Diagnostic performance of volume and limited oblique MRI of the anterior cruciate ligament compared to knee arthroscopy

Background: Many strategies have been used to improve the visualisation of the ACL including sagittal, coronal oblique sequences, and 3D volume imaging. Nevertheless, the ACL may not always be visualised. Methods: Two hundred and thirty-one consecutive patients (77 females; 154 males; Average age 43.5, range 18 to 82 years; 205 with chronic, 20 acute, and 6 acute on chronic symptoms) underwent knee arthroscopy for mechanical symptoms within a week of MRI. After routine orthogonal sequences, if general MRI radiographers, with over four years experience, were not able to identify the presence of the ACL, then two 3D volume sequences and 2D limited sagittal oblique T1 sequences were performed. Patients requiring extra sequences, missed by the radiography technicians, were recalled. The MRI sequences were evaluated in a blinded fashion by three radiologists, and compared to the knee arthroscopy findings, with the normal ACL acting as internal controls. The radiography technicians performed additional ACL sequences in 63 patients (27%); Of these, 10 patients had a partial and 12 patients had a complete ACL tear. Only 2 patients (0.6%) were recalled (one with a normal, and one with a full thickness ACL tear). Results: The filmed ACL evaluation for complete tears and a normal ACL had a sensitivity of 100%, specificity of 97.1% and accuracy of 97.3%, slightly higher than evaluating on the monitor. Volume sequences had specificities and accuracies over 95%, with good intraobserver reliability (Kappa 0.859, 95% CI 0.705-1.0). Experienced radiographers identified most cases requiring supplementary MRI ACL sequences. An additional volume sequence was beneficial when filmed. Use of the monitor can offer some benefits. Limited oblique T1 sequence of the intercondylar notch was unreliable