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The value of MRI in diagnosing meniscus healing after repair in symptomatic patients
Author(s):
Lind M. (Denmark)
Lind M. (Denmark)
Affiliations:
ESSKA Academy. LIND M. 05/09/18; 209748; P14-1822 Topic: Knee
Prof. Martin LIND
Prof. Martin LIND
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Abstract
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Objectives: Magnetic resonance imaging (MRI) is frequently used to evaluate post-operative meniscus healing after repair. In previous studies meniscus healing after repair have been evaluated by clinical assessment, MRI and second-look arthroscopy in patients regardless of symptoms of unhealed meniscus. However, present study evaluated meniscus healing after repair in symptomatic patients by clinical assessment, MRI and second-look arthroscopy.

This study investigated the diagnostic accuracy of MRI and clinical assessment on determining failed meniscus repair in symptomatic meniscus-repaired patients verified by rearthroscopy.

Methods: Eighty patients (80 menisci), mean age of 25.51 ([SD], 8,36; range, 14-52 years) including fourty-seven men and thirty-three women, were included in this retrospective study as they all had undergone a primary meniscus repair in the years 2004-2012 followed by an MRI and a second-look-arthroscopy due to clinical symptoms of an unhealed meniscus. The postoperative MRIs were examined and graded 0-3 of which grade 3 defined lack of healing. Clinical assessment was divided into joint swelling, joint-line tenderness, locking and positive McMurray's test. Second-look arthroscopy descriptions from hospital records were equally examined. Based on the findings, the sensitivity, specificity, positive predictive value (ppv) and negative predictive value (npv) of the MRI and the clinical assessment holding second-look arthroscopy as a standard were calculated.

Results: The MRI found twenty-two (28 %) of the menisci healed and sixty-one (73 %) unhealed, whereas second-look arthroscopy found fifteen (19%) healed menisci and 68 (81%) unhealed menisci.
Isolated MRI findings had 0.85, 0.8, 0.95, 0.55, (sensitivity, specificity, ppv and npv respectively). The ppv of the clinical assessment was 0.77, 0.87, 0.94 at one, two and three clinical findings respectively.
The combination of a grade 3 MRI and either joint line tenderness or a positive McMurray's test presented ppv's of 0.98 and 1 respectively.

Conclusions: A supplementary MRI will increase the diagnostic accuracy when less than three clinical findings are present.

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