Comparison between MRI and Direct Vision in Diagnosing Intraarticular Pathologies in Patients with anterior cruciate ligament Tearing: A Retrospective Study

Document Type : Original Article


Department of Orthopedics, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.


Background and Objectives: The anterior cruciate ligament (ACL) is an important structure for maintaining the normal biomechanics of the knee and is the most commonly injured knee ligament. MRI has proved sensitivity and specificity in detecting intraarticular knee pathologies. The aim of this study was to compare the result of direct vision and MRI in detecting intraarticular pathologies in patient with ACL tearing.
Subjects and Methods: Seventy patients with clinical examination and MRI of ACL tearing entered in the study. The age range was between 22 and 45 years (57 men and 13 women). The patients were scheduled for ACL reconstruction via mini- arthrotomy approach. After mini-arthrotomy, the knee was examined directly for intraarticular pathology and if ACL was torn, ACL reconstruction was performed. The result of direct vision was recorded and compare with MRI of the patients after surgery. Sensitivity, specificity, positive and negative predictive values and kappa agreement measures were calculated.
Results: MRI had 98.5% sensitivity for ACL injuries. While for medial meniscus injuries, 73% sensitivity, and 93% specificity, for lateral meniscus 87.5% sensitivity and 95% specificit and for osteochondral lesions 40% sensitivity and 96% specificity.
Conclusion: Injuries to menisci and cruciate ligaments can be diagnosed on MRI with a high degree of sensitivity and specificity. We recommend MRI as the primary diagnostic tool for internal knee derangements; however, in cases of ACL reconstruction it is advisable to use direct vision viewing of the knee before beginning the reconstruction.


-McNally EG. Magnetic resonance imaging of the knee is accurate and helps in making therapeutic decisions. BMJ 2002; 325(7356): 115–6. doi: 10.1136/bmj.325.7356.115.
2-Erick M, Steven W. Anterior cruciate ligament injury: MR Imaging diagnosis and pattern of injury. Radiographics 1992Sep; 12(5): 901-15.
3-Yasuda K, van Eck CF, Hoshino Y, Fu FH, Tashman S. Anatomic single- and double-bundle anterior cruciate ligament reconstruction, part 1: basic science. Am J Sports Med 2011Aug; 39(8): 1789–99.
4-Crawford R, Walley G, Bridgman S, Maffulli N. Magnetic resonance imaging versus arthroscopy in the diagnosis of knee pathology, concentrating on meniscal lesions and ACL tears: a systematic review. Br Med Bull 2007; 84: 5–23. doi: 10.1093/bmb/ldm022
5-Griffith JF, Antonio GE, Tong CW, Ming CK. Cruciate ligament avulsion fractures. Arthroscopy 2004Oct; 20(8): 803–12.
6- Thomas S, Pullagura M, Robinson E, Cohen A, Banaszkiewicz P. The value of magnetic resonance imaging in our current management of ACL and meniscal injuries. Knee Surg Sports Traumatol Arthrosc 2007May; 15(5): 533–6. doi: 10.1007/s00167-006-0259-7.
7_Jyrki H, Koivico M. The efficacy of magnetic resonance imaging in acute multi-ligament injuries. Int Orthop2009 Dec; 33(6): 1733–8.
8-Cohen SB, VanBeek C, Starman JS, Armfield D, Irrgang JJ, Fu FH. MRI measurement of the 2 bundles of the normal anterior cruciate ligament. Orthopedics 2009Sep; 32(9): 687.
9- Behairy NH, Dorgham MA, Khaled SA. Accuracy of routine magnetic resonance imaging in meniscal and ligamentous injuries of the knee: comparison with arthroscopy. Int Orthop 2009 Aug; 33(4): 961–7.
10-Oei  EHG, MSC, Nikken JJ, Verstijnen ACM, Ginai, AZ.  Hunink MGM. MIR imaging of the menisci and cruciate igaments: a systematic review. Radiol 2003Mar; 226(3): 837–48.
11-Winters K, Tregonning R. Reliability of magnetic resonance imaging of the traumatic knee determined by arthroscopy. N Z Med J 2005; 118(1209): U1301.
12-Dejour D, Ntagiopoulos PG. The diagnostic value of clinical tests,magnetic resonsnce imaging,and instrumented laxity in differentiation of complete versus partial anterior cruciate ligament. Arthroscopy 2013Mar; 29(3): 491-9.
13-Vassilios S N, Choronopolos E, Savvidou C. MRI Efficacy in diagnosing internal lesions of the knee: a retrospective analysis. J Traum Manag Outcomes 2008Jun; 2(4):1-10.
14-Muhl C, Ahn  JM. Diagnosis of ACL and meniscal injuries: MR imaging of knee flexion versus extension compared to arthroscopy. Springer plus 2013 may 8; 2(1):213
15-Ng AW, Griffith JF, Hung EH, Law KY, Yung PS. MRI diagnostic of ACL bundle tears: value of oblique axial imaginig. Skeletal Radiol 2013Feb; 42(2): 125–6.
16-Kostov H, Arsovski O, Kostova E, Nikolov V. Diagnostic assessment in anterior cruciate ligament (ACL) tears. Prilozi 2014; 35(1): 209-18.
17-Kosaka M, Nakase J, Toratani T. Oblique coronal and oblique sagittal MRI for diagnosis of anterior cruciate ligament tears and evaluation of anterior cruciate ligament remnant tissue. Knee2014 Jan; 21(1): 54-7.
18-Nam TS1, Kim MK2, Ahn JH3. Efficacy of magnetic resonance imaging evaluation for meniscal tear in acute anterior cruciate ligament injuries. Arthroscopy2014 Apr; 30(4): 475-82
19-Yaqoob J1, Alam MS2, Khalid N. Diagnostic accuracy of Magnetic Resonance Imaging in assessment of Meniscal and ACL tear: Correlation with arthroscopy. Pak J Med Sci2015 Mar-Apr; 31(2): 263-8.