2015 ISAKOS Biennial Congress ePoster #1002
Magnetic Resonance (MRI) Imaging is Not Suitable to Predict Meniscal Repair
Rodrigo Araujo Góes, MD, MSc, Lisboa, Odivelas PORTUGAL
Rodrigo De Farias Cardoso, MD, Niterói, Rio de Janeiro BRAZIL
André Luiz Siqueira Campos, Niterói, RJ BRAZIL
Julie Calixto Lobo, PhD, Niteroi, RJ BRAZIL
Priscila Ladeira Casado, PhD, Niteroi, RJ BRAZIL
Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, Rio de Janeiro, BRAZIL
FDA Status Not Applicable
Summary: Magnetic resonance imaging crearly, is not an effective or efficient predictor of reparability of meniscal tears compared with the current arthroscopic criteria. A more efficient method of image must be developed, in order to increase accuracy and enhance suture menisci surgery, rather neglected in Brazil.
Abstract:
Objectives: Meniscal surgery is one of the most common orthopedic procedures performed in clinical practice. It is well established that subtotal meniscectomy is associated with joint instability and the development of cartilage degeneration. Thus, whenever possible, meniscal repair should be preferable. The Magnetic Resonance imaging (MR) is currently the modality of choice for detecting meniscal injuries and planning subsequent treatment. However, the efficiency of this test to predict meniscal repair still controversial. Our aim was to assess the accuracy of MR to predict the reparability of meniscal tears with good to excellent accuracy compared with arthroscopic criteria. Methods: In this retrospective study between April 2007 to December 2013, we selected 114 patients (of them 38 athletes) [101 men (88.5%) mean age 27.37 ± 6.17 years, comprising 58 right and 53 left knees], who underwent clinical and MR exams prior and had been arthroscopic operated, by one experienced surgeon in a private clinic (Niteroi, Rio de Janeiro, Brazil). Statistical analyzes were performed using STATA 11.1 software (StataCorp, Texas, USA). Results: First, the patients were divided in two groups: Reparable according to MRI evaluation (Group A, N=79) and irreparable according to MRI evaluation (Group B, N=35). According to RM parameters, we observed the following significantly differences between groups: meniscal tests (0.003), presence of lesion (p = 0.0001), lesion pattern (0.0001) and vascular zone (0.0001). Regarding arthroscopy criteria, we observed differences in lesion site (0.0001) and lesion pattern (0.01). The time interval between meniscal tears and surgery was significantly higher in group B (551.45 ± 606.44 days) compared to group A (382.84 ± 472.75 days) (0.0006). There was no difference in time interval between RM and surgery. In 44 (56%) cases MR indicated a reparable lesion, which actually proved to be irreparable at arthroscopy. In 23 (66%) cases, an arthroscopically reparable lesion was missed by MR. in 47 cases, there was no difference between the MR predicted reparability and the arthroscopic findings. Patients who had sutured meniscus (N=54, 27 athletes), presented differences in lesions associated (0.03), meniscal tests (0.0001), lesion pattern (0.0001), vascular zone (0.0001) according to RM, as well as, lesion pattern (0.0001), vascular zone (0.0001) in arthroscopy criteria compared to patients who did not had sutured meniscus (N = 56).
Conclusion
In our study, Magnetic resonance imaging crearly, is not an effective or efficient predictor of reparability of meniscal tears compared with the current arthroscopic criteria. A more efficient method of image must be developed, in order to increase accuracy and enhance suture menisci surgery, rather neglected in Brazil.