The Research Of Establishing Trinity Diagnostic Theory In Diagnosising Meniscal Tears Of Knee

ObjectivesThis research analysis the physical examination, Magnetic resonance imaging (MRI) and arthroscopic examination data of patient with meniscal tears, in order to investigate the correlation among these examination method, and explore the regulation of diagnosising meniscal tears. And then, summarized this regulation as Trinity diagnostic theory. Using the theory mainly to improve the accuracy rate of a doctor diagnosising meniscal tears.MethodsIn a prospective study, We collected physical examination, MRI and arthroscopic examination data of patients who underwent arthroscopic procedure because of knee injury. All patients had a history taking, physical examination and MRI scan preoperation. A experts groud diagnosed the disease knee injury and decide the patient could do arthroscopy or not. First, calculate the diagnostic value of symptom, physical examination and MRI. Then, investigate the influencing factors of the accuracy of these three method from the type and location of meniscal tears.Result180cases were included in our study,156cases194meniscus tears were confirmed meniscal tears by arthroscopic examination, of which54cases were medial meniscus,65cases lateral meniscus,38cases bilateral. The most common tear pattern is longitudinal(33.9%),29cases of which is bucket handle. In radial zone, A total of33%of tears involved the posterior horn, compared to only6.9%that involved the anterior horn. Tears that extended into the zone2accounted for95of the total. The Youden index of three symptom(crepitus, locking, limitation of rang of movetion) is bigger than0, the sensitivity, specificity and accuracy of the symptom diagnosis(one of three symptom is positive) is0.71,0.62,0.70. There was significant difference between meniscal tear group and normal group in McMurray test, Apley test, Ege's test, Thessaly test and Joint-line tenderness. Physical examination diagnosis positive is defined as blow:one of non-weight-bearing test (McMurray test, Apley test) positive combine with one of weight-bearing test (Ege's test, Thessaly test) positive. The sensitivity, specificity and accuracy of the physical examination diagnosis is0.92,1,0.93, and the sensitivity, specificity, accuracy of MRI is0.89,0.58,0.85. There was significant difference among symptom diagnosis, physical examination diagnosis and MRI diagnosis. The result of Binary Logistic analysis shows that, the influencing factors of symptom diagnosis is a bucket handle, and the MRI diagnosis influencing factors is the depth of tear, anterior horn tear, a zone2or zone1tear, ACL injury.ConclusionCrepitus, locking,limitation of ROM are three significative symptom in the diagnosis of the meniscus tears, the accuracy of symptom diagnosis at a bucket handle tear is highest. The physical examination diagnosis have a higher accuracy compare to MRI diagnosis, and it can use for diagnosing meniscus tears separately. MRI is a reliable, noninvasive diagnostic tool for meniscal tears, can be used to as a guidance in knee arthroscopy surgery because of it can confirm the type and location of meniscus tears. Arthroscopic diagnosis is the gold standard of diagnosing meniscus tears, combining with the physical examination, MRI, misdiagnose of meniscal tears can be avoided.