Predictive Value of Clinical and Magnetic Resonance Image Findings in the Diagnosis of Meniscal and Anterior Cruciate Ligament Injuries.

BACKGROUND: Anterior Cruciate Ligament (ACL) injuries may be accompanied by associated injuries such as meniscal injuries. Clinical evaluation alone may at times miss the diagnosis of ACL injury and one or more associated injuries. However, an adjuvant diagnostic tool such as an MRI of the knee may be unaffordable to some patients. The goal of this study was to compare the sensitivity, specificity and predictive value of clinical and magnetic resonance image (MRI) findings in the diagnosis of anterior cruciate ligament and meniscal injuries. METHODS: This was a prospective study. The cases of ACL injury recruited had a magnetic resonance imaging of the injured knee, and knee arthroscopy done. The clinical, magnetic resonance imaging and arthroscopic diagnostic findings were all noted. The sensitivity, specificity, positive predictive value and negative predictive values of clinical and MRI findings were compared, with arthroscopic findings as gold standard. RESULTS: A total of seventy-seven patients were recruited for the study. There were fifty-four males and twenty three females. The results of the tests of the sensitivity, specificity, positive predictive value and negative predictive value of clinical diagnosis and MRI when compared with arthroscopy findings, in detecting meniscal and anterior cruciate ligament injuries were as follows: For Clinical evaluation; Anterior Cruciate ligament: 81%, 80%, 86% and 76%; Medial Meniscus: 84%, 77%, 84% and 93%; and Lateral Meniscus: 85%, 77%, 85% and 82% respectively. For MRI: Anterior Cruciate Ligament (ACL): 87%, 89%, 93% and 78% ; Medial Meniscus: 87% 79%, 70% and 82%; and the Lateral Meniscus: 70%, 76% 73% and 72%. CONCLUSION: The specificity, sensitivity and predictive value of clinical and MRI findings were comparable in relation to the diagnosis of ACL and Medial Meniscus tears. However, the values of these parameters were better with clinical examination than with MRI in relation to the diagnosis of lateral meniscus tears.

Subvastus versus Medial Parapatellar Approach in Primary Total Knee Replacement: An Assessment of Early Function.

BACKGROUND: Total knee replacements are increasingly being carried out for the arthritic knee. This procedure is constantly being improved upon in order to improve outcome. There is currently no consensus of the best surgical approach for primary total knee arthroplasty. This study aims to test the hypothesis that the subvastus approach has significantly better early functional outcomes compared to the medial parapatellar approach. STUDY DESIGN: Patients with bilateral knee arthritis who met the inclusion criteria were randomised into either the subvastus or medial parapatellar approach over a twelve month period. All patients had the same prosthesis inserted by one surgeon. Primary outcome measures were the Knee Society Score (KSS) at six (6) weeks post-operatively and evaluation of postoperative pain using the Visual Analogue Score (VAS) on the 2nd and 5th postoperative day. Secondary outcomes included blood loss and transfusion requirements. RESULTS: Twenty-four knees recruited with 11 knees in the subvastus and 13 in the medial parapatellar group. Results showed a significantly lower postoperative pain in the subvastus group versus the medial parapatellar group (2.8 versus 4.62 p < 0.05). Transfusion requirements for subvastus group was half that needed for the medial parapatellar group; this however was not statistically significant. Evaluation of knee score at six weeks did not show any difference in outcome (80.8 versus 84.27 p > 0.05). CONCLUSION: Post-operative pain is significantly reduced in the subvastus group, however short term knee function is not affected by surgical approach.