DIAGNOSING MENISCAL PROBLEMS: LABORATORY TESTSX ray.

An X ray will only show whether a joint space has narrowed due to the almost complete destruction of articular cartilage; it will not show meniscal damage per se. However, it may reveal calcification of the cartilage—a disorder called chondrocalcinosis—which is usually indicative of a degenerative meniscus, which may be prone to tears.MRI. An MRI is the test that is most often used to diagnose meniscal injuries. It has a 90 percent accuracy rate for the meniscus, which means it is good but not perfect. On an MRI the meniscus should appear absolutely black. A tear or injury to the meniscus shows up as tiny dots. A tear that is incomplete is classified as a grade 1 or 2. A complete tear through the top and bottom, such as the parrot beak or bucket handle, is classified as grade 3. An MRI should be interpreted by an experienced knee surgeon or orthopedic radiologist; a general radiologist may not be able to distinguish between a grade 2 or 3 tear with the same degree of accuracy as someone who performs a lot of knee surgeries. Generally speaking, a grade 1 or even a grade 2 tear is not considered serious, nor is it apparent through an arthroscopic examination. This tear is probably insignificant as far as causing any symptoms. If the patient is no longer in pain, the physician may conclude that the meniscus has a stable tear that may not be causing any symptoms. Therefore, the physician may decide to forego surgery in favor of a good muscle-strengthening program. If at a later date, the tear worsens and the patient experiences pain, surgery may be reconsidered.Under the best of circumstances, the MRI is not infallible, and about 10 percent of the time, an MRI will show a grade 2 tear that is actually a more serious grade 3 and vice versa. Therefore, it is very important for the physician to consider carefully the patient’s symptoms before making the diagnosis. If the physician is convinced that the patient has a serious tear that will require surgical repair or resection, she will probably decide to arthroscope the knee.Arthroscopy. An arthroscope by an experienced arthro-scopist can achieve an accuracy rate of about 100 percent. From the arthroscope, the physician can determine if a tear is significant and whether it needs surgical repair.*23\185\2*

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