关节损伤患者被转诊至大不里士沙希德医院接受关节镜检查。关节镜或膝关节手术史被视为排除标准。在进行 MRI 和关节镜检查之前，对受影响的膝关节进行了全面的体格检查并做出了初步诊断。关节镜检查的结果被认为是明确的诊断，因此根据该结果对体格检查和 MRI 检查的结果进行了判断。
在 120 名评估的膝关节损伤患者中，有 108 名男性和 12 名女性，平均年龄为 29.13±7.37 岁（16-54 岁）。内侧半月板损伤的体格检查准确性为 85%，敏感度为 94.8%，特异性为 75.8%。外侧半月板损伤的结果为：准确性（85%）、敏感度（70.8%）和特异性（88.5%）。前交叉韧带损伤的体格检查准确性为 95.8%，敏感度为 98.6%，特异性为 91.7%。根据 MRI 结果，内侧半月板损伤的准确性为 77.5%，敏感度为 84.2%，特异性为 71.4%。外侧半月板损伤的 MRI 准确性为 85.8%，敏感度为 56.5%，特异性为 92.8%。前交叉韧带损伤的 MRI 评估准确性为 92.5%，敏感度为 98.6%，特异性为 83.3%。后交叉韧带损伤的体格检查和 MRI 检查的准确性均为 100%。总的来说，在单纯损伤中，体格检查的准确性优于复杂病例。而在这方面，MRI 的结果则相反。
根据我们的结果，体格检查和 MRI 扫描在膝关节损伤的诊断中均非常敏感和准确，对体格检查略有偏好。对于可疑病例或复杂损伤，应保留 MRI 检查。
