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Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue 8, 1045-1048.
doi: 10.1302/0301-620X.90B8.20189  
Copyright © 2008 by British Editorial Society of Bone and Joint Surgery
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Accuracy of hand-held ultrasound scanning in detecting meniscal tears

A. A. Shetty, MCh, FRCS(Trauma & Orth), Consultant Orthopaedic Surgeon1; A. J. Tindall, MSc, FRCS(Trauma & Orth), Orthopaedic Specialist Registrar2; K. D. James, MRCS, Orthopaedic Specialist Registrar3; J. Relwani, FRCS(Trauma & Orth), Consultant Orthopaedic Surgeon4; and K. W. Fernando, MSc, Superintendent Radiographer5

1 King’s College Hospital, Denmark Hill, London SE5 9RS, UK.
2 Princess Royal University Hospital, Orpington, Kent BR6 8ND, UK.
3 Queen Elizabeth the Queen Mother Hospital, St Peters Road, Margate, Kent CT9 4AN, UK.
4 William Harvey Hospital, Kennington Road, Willesborough, Ashford, Kent TN24 0LZ, UK.
5 Medway Maritime Hospital, Windmill Road, Gillingham, Kent ME7 5NY, UK.

Correspondence should be sent to Mr A. J. Tindall at 12 Farington House, 22 Gloucester Street, Pimlico, London SW1V 2DN, UK; e-mail: alistair_tindall{at}hotmail.com

The diagnosis of a meniscal tear may require MRI, which is costly. Ultrasonography has been used to image the meniscus, but there are no reliable data on its accuracy. We performed a prospective study investigating the sensitivity and specificity of ultrasonography in comparison with MRI; the final outcome was determined at arthroscopy. The study included 35 patients with a mean age of 47 years (14 to 73).

There was a sensitivity of 86.4% (95% confidence interval (CI) 75 to 97.7), a specificity of 69.2% (95% CI 53.7 to 84.7), a positive predictive value of 82.6% (95% CI 70 to 95.2) and a negative predictive value of 75% (95% CI 60.7 to 81.1) for ultrasonography. This compared favourably with a sensitivity of 86.4% (95% CI 75 to 97.7), a specificity of 100.0%, a positive predictive value of 100.0% and a negative predictive value of 81.3% (95% CI 74.7 to 87.9) for MRI.

Given that the sensitivity matched that of MRI we feel that ultrasonography can reasonably be applied to confirm the clinical diagnosis before undertaking arthroscopy. However, the lower specificity suggests that there is still a need to improve the technique to reduce the number of false-positive diagnoses and thus to avoid unnecessary arthroscopy.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General