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Evaluation of Recurring Meniscal Tears with Gadolinium-Enhanced Magnetic Resonance Imaging

A Randomized, Prospective Study

Michael J. Vives, MD^*, David Homesley, MD^*, Michael G. Ciccotti, MD^*,, and Mark E. Schweitzer, MD

^* Department of Orthopaedic Surgery, Department of Radiology, Jefferson Medical College of Thomas Jefferson University, Rothman Institute, Philadelphia, Pennsylvania

Address correspondence and reprint requests to Michael G. Ciccotti, MD, Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107

Background: Magnetic resonance imaging has been shown to be of questionable accuracy in detecting recurrent meniscal tears after previous resection or repair.

Purpose: To compare the accuracy of nonenhanced magnetic resonance imaging with that of intraarticular contrast-enhanced direct magnetic resonance arthrography and intravenous contrast-enhanced indirect magnetic resonance arthrography for detection of recurrent meniscal tears.

Study Design: Prospective cohort study.

Methods: Forty-one patients who had previous meniscal tears treated by resection or repair but who were experiencing recurrent knee symptoms were prospectively randomized into one of three groups: conventional magnetic resonance imaging, indirect arthrography, and direct arthrography. The interpretations of two musculoskeletal radiologists were compared with the findings of an arthroscopic procedure performed 2 to 14 weeks later.

Results: Conventional imaging had a sensitivity of 57.9%, specificity of 80%, and overall accuracy of 62.5%. Intravenous contrast improved the sensitivity to 90.9%, specificity to 100%, and overall accuracy to 93.8%; intraarticular contrast had a sensitivity of 91.7%, specificity of 100%, and an overall accuracy of 92.9%.

Conclusions: We demonstrated an increased accuracy of intravenous or intraarticular contrast-enhanced magnetic resonance arthrography in detecting recurrent meniscal tears. Both contrast routes demonstrated similar accuracy, a finding not previously reported.

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