ARTHROSCOPIC DETERMINATION OF ACCURACY OF CLINICAL EXAMINATION IN INJURIES WITH INTERNAL DERANGEMENT OF KNEE

Abstract

Abstract

Background:  For the diagnosis of knee injuries some investigations along with detailed history and clinical examination such as arthrography and arthroscopy are required, which increase the authenticity of diagnosis.

Objective:  To determine diagnostic accuracy of pre-operative clinical diagnosis with arthroscopic diagno-sis in internal derangement of knee.

Methods:  This was a Comparative cross sectional study. Conducted at Department of Orthopaedic Sur-gery and Traumatology (DOST) Unit - 1, King Edward Medical University, Mayo Hospital Lahore. Total 45 patients having symptomatic knee injuries, were inclu-ded in this study. After  taking informed consent from these patients, a clinical diagnosis of medial meniscus tear (MMT), lateral meniscus tear (LMT), anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament(MCL) and lateral collateral ligament (LCL) injury of knee was made, confirmation with magnetic resonance imaging (MRI) was done and those patients having positive clinical and MRI findings of above mentioned injuries arthro-scopy was carried out and then findings of both clini-cal examination and arthroscopy were compared to find out the diagnostic accuracy of clinical examinat-ion. Data was analyzed with the help of SPSS version 20.

Results:  Mean age of all 45 patients was 29.51 ± 8.72 years. Minimum and maximum age of patients was 18 and 48 years respectively. Clinical examination is 70.83% sensitive and 19.05% specific for medial meniscus tear. Clinical examination has 50% Positive predictive value and 36.36% Negative predictive value. For the diagnosis of Lateral Meniscal tear, clini-cal examination is 16.67% sensitive and 89.47% speci-fic. While clinical examination has 20% positive pre-dictive value and 87.5% negative predictive value. For ACL rupture diagnosis clinical examination is 72.73% sensitive and 66.67% specific. While clinical examina-tion has 85.71% positive predictive value and 47.06% negative predictive value.

Conclusion:  Results of this study clearly revealed
that diagnostic accuracy of clinical examination for the diagnosis of internal derangement of knee shows vari-ability. Clinical examination findings have high sensi-tivity for diagnosis of MMT and ACL injuries while it shows very low sensitivity for LMT. While specificity of clinical examination for diagnosing LMT and ACL was high but for MMT was low.

Key Words:  Arthroscopy, Clinical Examination, Internal derangement, Knee.