Muhammad Noman Iqbal, Zaki Idrees, Muhammad Kazim Rahim Najjad, Syed Shahid Noor.
The Hand or the Scan: The best modality for diagnosing Internal Knee derangements.
Pak J Surg Jan ;31(3):208-12.

Objective: Th is study was designed to assess the value of MRI and Clinical examination in the diagnosis of Internal knee derangements in comparison with arthroscopic fi ndings. Materials and Methods: A retrospective analysis of arthroscopy records of 124 patients was done from 1st Jan. 2014 till 31st Dec. 2014. Clinical signs like eff usion, joint line tenderness, range of motion, McMurray sign, anterior drawer test, lachmann test and pivot shift test were assessed along with the MRI fi ndings. Arthoscopy fi ndings being gold standard in diagnosing knee derangements were looked for the accuracy of clinical signs as well as MRI fi ndings in establishing the sensitivity, specifi city, Positive predictive value (PPV), Negative predictive value (NPV) through SPSS ver 17.0 Results: Th e mean (SD) age was 37.42(14.53). 133.5 degree was the mean range of motion. 42.9% of injuries aff ected the right knee and 57.1% the left knee. On clinical examination Lachmann test was 91.7% sensitive and 84.2% specifi c; while anterior drawer test was 85.71% sensitive and 94.11% specifi c in diagnosing ACL pathology. On the contrary, in diagnosing Medial meniscal tear, joint line tenderness was 70% sensitive and 63.63% specifi c; while McMurray was 81% sensitive and 60% specifi c. Th e positive predictive value of Lachmann test was 78.6%, McMurray 81%, anterior drawer test 92.3% and joint line tenderness 77.77%. MRI was accurate in 88.5% of anterior cruciate ligament injuries. For Posterior cruciate ligament injuries accuracy of MRI was 94.6%. Accuracy of MRI was 85.9% in medial meniscal injuries. For lateral meniscus injuries accuracy of MRI was 73.8%. MRI fi ndings showed the lowest correlation with arthroscopic fi ndings in lateral meniscus injuries (r = 0.47). Clinical diagnostic performance was poorest in case of combined cruciate ligament and meniscal injuries. Conclusion: In diagnosing internal knee abnormalities, clinical signs can be helpful in clinical diagnosis and thus appropriate management can be instituted in the form of arthroscopy. However we also found signifi cant correlation between MRI and clinical fi ndings but when MRI is labeled normal, repeated clinical examination is considered more superior. So in our setup, clinical examination can save the time and money in form of radiological investigation like MRI.

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