Accuracy of High-Resolution Ultrasound in the Detection of Meniscal Tears and Determination of the Visible Area of Menisci

• Published in: Journal of bone and joint surgery. American volume 2015-05, Vol.97 (10), p.799-806
• Main Authors: Akatsu, Yorikazu, Yamaguchi, Satoshi, Mukoyama, Shunsuke, Morikawa, Tsuguo, Yamaguchi, Tadashi, Tsuchiya, Kan, Iwasaki, Junichi, Akagi, Ryuichiro, Muramatsu, Yuta, Katsuragi, Joe, Fukawa, Taisuke, Endo, Jun, Takahashi, Kazuhisa, Sasho, Takahisa
• Format: Article
• Language: English
• Subjects: Adult; Arthroscopy; Cadaver; Female; Humans; Male; Menisci, Tibial - diagnostic imaging; Needles; Radiography; Rupture - diagnostic imaging; Sensitivity and Specificity; Ultrasonography
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/JBJS.N.01055

BACKGROUND:Imaging is of great importance in diagnosing meniscal tears. The aim of this study was to assess the accuracy of high-resolution ultrasound in the diagnosis of meniscal tears, with arthroscopic examination as the standard reference, after resolution was confirmed with a target-mounted reference phantom. An additional goal was to elucidate the area of the meniscus that could be visualized with the same ultrasound machine after placement of markers into the menisci of cadaveric knees. METHODS:Seventy patients were included for the assessment of the accuracy of a high-resolution ultrasound machine with a 14.0 to 6.0-MHz linear transducer. The preoperative ultrasound diagnosis, in terms of the presence and type of tear, was compared with that in the surgical reports. In the cadaveric studies, nine needles were placed in the peripheral zone of the menisci at regular intervals and the number of needles that could be observed with the system was recorded. RESULTS:The overall sensitivity, specificity, positive predictive value, and negative predictive value of ultrasound examination for meniscal tears were 88%, 85%, 85%, and 88%, respectively. These statistical parameters did not differ significantly between the medial and lateral menisci. The sensitivity for diagnosing horizontal, vertical, radial, flap, bucket-handle, and complex tears and for detecting discoid lateral menisci was 83%, 64%, 0%, 64%, 54%, 90%, and 80%, respectively. Ten percent of the lateral menisci could not be evaluated because of poor images. The cadaveric studies revealed that the ultrasound visualized the entire meniscus except for the anterior horn. CONCLUSIONS:The findings of this study suggest that ultrasound examination may be suitable for screening for meniscal tears. The fact that almost 10% of the lateral menisci could not be evaluated because of poor images appears to be a weakness of ultrasound. LEVEL OF EVIDENCE:Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.