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Accuracy of 3-Tesla Magnetic Resonance Imaging for the Diagnosis of Intra-articular Knee Injuries in Children and Teenagers

Schub, David L. MD; Altahawi, Faysal MD; F. Meisel, Adam MD; Winalski, Carl MD; Parker, Richard D. MD; M. Saluan, Paul MD

Journal of Pediatric Orthopaedics: December 2012 - Volume 32 - Issue 8 - p 765–769
doi: 10.1097/BPO.0b013e3182619181
Trauma—Lower Extremity

Background: Magnetic resonance imaging (MRI) is a commonly used tool for the diagnosis of intra-articular knee pathologies. Although many studies have reported the accuracy of MRI in the adult population, fewer studies have investigated these tests in younger patients. Furthermore, these studies have shown a higher variability in both the sensitivity and the specificity of MRI for these knee injuries in this age group. Advancements in MRI technology, such as the 3-Tesla (3T) MRI magnet, have shown promising results for musculoskeletal injury diagnosis in adults. This study aims to evaluate 3 T MRI for the diagnosis of intra-articular knee pathologies in a pediatric and adolescent patient population.

Methods: The records of 116 patients (119 knees) under the age of 20 years who underwent 3 T MRI studies of the knee and subsequent knee arthroscopy were reviewed retrospectively. The MRI report from the musculoskeletal radiology staff, the interpretation from the staff orthopedic surgeon, and the operative note dictations were compared, with a focus on meniscus and anterior cruciate ligament (ACL) pathologies. Seventeen orthopedic staff reads were not obtainable. Arthroscopy was used as the gold standard for diagnosis.

Results: The average age at MRI exam was 16.0 years and at surgery was 16.2 years. Using the musculoskeletal radiologist interpretation, the sensitivity and the specificity of 3 T MRI were 81.0% and 90.9% for medial meniscus injuries, 68.8% and 93% for lateral meniscus injuries, and 97.9% and 98.6% for ACL injuries, respectively. The orthopedic surgeon’s interpretation of 3 T MRI had a sensitivity and specificity of 75.7% and 92.4% for medial meniscus injuries, 69.8% and 98.3% for lateral meniscus injuries, and 100% and 98.6% for ACL injuries, respectively. Posterior horn tears had the greatest discrepancies.

Conclusions: When performed on pediatric and adolescent patients, newer 3 T MRI studies have excellent accuracy for diagnosing ACL tears. These studies also show a higher accuracy for the diagnosis of medial meniscal tears than lateral meniscal tears.

Level of Evidence: Diagnostic study—Level 2.

Department of Orthopaedic Surgery and Musculoskeletal Institute, Cleveland Clinic, Cleveland, OH

None of the authors received financial support for this study.

The authors declare no conflict of interest.

Reprints: David L. Schub, MD, Department of Orthopaedic Surgery, Cleveland Clinic Foundation, A-41, 9500 Euclid Avenue, Cleveland, OH 44195. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.