Diagnostic Accuracy of MRI in Detecting ACL and PCL Tears: A Systematic Review
Keywords:
MRI, anterior cruciate ligament, knee injury, diagnostic accuracy, arthroscopyAbstract
Background: Magnetic resonance imaging (MRI) is widely used for diagnosing anterior cruciate ligament (ACL) and associated knee injuries, but reported sensitivity and specificity vary across imaging protocols and study settings.
Objective: To evaluate MRI’s diagnostic accuracy, particularly compared with arthroscopy, in detecting ACL and related intra-articular knee pathologies.
Methods: A comprehensive literature search identified nine eligible studies published between 2020 and 2024 in Egypt, Sweden, China, Pakistan, and India. Designs included prospective, retrospective, cohort, and cross-sectional studies, with sample sizes ranging from 42 to 398 patients aged 14–69 years. Most participants had suspected or confirmed ACL tears, meniscal injuries, or combined pathologies. Some studies assessed novel MRI sequences, special positioning, or alternative imaging modalities.
Results: MRI showed consistently high sensitivity for ACL injuries (often >90%), although specificity and predictive values varied with injury type and imaging protocol. Lateral decubitus MRI improved detection of partial ACL tears, while modified DPP-TSO-Sag-FS-PDWI sequences enhanced diagnostic accuracy and repeatability, especially for intermediate and Grade II injuries. MRI was less effective than arthroscopy in identifying ramp lesions but remained reliable for most intra-articular pathologies.
Conclusion: MRI demonstrates high accuracy in diagnosing ACL and associated knee injuries, often surpassing clinical tests and approaching arthroscopy, though limitations in detecting partial tears and subtle lesions highlight the need for standardized protocols, advanced imaging, and AI-assisted interpretation to optimize diagnostic pathways.
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Copyright (c) 2026 Ni Made Wahyu Surya Aryantini, Ni Putu Udayani Nesa (Author)
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