Diagnostic accuracy of magnetic resonance imaging in detecting anterior cruciate ligament injuries

  • Ashfaq Ahmed Department of Orthopedics and Spine, Ghurki Trust Teaching Hospital, Lahore
  • Muhammad A. Razzaque Department of Orthopedics and Spine, Ghurki Trust Teaching Hospital, Lahore
  • Muhammad Kaleem Department of Orthopedics and Spine, Ghurki Trust Teaching Hospital, Lahore
  • Atiq U. Zaman Department of Orthopedics and Spine, Ghurki Trust Teaching Hospital, Lahore
  • Rizwan Akram Department of Orthopedics and Spine, Ghurki Trust Teaching Hospital, Lahore
  • Shahzad Javed Department of Orthopedics and Spine, Ghurki Trust Teaching Hospital, Lahore
Keywords: ACL, arthroscopy, knee, MRI
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Background: The anterior cruciate ligament (ACL) stabilizes the joint during hyperextension and prevents anterior translation over femur. The objective of this study was to determine the diagnostic accuracy of magnetic resonance imaging (MRI) in detecting ACL injury by taking arthroscopy as gold standard in patients with traumatic knee injury.

Methods: Patients fulfilling the study criteria were treated with clinical examination, MRI and then arthroscopy at the Department of Orthopedics and Spine in the Ghurki Trust Teaching Hospital, Lahore. The accuracy, sensitivity and specificity of MRI in diagnosing the anterior cruciate ligament injury were calculated based on arthroscopic findings. All the data were analyzed using SPSS 17.0 version.

Results: A total 185 patients were included. 91.1% were males and 8.9% were females with Mean age of 28.25±0.433. The accuracy of MRI in diagnosing the anterior cruciate ligament was 91.89%, with sensitivity of 93.33%, specificity of 85.71%, positive predictive value of 96.55% and the negative predictive value of 75%.

Conclusion: MRI is accurate and non-invasive modality for the assessment of ligamentous injuries. It can be used as a first line investigation to patients with suspicion of ACL injury.

Author Biography

Ashfaq Ahmed, Department of Orthopedics and Spine, Ghurki Trust Teaching Hospital, Lahore
Department of Orthopedics and spine centre


  1. Solomon L. Warwick D, Nayagam S. Apley’s system of orthopaedics and fractures. 9th edition. Imaging of knee. Bristol. UK;2010:553.

  2. Canale ST, Beaty JH. Campbell's operative orthopaedics. 12th edition New York: Mosby; 2013:2133-6.

  3. Clayton RA, Court-Brown CM. The epidemiology of musculoskeletal tendinous and ligamentous injuries. Injury. 2008;39(12):1338-44. https://doi.org/10.1016/j.injury.2008.06.021

  4. Muhle C, Ahn JM, Dieke C. Diagnoses of ACL and meniscal injuries: MR imaging of knee flexion versus extension compared to arthroscopy. Springerplus. 2013;2(1):213. https://doi.org/10.1186/2193-1801-2-213

  5. Noyes F, Mooar P, Matthews D, Butler DL. The symptomatic anterior crucial deficient knee: Part I: the long-term functional disability in athletically active individuals. J Bone Joint Surg Am. 1983;65(2):154-62. https://doi.org/10.2106/00004623-198365020-00003

  6. Kostov H, Stojmenski S, Kostova E. Reliability assessment of arthroscopic findings versus MRI in ACL injuries of knee. Acta Inform Med. 2014;22(2):111-4. https://doi.org/10.5455/aim.2014.22.111-114

  7. Cellar R, Sokol D, Lacko M, Štolfa Š, Gharaibeh A, Vaško G. Magnetic resonance imaging in the diagnosis of intraarticular lesions of the knee. Acta Chir Orthop Traumatol Cech. 2012;79(3):249–54. http://dx.doi.org/10.1590/S0100-39842007000300009

  8. Sharma UK, Shrestha BK, Rijal S, Bijukachhe B, Barakoti R, Banskota B, et al. Clinical, MRI and arthoscopic correlation in internal derrangement of knee. Kathmandu Univ Med J. 2011;9(35):174-8.

  9. Siddiqui A, Ahmad I, Sabir AB, Ekram Ullah, Rizvi SA, RizvI SW. Clinical examination vs. MRI: evaluation of diagnostic accuracy in detecting ACL and meniscal injuries in comparison to arthroscopy. Pol Orthop Traumatol. 2013;78:59-63.

  10. Gupta S, Sharma R, Sachar R, Saini Y, Saini N. Comparison of clinical examination, MRI and arthroscopy in knee injuries. Internet J Orthop Surg. 2012;19(3):275-81.

  11. Stein V, Li L, Lo G, Guermazi A, Zhang Y, Kent Kwoh C, et al. Pattern of joint damage in persons with knee osteoarthritis and concomitant ACL tears. Rheumatol Int. 2012;32(5):1197-208. https://doi.org/10.1007/s00296-010-1749-y

  12. Leblanc M-C, Kowalczuk M, Andruszkiewicz N, Simunovic N, Farrokhyar F, Turnbull TL, et al. Diagnostic accuracy of physical examination for anterior knee instability: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2015;23(10):2805-13. https://doi.org/10.1007/s00167-015-3563-2

  13. Palm H-G, Bergenthal G, Ehry P, Schwarz W, Schmidt R, Friemert B. Functional ultrasonography in the diagnosis of acute anterior cruciate ligament injuries: a field study. Knee. 2009;16(6):441-6. https://doi.org/10.1016/j.knee.2009.04.012

  14. Milewski MD, Sanders TG, Miller MD. MRI-arthroscopy correlation: the knee. J Bone Joint Surg Am. 2011;93(18):1735-45. https://doi.org/10.2106/JBJS.9318ICL

  15. Ng AW, Griffith JF, Hung EH, Law KY, Yung PS. MRI diagnosis of ACL bundle tears: value of oblique axial imaging. Skeletal Radiol. 2013;42(2):209-17. https://doi.org/10.1007/s00256-012-1372-y

  16. Han Y, Kurzencwyg D, Hart A, Powell T, Martineau PA. Measuring the anterior cruciate ligament's footprints by three-dimensional magnetic resonance imaging. Knee Surg Traumatol Arthrosc. 2012;20(5):986-95. https://doi.org/10.1007/s00167-011-1690-y

  17. Smith TO, Lewis M, Song F, Toms AP, Donell ST, Hing CB. The diagnostic accuracy of anterior cruciate ligament rupture using magnetic resonance imaging: a meta-analysis. Eur J Orthop Surgery Traumatol. 2012;22(4):315-26. https://doi.org/10.1007/s00590-011-0829-3

  18. Liodakis E, Hankemeier S, Jagodzinski M, Meller R, Krettek C, Brand J. The role of preoperative MRI in knee arthroscopy: a retrospective analysis of 2,000 patients. Knee Surgery Sports Traumatol Arthroscopy. 2009;17(9):1102-6. https://doi.org/10.1007/s00167-009-0835-8

  19. Khan HA, Ahad H, Sharma P, Bajaj P, Hassan N, Kamal Y. Correlation between magnetic resonance imaging and arthroscopic findings in the knee joint. Trauma Mon. 2015;20(1):e18635. doi: 10.5812/traumamon.18635

  20. Gupta K, Guleria M, Sandhu P, Galhotra R. Correlation of clinical, MRI and arthroscopic findings in diagnosing meniscus and ligament injuries at knee joint: A prospective study. J Orthop Allied Sci. 2013;1(1):2-6. https://doi.org/10.4103/2319-2585.117379

  21. Thiga L. Findings of magnetic resonance imaging of intra-articular knee pathology: Radioarthroscopic correlation. University of Nairobi, CHS, Kenya; 2008.

  22. Khalil AO, Resnick D, Zeid AF, Zaiton FM. The role of magnetic resonance musculoskeletal imaging in evaluation of sports injuries of the knee joint. Zagazig University Medical Journal. 2015;20(6).

  23. Murmu C, Tiwari P, Sircar S, Agrawal V. Accuracy of magnetic resonance imaging in diagnosis of knee injuries. Int J Orthop. 2017;3(1):85-8. https://doi.org/10.22271/ortho.2017.v3.i1b.15

How to Cite
Ahmed A, Razzaque MA, Kaleem M, Zaman AU, Akram R, Javed S. Diagnostic accuracy of magnetic resonance imaging in detecting anterior cruciate ligament injuries. Med J Indones [Internet]. 2017Nov.27 [cited 2024Apr.24];26(3):218-23. Available from: https://mji.ui.ac.id/journal/index.php/mji/article/view/1873
Clinical Research