Knee meniscal retears after repair: A systematic review comparing diagnostic imaging modalities

Figures & data

Figure 1. PRISMA chart.

Table 1. Summary of included studies

Study	Cardello et al.	Magee T.	Cılız et al.	Kececi et al.
Study design	Non-randomized study	Non-randomized study	Non-randomized study	Cohort study
Year of publication	2008	2014	2008	2014
Number of participants	95	100	72	24
Number of menisci	95	100	72	26
Percentage of females	45.26	32	25	12.5
Age range and mean	22–63 (42)	13–72 (37)	27–52 (41)	17–42 (29.3)
Diagnostic modalities compared	MRI and Direct MRA	MRI, Direct MRA and MRI+ Direct MRA	MRI and Direct MRA	Direct MRA
Mean time gap between meniscal repair surgery and imaging protocol (months)	5–12	Less than 24 months	N/A	7–70
Mean time gap between imaging protocol and second-look arthroscopy (weeks)	2	Less than 7 weeks	7.5	Less than 4 weeks
Number of retears	45	94	37	20
Number of retears proven arthroscopically	43	94	37	20
Kappa test	0.89	N/A	N/A	0.65
Level of evidence	IIa	IIa	IIa	IIb
Reference	12	13	11	14

*N/A: Data not available from the paper.

Table 2. Assessment of bias using MINORS criteria

Study	Cardello et al.	Magee T.	Cılız et al.	Kececi et al.
Other biases	High	Low	High	Low
A clearly state aim	Present	Present	Present	Present
Inclusion of prospective patients	Absent	Absent	Present	Absent
Prospective collection of data	Absent	Absent	Present	Absent
Endpoints appropriate to the aim of the study	Present	Present	Present	Present
Unbiased assessment of study endpoint	Present	Present	Present	Absent
Follow-up period appropriate to the aim of the study	Present	Present	Present	Absent
Loss to follow-up less than 5%	Absent	Absent	Absent	Absent
Prospective calculation of the study size	Absent	Absent	Absent	Absent
Reviewer’s assessment of bias	Moderate	Moderate	Low	High

Table 3. Comparison between meniscal signs on MRI

Study	Cardello et al.		Magee T	Cılız et al.
MR sign	Meniscal shape changes		Meniscal shape changes on both T1 and T2 images	Meniscal shape changes both T1 and T2 images
Type of magnet	0.2 T	1.5 T	3.0 T	0.5 T
Sensitivity (95% CI) (%)	91.11 (78.78–97.52)	86.67 (73.21–94.95)	78.82 (69.07–86.49)	54.05 (36.92–70.51)
Specificity (95% CI) (%)	26 (14.63–40.34)	26 (14.63–40.34)	83.33 (35.88–99.58)	94.29 (80.84–99.30)
PPV (95% CI) (%)	52.56 (47.87–57.21)	51.32 (46.31–56.29)	98.67 (92.5–99.78)	90.91 (71.59–97.54)
NPV (95% CI) (%)	76.47 (53.32–90.24)	68.42 (47.34–83.93)	20 (12.84–29.78)	66.00 (57.55–73.54)
Accuracy (95% CI) (%)	56.84 (46.28–66.97)	54.74 (44.19–64.98)	79 (69.71–86.51)	73.61 (61.90–83.30)

Table 4. Comparison between meniscal signs on Direct MR arthrography

Study	Cardello et al.					Magee T	Cılız et al.	Kececi et al.
MR sign	Contrast tracking into the tear in T1-weighted sequences			Contrast tracking into the tear in T2-weighted sequences		Contrast tracking into the tear in T1-weighted sequences	Contrast tracking into the tear in T1-weighted sequences	Contrast tracking into the tear in T1-weighted sequences
Type of magnet	0.2 T	1.5 T	0.2 T		1.5 T	3 T	0.5 T	1.5 T
Sensitivity (95% CI) (%)	80 (65.4–90.42)	86.67 (73.21–94.95)	84.44 (70.54–93.51)		88.89 (75.95–96.29)	88.3 (80.03–94.01)	94.59 (81.81–99.34)	80 (56.34–94.27)
Specificity (95% CI) (%)	84 (70.89–92.83)	90 (78.19–96.67)	84 (70.89–92.83)		74 (59.66–85.37)	100 (54.07–100)	97.14 (85.68–99.93)	100 (54.07–100)
PPV (95% CI) (%)	81.82 (70.11–89.62)	88.64 (77.11–94.75)	82.61 (71.32–90.07)		75.47 (65.59–83.24)	100 (C/C)	97.22 (83.51–99.59)	100 (C/C)
NPV (95% CI) (%)	82.35 (71.98–89.45)	88.24 (77.98–94.08)	85.71 (75.03–92.3)		88.1 (76.11–94.5)	35.29 (23.84–48.73)	94.44 (81.52–98.5)	60 (38.44–78.28)
Accuracy (95% CI) (%)	82.11 (72.9–89.22)	88.42 (80.23–94.08)	84.21 (75.3–90.88)		81.05 (71.72–88.37)	89 (81.17–94.38)	95.83 (88.3–99.13)	84.62 (65.13–95.64)

C/C: Cannot be calculated.

Figure 2. Forest plot highlighting the sensitivity, specificity, and overall accuracy of MRI and direct MRA.