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Evaluation of the predictability of meniscal suture by magnetic resonance imaging
Author(s):
Goes R. (Brazil)
Goes R. (Brazil)
Affiliations:
ESSKA Academy. Goes R. May 9, 2018; 209739; P14-38
Rodrigo Goes
Rodrigo Goes
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Abstract
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Objectives: Main Objective: To evaluate the ability of magnetic resonance imaging to predict the suture of meniscal lesions.
Specific Objectives: To calculate the sensitivity, specificity, positive predictive value, negative predictive value and MRI accuracy to detect meniscal lesion and predictability of suture; To assess the concordance between MRI findings and arthroscopic findings for lesion detection and predictability of medial and lateral meniscal sutures; To verify if the time between the MRI examination and surgery influences the outcome of the treatment of the lesion; To describe the profile of sutured meniscal lesions.

Methods: This was an unicentric retrospective study that included 104 patients who underwent knee joint ligament reconstruction and / or arthroscopy for the treatment of meniscal injury at knee joint level. The MRI images of the meniscus were evaluated and later the arthroscopic findings were used as the gold standard. After the operative procedure, the cases were allocated into two groups according to the necessity of meniscus suture: Sutured Group "MSu" (n = 58) and Non sutured Group "MNSu" (n = 150).

Results: Considering the lesion detection capacity in the medial meniscus, the sensitivity, specificity and accuracy of MR were 85.3%, 63.9% and 77.9%, respectively. The positive predictive value (PPV) was 81.7% and the negative predictive value (NPV) was 69.7%. The agreement between MRI and arthroscopy was moderate. For the lateral meniscus, sensitivity, specificity and accuracy of MRI were 80.6%, 89.0% and 86.5%, respectively, with PPV of 75.7% and NPV of 91.5% and a substantial agreement. Regarding suture predictability, the sensitivity, specificity and accuracy were respectively 60.3%, 66.7% and 64.9% with PPV of 41.2% and NPV of 81.3%, with weak agreement. According to the arthroscopy, the 58 meniscal lesions of the MSu group were more frequent in the posterior horn, had the longitudinal pattern and were located in the red-red vascular zone.

Conclusions: - In our study, MRI was not a good predictor of meniscal suture;
- MRI has poor agreement with arthroscopy for suture predictability;
- MRI is a tool with moderate agreement with arthroscopy for the diagnosis of medial meniscal lesions and substantial concordance in the lateral meniscus;
- MRI is a good tool to confirm true negative cases in the lateral meniscus, presenting good specificity, accuracy and negative predictive value for suture predictability, but does not present good sensitivity, specificity, accuracy, positive predictive value and negative predictive value for Predictability of suture in the medial meniscus;
- The time elapsed between MRI and arthroscopy does not influence the treatment outcome;
- Most meniscal suturable lesions are located in the posterior horn, in the red-red zone and have a longitudinal pattern.

Keywords:
Meniscus, Magnetic Ressonance, Meniscus repair
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