Assessment of the menisci and cruciate ligaments: an audit of clinical practice

doi:10.1016/0020-1383(91)90008-3

Injury

Volume 22, Issue 4, July 1991, Pages 291-294

https://doi.org/10.1016/0020-1383(91)90008-3 Get rights and content

Abstract

The reliability of clinical assessment of the knee was evaluated in 203 patients using magnetic resonance imaging (MRI). Neither the mechanism of injury nor clinical symptoms were useful indicators of the type of pathology. Physical signs proved insufficiently sensitive in detecting abnormalities. Overall, the accuracy of clinical diagnosis was 80.8 per cent for the anterior cruciate ligament, 62.9 per cent for the medial meniscus and 74.9 per cent for the lateral meniscus.

Accurate investigations allow arthroscopy to be targeted to those likely to obtain therapeutic benefit. Reliance upon clinical judgement alone would have resulted in an 89 per cent increase in arthroscopic procedures. Investigations such as MRI or arthrography are concluded to be cost-effective methods of avoiding unnecessary hospitalization, morbidity and waste of limited resources.

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There are more references available in the full text version of this article.

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Anamnestic prediction of bucket handle compared to other tear patterns of the medial meniscus in stable knees
2016, Acta Orthopaedica et Traumatologica Turcica
Citation Excerpt :
Unfortunately, while several studies have evaluated the accuracy of various physical maneuvers,3,4,8 few studies have measured the accuracy of the clinical history in patients with suspected torn meniscus. These studies found that the history can heighten clinical suspicion but is of little value in distinguishing between meniscal and ligamentous injury or in pinpointing which one has sustained damage.10,11 In a prospective study of 145 patients, Abdon et al12 found a history of mechanical locking, patient's localization of pain to the joint line, and a decreased ability to participate in sporting activities associated with meniscus tears.
The aim of this study was to analyze and compare the preoperative anamnestic details between patients with an arthroscopic diagnosis of bucket handle and other tear patterns of the medial meniscus in stable knees.
A total of 204 patients (mean age 49.3 ± 13 years) were included in the study. The mean age was 49.3 ± 13 years. The study group included 65 patients (63 males, 2 females) with an arthroscopic diagnosis of bucket handle tear and the control group included 139 patients (90 males, 49 females) with non-bucket handle tear patterns. The preoperative clinical assessments of the two groups were analyzed retrospectively. Anamnestic prediction for the diagnosis of a bucket handle tear was based upon various medical history parameters. Multivariate logistic regression was carried out to identify independent anamnestic factors for predicting isolated bucket handle tears of the medial meniscus compared to non-bucket handle tears.
Analysis of the multivariate logistic regression yielded 3 statistically significant independent anamnestic risk factors for predicting isolated bucket handle tears of the medial meniscus: male gender (OR, 9.7; 95% CI, 1.1–37.6), locking events (OR, 4.6; 95% CI, 1.8–11.3) and pain in extension (OR, 6.9; 95% CI, 2.5–23.7). Other preoperative variables such as age, BMI, activity level, comorbidities, duration of symptoms, pain location, preceding injury and its mechanism had no significant effect on tear pattern.
Preoperative strong clues for bucket handle tears of the medial meniscus in stable knees are male gender, locking events and limitation in extension.
Level of evidence: Level III, Diagnostic study.
Diagnostic and therapeutic impact of MR enterography in Crohn's disease
2011, Clinical Radiology
Citation Excerpt :
The costs associated with MRE were not directly measured in the present study. Previous studies have shown MRI reduced the rate of subsequent knee arthroscopy with positive cost savings.17,22–26 It is interesting that in the present study, less than half of patients underwent concurrent colonoscopy, which added to MRE information in only four cases.
To assess the impact of magnetic resonance enterography (MRE) on clinician diagnostic confidence and therapeutic strategy in patients under investigation for small bowel Crohn’s disease.
Gastroenterologists completed a proforma before and following MRE in 51 patients (mean age 35 years, 26 female) under investigation for small bowel Crohn’s disease, indicating percentage confidence for presence/absence of small bowel involvement. In suspected disease, diagnostic confidence (using a scoring system from 1 = no to 6 = yes) was scored for subcategories: extent >30 cm (DE), terminal ileum (lTI), jejunal (JD), colonic disease (CoD), strictures (ST), activity (AD), extraluminal complications (EL), and surgical need (NS). Therapeutic strategy was recorded. Patients were divided into three groups: 1 = suspected disease, MRE normal (n = 15); 2 = suspected disease, MRE abnormal (n = 30); 3 = no suspected disease, MRE normal (n = 6). Binomial exact and paired t-tests were use to compare confidence pre and post-MRE.
Mean percentage confidence for the presence/absence of small bowel disease increased from 62 to 84% (p = 0.003), 87 to 98% (p = 0.0001), and 83 to 98% (p = 0.005) after MRE for groups 1, 2, and 3, respectively. In suspected disease, confidence changed significantly for all of the subcategories (p < 0.001) except EL in group 1. The percentage of patients with a confidence change ranged from 40% (CoD) to 87% (lTI; group 1) and from 7% (EL) to 93% (DE; group 2). Therapeutic strategy changed in 31/51 (61%, 95% CI 47–74%), 14 with a reduction in planned therapy and 17 with an increase.
MRE had a positive diagnostic impact in patients under investigation for small bowel Crohn’s disease and this influenced therapeutic strategy in 61% of the patients.
Knee instability
2005, EMC-Rhumatologie-Orthopedie
L'instabilité du genou est un symptôme subjectif qui recouvre plusieurs réalités anatomocliniques. L'interrogatoire, un examen clinique bien conduit et des radiographies simples permettent le plus souvent de faire un diagnostic précis. Les examens complémentaires plus sophistiqués peuvent être demandés secondairement dans le bilan préopératoire. Le praticien analysant les symptômes se doit, à la manière d'un puzzle, de replacer l'instabilité dans son contexte clinique (interrogatoire, examens clinique et paraclinique) afin d'établir le diagnostic lésionnel. Les grands cadres diagnostiques que nous allons évoquer sont les instabilités d'origine ligamentaire et méniscale puis les instabilités d'origine fémoropatellaire.
Knee instability is a subjective symptom that encompasses many anatomo-clinical situations. Patient's declarations, clinical examination, and x-ray pictures allow, most of the time, establishing precise diagnosis. More sophisticated investigations may be necessary secondarily, in the pre-operating context. When analysing the symptoms and for the determination of the lesion diagnosis, the practitioner has to put the instability in clinical context (patient questioning, clinical and paraclinical examination). The main diagnostic contexts that will be considered in the present chapter are those instabilities of ligament and meniscus origin and those of patellofemoral origin.
Consensus Delphi study on guidelines for the assessment of anterior cruciate ligament injuries in children
2022, World Journal of Orthopedics
The diagnostic accuracy of clinical tests for anterior cruciate ligament tears are comparable but the Lachman test has been previously overestimated: a systematic review and meta-analysis
2022, Knee Surgery, Sports Traumatology, Arthroscopy
Meniscal Pathology: Presentation and Diagnosis
2020, The Management of Meniscal Pathology: From Meniscectomy to Repair and Transplantation

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PaperAssessment of the menisci and cruciate ligaments: an audit of clinical practice

Abstract

Comparison of open and endoscopic meniscectomy

Clin. Orthop.

Magnetic resonance imaging in the assessment of meniscal and cruciate ligament injuries of the knee

J. Bone Joint Surg.

Meniscal abnormalities: prospective correlation of double-contrast arthrography and arthroscopy

Radiology

Paper
Assessment of the menisci and cruciate ligaments: an audit of clinical practice