🇺🇸 Approved for CEUs for PTs & PTAs in 42 states

Diagnostic accuracy of clinical examination versus MRI for meniscal tears: a systematic review and meta-analysis

Review written by Dr Michael Reiman info

Key Points

  1. The main use of MRI is to exclude the presence of pathology, to resolve cases of genuine diagnostic uncertainty, or to provide detailed structural mapping before surgery.
All key points available for members only
Start free trial Icon
Or log in here

BACKGROUND & OBJECTIVE

Meniscal tears are among the most frequent knee joint injuries and show a bimodal distribution, affecting both young athletes and older people. They place a heavy burden on the healthcare system and are well known as a long-term risk factor for knee osteoarthritis (1).

In normal clinical practice, the diagnostic process takes place in a step-by-step manner, starting with an examination of the patient's history and including the use of provocative physical tests; if any doubt remains, then clinicians arrange for magnetic resonance imaging (MRI) to confirm the diagnosis, with arthroscopy being regarded as the diagnostic reference standard (2).

It is still disputed whether a clinical examination or an MRI should be the first-line test, particularly since a thorough clinical assessment by experienced specialists can reach diagnostic accuracy similar to that of MRI (3).

The main aim of this systematic review was to combine evidence from studies that used a rigorous paired design to compare diagnostic accuracy directly. The sensitivity and specificity of the composite clinical examination were compared with those of MRI, with arthroscopy as the reference standard.

Meniscal tears place a heavy burden on the healthcare system and are well known as a long-term risk factor for knee osteoarthritis.
bulb
An experienced examiner has a low false-positive rate which gives a high level of diagnostic certainty for confirming a tear and thus obviates the need for immediate further imaging.

METHODS

  • The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Diagnostic Test Accuracy (PRISMA-DTA) guidelines and was prospectively registered on PROSPERO. The authors searched four major databases, PubMed, CINAHL Complete, MEDLINE, and Web of Science, from their
Start free trial Icon
to unlock full access to this review and 1337 more
Or log in here
Trustpilot