ADVANCED IMAGINING

Nineteen high quality (Ahmadi, 2022; Alizadeh, 2013; DeSmet, 1994; Grevitt, 1992; Grevitt, 1993; Jurik, 1986; Lohmann, 1991; Murray, 1990; Nazem, 2006; Nederveen, 1989; Porter, 2021; Rand, 1999; Raunest, 1991; Reicher, 1987; Rubin, 1994; Shantanu, 2021; Shetty, 2008; Syal, 2015; Wareluk, 2012) and twenty-two moderate quality (Abd Elkhalek, 2019; Abdon, 1989; Araki, 1992; Dhillon, 1985; Elshimy, 2021; Evancho, 1990; Gokalp, 2012; Habib, 2023; Mackenzie, 1995; Madhusudhan, 2008; Matava, 1999; McNally, 2002; Muellner, 1997; Nalaini, 2022; Nemec, 2008; Orlando Junior, 2015; Reicher, 1986; Roper, 1986; Schafer, 2006; Tahmasebi, 2005; Vande Berg, 2000; Van Heuzen, 1988) studies evaluated advanced imaging modalities as diagnostic tests for acute meniscal tears. A meta-analysis was performed using findings of acute meniscal pathology on an MRI compared to arthroscopic findings demonstrated acceptable sensitive and specificity of an MRI in the identification of acute meniscal pathology (sensitivity 0.93[0.71,0.99] and specificity 0.83 [0.45, 0.97])[13 High, Alizadeh, Grevitt, Shetty, De Smet, Nazem, Nederveen, Raunest, Reicher, Shantanu, Syal, Porter, Rand, Rubin; 17 Mod, Habib, Mackenzie, Matava, Nemec, Abd Elkhalek, Elshimy, Madhusudhan, McNally, Muellner, Tahmasebi, van Heuzen, Araki, Orlando Junior, Reicher, Evancho, Gokalp, Nailani, Schafer]. Similar findings were observed in both medial and lateral meniscal pathology with lateral meniscus having a higher specificity (0.94 [0.86,0.97] versus 0.78[0.66, 0.86]) and medial meniscus having a higher sensitivity (0.94[0.89, 0.97] versus 0.80 [0.70, 0.87]).
For patients in which an MRI is contra-indicated including, but not limited to, those with cardiac implants (ie pacemaker), spinal implants, some dental implants, infusions pumps, or cochlear implants, ultrasound [4 High, Ahmadi, Alizadeh, Shetty, Wareluk; 1 Mod, Elshimy] and computed tomography/SPECT [4 High, Jurik, Grevit, Lohmann, Murray; 2 Mod. Tahmasebi, Vande Berg], or arthrography [3 Mod, van Heuzen, Abdon, Dhilllon] are acceptable options with added risk for an infection when an arthrogram is performed or radiation exposure.

Benefits/Harms of Implementation
Advantages of MRI to identify acute meniscal pathology is high accuracy compared with ultrasound and computed tomography and avoiding any radiation or intervention (arthrogram). Ultrasound also presented with limited harm with added benefit when applicable.

Computed tomography or a SPECT can afford potential harmful effects of radiation to the patient. Particular harm should be considered in those of childbearing age due to detrimental effects of radiation during pregnancy.

Despite the value of arthrography, there is added risk with injection, which include infection and pain as well as intolerance (ie allergic reaction) to contrast that should be noted.

Outcome Importance
Value to identify acute meniscal pathology will aid in accurate and appropriate treatment.

Cost Effectiveness/Resource Utilization
Recent cost and accessibility of MRI has allowed for reasonable cost associated with this advanced modality compared to other forms of advanced imaging. More cost-effective treatment including ultrasound and CT scan are acceptable options.

Acceptability
MRI and other forms of advanced imaging are readily available and accessible to most modern medical communities. Ultrasound and CT scan may be more accessible in rural or underserved areas and are acceptable options.

Feasibility
Advanced imaging modalities are feasible, however, arthrography may be out of favor with routine assessment of acute meniscal pathology due to its invasiveness.

Future Research
Abundant high-quality studies are available on this topic. Future research may focus on value based imaging modalities and minimizing risks.