The value of clinical examination versus magnetic resonance imaging in the diagnosis of meniscal tears and anterior cruciate ligament rupture

Purpose: The purpose of this study was to compare the accuracy of clinical examination versus magnetic resonance imaging (MRI) in diagnosing meniscal and anterior cruciate ligament (ACL) pathology. Type of Study: Prospective, longitudinal study. Methods: Between August 2001 and December 2001, we prospectively evaluated 50 consecutive patients (37 male, 13 female) with 65 pathologies of medial meniscal tears, lateral meniscal tears, and/or ACL rupture. The average preoperative period for the patients was 5 weeks (range, 5 days to 5 months) and their mean age was 22 years (range, 12 to 42 years). After initial clinical examination, the same sports medicine fellowship-trained orthopaedic surgeon (10-year practice profile of 100% sports medicine) evaluated the MRI of the patients and performed their arthroscopic procedure. Accuracy, sensitivity, specificity, and positive and negative predictive values were calculated comparing clinical examination, MRI, and arthroscopic evaluation. Results: There was no statistical difference between MRI or clinical examination in diagnosing medial or lateral meniscal tears or ACL tears (P > .05). The accuracy of the clinical examination and MRI evaluation was equal for diagnosing meniscal tears and ACL ruptures. Conclusions: A well-trained qualified surgeon can safely rely on clinical examination for diagnosing meniscal and ACL injuries. Clinical examination is at least as accurate as MRI in the skilled orthopaedic surgeon's hand. MRI should be reserved for more complicated and confusing cases. The routine ordering of an MRI scan of the knee before examination by a well-trained orthopaedic surgeon is not recommended. Level of Evidence: Level II, diagnostic.