Integrating Clinical, MRI and Arthroscopic Findings for Accurate Diagnosis of Meniscal Tears.

Abstract

Objective: To compare the diagnostic efficacy of clinical examination (joint line tenderness and McMurray test) versus MRI for detection of medial and lateral meniscal tears, by utilizing arthroscopy as the gold standard.

Methodology: This retrospective cross-sectional study was carried out at Shifa International Hospital Islamabad from Sep 2024 to August 2025. Clinical data of 200 patients with suspected meniscus tears subjected to clinical evaluation, MRI, and arthroscopy were included. Clinical examinations including joint line tenderness and McMurray test, MRI and arthroscopic findings were documented. Diagnostic indicator including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated

Results: The clinical examination for medial meniscus tear (n=154 confirmed by arthroscopy) yielded 84.4% sensitivity, 84.8% specificity, 94.9% PPV, 61.9% NPV, and 84.5% accuracy. The sensitivity of MRI was found to be 99.4%, its specificity was 82.6%, its PPV was 95.0%, its NPV was 97.4%, and its accuracy was 95.5%. For lateral meniscal tears (n=57 confirmed on arthroscopy), sensitivity was 73.7%, specificity was 98.6%, and accuracy was 91.5% on physical examination, whereas sensitivity was 91.2%, specificity was 95.8%, and accuracy was 94.5% on MRI. MRI had markedly higher negative predictive value (97.4% medial; 96.5% lateral), while clinical examination showed higher specificity for lateral tears.

Conclusion: MRI proved to be most valid and accurate non-invasive diagnostic tool before arthroscopy for both medial and lateral tears owing to its higher sensitivity, negative predictive value and overall precision in comparison with clinical findings. Clinical assessment is quite facilitative, but it cannot be substituted for MRI as a single diagnostic modality.