Comparison of Diagnostic Accuracy of Physical Examination and MRI in the Most Common Knee Injuries

Comparison of a New Radiographic Technique with MRI Measurements for Tibial Tunnel Evaluation in ACL Reconstruction

Background/Objectives: The correct angular placement of the tibial tunnel is crucial to ensure graft tension, maintain knee stability, and ensure optimal clinical outcomes after anterior cruciate ligament (ACL) reconstruction. While 3D imaging methods such as MRI and CT are the gold standard for evaluating tunnel positioning, their routine use is limited by cost, availability, and time constraints. In clinical practice, 2D radiographs are more accessible but lack established reliability in accurately estimating tunnel angles. The aim of this study was to convert 2D radiographic angular measurements used in the evaluation of patients undergoing anterior cruciate ligament reconstruction into 3D values with a simple method and to compare these measurements with three-dimensional angles calculated using conventional MRI and CT. Methods: This retrospective study included 38 patients who underwent anatomic anterior cruciate ligament reconstruction. Postoperative radiographs and MR images were analyzed to determine the tibial tunnel angles. The angles calculated from 2D radiographs were statistically analyzed for their correlation with the actual 3D angles measured by MRI. Results: The analysis showed a strong correlation between tibial tunnel angles from radiographs and MRI, with minimal, non-significant differences. This suggests that radiographs can provide a reliable estimate of tibial tunnel angles. Conclusions: These findings suggest that radiographs can predict tibial tunnel angles in ACL reconstruction as accurately as MRI. This method can guide the correct tunnel angle and facilitate postoperative evaluation. Further studies are needed to confirm these results across various populations and techniques.

The Lever Sign Test Demonstrates Limited Clinical Utility for Diagnosing Full-Thickness Anterior Cruciate Ligament Tears After a Traumatic Knee Injury

Background

Current systematic reviews with meta-analyses have identified the lever sign test as the best clinical examination for ruling out an anterior cruciate ligament (ACL) tear, but the included studies have methodological limitations that could bias the test outcome, potentially overestimating its clinical utility.

Purpose

To investigate the interrater reliability and concurrent validity of the lever sign test after a traumatic knee injury and to investigate the association between test variables (surface used, fist position, effusion grade, force applied, pain reported) and test outcomes.

Study Design

Cohort study (Diagnosis); Level of evidence, 2.

Methods

The lever sign test was performed on hard and soft surfaces in 101 participants after a traumatic knee injury. Magnetic resonance imaging was used as the reference standard, with index testing performed after magnetic resonance imaging was conducted (>3 weeks after injury). Agreement between observers based on the surface used and fist position was evaluated with the Cohen kappa coefficient (κ). Concurrent validity was assessed through sensitivity, specificity, and likelihood ratios. Logistic regression was used to determine whether effusion grade, force applied, and pain reported were significantly associated with test outcomes.

Results

Interrater reliability was superior on the soft surface but demonstrated only moderate agreement (κ = 0.529 [95% CI, 0.368-0.691]). Sensitivity was higher on the soft surface, and specificity was higher on the hard surface, for both assessors. At best, positive and negative likelihood ratios were 3.02 (95% CI, 1.60-5.69) and 0.45 (95% CI, 0.28-0.73), respectively. Test outcomes were affected by the surface used and fist position, but effusion grade, force applied, and pain reported were not significantly associated with correct/incorrect test results.

Conclusion

In participants assessed from 3 weeks after a traumatic knee injury, the lever sign test demonstrated limited clinical utility for diagnosing full-thickness ACL tears. Test outcomes were affected by the surface used and fist position of the assessor.

Registration

NCT05416632 (ClinicalTrials.gov).

A newly developed 2 mm needle arthroscope with high-definition for orthopedic outpatient knee joint examination

Currently, the diagnosis of orthopedic joint diseases relies mainly on magnetic resonance imaging (MRI), which is valuable for detecting bone injuries, as well as lesions in intra-articular cartilage, ligaments, bone marrow, synovium, and other areas. However, MRI has significant drawbacks. Firstly, MRI cannot provide detailed pathological assessments of joint interiors comparable to arthroscopic examination results. Secondly, MRI is costly, imposing substantial financial burdens on patients with each additional site examined clinically. Lastly, MRI resources are scarce in medical institutions due to widespread applications beyond joint examinations, requiring appointments days in advance. Each examination is limited to one site, taking approximately 20-30 min per session; multiple sites necessitate sequential examinations, entailing considerable time costs and potentially delaying diagnoses. The development of needle arthroscopy (NA) for outpatient knee joint examinations offers more accurate and detailed visualization of knee joint pathologies compared to traditional MRI imaging, with lower economic and time costs. Moreover, NA provides a valuable diagnostic alternative for patients unsuitable for MRI examinations. In-office needle arthroscopy (IONA) also enables orthopedic surgeons to deliver more comprehensive medical services beyond diagnostic examinations. Based on this theory, we have designed and manufactured a 2 mm-diameter lens arthroscope useable under local anesthesia in outpatient settings to examine tissue injuries within knee joints. The needle arthroscope objective 2 mm has an 85°field of view, a 30°viewing angle, and an imaging resolution of 10 lp/mm. This device provides clear imaging of cartilage surfaces, ligaments, synovium, and other soft tissues inside cadaveric knee joints, enabling more detailed and accurate evaluations of knee joint tissue pathologies. This method facilitates convenient, efficient joint examinations with lower economic and time costs, serving as a viable alternative to knee joint MRI examinations.

Rethinking the Assessment of Arthrogenic Muscle Inhibition After ACL Reconstruction: Implications for Return-to-Sport Decision-Making-A Narrative Review

Arthrogenic muscle inhibition (AMI) is a neuromuscular impairment commonly observed following anterior cruciate ligament reconstruction (ACLR). This condition, characterized by persistent quadricep inhibition due to altered afferent feedback, significantly impacts neuromuscular recovery, delaying return to running and sport. Despite advancements in rehabilitation strategies, AMI may persist for months or even years after ACLR, leading to muscle strength asymmetries, altered biomechanics, and an increased risk of reinjury. The mechanisms underlying AMI involve both peripheral (joint effusion, mechanoreceptor dysfunction) and central (corticospinal inhibition, neuroplasticity alterations) components, which collectively hinder voluntary muscle activation and movement control. AMI alters gait mechanics, reduces knee stability, and promotes compensatory patterns that increase injury risk. Current return-to-sport protocols emphasize strength symmetry and functional performance but often neglect neuromuscular deficits. A comprehensive assessment integrating neuromuscular, biomechanical, and proprioceptive evaluations is needed at specific stages to optimize rehabilitation and minimize reinjury risk. Future research should explore targeted interventions such as neuromuscular stimulation, cognitive-motor training, and advanced gait analysis to mitigate AMI's impact and facilitate a safer, more effective return to sport.

Exploring the early diagnostic value of MRI for type I stress fractures: a retrospective analysis based on imaging manifestations

Objective

To compare the positive rate of early diagnosis and the detection rate of fracture signs in Type I stress fractures using x-ray, CT, and MRI.

Methods

A total of 56 patients with Type I stress fractures admitted to the 904st Hospital of the PLA Joint Logistics Support Force from January 2011 to June 2021 were included in the retrospective analysis, including 35 cases of tibial stress fractures (tibia group) and 21 cases of femoral stress fractures (femur group). The positive rate of early diagnosis and the detection rates of visible fracture lines, periosteal reaction, callus formation, surrounding soft tissue swelling, and marrow cavity signal changes were compared between x-ray, CT, and MRI.

Results

(1) The positive rate of early diagnosis of MRI in the tibia and femur groups were significantly higher than those of x-ray and CT examinations, and the differences were statistically significant (P < 0.05). (2) In the tibia group, MRI had significantly higher detection rates than x-ray and CT examinations for visible fracture lines, periosteal reaction, surrounding soft tissue swelling, and marrow cavity signal changes, and the differences were statistically significant (P < 0.05). There was no significant difference in the detection rate of callus formation (P > 0.05). (3) In the femur group, MRI had significantly higher detection rates than x-ray and CT examinations for visible fracture lines, surrounding soft tissue swelling, and marrow cavity signal changes, and the differences were statistically significant (P < 0.05). There was no significant difference in the detection rates of periosteal reaction and callus formation (P > 0.05).

Conclusion

Based on the definitely diagnostic advantages of MRI for signs such as visible fracture line, surrounding soft tissue swelling, and marrow cavity signal changes, it shows higher accuracy and application value in the early diagnosis of type Ⅰ stress fractures.

The Meniscus: Basic Science and Therapeutic Approaches

The proper function and longevity of the knee joint are ensured by the knee menisci. Their susceptibility to damage and injury is one of the main risk factors for rapid cartilage loss and the development of osteoarthritis. The vascularization pattern and nutritional status of a torn meniscus determine its potential for healing and the success of meniscus surgery. Blood supply is a crucial factor in assessing healing potential. Knee cartilage volume loss and its modification often result from meniscal damage or excision, leading to osteoarthritis. Modern methods for preserving meniscal tissue are currently the treatment of choice. Magnetic resonance imaging (MRI) is the gold standard for assessing meniscus lesions. It provides a comprehensive evaluation of tear stability and progression risk. Additionally, it offers high sensitivity and specificity. Arthrography combined with computed tomography (CT) can be used for patients who are unable to undergo MRI. Other methods, such as X-ray and ultrasound, are not useful for the typical diagnosis of meniscal lesions. Minimally invasive surgery has become the gold standard for both treatment and diagnosis. Modern techniques, such as all-inside compression sutures and other suturing techniques, are also considered. In contrast, in the past, open total meniscectomy was routinely performed as the gold standard, based on the mistaken belief that the menisci were functionless. Currently, new treatment methods for meniscal lesions are being explored, including mesenchymal stem cells, synthetic implants, and platelet-rich plasma (PRP). The crucial role of the menisci in knee biomechanics drives the development of modern solutions focused on preserving meniscal tissue.

Risk of Iatrogenic Peroneal Nerve Injury in Inside-Out Lateral Meniscal Repairs Using Differently Curved Repair Devices and Surgical Portals

Background: Inside-out meniscal repair is a widely adopted treatment for lateral meniscal injuries. A significant complication associated with this procedure is iatrogenic peroneal nerve (PN) injury, reported in approximately 9% of cases. The risk varies depending on the choice of surgical portals, curvature of repair devices, and anatomical landmarks. This study aimed to assess the risk of PN injury and define safe zones for inside-out lateral meniscal repair using different device curvatures and portal combinations. Methods: Axial MRI scans of knees positioned in the figure-of-four posture, with joint fluid distension and varus force applied, were analyzed in 29 adult patients. Transparent overlays representing the operative routes of the anterior-, middle-, and posterior-curved needles were superimposed on the MRI scans. Simulations of repair procedures were performed using the anteromedial, accessory anteromedial, anterolateral, and accessory anterolateral portals, targeting the medial and lateral borders of the popliteus tendon (PT). Instances where the needle path intersected or contacted the PN were recorded to delineate risk zones. Results: Repairs targeting the medial PT border with anterior-curved devices via the anteromedial or accessory anteromedial portals were identified as safe. At the lateral PT border, all device curvatures and portals were considered safe, except for middle- and posterior-curved devices used through the accessory anteromedial portal, which posed a risk of PN injury. Conclusions: The risk of iatrogenic PN injury in inside-out lateral meniscal repair depends on the curvature of the repair device and portal used. Adhering to the identified safe zones can substantially reduce this risk.

Exploring the Posterolateral Corner of the Knee Joint: A Detailed Review of Recent Literature

One of the least understood and most elaborate and neglected knee stabilizers is the posterolateral corner (PLC) complex. PLC injury is associated with a high risk of re-injury, early athletic career termination, instability, progressive osteoarthritis, and a high risk of artificial knee replacement. The growing focus on the PLC, along with various recent anatomical and biomechanical studies, has provided further insights into the anatomy and function of posterolateral structures in knee stabilization and kinematics. The PLC should be considered as a functional unit, not only an anatomical unit. A low suspicion threshold should be maintained when considering PLC injuries, and thorough history evaluation, clinical examination, and adequate imaging should be conducted to reduce the chances of neglected PLC injuries. Various PLC repair and reconstruction techniques, ranging from non-anatomical to anatomical, have been introduced, with treatments increasingly favoring minimal incisions and arthroscopic procedures. Recent studies on the PCL have reported an increasing number of satisfactory clinical outcomes. This study aimed to provide a deeper understanding, as well as review the current and most feasible treatments for PLC injuries.

Gait Asymmetry and Post-Traumatic Osteoarthritis Following Anterior Cruciate Ligament Rupture: A Preliminary Study

Knee post-traumatic osteoarthritis (PTOA) often develops in younger populations following anterior cruciate ligament (ACL) rupture, accounting for 12% of all symptomatic osteoarthritis (OA). The current literature implicates gait asymmetry in late-stage knee OA progression; however, early-knee PTOA development involvement is ill defined. This study explored gait asymmetry involvement in early-stage knee PTOA following ACL ruptures. Gait asymmetry, measured as asymmetry in duty factor (relative contact time), and joint loading data were collected, using infrared-camera motion capture and Kistler force plates for participants exhibiting either historical ACL ruptures (ACL+; n = 4) or no previous joint trauma (ACL-; n = 11). Joint loading measures included external knee adduction moment (EKAM) and external knee flexion moment (KFM), early (peak 1; EKAMp1 and KFMp1) and late (peak 2; EKAMp2 and KFMp2), stance peaks (Nm/kg), and respective time integrals (Nm·ms/kg; iEKAMp1, iEKAMp2, iKFMp1, and iKFMp2). ACL+ exhibited greater asymmetrical duty factor (78% difference) and greater joint load differences: EKAMp1 (26%), EKAMp2 (49%), KFMp1 (37%), iKFMp1 (44%), and iKFMp2 (60%). Significant relationships were found between duty factor asymmetry and both KFMp2 (R2 = 0.665) and iKFMp2 (R2 = 0.504). These preliminary data suggest gait asymmetry-induced joint loading may contribute to knee PTOA progression, but further research with increased sample sizes and the quantitative assessment of cartilage status is required.

Pediatric Voluntary Habitual Hip Dislocation: Clinical Characteristics, Family Dynamics, and Long-Term Outcomes-A Retrospective Study

Background/Objectives: Recurrent hip dislocations are a rare occurrence in pediatric patients. As there are few cases of voluntary habitual dislocation documented in the literature, there is a paucity of information available regarding its pathogenesis, risk factors, and classification. The prognosis for these patients is generally good. A long-term follow-up duration of two years was conducted to evaluate outcomes. Statistical analysis was performed to assess the impact of family structure and treatment approaches on outcomes. Methods: From January 2010 to December 2022, patients with voluntary habitual hip dislocation were retrospectively identified through the hospital information system. Data regarding demographic characteristics, clinical findings, and treatment outcomes were analyzed. A total of 13 patients (14 hips) met the inclusion criteria. Conservative treatment methods, including orthosis and family therapy, were applied. Statistical analysis was performed to assess the impact of family structure and treatment approaches on outcomes. Results: The mean age at diagnosis was 48.7 months, with 77% of cases being female. Posterior dislocation was observed in all cases, and no underlying bone pathology was detected on imaging. The prognosis for these patients is generally good. At the one-year follow-up, 85% of patients achieved a complete resolution of dislocations, increasing to 100% by the two-year follow-up. Patients from larger families demonstrated significantly slower recovery rates at the first- and sixth-month evaluations (p = 0.033 and p = 0.048, respectively), but outcomes were comparable by one year. A unique aspect of this study is the emphasis on family dynamics, which significantly influenced treatment adherence and recovery. Statistical analysis was performed to assess the impact of family structure and treatment approaches on outcomes. Conclusions: Voluntary habitual hip dislocation is a rare condition with good long-term outcomes under conservative management. This study highlights the importance of addressing family dynamics in the treatment plan, especially in larger families, where attention and psychological factors may play a significant role in delayed recovery.

Use of Anthropometric Data for the Prediction of Four-Strand Hamstring Graft Size in White Caucasian Population

Background/Objectives: The purpose of this study was to preoperatively estimate the four-strand hamstring graft size in a White Caucasian population, using anthropometric data. Methods: This was a prospective study of a consecutive series of fifty patients with anterior cruciate ligament (ACL) rupture, who were scheduled for reconstruction using hamstring autografts; however, one of them was ultimately not enrolled according to the exclusion criteria (49 patients in total). Preoperatively, age, sex, weight, body mass index (BMI), length, and diameter of the contralateral thigh, length of the harvested gracilis/semitendinosus tendons, and length and thickness of the four-stranded graft were recorded. Graft diameter and length were dependent variables, measured via a graft sizer and a ruler, respectively. Quantitative variables were described with mean ± SD (correlated in a pairwise manner with Pearson's r correlation). Qualitative variables were described with an absolute count (relative % percent) per categorical level, and their dependency on any quantitative (dependent) variable was assessed via Student's t-test. Results: The mean lengths of the gracilis and semitendinosus were 25.6 ± 3.2 cm and 28.4 ± 3.3 cm, respectively, and they were positively correlated with the length of the four-strand hamstring graft along with the patients' height and thigh length. Conclusions: The use of anthropometric data can assist in the prediction of the hamstring autograft size, aiding the selection of an appropriate graft type. The four-strand hamstring graft length was related to the gracilis, semitendinosus, and thigh length. The patients' height was related to the graft length and diameter.

Anterior Cruciate Ligament Mechanical Response to Load in the Setting of Changes to the Medial Meniscus

The anterior cruciate ligament (ACL) is a major ligament in the knee joint, and its function is crucial for both the movement and stability of the knee. Our research takes a novel approach by investigating the effect of meniscus tears on the ACL, how such tears will impact the stress on the ACL, and its overall compensation in response to the changes in the meniscus. Hypothesis/Purpose: This study aims to investigate how the ACL compensates for the change in knee joint stability and contact pressures due to partial horizontal cleavage tears (HCTs) in the meniscus, such as partial meniscectomy and partial transplantation on knee joint stability and contact pressures. We hypothesize that HCTs will increase contact pressures and decrease joint stability, thereby inducing compensatory stress on the anterior cruciate ligament (ACL). Method: Seven freshly frozen human cadaveric knees were used in a study to investigate the effects of different meniscal conditions and surgical interventions on the meniscus itself. Four testing scenarios were established: intact knees, knees with partial horizontal cleavage tears (HCTs) of the meniscus, knees with partial meniscectomy, and knees with partial transplantation. Axial loading was applied, and the medial meniscus contact pressures were measured at 0° and 30° of flexion. Additionally, a mathematical 3D finite element model was created to evaluate the behavior of the ACL under different meniscus scenarios, which could not have been measured experimentally. Results: ACL contact pressure and stress analysis across various meniscal conditions demonstrated substantial variability. Horizontal cleavage tears (HCTs) resulted in heightened contact pressures and diminished joint stability, as evidenced by increased ACL stress attributed to compensatory mechanisms in the presence of meniscal tears. Conversely, transplantation procedures exhibited a mitigating effect, maintaining joint mechanics closer to intact conditions and minimizing alterations in ACL forces. These trends persisted at 30 degrees of knee flexion, where significant increases in ACL forces were observed in partial and complete HCT conditions. Conclusions: This study uncovers the biomechanical impacts of meniscal injuries, demonstrating how the ACL compensates for various meniscus conditions. In contrast, transplantation and repair conditions only slightly increase the stress on the ACL, putting much less strain on the ACL and supporting structures of the knee joint than an unrepaired tear.

The "11 to Perf Score", a Test for Professional Players Returning to Soccer After Anterior Cruciate Ligament Reconstruction

Rupture of the anterior cruciate ligament (ACL) is common among soccer players. Although there are no strict recommendations for the return to sport, more and more practitioners are having their patients perform isokinetic and even composite tests. However, these tests have not yet been shown to be predictive of re-injury, and are not specific to professional footballers. Objectives: The "11 to Perf" is a test designed to help professional footballers return to sport after ACL reconstruction. Its originality lies in its integration of soccer practice with specific tests. The aim of this article is to present the "11 to Perf" evaluation method. Methods: A prospective cohort study was conducted at the Centre National du Football (FIFA center) in Clairefontaine, including professional footballers who have undergone anterior cruciate ligament surgery and rehabilitation. Tests include clinical assessments, jumping, agility, psychological and isokinetic tests and match simulation. Conclusions: The "11 to Perf" is a composite test designed to assess the return to sport of professional footballers after ACL reconstruction. Its predictive capacity for recurrence should be assessed in the future.

Effects of Intra-Articular Stromal Vascular Fraction Injection on Clinical Symptoms and Cartilage Health in Osteoarthritic Knees: A Single-Center Pilot Study

Osteoarthritis (OA) is a prevalent form of arthritis worldwide. Intra-articular stromal vascular fraction (SVF) injections are a potential therapeutic option for patients with OA. This study aims to assess the effects of intra-articular SVF injections on knee OA. Ten patients with knee OA participated in this study. After administering them with intra-articular SVF injections, their outcomes were evaluated using various questionnaires. MRI T2 mapping was conducted and compared before the intervention and 6 months after. All the data underwent analysis using various tests. Significant differences were observed in the change of Western Ontario and McMaster Universities Arthritis Index, VAS, and Knee Injury and Osteoarthritis Outcome Score between pre-intervention and 6 months post-intervention. The T2 values were significantly lower in the anterior superficial layer of the medial femoral cartilage and middle superficial layer of the lateral femoral cartilage. However, no positive effects were observed in any other regions of the knee cartilage. This study revealed significant differences between the pre- and 6-month post-intervention questionnaires. However, the T2 values did not show consistent changes across all regions of the knee cartilage. Despite positive effects in two regions, the degenerative process appeared to continue in other regions during the tracking period.

Persistent Lateral Knee Pain From a 10% Thickness Anterior Cruciate Ligament (ACL) Tear in a 36-Year-Old Runner

Anterior cruciate ligament (ACL) tears are due to jumping, rapid decelerating, or quick changes in direction, but recent research indicates that accumulated tissue fatigue from repetitive submaximal knee loading can also cause ACL disruption. Partial degenerative ACL tears due to overuse are currently thought to be asymptomatic until the ligament is at least 50% torn. In this case, a 36-year-old female runner presenting with sharp lateral joint line knee pain, which precluded running or hiking over one mile, was found to have an atraumatic 10% thickness ACL tear. After ACL debridement, the patient was able to return to full activity. Females may be more prone to degenerative partial ACL tears due to biomechanical and hormonal factors. Partial ACL tears should be considered in the differential diagnosis of knee pain even without a history of trauma.

Cartilage Integrity: A Review of Mechanical and Frictional Properties and Repair Approaches in Osteoarthritis

Osteoarthritis (OA) is one of the most common causes of disability around the globe, especially in aging populations. The main symptoms of OA are pain and loss of motion and function of the affected joint. Hyaline cartilage has limited ability for regeneration due to its avascularity, lack of nerve endings, and very slow metabolism. Total joint replacement (TJR) has to date been used as the treatment of end-stage disease. Various joint-sparing alternatives, including conservative and surgical treatment, have been proposed in the literature; however, no treatment to date has been fully successful in restoring hyaline cartilage. The mechanical and frictional properties of the cartilage are of paramount importance in terms of cartilage resistance to continuous loading. OA causes numerous changes in the macro- and microstructure of cartilage, affecting its mechanical properties. Increased friction and reduced load-bearing capability of the cartilage accelerate further degradation of tissue by exerting increased loads on the healthy surrounding tissues. Cartilage repair techniques aim to restore function and reduce pain in the affected joint. Numerous studies have investigated the biological aspects of OA progression and cartilage repair techniques. However, the mechanical properties of cartilage repair techniques are of vital importance and must be addressed too. This review, therefore, addresses the mechanical and frictional properties of articular cartilage and its changes during OA, and it summarizes the mechanical outcomes of cartilage repair techniques.

CONCEPT AND VALIDATION OF A SYSTEM FOR RECORDING VIBROACOUSTIC SIGNALS OF THE KNEE JOINT

Cartilage degeneration is a serious health condition in modern society, leading to problems in mobility and significant reduction in the quality of life of patients of all ages. It is mainly caused by obesity, workload, sports or trauma to the joint. Proper diagnosis is crucial to implement appropriate treatment to stop the further degeneration of the tissue. Usually the assessment is performed by using magnetic resonance. This paper describes the design and application of an alternative measurement system for vibroartography of the knee joint. The use of such device allows for fast, safe, easy and cheap assessment of joint condition, which in turn can lead to proper treatment planning. Similar portable systems can be rapidly deployed and used by entry level medical staff in hospitals, clinics or at patient’s home. The system consists of an orthosis, set of three vibroacoustic sensors, encoder for reading knee position, microcontroller with galvanic barrier and battery power and a computer for data storage and processing. The system is light, simple and portable. Data is recorded in both closed and open kinematic chains. Results show over 90% diagnostic accuracy based on the data obtained in the process of testing this device. In the future, the system will be further miniaturized and completely placed on the orthosis, leading to more portability and diagnostic merit.

Examining the Evidence Regarding Smoking and Patient Outcomes for Isolated Meniscus Pathology: A Comprehensive Systematic Review and Meta-Analysis

Smoking is a well-known cause of impairment in wound healing and postoperative outcomes; however, its effects on treating meniscus issues remain unclear. This study assesses the relationship between smoking and meniscus treatment outcomes. PubMed, Scopus, Cochrane, and CINAHL were searched from inception to 24 December 2023. Inclusion criteria encompassed studies examining smoking's impact on patient outcomes regarding meniscus pathology. A secondary PubMed search targeted randomized controlled trials (RCTs) in the top ten orthopedic journals focusing on meniscus pathology and smoking as a demographic variable. Meta-analysis of six studies (n = 528) assessed meniscus failure rate based on smoking status. Eighteen observational studies (n = 8353 patients; 53.25% male; mean age: 51.35 ± 11.53 years; follow-up: 184.11 ± 117.34 months) were analyzed, covering meniscus repair, meniscectomy, allograft transplant, conservative care, and arthroscopy. Results showed four studies (36.36%) linked smoking with worse meniscus repair outcomes, while seven studies (63.64%) did not find significant associations. Meta-analysis from six studies showed no significant impact of smoking on repair failure (p = 0.118). Regarding meniscectomy, one study (33.33%) identified a significant association with smoking, but two did not. Only one (3.8%) of the RCTs in leading orthopedic journals included smoking as a factor. The evidence on smoking's effect on meniscus treatment is mixed, necessitating further investigation.

A Systematic Review of Bone Bruise Patterns following Acute Anterior Cruciate Ligament Tears: Insights into the Mechanism of Injury

(1) Background: The purpose of this systematic review was to determine the prevalence of bone bruises in patients with anterior cruciate ligament (ACL) injuries and the location of the bruises relative to the tibia and femur. Understanding the relative positions of these bone bruises could enhance our comprehension of the knee loading patterns that occur during an ACL injury. (2) Methods: The MEDLINE, EMBASE, and the Cochrane Library databases were searched for studies that evaluated the presence of bone bruises following ACL injuries. Study selection, data extraction, and a systematic review were performed. (3) Results: Bone bruises were observed in 3207 cases (82.8%) at the lateral tibia plateau (LTP), 1608 cases (41.5%) at the medial tibia plateau (MTP), 2765 cases (71.4%) at the lateral femoral condyle (LFC), and 1257 cases (32.4%) at the medial femoral condyle (MFC). Of the 30 studies, 11 were able to assess the anterior to posterior direction. The posterior LTP and center LFC were the most common areas of bone bruises. Among the 30 studies, 14 documented bone bruises across all four sites (LTP, MTP, LFC, and MFC). The most common pattern was bone bruises appearing at the LTP and LFC. (4) Conclusions: The most frequently observed pattern of bone bruises was restricted to the lateral aspects of both the tibia and femur. In cases where bone bruises were present on both the lateral and medial sides, those on the lateral side exhibited greater severity. The positioning of bone bruises along the front-back axis indicated a forward shift of the tibia in relation to the femur during ACL injuries.

Lever sign test shows high diagnostic accuracy for anterior cruciate ligament injuries: A systematic review and meta-analysis of 3299 observations

PURPOSE

Injuries of the anterior cruciate ligament (ACL) are common knee injuries among active and younger patients. The Lever Sign Test (LST) is a relatively newer test, of which the accuracy is disputed in the existing literature. The aim of this study was to assess the accuracy with and without anesthesia of the Lever Sign test in the literature.

METHODS

PRISMA guidelines were followed, studies were identified using PubMed, EMBASE and Google Scholar. All studies that reported accuracy of LST performed by a clinical professional were included. Integrity of ACL was confirmed using magnetic resonance imaging or arthroscopy. Sensitivity and specificity were calculated using uni- and bivariate methods.

RESULTS

After inclusion, 3299 observations in 2516 patients were included from 23 studies. Mean age was 31.8 years and 64.2% were male. Without anesthesia, sensitivity was 79.2% (95% CI 68.7-86.9) and specificity was 92.0% (95% CI 82.2-96.6). An area under the curve (AUC) of 86.1% was found. With anesthesia, sensitivity was 86.6% (95% CI 68.0-95.2), specificity was 93.4% (95% CI 84.5-97.3) and the AUC was 91.6%.

CONCLUSION

The Lever Sign test shows very good to excellent accuracy for ACL injury, and is a useful tool for clinical practice.

A deep learning knowledge distillation framework using knee MRI and arthroscopy data for meniscus tear detection

Purpose: To construct a deep learning knowledge distillation framework exploring the utilization of MRI alone or combing with distilled Arthroscopy information for meniscus tear detection. Methods: A database of 199 paired knee Arthroscopy-MRI exams was used to develop a multimodal teacher network and an MRI-based student network, which used residual neural networks architectures. A knowledge distillation framework comprising the multimodal teacher network T and the monomodal student network S was proposed. We optimized the loss functions of mean squared error (MSE) and cross-entropy (CE) to enable the student network S to learn arthroscopic information from the teacher network T through our deep learning knowledge distillation framework, ultimately resulting in a distilled student network S T. A coronal proton density (PD)-weighted fat-suppressed MRI sequence was used in this study. Fivefold cross-validation was employed, and the accuracy, sensitivity, specificity, F1-score, receiver operating characteristic (ROC) curves and area under the receiver operating characteristic curve (AUC) were used to evaluate the medial and lateral meniscal tears detection performance of the models, including the undistilled student model S, the distilled student model S T and the teacher model T. Results: The AUCs of the undistilled student model S, the distilled student model S T, the teacher model T for medial meniscus (MM) tear detection and lateral meniscus (LM) tear detection are 0.773/0.672, 0.792/0.751 and 0.834/0.746, respectively. The distilled student model S T had higher AUCs than the undistilled model S. After undergoing knowledge distillation processing, the distilled student model demonstrated promising results, with accuracy (0.764/0.734), sensitivity (0.838/0.661), and F1-score (0.680/0.754) for both medial and lateral tear detection better than the undistilled one with accuracy (0.734/0.648), sensitivity (0.733/0.607), and F1-score (0.620/0.673). Conclusion: Through the knowledge distillation framework, the student model S based on MRI benefited from the multimodal teacher model T and achieved an improved meniscus tear detection performance.

Development of a Soft Tissue Knee Clinical Decision-Making Tool for Patients Presenting to Primary Point-of-Care Providers in Alberta, Canada

Several barriers exist in Alberta, Canada to providing accurate and accessible diagnoses for patients presenting with acute knee injuries and chronic knee problems. In efforts to improve quality of care for these patients, an evidence-informed clinical decision-making tool was developed. Forty-five expert panelists were purposively chosen to represent stakeholder groups, various expertise, and each of Alberta Health Services' 5 geographical health regions. A systematic rapid review and modified Delphi approach were executed with the intention of developing standardized clinical decision-making processes for acute knee injuries, atraumatic/overuse conditions, knee arthritis, and degenerative meniscus. Standardized criteria for screening, history-taking, physical examination, diagnostic imaging, timelines, and treatment were developed. This tool standardizes and optimizes assessment and diagnosis of acute knee injuries and chronic knee problems in Alberta. This project was a highly collaborative, province-wide effort led by Alberta Health Services' Bone and Joint Health Strategic Clinical Network (BJH SCN) and the Alberta Bone and Joint Health Institute (ABJHI).

Stromal Vascular Fraction Therapy for Knee Osteoarthritis: A Systematic Review

Background and Objectives: Knee osteoarthritis (OA) is a widespread joint disease, set to increase due to aging and rising obesity. Beyond cartilage degeneration, OA involves the entire joint, including the synovial fluid, bones, and surrounding muscles. Existing treatments, such as NSAIDs and corticosteroid injections, mainly alleviate symptoms but can have complications. Joint replacement surgeries are definitive but carry surgical risks and are not suitable for all. Stromal vascular fraction (SVF) therapy is a regenerative approach using cells from a patient's adipose tissue. SVF addresses as degenerative and inflammatory aspects, with potential for cartilage formation and tissue regeneration. Unlike traditional treatments, SVF may reverse OA changes. Being autologous, it reduces immunogenic risks. Materials and Methods: A systematic search was undertaken across PubMed, Medline, and Scopus for relevant studies published from 2017 to 2023. Keywords included "SVF", "Knee Osteoarthritis", and "Regenerative Medicine". Results: This systematic search yielded a total of 172 articles. After the removal of duplicates and an initial title and abstract screening, 94 full-text articles were assessed for eligibility. Of these, 22 studies met the inclusion criteria and were subsequently included in this review. Conclusions: This review of SVF therapy for knee OA suggests its potential therapeutic benefits. Most studies confirmed its safety and efficacy, and showed improved clinical outcomes and minimal adverse events. However, differences in study designs and sizes require a careful interpretation of the results. While evidence supports SVF's positive effects, understanding methodological limitations is key. Incorporating SVF is promising, but the approach should prioritize patient safety and rigorous research.

Advanced MR Imaging for Knee Osteoarthritis: A Review on Local and Brain Effects

Knee osteoarthritis is one of the leading causes of chronic disability worldwide and is a significant social and economic burden on healthcare systems; hence it has become essential to develop methods to identify patients at risk for developing knee osteoarthritis at an early stage. Standard morphological MRI sequences are focused mostly on alterations seen in advanced stages of osteoarthritis. However, they possess low sensitivity for early, subtle, and potentially reversible changes of the degenerative process. In this review, we have summarized the state of the art with regard to innovative quantitative MRI techniques that exploit objective and quantifiable biomarkers to identify subtle alterations that occur in early stages of osteoarthritis in knee cartilage before any morphological alteration occurs and to capture potential effects on the brain. These novel MRI imaging tools are believed to have great potential for improving the current standard of care, but further research is needed to address limitations before these compositional techniques can be robustly applied in research and clinical settings.

The diagnostic accuracy of clinical tests for anterior cruciate ligament tears are comparable but the Lachman test has been previously overestimated: a systematic review and meta-analysis

PURPOSE

The diagnostic accuracy of clinical tests for anterior cruciate ligament injury has been reported in previous systematic reviews. Numerous studies in these reviews include subjects with additional knee ligament injury, which could affect the sensitivity of the tests. Meta-analyses have also been performed using methods that do not account for the non-independence of sensitivity and specificity, potentially overestimating diagnostic accuracy. The aim of this study was to report the diagnostic accuracy of clinical tests for anterior cruciate ligament tears (partial and complete) without concomitant knee ligament injury.

METHODS

A systematic review with meta-analysis was performed according to the PRISMA guidelines. Meta-analyses included studies reporting the specificity and/or sensitivity of tests with or without concomitant meniscal injury. Where possible, pooled diagnostic estimates were calculated with bivariate random-effects modelling to determine the most accurate effect sizes. Diagnostic accuracy values are presented for the anterior drawer, Lachman, Lever sign and pivot shift tests overall and in acute or post-acute presentations.

RESULTS

Pooled estimates using a bivariate model for overall sensitivity and specificity respectively were as follows: anterior drawer test 83% [95% CI, 77-88] and 85% [95% CI, 64-95]; Lachman test 81% [95% CI, 73-87] and 85% [95% CI, 73-92]; pivot shift test 55% [95% CI, 47-62] and 94% [95% CI, 88-97]; Lever sign test 83% [95% CI, 68-92] and 91% [95% CI, 83-95]. For specific presentations, the sensitivity and specificity of the Lachman test, respectively, were: complete tears 68% [95% CI, 54-79] and 79% [95% CI, 51-93]; post-acute injuries 70% [95% CI, 57-80] and 77% [95% CI, 53-91].

CONCLUSIONS

The pivot shift and Lever sign were the best tests overall for ruling in or ruling out an anterior cruciate ligament tear, respectively. The diagnostic accuracy of the Lachman test, particularly in post-acute presentations and for complete tears, is lower than previously reported. Further research is required to establish more accurate estimates for the Lachman test in acute presentations and partial ligament tears using bivariate analysis.

LEVEL OF EVIDENCE

III.

Analysis of the Effect of Component Ratio Imbalances on Selected Mechanical Properties of Seasoned, Medium Viscosity Bone Cements

The paper presents the results of experimental strength tests of specimens made of two commercially available bone cements subjected to compression, that is a typical variant of load of this material during use in the human body, after it has been used for implantation of prostheses or supplementation of bone defects. One of the factors analysed in detail was the duration of cement seasoning in Ringer's solution that simulates the aggressive environment of the human body and material degradation caused by it. The study also focused on the parameters of quantitative deviation from the recommended proportions of liquid (MMA monomer, accelerator and stabiliser) and powder (PMMA prepolymer and initiator) components, i.e., unintentional inaccuracy of component proportioning at the stage of cement mass preparation. Statistical analysis has shown the influence of these factors on the decrease in compressive strength of the cements studied, which may be of significant importance in operational practice.

Value of clinical tests in diagnosing anterior cruciate ligament injuries: A systematic review and meta-analysis

OBJECTIVES

This study compared 4 clinical tests with reference to magnetic resonance imaging and arthroscopic visualization to comprehensively evaluate their diagnostic value for anterior cruciate ligament injuries.

METHODS

We systematically searched 10 electronic databases from January 1, 2010, to May 1, 2021. Two reviewers collected data in accordance with the Preferred Reporting Item for Systematic Reviews and Meta-Analyses 2020 guidelines. The quality of each study was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. A meta-analysis was performed using Meta-Disc version 1.4 and Stata SE version 15.0.

RESULTS

Eighteen articles involving 2031 participants were included. The results of the meta-analysis showed that for the Lachman test, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnosis odds ratio, area under the curve (AUC) of summary receiver operating characteristic (SROC), and Q* were 0.76 (95% CI, 0.73-0.78), 0.89 (95% CI, 0.87-0.91), 5.65 (95% CI, 4.05-7.86), 0.28 (95% CI, 0.23-0.36), 22.95 (95% CI, 14.34-36.72), 0.88, and 0.81, respectively. For the anterior drawer test, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnosis odds ratio, AUC of SROC, and Q* were 0.64 (95% CI, 0.61-0.68), 0.87 (95% CI, 0.84-0.90), 3.57 (95% CI, 2.13-5.96), 0.44 (95% CI, 0.32-0.59), 8.77 (95% CI, 4.11-18.74), 0.85, and 0.78, respectively. For the pivot shift test, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnosis odds ratio, AUC of SROC, and Q* were 0.59 (95% CI, 0.56-0.62), 0.97 (95% CI, 0.95-0.98), 13.99 (95% CI, 9.96-19.64), 0.44 (95% CI, 0.35-0.55), 29.46 (95% CI, 15.60-55.67), 0.98, and 0.94, respectively. For the lever sign test, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnosis odds ratio, AUC of SROC, and Q* were 0.79 (95% CI, 0.75-0.83), 0.92 (95% CI, 0.87-0.95), 9.56 (95% CI, 2.76-33.17), 0.23 (95% CI, 0.12-0.46), 47.38 (95% CI, 8.68-258.70), 0.94, and 0.87, respectively.

CONCLUSIONS

Existing evidence shows that these clinical tests have high diagnostic efficacy for anterior cruciate ligament injuries, and that every test has its own advantages and disadvantages. However, the above results should be validated through additional studies, considering the limited quality and quantity of our sample.

Anterior cruciate ligament reconstruction related complications: 2D and 3D high-resolution magnetic resonance imaging evaluation

Anterior cruciate ligament (ACL) injury is a common indication for sports-related major surgery and accounts for a large proportion of ligamentous injuries in athletes. The advancements in 2D and 3D MR imaging have provided considerable potential for a one-stop shop radiation-free assessment with an all-in-one modality examination of the knee, for both soft-tissue and bone evaluations. This article reviews ACL injuries and types of surgical managements with illustrative examples using high resolution 2D and 3D MR imaging. Various complications of ACL reconstruction procedures are highlighted with a focus on the use of advanced MR imaging and relevant arthroscopic correlations.

Diagnostics of Articular Cartilage Damage Based on Generated Acoustic Signals Using ANN-Part II: Patellofemoral Joint

Cartilage loss due to osteoarthritis (OA) in the patellofemoral joint provokes pain, stiffness, and restriction of joint motion, which strongly reduces quality of life. Early diagnosis is essential for prolonging painless joint function. Vibroarthrography (VAG) has been proposed in the literature as a safe, noninvasive, and reproducible tool for cartilage evaluation. Until now, however, there have been no strict protocols for VAG acquisition especially in regard to differences between the patellofemoral and tibiofemoral joints. The purpose of this study was to evaluate the proposed examination and acquisition protocol for the patellofemoral joint, as well as to determine the optimal examination protocol to obtain the best diagnostic results. Thirty-four patients scheduled for knee surgery due to cartilage lesions were enrolled in the study and compared with 33 healthy individuals in the control group. VAG acquisition was performed prior to surgery, and cartilage status was evaluated during the surgery as a reference point. Both closed (CKC) and open (OKC) kinetic chains were assessed during VAG. The selection of the optimal signal measures was performed using a neighborhood component analysis (NCA) algorithm. The classification was performed using multilayer perceptron (MLP) and radial basis function (RBF) neural networks. The classification using artificial neural networks was performed for three variants: I. open kinetic chain, II. closed kinetic chain, and III. open and closed kinetic chain. The highest diagnostic accuracy was obtained for variants I and II for the RBF 9-35-2 and MLP 10-16-2 networks, respectively, achieving a classification accuracy of 98.53, a sensitivity of 0.958, and a specificity of 1. For variant III, a diagnostic accuracy of 97.79 was obtained with a sensitivity and specificity of 0.978 for MLP 8-3-2. This indicates a possible simplification of the examination protocol to single kinetic chain analyses.

Evaluation of the Effect of Selected Physiological Fluid Contaminants on the Mechanical Properties of Selected Medium-Viscosity PMMA Bone Cements

Revision surgeries several years after the implantation of the prosthesis are unfavorable from the patient’s point of view as they expose him to additional discomfort, to risk of complications and are expensive. One of the factors responsible for the aseptic loosening of the prosthesis is the gradual degradation of the cement material as a result of working under considerable loads, in an aggressive environment of the human body. Contaminants present in the surgical field may significantly affect the durability of the bone cement and, consequently, of the entire bone-cement-prosthesis system. The paper presents the results of an analysis of selected mechanical properties of two medium-viscosity bone cements DePuy CMW3 Gentamicin and Heraeus Palamed, for the samples contaminated with saline and blood in the range of 1–10%. The results obtained for compressive strength and modulus of elasticity were subjected to statistical analysis, which estimated the nature of changes in these parameters depending on the amount and type of contamination and their statistical significance.

Diagnostics of Articular Cartilage Damage Based on Generated Acoustic Signals Using ANN-Part I: Femoral-Tibial Joint

Osteoarthritis (OA) is a chronic, progressive disease which has over 300 million cases each year. Some of the main symptoms of OA are pain, restriction of joint motion and stiffness of the joint. Early diagnosis and treatment can prolong painless joint function. Vibroarthrography (VAG) is a cheap, reproducible, non-invasive and easy-to-use tool which can be implemented in the diagnostic route. The aim of this study was to establish diagnostic accuracy and to identify the most accurate signal processing method for the detection of OA in knee joints. In this study, we have enrolled a total of 67 patients, 34 in a study group and 33 in a control group. All patients in the study group were referred for surgical treatment due to intraarticular lesions, and the control group consisted of healthy individuals without knee symptoms. Cartilage status was assessed during surgery according to the International Cartilage Repair Society (ICRS) and vibroarthrography was performed one day prior to surgery in the study group. Vibroarthrography was performed in an open and closed kinematic chain for the involved knees in the study and control group. Signals were acquired by two sensors placed on the medial and lateral joint line. Using the neighbourhood component analysis (NCA) algorithm, the selection of optimal signal measures was performed. Classification using artificial neural networks was performed for three variants: I—open kinetic chain, II—closed kinetic chain, and III—open and closed kinetic chain. Vibroarthrography showed high diagnostic accuracy in determining healthy cartilage from cartilage lesions, and the number of repetitions during examination can be reduced only to closed kinematic chain.

Higher psychological distress in patients seeking care for a knee disorder is associated with diagnostic discordance between health care providers: a secondary analysis of a diagnostic concordance study

Background

Knee disorders are highly prevalent and may be a disabling condition. An accurate diagnosis is necessary to guide toward a rapid and efficient management of knee disorders. However, the ability to make a valid diagnosis is often complex for clinicians and evidence is mainly focused on clinician cognitive biases or errors produced during clinical reasoning. The aim of this secondary exploratory analysis is to identify patient-specific characteristics associated with diagnostic discordance between health care providers in making a diagnosis for a new knee disorder.

Methods

We performed a secondary analysis of a diagnostic study comparing the diagnostic ability of a physiotherapist to medical musculoskeletal specialists. Patients’ socio-demographic, psychosocial and clinical characteristics were compared between the concordant and discordant diagnostic groups. Psychosocial symptoms were evaluated using the validated Kessler 6 (K6) questionnaire. We performed multivariable logistic regressions using the Bayesian Information Criterion to identify the most probable model including patients’ characteristics associated with diagnostic discordance. Overall probability of identified variables to explain diagnostic discordance and associated odd ratios (OR) with 95% credibility intervals (95% CrI) were calculated.

Results

Overall, 279 participants were evaluated by a physiotherapist and medical musculoskeletal specialists. The mean age of the participants was 49.1 ± 15.8 years and 57.7% were female. The most common disorder was osteoarthritis (n = 117, 18.8% of cases were discordant). The most probable model explaining diagnostic discordance (11.13%) included having depressive symptoms, which was associated with an increased probability of diagnostic discordance (OR: 3.9; 95% CrI: 1.9 – 8.0) and having a higher number of comorbidities, which was associated with a decreased probability of diagnostic discordance (OR: 0.6; 95% CrI: 0.5 – 0.9). The depression item of the K6 questionnaire had a 99.4% chance to be included in a model explaining diagnostic discordance. Other variables taken separately had less than 50% chance to be included in a model explaining diagnostic discordance and cannot be considered significant.

Conclusion

Our results suggest that depressive symptoms may increase the risk of knee diagnostic discordance. Clinicians may be more likely to make diagnostic errors and should be more cautious when evaluating patients with knee disorders suffering from psychological distress.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-021-04534-9.

Nanoscopic Medial Meniscus Repair

Arthroscopic meniscus repair is one of the commonly used arthroscopic surgical procedures. Open treatment was the standard for meniscus repairs and recently arthroscopic all-inside treatment has become popular. Novel and more minimally invasive techniques to common arthroscopic procedures are paving the foundation to better patient outcomes. With the use of the NanoScope and nanoinstruments, we continue to develop new minimally invasive diagnostic and treatment techniques that do not require standard portals. The nanoscopic medial meniscus repair technique described here uses a less-invasive approach to a meniscus repair.

Accuracy of standard magnetic resonance imaging sequences for meniscal and chondral lesions versus knee arthroscopy. A prospective case-controlled study of 719 cases

BACKGROUND

Magnetic resonance imaging (MRI) is commonly used for diagnosis and as a research tool, but its accuracy is questionable. The goal of this study was to compare the accuracy of knee MRI with clinical assessment for diagnosing meniscal tears, and to determine the accuracy of MRI for grading chondral lesions, relative to arthroscopy.

METHODS

Physically active patients presenting with mechanical symptoms warranting a knee arthroscopy and satisfying the inclusion criteria, had both a knee arthroscopy and MRI performed. Arthroscopic findings were compared with those of MRI, using the International Chondral Research Society grading for chondral damage, and the presence or absence of a meniscal tear.

RESULTS

A total of 719 patients were recruited over a period of 6.5 years, average age 52 years (standard deviation, SD 5.2), male:female = 493:226. Kappa scores with standard errors (SE) for agreement between MRI and knee arthroscopy were 0.41 (SE 0.1) for medial meniscal tears, and 0.44 (SE 0.1) for lateral meniscal tears. For the grade of chondral damage, the Kappa scores with SE values were 0.09 (0.1), 0.17 (0.1), and 0.22 (0.07) for anterior, medial and lateral compartments, respectively. Using areas under the receiver operating characteristic curves, we found clinical assessment was more accurate than MRI for diagnosis of lateral meniscal tears (P < 0.001), and of similar accuracy for the diagnosis of medial meniscal tears (P = 0.12).

CONCLUSIONS

MRI has relatively poor correlation with arthroscopic findings for grading the chondral damage and was less accurate than clinical assessment for the diagnosis of lateral meniscal tears.