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. 2022 Mar 9;10(3):23259671221079338.
doi: 10.1177/23259671221079338. eCollection 2022 Mar.

Sensitivity and Specificity of MRI in Diagnosing Concomitant Meniscal Injuries With Pediatric and Adolescent Acute ACL Tears

Brody J Dawkins  1 , David A Kolin  2 , Joshua Park  3   4 , Peter D Fabricant  5 , Allison Gilmore  6 , Mark Seeley  7 , R Justin Mistovich  6
Affiliations

Sensitivity and Specificity of MRI in Diagnosing Concomitant Meniscal Injuries With Pediatric and Adolescent Acute ACL Tears

Brody J Dawkins et al. Orthop J Sports Med. .

Abstract

Background: Preoperative diagnosis of concomitant meniscal tears in pediatric and adolescent patients with acute anterior cruciate ligament (ACL) deficiency is challenging.

Purpose: To investigate the diagnostic performance of magnetic resonance imaging (MRI) in detecting meniscal injuries for pediatric and adolescent patients with acute ACL tears.

Study design: Cohort study (diagnosis); Level of evidence, 2.

Methods: The authors retrospectively identified patients aged ≤18 years who underwent acute ACL reconstruction between 2006 and 2018 at 2 tertiary academic hospitals. The primary outcomes were arthroscopically confirmed medial, lateral, or any (defined as medial and/or lateral) meniscal tears. To control for chronically deficient knees, patients must have received their MRI study within 4 weeks of injury and must have undergone surgery no more than 8 weeks after their MRI study. Preoperative MRI reports were compared with the gold standard of arthroscopically confirmed tears to calculate sensitivity, specificity, positive predictive value, and negative predictive value. In a secondary analysis, patients were stratified by age into 2 groups (≤13 or ≥14 years), body mass index-for-age data from the Centers for Disease Control were used to classify patients as obese or nonobese, and differences between sensitivity and specificity proportions were analyzed using chi-square test for homogeneity.

Results: Overall, 406 patients with a mean age of 15.4 years (range, 10-18 years) were identified. The sensitivity, specificity, positive predictive value, and negative predictive value were as follows: for lateral meniscal (LM) tears, 51.0%, 86.5%, 78.3%, and 65.0%; for medial meniscal tears, 83.2%, 80.6%, 62.3%, and 92.5%; and for any meniscal tear, 75.0%, 72.1%, 81.5%, and 63.8%, respectively. In the stratified analysis, MRI was less specific for the following diagnoses: any meniscal tear in patients aged ≤13 years (P = .048) and LM tears in obese patients (P = .020).

Conclusion: The diagnostic ability of MRI to predict meniscal injuries present at acute ACL reconstruction was moderate. Performance was poorest at the lateral meniscus, where MRI failed to detect 97 tears that were found arthroscopically. Specificity was significantly lower in younger patients for any meniscal tear and in obese patients for LM tears.

Keywords: MRI; adolescent; meniscus; pediatric; sensitivity; specificity.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: P.D.F. has received hospitality payments from Medical Device Business Services. A.G. has received education payments from Arthrex. M.S. has received consulting fees and royalties from OrthoPediatrics and hospitality payments from Stryker. R.J.M. has received education payments from Arthrex, consulting fees from Medical Device Business Services and OrthoPediatrics, speaking fees from Philips Electronic North America, and hospitality payments from Globus Medical and Medical Device Business Services. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
CONSORT (Consolidated Standards of Reporting Trials) flow diagram for patients included in the study. ACL, anterior cruciate ligament; BMI, body mass index; CPT, Current Procedural Terminology; MRI, magnetic resonance imaging.
See this image and copyright information in PMC

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