Diagnostic Accuracy of Magnetic Resonance Imaging in Evaluation of Anterior Cruciate Ligament Tear

Mymensingh Med J. 2023 Jan;32(1):200-206.

Abstract

The anterior cruciate ligament (ACL) is the most generally injured one of the major knee ligaments. These injuries plague both athletes and non-athletes. This cross-sectional and comprehensive study was conducted in the Department of Radiology and Imaging collaborating with Department of Orthopedics of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, completed from January 2014 to December 2015. The study evaluated the role of MRI in the diagnosis of anterior cruciate ligament injury of knee joint, keeping Arthroscopy as standard, compared the MRI and arthroscopic findings to determine accuracy, sensitivity and predictivity of MRI in the diagnosis of ACL injury in knee joint. For this purpose, a total of 50 patients having clinical suspicion of ACL injury in knee joint were enrolled in this study to perform MRI and Arthroscopy. MRI was done in all these patients. Clinically suspected but MRI diagnosed as no ACL injury, patients who were not willing to undergo arthroscopy examination and patient who were not fit for arthroscopy were excluded from the study. More than half (52.0%) of the patients were in 3rd decade and male to female ratio was 3.5:1. Less than one fourth (24.0%) of the patients were service holder. Forty two percent patients had duration of suffering for 2 weeks. Most 49(98.2%) patients had history of trauma, 45(90.0%) had pain in Knee joint, 24(48.0%) had difficulty in walking, 19(38.0%) had swelling in Knee joint and 13(26.0%) had restricted range of motion. Anterior drawer test was 37(74.0%) and Lachman test 16(32.0%). Loss of normal contour of ACL was found in 50.0%. Signal change of ACL in PD and T2W1 was found 42(84.0%) patients, and thickened ACL in 33(66.0%) patients. In MRI diagnosis tear was present in 80.0% of the patients. ACL tear diagnosed by MRI among the patients, 20(40.0%) had partial tear and 20(40.0%) had complete tear. In arthroscopy diagnosis 38(76.0%) had tear present. ACL tear diagnosed by arthroscopy of the patients 15(30.0%) had partial tear and 23(46.0%) had complete tear. Majority 20(40.0%) patients had medial meniscus injury, 15(30.0%) had lateral meniscus injury, 11(22.0%) had PCL injury, 4(8.0%) had lateral co-lateral ligament injury and 2(4.0%) had medial co-lateral ligament injury. In MRI diagnosis of anterior cruciate ligament tear, 37 cases were true positive, three cases false positive, one case false negative and nine cases was true negative. The validity of MRI diagnosis evaluation for anterior cruciate ligament tear was 97.4% sensitivity, 75.0% specificity, 92.0% accuracy, 92.5% positive predictive values and 90.0% negative predictive values.

MeSH terms

  • Anterior Cruciate Ligament Injuries* / diagnostic imaging
  • Anterior Cruciate Ligament Injuries* / surgery
  • Arthroscopy / methods
  • Bangladesh
  • Cross-Sectional Studies
  • Female
  • Humans
  • Knee Injuries* / diagnostic imaging
  • Magnetic Resonance Imaging / methods
  • Male
  • Rupture