Diagnosis of partial tears of the anterior cruciate ligament of the knee: Value of MR imaging

OBJECTIVE. The purpose of our study was to assess the ability of MR imaging to detect partial tears of the anterior cruciate ligament (ACL) as these injuries, if extensive enough, may result in ligamentous insufficiency or predispose to subsequent acquired knee instability. MATERIALS AND METHODS. A review of all arthroscopic reports from two institutions during the periods 1990-1992 and 1992-1993, respectively, revealed 13 patients with partial tears of the ACL. Thirteen cases each of intact and completely ruptured anterior cruciate ligaments on arthroscopy were randomly selected as controls from the same report review. Preoperative MR images for all cases selected were obtained. Criteria for diagnosis included the absence of findings of complete ACL tear in conjunction with abnormal intrasubstance signal, bowing of the ACL, or nonvisualization of the ACL on one MR imaging sequence with visualization of intact fibers on other sequences. Inter- and intraobserver agreement was assessed using the kappa statistic. RESULTS. The sensitivity of MR imaging for detecting partial ACL tears ranged from 0.40 to 0.75, and the specificity ranged from 0.62 to 0.89. Variability of both inter- and intraobserver interpretations was greater than 0.7 kappa in all but one combination, comparing the diagnostic consistency of each of three readers both with himself, using two readings on separate days, and with each separate interpretation by the other two radiologists. CONCLUSION. Our results show that MR evaluation of partial ACL tears is not sufficiently sensitive to establish the diagnosis without arthroscopy. This study was limited, however, by its small size and by the heterogeneity of the MR imaging technique.