Clinical Tests and MRI in the Evaluation of Anterior Cruciate Ligament Injuries: A Comparative Study with Arthroscopic Findings

Abstract

Background

Accurate diagnosis of Anterior Cruciate Ligament (ACL) injuries is essential for optimal management. While clinical examination and Magnetic Resonance Imaging (MRI) are standard, their diagnostic reliability varies. This study aimed to evaluate the diagnostic accuracy of clinical tests and MRI compared to the gold standard of arthroscopy.

Methods

A prospective analytical study was conducted at Dhulikhel Hospital (June 2018–March 2020) involving 108 adult patients with suspected ACL or meniscal injuries. Patients underwent clinical evaluation (Anterior Drawer, Lachman, and Pivot Shift tests) and a 1.5-T MRI before undergoing diagnostic arthroscopy. Sensitivity, specificity, and diagnostic accuracy (DA) were calculated.

Results

The mean age of patients was 35.41±13.12 years. Arthroscopy confirmed the diagnosis in all cases. Among individual clinical tests, the Lachman test was the most sensitive (78.79%, DA: 84.26%), while the Pivot Shift test was the most specific (97.62%, DA: 79.63%). MRI demonstrated a sensitivity of 86.36% and a specificity of 88.10% (DA: 87.04%). Notably, the combination of any one of the three clinical tests being positive yielded the highest sensitivity (89.39%) and a diagnostic accuracy (87.96%) that surpassed MRI alone.

Conclusion

Clinical examination remains a highly reliable tool for diagnosing ACL injuries. The Lachman test is the best “rule-out” screening tool, while the Pivot Shift test is a superior “rule-in” confirmatory test. MRI should be used as a complementary tool for assessing associated pathologies rather than a replacement for thorough clinical evaluation.