Knee Arthroscopy versus Magnetic Resonance Imaging in the Diagnosis of ACL Injury – A Comparative Study

Background: Accurate diagnosis of anterior cruciate ligament (ACL) injuries is critical for selecting appropriate treatment strategies and preventing long-term knee dysfunction. Magnetic resonance imaging (MRI) is widely used as a non-invasive diagnostic tool, while arthroscopy remains the gold standard. Objectives: This study aimed to compare the diagnostic accuracy of MRI against arthroscopic findings in ACL injuries and to assess its current performance in clinical settings for the years 2024–2025. Methods: A total of 40 patients (31 males, 77%; 9 females, 23%) aged 20–50 years (median age 35 years) who presented with suspected ACL injury were enrolled. All patients underwent MRI examination followed by arthroscopic evaluation, which served as the reference standard. Diagnostic indices, including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy, were calculated. Results: MRI correctly identified 22 actual positive cases and three true negative cases, with one false positive and 14 false negative results when compared with arthroscopy. The calculated diagnostic performance of MRI was as follows: sensitivity 93%, specificity 88%, PPV 82%, NPV 95%, and overall accuracy 90%. Conclusion: MRI demonstrates high sensitivity and accuracy in diagnosing ACL injuries, making it a valuable non-invasive diagnostic tool. However, certain discrepancies compared with arthroscopy suggest that MRI should be interpreted with caution in equivocal cases.