A Retrospective Study of the Accuracy of MRI in Diagnosing Meniscal Tears, Including Sensitivity, Specificity, and Correlation with Arthroscopic Findings

Diagnostic accuracy of clinical examination versus MRI for meniscal tears: a systematic review and meta-analysis.

Assessment of the Reliability and Diagnostic Accuracy of Indirect MRI Signs for ACL Tears: Comparison with Arthroscopic Findings as the Gold Standard

Background: The objective of this study was to evaluate the sensitivity and specificity of indirect MRI signs (PCL Angle, PCL Inclination Angle, PCL-PCA, and Anterior Drawer Sign) in diagnosing ACL tears, as confirmed by arthroscopy. Methodology: This retrospective case-control study, conducted at Shifa International Hospital in Islamabad from January to December 2023, included 100 patients divided into two groups based on arthroscopy findings: 50 with a healthy ACL (Control) and 50 with ACL deficiency (Test). MRI signs were analyzed retrospectively to calculate cut-off values, sensitivity, specificity, and AUC. Results: The study involved 100 patients (77 males, 23 females), with a mean age of 35.12 years (range 16–75). Among MRI parameters, PCL-PCA was the most sensitive (81.3%, AUC 0.821), followed by PCL angle (78.1%, AUC 0.870) and PCL inclination angle (68.8%, AUC 0.697). The Anterior Drawer Sign showed high specificity (89.19%) but lower sensitivity (57.14%) and was statistically significant (p = 0.001). Conclusion: The crux of this study is that PCL-PCA is highly sensitive in diagnosing ACL tear as an indirect and secondary parameter, followed by PCL angle, then by PCL inclination angle, and lastly by anterior drawer sign. These provided an excellent distinction between patients with and without an ACL tear.

Meniscal Ramp Lesions Are More Commonly Detected on Magnetic Resonance Imaging Than Arthroscopy in Patients With Anterior Cruciate Ligament Tears.

PURPOSE To assess the prevalence of, and factors associated with, meniscal ramp lesions in patients with anterior cruciate ligament (ACL) tears. METHODS All patients who underwent primary ACL reconstruction (ACLR) during 2018 were evaluated. Preoperative magnetic resonance imaging (MRI) scans and surgical reports were reviewed searching for the presence of meniscal ramp lesions. The Greif classification was applied to MRI-detected lesions. Univariable and multivariable logistic regression analyses, and a backward logistic regression analysis, were used to evaluate the associations between patient characteristics and concomitant knee injuries and the presence of meniscal ramp lesions on MRI and at ACLR, respectively. RESULTS Of the 579 patients included in this study (51.0% men; mean age 28.4 ± 11.4), 250 (43.2%) meniscal ramp lesions were diagnosed on MRI, and 57 (9.8%) were diagnosed at ACLR. None of the 25 MRI-detected Greif´s type 1 and 2 meniscal ramp lesions were confirmed intraoperatively. Posteromedial tibial bone bruising increased likelihood of having meniscal ramp lesions on MRI (odds radio 4.04, 95% confidence intervals 2.85-5.76; P < .001) and at ACLR (odds radio 2.29, 95% confidence intervals 1.29-4.19; P < .01). CONCLUSIONS Meniscal ramp lesions were frequently detected on MRI in patients undergoing ACL reconstruction, although less commonly observed at the time of surgery. MRI-detected stable meniscal ramp lesions according to the Greif classification (type 1 and 2) showed poor surgical correlation, with no lesions identified at subsequent arthroscopy. Posteromedial tibial bone bruising on MRI was associated with the presence of meniscal ramp lesions both on MRI and at surgery. LEVEL OF EVIDENCE Level III, retrospective cohort study.

Magnetic Resonance Imaging Evaluation of Meniscal Ramp Lesions and their Association with Anterior Cruciate Ligament Injury Severity: A Retrospective Observational Study.

BACKGROUND Meniscal ramp lesions are frequently associated with anterior cruciate ligament (ACL) injuries and are often overlooked on magnetic resonance imaging (MRI). Their relationship with the severity of ACL injury remains incompletely understood. OBJECTIVE The purpose of this study is to determine the association of meniscal rupture of the posterior meniscocapsular attachment (RAMP) lesions in anterior cruciate ligament (ACL) injury and evaluate the different grades of RAMP lesions with the severity of ACL tear. SUBJECTS AND METHODS This retrospective study included 252 patients who underwent magnetic resonance imaging (MRI) knee examination with a history of trauma to the knee while playing sports between April 2024 and April 2025. The two experienced radiologists reviewed the MRI examinations of these patients and reached a consensus regarding various MRI findings of different grades of ACL tears and their association with RAMP lesions. The Cohen's kappa (k) and Fisher's exact test statistics were used. RESULTS Out of 252 patients with a sports injury to the knee and clinical suspicion of an acute ACL injury, 109 (43.3%) had an ACL injury and 27 had a RAMP lesion, with a prevalence of 10.7%. The RAMP lesion was seen only in patients with ACL injury and higher grades of ACL injury, i.e., Grade 2 and 3 were associated with RAMP lesion 11 (40.7%) and 10 (37.0%), respectively, although statistically not significant ( P = 0.291). CONCLUSION Out of 252 patients with sports-related injuries to the knee with clinical suspicion of ACL injury, only 43.3% had ACL injuries and RAMP lesions have a prevalence of 10.7% (27) of all the patients with acute ACL injury. The strong association with ACL injury and having a potentially important role in knee stabilisation, their injuries need to be given due importance by radiologists and should not be underreported.

Diagnostic accuracy of ultrasound in diagnosis of rotator cuff injuries keeping MRI as gold standard.

Objective: To determine Diagnostic accuracy of ultrasonography in diagnosis of rotator cuff injuries keeping MRI as gold standard. Study Design: Cross-sectional Validation study. Setting: Department of Radiology, DHQ Hospital, Gujranwala. Period: September, 2025 to February, 2026. Methods: A total of 184 patients aged 18–60 years presenting with clinical suspicion of rotator cuff injury were enrolled through consecutive non-probability sampling. All patients underwent US examination using a high-frequency (7–12 MHz) linear probe followed by MRI on a 1.5 Tesla scanner. Ultrasonographic findings for full-thickness tear, partial-thickness tear, and tendinopathy were compared with MRI results considered as the reference standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated. Results: Among 184 participants, 55% were female and the mean age was 39 years (range 18–60 years). MRI detected full-thickness tear in 32.6%, partial-thickness tear in 27.2%, and tendinopathy in 21.7% of cases, while 18.5% had normal findings. Ultrasound identified full-thickness tears in 30.4%, partial-thickness tears in 25.0%, and tendinopathy in 19.6%. When compared with MRI, ultrasonography demonstrated a sensitivity of 90.2%, specificity of 89.5%, PPV of 91.1%, NPV of 88.3%, and an overall diagnostic accuracy of 90.0%. Conclusion: Ultrasonography is a highly accurate, accessible, and cost-effective imaging modality for evaluating rotator cuff pathology. Its strong concordance with MRI supports its use as a first-line diagnostic tool, particularly for full-thickness tears. MRI remains essential in equivocal cases or when detailed pre-operative assessment is required.

A head-to-head comparison of high-frequency ultrasound and magnetic resonance imaging for preoperative assessment of ATFL tears and concomitant CFL injuries

Background This study aims to comparatively evaluate the diagnostic performance of high-frequency ultrasound (HFUS) and magnetic resonance imaging (MRI) in the assessment of anterior talofibular ligament (ATFL) injuries, particularly in the context of associated concomitant injuries. By analyzing sensitivity, specificity, accuracy, and inter-modality agreement, we seek to determine the relative clinical utility of these two imaging modalities for comprehensive evaluation of lateral ankle instability and multi-structure involvement. Methods A retrospective, single-center study was conducted on clinical data from 123 surgically treated patients suspected of ATFL ankle injuries who presented to our hospital between May 2015 and June 2025. All patients underwent both HFUS and MRI examinations prior to surgery. Surgical findings were used as the reference standard to compare the diagnostic performance of HFUS and MRI in assessing the severity of acute ATFL injuries. The diagnostic efficacy of HFUS and MRI for ATFL injuries was evaluated using receiver operating characteristic (ROC) curve analysis. Results In grading ATFL injuries, HFUS demonstrated significantly higher diagnostic accuracy compared to MRI (90.24% vs. 78.05%, p < 0.01). The AUC for detecting complete ATFL tears was also markedly superior for HFUS (0.938, 95% CI: 0.898–0.975) compared to MRI (0.857, 95% CI: 0.792–0.917). However, in detecting concomitant calcaneofibular ligament (CFL) injuries, MRI demonstrated substantially higher sensitivity (95.83%, 95% CI: 91.67–99.00) than HFUS (63.54%, 95% CI: 53.69–72.00), highlighting its superior performance in identifying combined ATFL-CFL injuries. Conclusion HFUS demonstrates better diagnostic performance for preoperative grading of ATFL tear severity, whereas MRI shows moderate diagnostic capability in detecting concomitant CFL injuries in the setting of combined lateral ankle ligament trauma. These findings support a complementary imaging strategy, with HFUS as a useful initial tool for ATFL assessment and MRI reserved for comprehensive evaluation when concomitant CFL or other pathologies are suspected.