Ultrasound Useful for Diagnosing Meniscal Pathology

Maureen Leahy

Study data presented Thursday demonstrate that ultrasound is a useful tool for diagnosing meniscal pathology, with potential advantages over magnetic resonance imaging (MRI).

MRI is often considered the gold standard diagnostic imaging modality for detection of meniscal abnormalities, but it is costly, not readily available to large numbers of patients, and associated with misdiagnoses in up to 20 percent of cases, according to presenter James L. Cook, DVM, PhD, of the University of Missouri.

“Ultrasonographic examination may be an effective diagnostic tool for this purpose, with the potential to overcome many of the shortcomings of MRI,” he said. “In addition, the portability of ultrasound equipment makes accurate diagnosis at athletic events possible. However, the capabilities of ultrasound for clinical diagnosis of meniscal abnormalities in patients have not been fully evaluated.

“If this technique could be standardized to consistently provide sensitive and specific data for diagnosis and characterization of meniscal pathology in traumatized knees, it would be extremely useful,” continued Dr. Cook, “because it can be used on the field, is routinely available, does not have limitations with respect to patient size, and is less expensive than MRI.”

Prospective comparisons
Dr. Cook and his colleagues conducted a study to determine the clinical usefulness of ultrasound for diagnosing meniscal pathology in patients with acute knee pain, and to compare its diagnostic accuracy to MRI in a clinical setting. The IRB-approved prospective study cohort included 71 patients with acute knee pain.

Preoperative MRI (1.5 T) scans and ultrasound assessments were performed on each affected knee. MRIs were read by radiologists trained in musculoskeletal MRI; ultrasound was performed by faculty members trained in musculoskeletal ultrasonography. Orthopaedic surgeons performed arthroscopic evaluations of each affected knee to assess and record all joint pathology, which served as the reference standard for determining presence, type, and severity of meniscal pathology.

Evaluators for each diagnostic modality were blinded to all other data. Data were collected and compared by a separate investigator. The results are shown in Table 1.

“In this prospective clinical study, ultrasound was two times more likely than MRI to correctly determine the presence or absence of meniscal pathology seen arthroscopically,” said Dr. Cook.

He concluded, “Ultrasound is a useful tool for diagnosis of meniscal pathology, with potential advantages over MRI. With the availability and portability of current equipment, ultrasound could be used as a point-of-injury diagnostic modality for meniscal injuries in athletes.”

Dr. Cook’s coauthors of Scientific Paper 297, “Prospective Assessment of MRI versus Ultrasound for Diagnosis of Meniscal Pathology,” are Cristi R. Cook, DVM, MS, DACVR; James P. Stannard, MD; Gavin M. Vaughn, MD; Nichole Wilson, RN; Brandon L. Roller, MD; Aaron M. Stoker, MS, PhS; Prakash S. Jayabalan, MD; and Keiichi Kuroki, DVM, PhD. The study was funded by the National Football League Charities.

Disclosures: Dr. James Cook—Arthrex; Apollo Surgical; Schwartz Biomedical; Synthes; Iams; ACELL; Aratana; Journal of Knee Surgery; Clinical Orthopaedics and Related Research. Dr. Cristi Cook—Arthrex; Iams; Schwartz Biomedical. Dr. Stannard—KCI; Medtronic Sofamor Danek; Sonoma; Smith & Nephew; Thieme; Journal of Knee Surgery; Orthopaedic Trauma Association. Dr. Roller—Arthrex. Mr. Stoker—Arthrex, Inc.; Synthes. Drs. Vaughn, Jayabalan, and Kuroki and Ms. Wilson—no conflicts.

2013 Annual Meeting News
Tuesday through Friday, February 19 – 23, 2013.
http://www.aaos.org/news/acadnews/2013/AAOS12_3_22.asp