Diagnostic Accuracy of Magnetic Resonance Imaging for the Assessment of Meniscal Tears Using Arthroscopic Findings as the Gold Standard

Background: Meniscal injuries are a frequent consequence of knee trauma and represent a common cause of pain, instability, and functional limitation. Accurate diagnosis is essential for appropriate surgical planning. Although arthroscopy remains the gold standard for detecting meniscal pathology, it is an invasive procedure. Magnetic resonance imaging (MRI) offers a non-invasive alternative with high diagnostic potential for evaluating meniscal and ligamentous injuries of the knee. Objective: To determine the diagnostic accuracy of magnetic resonance imaging in the detection of meniscal tears, using arthroscopic findings as the gold standard. Methodology: This prospective diagnostic accuracy study was conducted in the Diagnostic Radiology Department of Children’s Hospital and The Institute of Child Health, Multan, over a six-month period. A total of 200 patients aged 14–55 years with clinical suspicion of meniscal tear underwent knee MRI followed by arthroscopy. MRI examinations were performed using a 1.5-Tesla scanner and interpreted by a consultant radiologist. Arthroscopic evaluation was carried out by a single consultant orthopedic surgeon blinded to MRI findings. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy of MRI were calculated using arthroscopy as the reference standard. Results: The median age of participants was 30 years, and 58.5% were male. MRI detected medial and lateral meniscal tears in 46.5% and 22% of patients, respectively, while arthroscopy identified tears in 55% and 27%. For medial meniscal tears, MRI demonstrated a sensitivity of 84.6%, specificity of 100%, PPV of 100%, NPV of 84.1%, and accuracy of 91.5%. For lateral meniscal tears, sensitivity was 79.6%, specificity 99.3%, PPV 97.7%, NPV 92.9%, and accuracy 94%. Conclusion: Magnetic resonance imaging demonstrated good diagnostic accuracy for both medial and lateral meniscal tears, with excellent specificity and positive predictive value, particularly for medial meniscal injuries. These findings support the use of MRI as a reliable, non-invasive diagnostic tool prior to arthroscopy. Keywords: Arthroscopy, Diagnostic Accuracy, Knee Injury, Magnetic Resonance Imaging, Meniscal Tears.