Diagnostic performance of clinical examination and selective magnetic resonance imaging in the evaluation of intraarticular knee disorders in children and adolescents

To determine the diagnostic performances of clinical examination and select ive magnetic resonance imaging in the evaluation of intraarticular knee dis orders in children and adolescents we compared them with arthroscopic findi ngs in a consecutive series of pediatric patients (less than or equal to 16 years old). Stratification effects by patient age and magnetic resonance i maging center were examined. There were 139 lesions diagnosed clinically, 1 28 diagnosed by magnetic resonance imaging, and 135 diagnosed arthroscopica lly. There was no significant difference between clinical examination and m agnetic resonance imaging with respect to agreement with arthroscopic findi ngs (clinical examination, 70.3%; magnetic resonance imaging, 73.7%), overa ll sensitivity (clinical examination, 71.2%; magnetic resonance imaging, 72 .0%), and overall specificity (clinical examination, 91.5%; magnetic resona nce imaging, 93.5%). Stratified analysis by diagnosis revealed significant differences only for sensitivity of lateral discoid meniscus (clinical exam ination, 88.9%; magnetic resonance imaging, 38.9%) and specificity of media l meniscal tears (clinical examination, 80.7%; magnetic resonance imaging, 92.0%). For magnetic resonance imaging, children younger than 12 years old had significantly lower overall sensitivity (61.7% versus 78.2%) and lower specificity (90.2% versus 95.5%) compared with children 12 to 16 years old. There was no significant effect of magnetic resonance imaging center. In c onclusion, selective magnetic resonance imaging does not provide enhanced d iagnostic utility over clinical examination, particularly in children, and should be used judiciously in cases where the clinical diagnosis is uncerta in and magnetic resonance imaging input will alter the treatment plan.