The role of magnetic resonance imaging in routine decision making for meniscal surgery

The meniscus is the most commonly injured structure of the knee requiring surgery. Traditionally the diagnosis of a meniscal tear is based on patient history and clinical examination.

However, it has been reported that the false diagnosis rates based on such clinical examinations lie between 40% and 80% [1, 3, 6, 12, 15]. The resulting high costs and potential morbidity related to arthroscopic operations has led to the search for less invasive methods of diagnosing meniscal tears.

One such method is magnetic resonance imaging (MRI), its foremost advantage being greater diagnostic accuracy, thereby reducing the diagnostic arthroscopy rate [17, 18]. The continuing improvement in diagnostic methods now available makes it especially important to compare the results and recommendations offered in the literature. Considering the mainly trauma-related meniscal tears in athletes, it is obvious that the relatively high accuracy of the clinical examination is due to the difference in the diagnostic approach between traumatic and degenerative meniscal tears [9]. Moreover, recent studies have found no difference in accuracy between clinical and MRI diagnosis of meniscal tears [8, 14]. The disadvantages of these studies were that Rose and Gold [14] included only patients who were treated symptomatically for at least 3 months before surgery, and in the study of Miller [8] MRI investigations were performed at 12 different centers.

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