Critically low accuracy of MRI in knee injury diagnosis in Afghanistan healthcare system: a comparative study with arthroscopy and physical examination.

backgroundKnee injuries, particularly those involving the meniscus and anterior cruciate ligament (ACL), are common musculoskeletal disorders that can lead to significant clinical and functional impairment. Accurate diagnosis is crucial for effective management and recovery. This study aimed to compare the diagnostic efficacy of physical examination (PE) and magnetic resonance imaging (MRI) for detecting meniscus tears and ACL injuries, at Afghanistan using arthroscopy as the reference standard. METHODOLOGY: A retrospective cross-sectional study was conducted on 377 patients with meniscus tears and 570 patients with ACL injuries at multiple hospitals in Kabul, Afghanistan. Diagnostic performance metrics, including sensitivity, specificity, accuracy, and predictive values, were calculated for PE and MRI.

resultsThe results revealed that PE demonstrated superior diagnostic performance compared to MRI. For meniscus tears, PE exhibited a sensitivity of 91.0%, specificity of 91.0%, and overall accuracy of 91.0%, with a positive predictive value (PPV) of 91.92% and a negative predictive value (NPV) of 90.0%. The diagnostic odds ratio (DOR) for PE was 102.12, indicating high reliability. In contrast, MRI showed significantly lower diagnostic accuracy for meniscus tears, with a sensitivity of 42.0%, specificity of 14.1%, and overall accuracy of 28.91%. The DOR for MRI was only 0.1188, reflecting poor diagnostic utility. Similarly, for ACL injuries, PE outperformed MRI with a sensitivity of 87.4%, specificity of 82.2%, and overall accuracy of 86.1%. The PPV and NPV for PE were 93.7% and 68.2%, respectively, with a DOR of 32.1. MRI, on the other hand, showed a sensitivity of 76.9% and a specificity of 8.5%, resulting in an overall accuracy of 60.0% and a DOR of 0.310. Receiver operating characteristic (ROC) curve analysis further confirmed the diagnostic superiority of PE, with an area under the curve (AUC) of 0.910 for meniscus tears and 0.848 for ACL injuries, compared to MRI’s AUC of 0.281 and 0.427, respectively. Combining PE and MRI using logical OR and AND analyses improved sensitivity but reduced specificity, indicating that PE alone remains the more reliable diagnostic tool.

conclusionThis study highlights the diagnostic superiority of PE over MRI for meniscus tears and ACL injuries, particularly in resource limited sittings specifically at Afghanistan PE demonstrated higher diagnostic accuracy than MRI for both ACL and meniscus injuries, highlighting its reliability as a cost-effective first-line tool in resource-limited settings like Afghanistan.