Can a combination of physical tests detect ACL deficiency better than MRI?

Details

The study evaluated the diagnostic accuracy of physical examination and magnetic resonance imaging (MRI) for knee injuries. It included 96 patients at a regional hospital. Each participant had a physical examination assessing the menisci and anterior cruciate ligament (ACL). A knee joint MRI was also collected from each patient. The examinations and MRI scans were compared with knee arthroscopy findings as the gold standard for meniscal and ligamentous lesions. Sensitivity and specificity were calculated and correlated on receiver operating characteristic (ROC) curves.

Arthroscopy diagnosed 32 total ACL ruptures, 45 medial meniscus lesions and 17 lateral meniscus lesions. Three patients were diagnosed with bilateral meniscal lesions. For the medial meniscus, the McMurray test had the highest sensitivity at 87.5%; for the lateral meniscus, the Thessaly test had the highest sensitivity at 70%. The most sensitive ACL test was Lachman at 84.5%, while the pivot shift and Lelli tests were the most specific at 98.5%.

For medial meniscus lesions, MRI sensitivity was 96% and specificity was 52%. For lateral meniscus lesions, MRI sensitivity was lower at 70% and specificity higher at 85.5%. For ACL rupture, MRI specificity was 92% and sensitivity was 75%.

The researchers concluded that the McMurray and Apley tests seemed most appropriate for meniscal lesions in daily practice. A combination of lever signs, pivot shifts and Lachman tests showed the best sensitivity and specificity for detecting ACL deficiency and was superior to MRI.