Acute rotational trauma to the knee: poor agreement between clinical assessment and magnetic resonance imaging findings

Scand J Med Sci Sports. 2007 Apr;17(2):109-14. doi: 10.1111/j.1600-0838.2006.00559.x.


Objectives: To determine the incidence of anterior cruciate ligament (ACL) injuries in the general population; the pathology associated with a knee sprain verified by magnetic resonance imaging (MRI); and the agreement between clinical findings and MRI.

Material and methods: Inclusion criterion was an acute rotational trauma to the knee associated with effusion. One hundred and fifty-nine consecutive patients, mean age 27 years and 36% women, were included after clinical assessment at the orthopedic emergency unit. Patients were referred to an MRI examination (1.0 or 1.5 T) performed within a median of 8 days of the initial visit.

Results: The annual incidence of MRI verified ACL injuries was 0.81/1000 inhabitants aged 10-64 years. Fifty-six percent (n=89) of those included had sustained an ACL injury of whom 38% had an associated medial meniscus tear. There was a poor agreement between initial clinical antero-posterior laxity and MRI verified presence of an ACL tear (kappa 0.281). Every second patellar dislocation was diagnosed as a ligament injury.

Conclusion: Our findings indicate that the incidence of ACL injuries is higher than previously described. We also show that the first clinical examination after an acute knee trauma has a low diagnostic value. Further assessment with MRI improves the chances of a correct diagnosis of intraarticular pathology and is recommended in the early phase after a rotational knee trauma.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Anterior Cruciate Ligament Injuries*
  • Child
  • Female
  • Humans
  • Incidence
  • Knee Injuries / diagnosis*
  • Knee Injuries / epidemiology*
  • Magnetic Resonance Imaging*
  • Male
  • Middle Aged
  • Risk Factors
  • Rotation