Top

Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-01-2019 | Knee

3D-MRI combined with signal-to-noise ratio measurement can improve the diagnostic accuracy and sensitivity in evaluating meniscal healing status after meniscal repair

Authors: Bin Song, Weiquan Tan, Yue Xu, Taihui Yu, Weiping Li, Zhong Chen, Rui Yang, Jingyi Hou, Yunfeng Zhou

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 1/2019

Abstract

Purpose

This study compared the diagnostic accuracy of second-look arthroscopy, clinical assessment, and magnetic resonance imaging (MRI) in evaluating meniscal healing following repair. To explore the application of 3D-MRI sequences with signal-to-noise ratio (SNR) measurements and the analysis of sensitivity and accuracy in evaluating meniscal healing status after meniscal repair.

Methods

This study included 75 patients (75 menisci; mean age, 25.4 ± 6.6 years) who underwent arthroscopic meniscal repair (medial menisci, 45; and lateral menisci, 29). Follow-up evaluation included clinical assessment, magnetic resonance imaging (MRI), and second-look arthroscopy (mean follow-up, 10.2 ± 3.4 months). The criteria defined for unhealed menisci were: on arthroscopy, presence of cleft; on clinical assessment, presence of joint-line tenderness, swelling, locking, or positive McMurray test; on MRI, grade III signal intensity at the site of repair. Finally, the SNR on 3D-MRI of the healed and the unhealed groups were compared.

Results

On second-look arthroscopy, 68 (90.7%) menisci were found to be completely healed. With the arthroscopic healing rate as the standard, the clinical healing rate was 69.3% (63 menisci) [sensitivity, 85.7%; specificity, 75.0%; accuracy, 76.0%; positive predictive value (PPV), 26.1%; negative predictive value (NPV), 98.1%]. Similarly, the sensitivity, specificity, accuracy, PPV and NPV, respectively, for MRI in four sequences were as follows: 2D-T2W-Sag: 71.4, 79.4, 78.7, 26.3, and 96.4%; 2D-T2W-Cor: 71.4, 82.4, 81.3, 29.4, and 96.6%; 3D-PDW-Sag: 100.0, 50.0, 54.7, 17.1, and 100.0%; 3D-PDW-Cor: 100.0, 58.8, 62.7, 20.0, and 100.0%. The mean SNRs of the healed group (3D-PDW-Sag, 66.7 ± 11.9; 3D-PDW-Cor, 63.9 ± 12.4) were significantly lesser than that of the unhealed group (3D-PDW-Sag, 89.2 ± 9.6; 3D-PDW-Cor, 82.2 ± 18.5) (P < 0.05). Identifying grade 3 meniscal damage on 3D-PDW images prior to applying the different SNR cut-off points revealed SNR values 80 in the sagittal plane and 70 in the coronal plane as having better diagnostic accuracy and sensitivity. The clinical relevance of the study was that 3D-MRI combined with SNR measurement may be a noninvasive and accurate method of assessment clinically, and a reliable alternative to second-look arthroscopy.

Level of evidence

III.

Ahn JH, Wang JH, Yoo JC (2004) Arthroscopic all-inside suture repair of medial meniscus lesion in anterior cruciate ligament–deficient knees: results of second-look arthroscopies in 39 cases. Arthroscopy 20(9):936–945CrossRefPubMed

Applegate GR, Flannigan BD, Tolin BS et al (1993) MR diagnosis of recurrent tears in the knee: value of intraarticular contrast material. Am J Roentgenol 161(4):821–825CrossRef

Arnoczky SP, Cooper TG, Stadelmaier DM et al (1994) Magnetic resonance signals in healing menisci: an experimental study in dogs. Arthroscopy 10(5):552–557CrossRefPubMed

Barrett GR, Field MH, Treacy SH et al (1998) Clinical results of meniscus repair in patients 40 years and older. Arthroscopy 14(8):824–829CrossRefPubMed

Brittberg M, Winalski CS (2003) Evaluation of cartilage injuries and repair. J Bone Jt Surg Am 85-A(Suppl 2):58–69CrossRef

Bronstein R, Kirk P, Hurley J (1992) The usefulness of MRI in evaluating menisci after meniscus repair. Orthopedics 15(2):149–152PubMed

Cheung LP, Li KC, Hollett MD et al (1997) Meniscal tears of the knee: accuracy of detection with fast spin-echo MR imaging and arthroscopic correlation in 293 patients. Radiology 203(2):508–512CrossRefPubMed

De Smet AA, Tuite MJ, Norris MA et al (1994) MR diagnosis of meniscal tears: analysis of causes of errors. Am J Roentgenol 163(6):1419–1423CrossRef

Deutsch AL, Mink JH, Fox JM et al (1990) Peripheral meniscal tears: MR findings after conservative treatment or arthroscopic repair. Radiology 176(2):485–488CrossRefPubMed

10.

Disler DG, Kattapuram SV, Chew FS et al (1993) Meniscal tears of the knee: preliminary comparison of three-dimensional MR reconstruction with two-dimensional MR imaging and arthroscopy. Am J Roentgenol 160(2):343–345CrossRef

11.

Eggli S, Wegmuller H, Kosina J et al (1995) Long-term results of arthroscopic meniscal repair. an analysis of isolated tears. Am J Sports Med 23(6):715–720CrossRefPubMed

12.

Farley TE, Howell SM, Love KF et al (1991) Meniscal tears: MR and arthrographic findings after arthroscopic repair. Radiology 180(2):517–522CrossRefPubMed

13.

Gold GE, Han E, Stainsby J et al (2004) Musculoskeletal MRI at 3.0 T: relaxation times and image contrast. Am J Roentgenol 183(2):343–351CrossRef

14.

Hoffelner T, Resch H, Forstner R et al (2011) Arthroscopic all-inside meniscal repair—does the meniscus heal? A clinical and radiological follow-up examination to verify meniscal healing using a 3-T MRI. Skelet Radiol 40(2):181–187CrossRef

15.

Horibe S, Shino K, Maeda A et al (1996) Results of isolated meniscal repair evaluated by second-look arthroscopy. Arthroscopy 12(2):150–155CrossRefPubMed

16.

Horibe S, Shino K, Nakata K et al (1995) Second-look arthroscopy after meniscal repair. Review of 132 menisci repaired by an arthroscopic inside-out technique. J Bone Jt Surg Br 77(2):245–249CrossRef

17.

Jiang D, Ao YF, Miao Y, Zheng ZZ, Yu JK (2013) Signal characteristics of magnetic resonance imaging after meniscus repair by FasT-Fix and meniscus arrows. Chin J Minim Invasive Surg 11:1021–1025

18.

Jung JY, Jee WH, Park MY et al (2012) Meniscal tear configurations: categorization with 3D isotropic turbo spin-echo MRI compared with conventional MRI at 3 T. Am J Roentgenol 198(2):W173–W180CrossRef

19.

Jung JY, Yoon YC, Choi SH et al (2009) Three-dimensional isotropic shoulder MR arthrography: comparison with two-dimensional MR arthrography for the diagnosis of labral lesions at 3.0 T. Radiology 250(2):498–505CrossRefPubMed

20.

Kececi B, Bicer EK, Arkun R et al (2015) The value of magnetic resonance arthrography in the evaluation of repaired menisci. Eur J Orthop Surg Traumatol 25(1):173–179CrossRefPubMed

21.

Kijowski R, Davis KW, Woods MA et al (2009) Knee joint: comprehensive assessment with 3D isotropic resolution fast spin-echo MR imaging—diagnostic performance compared with that of conventional MR imaging at 3.0 T. Radiology 252(2):486–495CrossRefPubMed

22.

Klimkiewicz JJ, Shaffer B (2002) Meniscal surgery 2002 update: indications and techniques for resection, repair, regeneration, and replacement. Arthroscopy 18(9 Suppl 2):14–25CrossRefPubMed

23.

Koukoulias N, Papastergiou S, Kazakos K et al (2007) Mid-term clinical results of medial meniscus repair with the meniscus arrow in the unstable knee. Knee Surg Sports Traumatol Arthrosc 15(2):138–143CrossRefPubMed

24.

Kruger N, McNally E, Al-Ali S et al (2016) Three-dimensional reconstructed magnetic resonance scans: accuracy in identifying and defining knee meniscal tears. World J Orthop 7(11):731–737(CrossRefPubMedPubMedCentral

25.

Laible C, Stein DA, Kiridly DN (2013) Meniscal repair. J Am Acad Orthop Surg 21(4):204–213CrossRefPubMed

26.

Lim PS, Schweitzer ME, Bhatia M et al (1999) Repeat tear of postoperative meniscus: potential MR imaging signs. Radiology 210(1):183–188CrossRefPubMed

27.

Logan M, Watts M, Owen J et al (2009) Meniscal repair in the elite athlete: results of 45 repairs with a minimum 5-year follow-up. Am J Sports Med 37(6):1131–1134CrossRefPubMed

28.

Magee T (2014) Accuracy of 3-Tesla MR and MR arthrography in diagnosis of meniscal retear in the post-operative knee. Skeletal Radiol 43(8):1057–1064CrossRefPubMed

29.

Majeed H, Karuppiah S, Sigamoney KV et al (2015) All-inside meniscal repair surgery: factors affecting the outcome. J Orthop Traumatol 16(3):245–249CrossRefPubMedPubMedCentral

30.

Miao Y, Yu JK, Ao YF et al (2011) Diagnostic values of 3 methods for evaluating meniscal healing status after meniscal repair: comparison among second-look arthroscopy, clinical assessment, and magnetic resonance imaging. Am J Sports Med 39(4):735–742CrossRefPubMed

31.

Muellner T, Egkher A, Nikolic A et al (1999) Open meniscal repair: clinical and magnetic resonance imaging findings after twelve years. Am J Sports Med 27(1):16–20CrossRefPubMed

32.

Ohishi T, Takahashi M, Abe M et al (2005) The use of axial reconstructed images from three-dimensional MRI datasets for morphological diagnosis of meniscal tears of the knee. Arch Orthop Trauma Surg 125(9):622–627CrossRefPubMed

33.

Popescu D, Sastre S, Garcia AI et al (2015) MR-arthrography assessment after repair of chronic meniscal tears. Knee Surg Sports Traumatol Arthrosc 23(1):171–177CrossRefPubMed

34.

Pujol N, Tardy N, Boisrenoult P et al (2013) Magnetic resonance imaging is not suitable for interpretation of meniscal status ten years after arthroscopic repair. Int Orthop 37(12):2371–2376CrossRefPubMedPubMedCentral

35.

Rockborn P, Messner K (2000) Long-term results of meniscus repair and meniscectomy: a 13-year functional and radiographic follow-up study. Knee Surg Sports Traumatol Arthrosc 8(1):2–10CrossRefPubMed

36.

Sciulli RL, Boutin RD, Brown RR et al (1999) Evaluation of the postoperative meniscus of the knee: a study comparing conventional arthrography, conventional MR imaging, MR arthrography with iodinated contrast material, and MR arthrography with gadolinium-based contrast material. Skelet Radiol 28(9):508–514CrossRef

37.

Sharifah MI et al (2015) Accuracy of MRI in the diagnosis of meniscal tears in patients with chronic ACL tears. Knee Surg Sports Traumatol Arthrosc 23(3):826–830CrossRefPubMed

38.

Steenbrugge F, Verdonk R, Verstraete K (2002) Long-term assessment of arthroscopic meniscus repair: a 13-year follow-up study. Knee 9(3):181–187CrossRefPubMed

39.

Stoller DW, Martin C, Crues JR et al (1987) Meniscal tears: pathologic correlation with MR imaging. Radiology 163(3):731–735CrossRefPubMed

40.

Stone RG, Frewin PR, Gonzales S (1990) Long-term assessment of arthroscopic meniscus repair: a two- to six-year follow-up study. Arthroscopy 6(2):73–78CrossRefPubMed

41.

Tachibana Y, Sakaguchi K, Goto T et al (2010) Repair integrity evaluated by second-look arthroscopy after arthroscopic meniscal repair with the FasT-Fix during anterior cruciate ligament reconstruction. Am J Sports Med 38(5):965–971CrossRefPubMed

42.

Vives MJ, Homesley D, Ciccotti MG et al (2003) Evaluation of recurring meniscal tears with gadolinium-enhanced magnetic resonance imaging: a randomized, prospective study. Am J Sports Med 31(6):868–873CrossRefPubMed

43.

Wang JT, Liu YJ, Wang JL et al (2014) Arthroscopic repair of meniscus injury with Fast-fix under local anesthesia. Zhongguo Gu Shang 27(8):683–685PubMed

44.

White LM, Schweitzer ME, Weishaupt D et al (2002) Diagnosis of recurrent meniscal tears: prospective evaluation of conventional MR imaging, indirect MR arthrography, and direct MR arthrography. Radiology 222(2):421–429CrossRefPubMed

45.

Xu C, Zhao J (2015) A meta-analysis comparing meniscal repair with meniscectomy in the treatment of meniscal tears: the more meniscus, the better outcome? Knee Surg Sports Traumatol Arthrosc 23(1):164–170CrossRefPubMed

Title: 3D-MRI combined with signal-to-noise ratio measurement can improve the diagnostic accuracy and sensitivity in evaluating meniscal healing status after meniscal repair
Authors: Bin Song
Weiquan Tan
Yue Xu
Taihui Yu
Weiping Li
Zhong Chen
Rui Yang
Jingyi Hou
Yunfeng Zhou
Publication date: 01-01-2019
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 1/2019
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-018-5018-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

3D-MRI combined with signal-to-noise ratio measurement can improve the diagnostic accuracy and sensitivity in evaluating meniscal healing status after meniscal repair

Abstract

Purpose

Methods

Results

Level of evidence

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Level of evidence

Please log in to get access to this content

Other articles of this Issue 1/2019

A combination of an anteromedial, anterolateral and midlateral portals is sufficient for 360° exposure of the radial head for arthroscopic fracture fixation

Correction to: The WOMAC score can be reliably used to classify patient satisfaction after total knee arthroplasty

Primary repair of the anterior cruciate ligament: real innovation or reinvention of the wheel?

More tendon degeneration in patients with shoulder osteoarthritis

Pullout fixation for medial meniscus posterior root tears: clinical results were not age-dependent, but osteoarthritis progressed

Increasing the deltoid muscle volume positively affects functional outcomes after arthroscopic rotator cuff repair