The Accuracy of Ultrasonography in the Diagnosis of Ligamentous and Meniscal Injuries of the Knee among Patients Attending Muhimbili Orthopaedic Institute (MOI)

The Accuracy of Ultrasonography in the Diagnosis of Ligamentous and Meniscal Injuries of the Knee among Patients Attending Muhimbili Orthopaedic Institute (MOI) | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Accuracy of Ultrasonography in the Diagnosis of Ligamentous and Meniscal Injuries of the Knee among Patients Attending Muhimbili Orthopaedic Institute (MOI) Augustine Muhiza Msonge, Twalib Ngoma, Lulu Fundikira, Mechris Mango, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8916716/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background Ligamentous and meniscal knee injuries are among the most common conditions managed at MOI and represent a significant burden primarily among the young adult population. Magnetic resonance imaging (MRI) has served as the key diagnostic investigation and basis for management decisions, yet it is expensive and less available in peripheral hospitals. Ultrasonography, which is readily available and affordable, remains underutilised and sonographic patterns of knee trauma in our setting are poorly described. Expanded use of ultrasonography could reduce the number of unnecessary referrals and lower treatment costs. Methods This was a prospective descriptive hospital-based cross-sectional study involving 100 consecutive patients with clinically suspected ligamentous and/or meniscal knee injuries referred for MRI at MOI between December 2022 and March 2023. All participants underwent standardised knee ultrasonography before MRI. A structured checklist captured sociodemographic data, clinical presentations, and imaging features. Statistical analysis was performed using SPSS version 23. Descriptive statistics were used for categorical and continuous variables. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy (DA) of ultrasonography were calculated against MRI as the reference standard using 2×2 contingency tables. A p-value < 0.05 was considered statistically significant. Results The study included 100 participants with a mean age of 43.88 years (SD ± 13.9); the majority (46%) fell within the 31–50 age group. Gender distribution was nearly equal (52% male). The most common mechanism of injury was falling (45%), followed by sports activities (33%). Medial meniscal injury was most prevalent (57%), followed by lateral meniscal injury (43%). The most frequent ultrasonographic feature was loss of uniform echopattern throughout the meniscus (68% for MM injuries). The sensitivity, specificity, and diagnostic accuracy of ultrasonography were: medial meniscus 90.5%, 70.3%, 83%; lateral meniscus 71.7%, 87.5%, 78%; medial collateral ligament 25%, 100%, 97%; lateral collateral ligament 0%, 100%, 99%; anterior cruciate ligament 14.3%, 100%, 82%; and posterior cruciate ligament 20%, 100%, 96%, respectively. Conclusions Ultrasonography demonstrated significant diagnostic agreement with MRI for medial and lateral meniscal injuries, with high sensitivity and specificity. High specificity (100%) was observed for all ligamentous injuries, though sensitivity was limited for collateral and cruciate ligaments, likely due to small sample sizes. Ultrasonography shows promise as a cost-effective, accessible first-line or adjunct imaging tool for knee injury assessment in resource-limited settings. knee injuries ultrasonography MRI meniscal injury ligamentous injury Muhimbili Orthopaedic Institute Tanzania Figures Figure 1 Background Knee injuries are among the most common conditions managed in orthopaedic practice, arising from accidents, sports participation, or other trauma. They may be classified as acute if symptoms arise within 30–40 days of the traumatic event, or chronic if symptoms persist beyond that period [ 1 ]. The spectrum of knee injuries ranges from minor conditions requiring conservative management such as rest, ice application, immobilisation, and physiotherapy to major injuries necessitating surgical intervention. Left inadequately diagnosed or managed, these injuries may result in diminished physical function or permanent disability [ 2 ]. The knee joint depends on a complex interplay of ligamentous and meniscal structures to maintain stability and permit its range of motion. These structures are composed of water and densely-packed collagen fibers orientated parallel to the predominant loading axis. Injury to any ligament, particularly complete disruption, precipitates clinical instability and may secondarily damage the menisci and articular cartilage through altered joint kinematics [ 3 ]. Epidemiological patterns of knee injuries vary by age and sex. Young adults particularly males are most commonly affected, typically through outdoor and sporting activities. In older populations, injuries more frequently result from low-energy mechanisms such as falls on level ground, stairs, or ramps [ 4 ]. The most frequently injured structure during sports is the anterior cruciate ligament (ACL), commonly accompanied by injury to the posterior cruciate ligament (PCL), medial collateral ligament (MCL), lateral collateral ligament (LCL), and menisci [ 1 ]. Long-term consequences of meniscal and ligamentous injuries include osteoarthrosis, which typically develops 5–15 years after injury [ 5 ]. Imaging is central to the diagnosis of knee injuries and guides management decisions. Plain radiography detects osseous fractures; computed tomography (CT) is useful for subtle fractures; ultrasonography assesses soft tissue structures; and MRI provides a comprehensive evaluation of both soft tissue and osseous structures. Among these, MRI is considered the reference standard for diagnosing ligamentous and meniscal injuries, with reported sensitivity, specificity, and accuracy of approximately 90.9%, 84.6%, and 88.6%, respectively [ 6 ]. Despite its diagnostic utility, MRI is expensive, time-consuming, and unavailable in many peripheral hospitals across sub-Saharan Africa. Ultrasonography is widely available, affordable, radiation-free, and can be performed at the bedside, making it particularly suitable for resource-limited settings. However, its role in diagnosing knee ligamentous and meniscal injuries in our setting has not been systematically evaluated. Establishing the diagnostic performance of ultrasonography against MRI in this context would support its use as an effective screening tool and potentially reduce unnecessary referrals, lowering costs to both the health system and patients [ 7 ]. Methods Study design, setting and participants This was a prospective, hospital-based, cross-sectional study conducted at the Ultrasonography Unit of the Department of Radiology and Imaging, Muhimbili Orthopaedic Institute (MOI), Dar es Salaam, Tanzania. MOI is a national referral centre for musculoskeletal conditions. The study was conducted from December 2022 to March 2023 and enrolled 100 consecutive participants clinically suspected of ligamentous and/or meniscal knee injuries. Sample size and sampling The sample size of 100 participants was determined using a binomial proportion formula, based on a prior estimated sensitivity of 0.75, a precision of 0.1, and a 95% confidence level. Consecutive sampling was applied to all eligible patients referred for knee MRI at MOI during the study period. Inclusion criteria All patients referred to MOI for an MRI scan with clinical suspicion of knee injuries, presenting with knee pain, swelling, locking, stiffness, popping sensation, or difficulty walking due to joint instability, were eligible for inclusion. Exclusion criteria Patients who were unable to undergo MRI, whose MRI findings were inconclusive, or who declined knee ultrasonography were excluded. Data collection and imaging protocol Data collection and imaging protocol A structured checklist was used to record sociodemographic characteristics, clinical presentations, and imaging findings. All eligible participants underwent standardised B-mode and colour Doppler knee ultrasonography performed by the principal investigator (a radiology resident) prior to MRI. MRI findings were reported by a licensed consultant radiologist. Ultrasonographic and MRI findings were recorded after the principal investigator and the radiologist reached agreement. Ultrasonographic features assessed included: for the menisci, loss of triangular (wedge) shaped appearance, loss of uniform echopattern, and increased vascularity on colour Doppler; for the collateral ligaments, loss of linear shaped appearance, loss of uniform echopattern, and increased vascularity; and for the cruciate ligaments, inhomogeneous hypoechoic pattern, loss of a sharply defined posterior border, increased vascularity, and for the PCL, increased thickness greater than 10 mm. Data analysis All data were entered and analysed using SPSS version 23 (IBM Corp., Armonk, NY, USA). Categorical variables are summarised as frequencies and percentages; continuous variables are presented as means and standard deviations. The diagnostic performance of ultrasonography was assessed against MRI as the reference standard. Sensitivity, specificity, PPV, NPV, and overall diagnostic accuracy were calculated from 2×2 contingency tables for each anatomical structure. A p-value < 0.05 was considered statistically significant. Ethical considerations Ethical approval was granted by the MUHAS Institutional Review Board (reference: MUHAS-REC-01-2023-1498). The study was conducted in accordance with the Declaration of Helsinki. The requirement for individual written informed consent was waived by the IRB, given the prospective observational nature of the study. Permission to collect data was obtained from the Executive Director of MOI. All participant data were anonymised; identifiers were not included in any dataset accessible to the research team. Data were stored securely, and access was restricted to the investigators. Results A total of 100 participants met the inclusion criteria and were enrolled. The gender distribution was nearly equal: 52 males (52%) and 48 females (48%) are summarised in Table 1 . The mean age was 43.88 years (SD ± 13.9), with the majority (46%) falling within the 31–50 year age group are shown in Fig. 1 . The most common mechanism of injury was falling (45%), followed by sports activities (33%) and road traffic accidents. Table 1 Distribution of participants by gender. Gender Number of patients Percentage (%) Male 52 52.0 Female 48 48.0 Total 100 100 Source: Author’s Work Source: Author’s Work Medial meniscal injury was the most prevalent finding on MRI (n = 63; 63%), followed by lateral meniscal injury (n = 60; 60%). ACL injury was identified in 21 participants (21%), MCL injury in 4 (4%), PCL injury in 5 (5%), and LCL injury in 1 (1%). The most frequent ultrasonographic feature was loss of uniform echopattern throughout the meniscus, observed in 68 participants with medial meniscal injury and 46 with lateral meniscal injury. All sonographic features by injury type are summarised in Table 2 . Table 2 The sonographic findings of the patients with a diagnosis of ligamentous and meniscal injuries of the knee Ultrasonographic features MM Injury LM Injury MCL Injury LCL Injury ACL Injury PCL Injury Frequency Loss of a wedge (triangular) shaped appearance 23 16 N/A N/A N/A N/A 39 Loss of uniform echopattern throughout 68 46 N/A N/A N/A N/A 114 Increased vascularity of the meniscus in colour Doppler 1 1 N/A N/A N/A N/A 2 Loss of the linear-shaped appearance of the collateral ligament N/A N/A 0 0 N/A N/A 0 Loss of uniform echopattern throughout the course (collateral) N/A N/A 1 0 N/A N/A 1 Increased vascularity in colour Doppler (collateral) N/A N/A 0 0 N/A N/A 0 Inhomogeneous hypoechoic pattern on the cruciate ligament N/A N/A N/A N/A 2 0 2 Loss of sharply defined posterior border (cruciate) N/A N/A N/A N/A 1 0 1 Increased vascularity in the cruciate on colour Doppler N/A N/A N/A N/A 0 1 1 Increased PCL thickness > 10mm N/A N/A N/A N/A N/A 0 0 Source: Author’s Work Image 1 Left Knee grey-scale (left) and color Doppler (right) ultrasound showing normal triangular (wedge) appearance of the lateral meniscus, homogenous echogenicity and normal vascularity on color doppler (orange arrows). Image 2 Right Knee gray-scale (left) and color Doppler (right) ultrasound show complete loss of triangular (wedge) shaped appearance of lateral meniscus with loss of uniform echopattern (homogenous echogenicity) throughout the meniscus (green arrows) with normal vascularity. Image 3 Grey-scale (left) and colour Doppler (right) show abnormal disruption of the triangular (wedge) shaped appearance of the lateral meniscus and abnormal heterogeneous echogenicity (white arrows). No increased vascularity on colour Doppler ultrasound The diagnostic performance of ultrasonography against MRI as the reference standard is presented in Table 3 . Ultrasonography demonstrated the highest sensitivity for medial meniscal injury (90.5%) and the highest specificity (100%) for MCL, LCL, ACL, and PCL injuries. Diagnostic accuracy was highest for LCL injury (99%) and MCL injury (97%), though these results should be interpreted with caution, given the small number of positive cases. Table 3 Sensitivity, specificity, PPV, NPV, and diagnostic accuracy of ultrasonography versus MRI for each anatomical structure. USS MRI Yes No Total Sensitivity % (95% CI) Specificity % (95% CI) PPV % NPV % DA % MM Injury Yes 57 11 68 90.5 70.3 83.8 81.2 83 No 6 26 32 Total 63 37 100 LM Injury Yes 43 5 48 71.7 87.5 89.6 67.3 78 No 17 35 52 Total 60 40 100 MCL Injury Yes 1 0 1 25 100 100 97 97 No 3 96 99 Total 4 96 100 LCL Injury Yes 0 0 0 0 100 0 99 99 No 1 99 100 Total 1 99 100 ACL Injury Yes 3 0 3 14.3 100 100 79 82 No 18 79 97 Total 21 79 100 PCL Injury Yes 1 0 1 20 100 100 96 96 No 4 95 99 Total 5 95 100 Source: Author’s Work Discussion This study evaluated the diagnostic accuracy of ultrasonography in detecting ligamentous and meniscal knee injuries compared with MRI as the reference standard, among patients attending a national orthopaedic referral centre in Tanzania. The mean participant age was 43.88 years, with the 31–50 age group most affected. This is higher than the age groups reported in several European studies for instance, studies from Denmark reported a mean age of 12 years, and studies from South Africa and Sweden reported affected age groups of 18–21 and 15–24 years, respectively [ 8 , 9 ]. This difference may reflect the types and patterns of physical activity in our setting, where adult recreational and occupational activities predominate over youth sports. The gender distribution was nearly equal (52% male), consistent with some published reports but differing from studies conducted predominantly in sports-active male populations [ 3 ]. The most commonly reported mechanism of injury was falling (45%), followed by sports activities (33%), and road traffic accidents. This contrasts with studies in high-income settings where sports activities, particularly soccer, skiing, and basketball, are the predominant aetiologies [ 1 ]. Sports such as skiing are not practised in Tanzania, and competitive youth sports participation patterns differ from those in higher-income settings. The ultrasonographic features identified in this study are consistent with those described in the established literature [ 10 , 11 ]. Loss of uniform echopattern throughout the meniscus was the most frequently observed finding (68% for medial meniscal injury and 46% for lateral meniscal injury), followed by loss of the triangular (wedge) shaped appearance. For collateral ligaments, loss of linear appearance and altered echotexture were assessed; and for cruciate ligaments, inhomogeneous hypoechoic signal, loss of a sharply defined posterior border, and increased vascularity on colour Doppler were evaluated. Ultrasonography showed the highest diagnostic performance for meniscal injuries. For medial meniscal injury, sensitivity was 90.5%, and specificity was 70.3%, yielding an overall diagnostic accuracy of 83%. For lateral meniscal injury, sensitivity was 71.7%, and specificity was 87.5%, with a diagnostic accuracy of 78%. These results are broadly consistent with those reported by Cook et al. and Alizadeh et al. [ 14 , 15 ], who reported sensitivities and specificities of 91.2%/84.2% and 76.2%/83.3%, respectively, and are superior to those reported by Azzoni et al. [ 12 , 13 ], who reported sensitivities as low as 60%. For ligamentous injuries, ultrasonography demonstrated perfect specificity (100%) for MCL, LCL, ACL, and PCL injuries, indicating that when ultrasonography was positive, MRI confirmed the diagnosis in all cases. However, sensitivity was markedly lower: 25% for MCL, 0% for LCL, 14.3% for ACL, and 20% for PCL. These findings should be interpreted with caution, given the small number of MRI-confirmed positive cases for each ligamentous structure (MCL n = 4; LCL n = 1; ACL n = 21; PCL n = 5). The low sensitivity likely reflects the inherent limitations of ultrasonography in visualising intra-articular ligaments such as the ACL and PCL, rather than representing the true clinical performance of the modality. The overall findings support the use of ultrasonography as a first-line or adjunct imaging tool for knee injuries in resource-limited settings such as Tanzania, where access to MRI is restricted. Its availability, low cost, lack of ionising radiation, portability, and compatibility with bedside use make it particularly suited for initial assessment and screening. This study has several limitations. First, the sample size was modest (n = 100), and the number of participants with confirmed ligamentous injuries was small, limiting the precision of sensitivity estimates for these structures. Second, the study was conducted at a single tertiary institution, which may limit generalisability to other settings. Third, as a cross-sectional study, the design did not allow for assessment of longitudinal outcomes or correlation with arthroscopic findings, which would represent a more definitive reference standard. Conclusions Ultrasonography demonstrated clinically meaningful diagnostic agreement with MRI for medial and lateral meniscal knee injuries, with high sensitivity for medial meniscal injury and high specificity across all ligamentous structures. These findings support the use of ultrasonography as a cost-effective and accessible first-line imaging modality for knee injury evaluation in resource-limited settings. Further studies with larger sample sizes are required to validate the sensitivity of ultrasonography for collateral and cruciate ligament injuries specifically. Abbreviations ACL Anterior Cruciate Ligament CI Confidence Interval CT Computed Tomography DA Diagnostic Accuracy IRB Institutional Review Board LCL Lateral Collateral Ligament LM Lateral Meniscus MCL Medial Collateral Ligament MM Medial Meniscus MOI Muhimbili Orthopaedic Institute MRI Magnetic Resonance Imaging MUHAS Muhimbili University of Health and Allied Sciences N/A Not Applicable NPV Negative Predictive Value PCL Posterior Cruciate Ligament PPV Positive Predictive Value SPSS Statistical Package for the Social Sciences USS Ultrasonography Declarations Ethics approval and consent to participate This study received ethical approval from the Muhimbili University of Health and Allied Sciences Institutional Review Board (MUHAS-REC-01-2023-1498). The study was conducted in accordance with the Declaration of Helsinki. The requirement for individual written informed consent was waived by the IRB, given the observational nature of the study. The Executive Director of MOI granted permission to collect data. All participant data were anonymised and access restricted to the research team. Consent for publication Not applicable. Availability of data and materials The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding No funding was received for conducting this study. Authors' contributions AMM: conceptualised and designed the study, performed data acquisition and analysis, interpreted the data, and drafted the manuscript. TN and LF: assisted in study design, data interpretation, and critically revised the manuscript for intellectual content. MM: assisted in study design, performed MRI reporting, contributed to data collection and interpretation, and critically revised the manuscript. MJ: contributed to data analysis and critical review of the manuscript. RS: contributed to data analysis and critical review of the manuscript. All authors read and approved the final manuscript. Acknowledgements The authors acknowledge the support of all staff members at MOI and the MUHAS Department of Radiology and Imaging. The authors also acknowledge the participants who consented to take part in this research. References Almaawi A, Awwad W, Bamugaddam A, Alasheikh M, Muaddi M, Almutair O, et al. Prevalence of knee injuries among male college students in Riyadh. Kingd Saudi Arabia. 2020;1:1–8. Mri T. Sensitivity and Specificity of Magnetic Resonance Imaging for Knee Injury and Clinical Application for the Naresuan University Hospital. 2012;95:151–7. Ã SLW, Abramowitch SD, Kilger R, Liang R. Biomechanics of knee ligaments: injury, healing, and repair. 2006;39:1–20. Gage BE, Mcilvain NM, Collins CL, Fields SK, Comstock RD. Presenting to United States Emergency Departments From 1999 Through 2008. 2012;378–85. Lohmander LS, Roos H, Lohmander LS, Roos H. Knee ligament injury, surgery and osteoarthrosis : Truth or consequences ? Knee ligament injury, surgery and osteoarthrosis Truth or consequences ? 2016;6470 (March). Laoruengthana A, Jarusriwanna A. Sensitivity and Specificity of Magnetic Resonance Imaging for Knee injury and Clinical Application for the Naresuan University Hospital. 95, J Med Assoc Thai. 2012. Ghosh N, Kruse D, Subeh M, Lahham S, Fox JC. Comparing Point-of-care-ultrasound (POCUS) to MRI for the Diagnosis of Medial Compartment Knee Injuries. J Med Ultrasound. 2017;25(3):167–72. Ying G, Maguire MG, Glynn RJ, Rosner B. Calculating Sensitivity, Specificity, and Predictive Values for Correlated Eye Data. 2020;0–5. Hanga AH, Hussain I. Brief review on Sensitivity, Specificity and Predictivities. 2015;(April). Razek AAKA, Fouda NS, Elmetwaley N, Elbogdady E. Sonography of the knee joint *. J Ultrasound. 2009;12(2):53–60. Available from: http://dx.doi.org/10.1016/j.jus.2009.03.002 Remer M, Fitzgerald W, Rogers LF, Hendrix W. Anterior Ligament Imaging Cruciate Injury: Diagnosis Patterns of Injury1. 1991. Azzoni R, Cabitza P. Is There a Role for Sonography in the Diagnosis of Tears of the. Knee Menisci ?; 2002. Stoja E, Konstandin S, Philipp D, Wilke RN, Betancourt D, Bertuch T et al. Improving magnetic resonance imaging with smart and thin metasurfaces. Sci Rep [Internet]. 2021;1–12. Available from: https://doi.org/10.1038/s41598-021-95420-w Cook JL, Cook CR, Stannard MSJP, Vaughn G. MRI versus Ultrasonography to Assess Meniscal Abnormalities in Acute Knees MRI versus Ultrasonography to Assess Meniscal Abnormalities in Acute Knees. 2014; (May 2015). Alizadeh A, Babaei A. Knee sonography as a diagnostic test for medial meniscal tears in young patients. 2013;927–31. Unlu EN, Ustuner E, Saylisoy S, Yilmaz O, Ozcan H, Erden I. The role of ultrasound in the diagnosis of meniscal tears and degeneration compared to. MRI Arthrosc. 2014;2(3). Images Images are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files DataCollectionTool.docx Images.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 23 Mar, 2026 Reviews received at journal 19 Mar, 2026 Reviewers agreed at journal 18 Mar, 2026 Reviewers invited by journal 18 Mar, 2026 Editor invited by journal 23 Feb, 2026 Editor assigned by journal 23 Feb, 2026 Submission checks completed at journal 23 Feb, 2026 First submitted to journal 19 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8916716","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":609695306,"identity":"a4f963c0-6a4f-4ebb-9240-f4772d359ace","order_by":0,"name":"Augustine Muhiza 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(MOI)","fulltext":[{"header":"Background","content":"\u003cp\u003eKnee injuries are among the most common conditions managed in orthopaedic practice, arising from accidents, sports participation, or other trauma. They may be classified as acute if symptoms arise within 30\u0026ndash;40 days of the traumatic event, or chronic if symptoms persist beyond that period [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe spectrum of knee injuries ranges from minor conditions requiring conservative management such as rest, ice application, immobilisation, and physiotherapy to major injuries necessitating surgical intervention. Left inadequately diagnosed or managed, these injuries may result in diminished physical function or permanent disability [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe knee joint depends on a complex interplay of ligamentous and meniscal structures to maintain stability and permit its range of motion. These structures are composed of water and densely-packed collagen fibers orientated parallel to the predominant loading axis. Injury to any ligament, particularly complete disruption, precipitates clinical instability and may secondarily damage the menisci and articular cartilage through altered joint kinematics [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEpidemiological patterns of knee injuries vary by age and sex. Young adults particularly males are most commonly affected, typically through outdoor and sporting activities. In older populations, injuries more frequently result from low-energy mechanisms such as falls on level ground, stairs, or ramps [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The most frequently injured structure during sports is the anterior cruciate ligament (ACL), commonly accompanied by injury to the posterior cruciate ligament (PCL), medial collateral ligament (MCL), lateral collateral ligament (LCL), and menisci [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Long-term consequences of meniscal and ligamentous injuries include osteoarthrosis, which typically develops 5\u0026ndash;15 years after injury [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eImaging is central to the diagnosis of knee injuries and guides management decisions. Plain radiography detects osseous fractures; computed tomography (CT) is useful for subtle fractures; ultrasonography assesses soft tissue structures; and MRI provides a comprehensive evaluation of both soft tissue and osseous structures. Among these, MRI is considered the reference standard for diagnosing ligamentous and meniscal injuries, with reported sensitivity, specificity, and accuracy of approximately 90.9%, 84.6%, and 88.6%, respectively [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite its diagnostic utility, MRI is expensive, time-consuming, and unavailable in many peripheral hospitals across sub-Saharan Africa. Ultrasonography is widely available, affordable, radiation-free, and can be performed at the bedside, making it particularly suitable for resource-limited settings. However, its role in diagnosing knee ligamentous and meniscal injuries in our setting has not been systematically evaluated. Establishing the diagnostic performance of ultrasonography against MRI in this context would support its use as an effective screening tool and potentially reduce unnecessary referrals, lowering costs to both the health system and patients [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design, setting and participants\u003c/h2\u003e \u003cp\u003eThis was a prospective, hospital-based, cross-sectional study conducted at the Ultrasonography Unit of the Department of Radiology and Imaging, Muhimbili Orthopaedic Institute (MOI), Dar es Salaam, Tanzania. MOI is a national referral centre for musculoskeletal conditions. The study was conducted from December 2022 to March 2023 and enrolled 100 consecutive participants clinically suspected of ligamentous and/or meniscal knee injuries.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSample size and sampling\u003c/h3\u003e\n\u003cp\u003eThe sample size of 100 participants was determined using a binomial proportion formula, based on a prior estimated sensitivity of 0.75, a precision of 0.1, and a 95% confidence level. Consecutive sampling was applied to all eligible patients referred for knee MRI at MOI during the study period.\u003c/p\u003e\n\u003ch3\u003eInclusion criteria\u003c/h3\u003e\n\u003cp\u003eAll patients referred to MOI for an MRI scan with clinical suspicion of knee injuries, presenting with knee pain, swelling, locking, stiffness, popping sensation, or difficulty walking due to joint instability, were eligible for inclusion.\u003c/p\u003e\n\u003ch3\u003eExclusion criteria\u003c/h3\u003e\n\u003cp\u003ePatients who were unable to undergo MRI, whose MRI findings were inconclusive, or who declined knee ultrasonography were excluded.\u003c/p\u003e\n\u003ch3\u003eData collection and imaging protocol\u003c/h3\u003e\n\u003cdiv class=\"Heading\"\u003eData collection and imaging protocol\u003c/div\u003e \u003cp\u003eA structured checklist was used to record sociodemographic characteristics, clinical presentations, and imaging findings. All eligible participants underwent standardised B-mode and colour Doppler knee ultrasonography performed by the principal investigator (a radiology resident) prior to MRI. MRI findings were reported by a licensed consultant radiologist. Ultrasonographic and MRI findings were recorded after the principal investigator and the radiologist reached agreement. Ultrasonographic features assessed included: for the menisci, loss of triangular (wedge) shaped appearance, loss of uniform echopattern, and increased vascularity on colour Doppler; for the collateral ligaments, loss of linear shaped appearance, loss of uniform echopattern, and increased vascularity; and for the cruciate ligaments, inhomogeneous hypoechoic pattern, loss of a sharply defined posterior border, increased vascularity, and for the PCL, increased thickness greater than 10 mm.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eAll data were entered and analysed using SPSS version 23 (IBM Corp., Armonk, NY, USA). Categorical variables are summarised as frequencies and percentages; continuous variables are presented as means and standard deviations. The diagnostic performance of ultrasonography was assessed against MRI as the reference standard. Sensitivity, specificity, PPV, NPV, and overall diagnostic accuracy were calculated from 2\u0026times;2 contingency tables for each anatomical structure. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthical considerations\u003c/h3\u003e\n\u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003ewas granted by the MUHAS Institutional Review Board (reference: MUHAS-REC-01-2023-1498). The study was conducted in accordance with the Declaration of Helsinki. The requirement for individual written informed consent was waived by the IRB, given the prospective observational nature of the study. Permission to collect data was obtained from the Executive Director of MOI. All participant data were anonymised; identifiers were not included in any dataset accessible to the research team. Data were stored securely, and access was restricted to the investigators.\u003c/p\u003e \u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 100 participants met the inclusion criteria and were enrolled. The gender distribution was nearly equal: 52 males (52%) and 48 females (48%) are summarised in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The mean age was 43.88 years (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;13.9), with the majority (46%) falling within the 31\u0026ndash;50 year age group are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The most common mechanism of injury was falling (45%), followed by sports activities (33%) and road traffic accidents.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of participants by gender.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of patients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e100\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e100\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eSource: Author\u0026rsquo;s Work\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eSource: Author\u0026rsquo;s Work\u003c/p\u003e \u003cp\u003eMedial meniscal injury was the most prevalent finding on MRI (n\u0026thinsp;=\u0026thinsp;63; 63%), followed by lateral meniscal injury (n\u0026thinsp;=\u0026thinsp;60; 60%). ACL injury was identified in 21 participants (21%), MCL injury in 4 (4%), PCL injury in 5 (5%), and LCL injury in 1 (1%). The most frequent ultrasonographic feature was loss of uniform echopattern throughout the meniscus, observed in 68 participants with medial meniscal injury and 46 with lateral meniscal injury. All sonographic features by injury type are summarised in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe sonographic findings of the patients with a diagnosis of ligamentous and meniscal injuries of the knee\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUltrasonographic features\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMM Injury\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLM Injury\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMCL Injury\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLCL Injury\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eACL Injury\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePCL Injury\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLoss of a wedge (triangular) shaped appearance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLoss of uniform echopattern throughout\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e114\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncreased vascularity of the meniscus in colour Doppler\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLoss of the linear-shaped appearance of the collateral ligament\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLoss of uniform echopattern throughout the course (collateral)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncreased vascularity in colour Doppler (collateral)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInhomogeneous hypoechoic pattern on the cruciate ligament\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLoss of sharply defined posterior border (cruciate)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncreased vascularity in the cruciate on colour Doppler\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncreased PCL thickness \u0026gt;\u0026thinsp;10mm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eSource: Author\u0026rsquo;s Work\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eImage 1\u003c/strong\u003e \u003cp\u003eLeft Knee grey-scale (left) and color Doppler (right) ultrasound showing normal triangular (wedge) appearance of the lateral meniscus, homogenous echogenicity and normal vascularity on color doppler (orange arrows).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eImage 2\u003c/strong\u003e \u003cp\u003eRight Knee gray-scale (left) and color Doppler (right) ultrasound show complete loss of triangular (wedge) shaped appearance of lateral meniscus with loss of uniform echopattern (homogenous echogenicity) throughout the meniscus (green arrows) with normal vascularity.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eImage 3\u003c/strong\u003e \u003cp\u003eGrey-scale (left) and colour Doppler (right) show abnormal disruption of the triangular (wedge) shaped appearance of the lateral meniscus and abnormal heterogeneous echogenicity (white arrows). No increased vascularity on colour Doppler ultrasound\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe diagnostic performance of ultrasonography against MRI as the reference standard is presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Ultrasonography demonstrated the highest sensitivity for medial meniscal injury (90.5%) and the highest specificity (100%) for MCL, LCL, ACL, and PCL injuries. Diagnostic accuracy was highest for LCL injury (99%) and MCL injury (97%), though these results should be interpreted with caution, given the small number of positive cases.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSensitivity, specificity, PPV, NPV, and diagnostic accuracy of ultrasonography versus MRI for each anatomical structure.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUSS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMRI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSensitivity % (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSpecificity % (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePPV %\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNPV %\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eDA %\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eMM Injury\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e90.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e70.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e83.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e81.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e63\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e37\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e100\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eLM Injury\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e71.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e87.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e89.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e67.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e60\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e40\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e100\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eMCL Injury\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e96\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e100\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eLCL Injury\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e99\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e100\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eACL Injury\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e21\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e79\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e100\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003ePCL Injury\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e95\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e100\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003eSource: Author\u0026rsquo;s Work\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study evaluated the diagnostic accuracy of ultrasonography in detecting ligamentous and meniscal knee injuries compared with MRI as the reference standard, among patients attending a national orthopaedic referral centre in Tanzania.\u003c/p\u003e \u003cp\u003eThe mean participant age was 43.88 years, with the 31\u0026ndash;50 age group most affected. This is higher than the age groups reported in several European studies for instance, studies from Denmark reported a mean age of 12 years, and studies from South Africa and Sweden reported affected age groups of 18\u0026ndash;21 and 15\u0026ndash;24 years, respectively [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This difference may reflect the types and patterns of physical activity in our setting, where adult recreational and occupational activities predominate over youth sports. The gender distribution was nearly equal (52% male), consistent with some published reports but differing from studies conducted predominantly in sports-active male populations [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The most commonly reported mechanism of injury was falling (45%), followed by sports activities (33%), and road traffic accidents. This contrasts with studies in high-income settings where sports activities, particularly soccer, skiing, and basketball, are the predominant aetiologies [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Sports such as skiing are not practised in Tanzania, and competitive youth sports participation patterns differ from those in higher-income settings.\u003c/p\u003e \u003cp\u003eThe ultrasonographic features identified in this study are consistent with those described in the established literature [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Loss of uniform echopattern throughout the meniscus was the most frequently observed finding (68% for medial meniscal injury and 46% for lateral meniscal injury), followed by loss of the triangular (wedge) shaped appearance. For collateral ligaments, loss of linear appearance and altered echotexture were assessed; and for cruciate ligaments, inhomogeneous hypoechoic signal, loss of a sharply defined posterior border, and increased vascularity on colour Doppler were evaluated.\u003c/p\u003e \u003cp\u003eUltrasonography showed the highest diagnostic performance for meniscal injuries. For medial meniscal injury, sensitivity was 90.5%, and specificity was 70.3%, yielding an overall diagnostic accuracy of 83%. For lateral meniscal injury, sensitivity was 71.7%, and specificity was 87.5%, with a diagnostic accuracy of 78%. These results are broadly consistent with those reported by Cook et al. and Alizadeh et al. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], who reported sensitivities and specificities of 91.2%/84.2% and 76.2%/83.3%, respectively, and are superior to those reported by Azzoni et al. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], who reported sensitivities as low as 60%.\u003c/p\u003e \u003cp\u003eFor ligamentous injuries, ultrasonography demonstrated perfect specificity (100%) for MCL, LCL, ACL, and PCL injuries, indicating that when ultrasonography was positive, MRI confirmed the diagnosis in all cases. However, sensitivity was markedly lower: 25% for MCL, 0% for LCL, 14.3% for ACL, and 20% for PCL. These findings should be interpreted with caution, given the small number of MRI-confirmed positive cases for each ligamentous structure (MCL n\u0026thinsp;=\u0026thinsp;4; LCL n\u0026thinsp;=\u0026thinsp;1; ACL n\u0026thinsp;=\u0026thinsp;21; PCL n\u0026thinsp;=\u0026thinsp;5). The low sensitivity likely reflects the inherent limitations of ultrasonography in visualising intra-articular ligaments such as the ACL and PCL, rather than representing the true clinical performance of the modality.\u003c/p\u003e \u003cp\u003eThe overall findings support the use of ultrasonography as a first-line or adjunct imaging tool for knee injuries in resource-limited settings such as Tanzania, where access to MRI is restricted. Its availability, low cost, lack of ionising radiation, portability, and compatibility with bedside use make it particularly suited for initial assessment and screening.\u003c/p\u003e \u003cp\u003eThis study has several limitations. First, the sample size was modest (n\u0026thinsp;=\u0026thinsp;100), and the number of participants with confirmed ligamentous injuries was small, limiting the precision of sensitivity estimates for these structures. Second, the study was conducted at a single tertiary institution, which may limit generalisability to other settings. Third, as a cross-sectional study, the design did not allow for assessment of longitudinal outcomes or correlation with arthroscopic findings, which would represent a more definitive reference standard.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eUltrasonography demonstrated clinically meaningful diagnostic agreement with MRI for medial and lateral meniscal knee injuries, with high sensitivity for medial meniscal injury and high specificity across all ligamentous structures. These findings support the use of ultrasonography as a cost-effective and accessible first-line imaging modality for knee injury evaluation in resource-limited settings. Further studies with larger sample sizes are required to validate the sensitivity of ultrasonography for collateral and cruciate ligament injuries specifically.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eACL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAnterior Cruciate Ligament\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConfidence Interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eComputed Tomography\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDiagnostic Accuracy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIRB\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInstitutional Review Board\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLCL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLateral Collateral Ligament\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLateral Meniscus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMCL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMedial Collateral Ligament\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMedial Meniscus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMOI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMuhimbili Orthopaedic Institute\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMRI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMagnetic Resonance Imaging\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMUHAS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMuhimbili University of Health and Allied Sciences\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eN/A\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNot Applicable\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNPV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNegative Predictive Value\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePCL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePosterior Cruciate Ligament\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePPV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePositive Predictive Value\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSPSS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStatistical Package for the Social Sciences\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUSS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUltrasonography\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eThis study received ethical approval from the Muhimbili University of Health and Allied Sciences Institutional Review Board (MUHAS-REC-01-2023-1498). The study was conducted in accordance with the Declaration of Helsinki. The requirement for individual written informed consent was waived by the IRB, given the observational nature of the study. The Executive Director of MOI granted permission to collect data. All participant data were anonymised and access restricted to the research team.\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\n\u003cp\u003eThe datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eNo funding was received for conducting this study.\u003c/p\u003e\n\u003ch2\u003eAuthors' contributions\u003c/h2\u003e\n\u003cp\u003eAMM: conceptualised and designed the study, performed data acquisition and analysis, interpreted the data, and drafted the manuscript. TN and LF: assisted in study design, data interpretation, and critically revised the manuscript for intellectual content. MM: assisted in study design, performed MRI reporting, contributed to data collection and interpretation, and critically revised the manuscript. MJ: contributed to data analysis and critical review of the manuscript. RS: contributed to data analysis and critical review of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003ch2\u003eAcknowledgements\u003c/h2\u003e\n\u003cp\u003eThe authors acknowledge the support of all staff members at MOI and the MUHAS Department of Radiology and Imaging. The authors also acknowledge the participants who consented to take part in this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cbr clear=\"all\"\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAlmaawi A, Awwad W, Bamugaddam A, Alasheikh M, Muaddi M, Almutair O, et al. Prevalence of knee injuries among male college students in Riyadh. Kingd Saudi Arabia. 2020;1:1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMri T. Sensitivity and Specificity of Magnetic Resonance Imaging for Knee Injury and Clinical Application for the Naresuan University Hospital. 2012;95:151\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e\u0026Atilde; SLW, Abramowitch SD, Kilger R, Liang R. Biomechanics of knee ligaments: injury, healing, and repair. 2006;39:1\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGage BE, Mcilvain NM, Collins CL, Fields SK, Comstock RD. Presenting to United States Emergency Departments From 1999 Through 2008. 2012;378\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLohmander LS, Roos H, Lohmander LS, Roos H. Knee ligament injury, surgery and osteoarthrosis : Truth or consequences ? Knee ligament injury, surgery and osteoarthrosis Truth or consequences ? 2016;6470 (March).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLaoruengthana A, Jarusriwanna A. Sensitivity and Specificity of Magnetic Resonance Imaging for Knee injury and Clinical Application for the Naresuan University Hospital. 95, J Med Assoc Thai. 2012.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGhosh N, Kruse D, Subeh M, Lahham S, Fox JC. Comparing Point-of-care-ultrasound (POCUS) to MRI for the Diagnosis of Medial Compartment Knee Injuries. J Med Ultrasound. 2017;25(3):167\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYing G, Maguire MG, Glynn RJ, Rosner B. Calculating Sensitivity, Specificity, and Predictive Values for Correlated Eye Data. 2020;0\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHanga AH, Hussain I. Brief review on Sensitivity, Specificity and Predictivities. 2015;(April).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRazek AAKA, Fouda NS, Elmetwaley N, Elbogdady E. Sonography of the knee joint *. J Ultrasound. 2009;12(2):53\u0026ndash;60. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1016/j.jus.2009.03.002\u003c/span\u003e\u003cspan address=\"10.1016/j.jus.2009.03.002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRemer M, Fitzgerald W, Rogers LF, Hendrix W. Anterior Ligament Imaging Cruciate Injury: Diagnosis Patterns of Injury1. 1991.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAzzoni R, Cabitza P. Is There a Role for Sonography in the Diagnosis of Tears of the. Knee Menisci ?; 2002.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStoja E, Konstandin S, Philipp D, Wilke RN, Betancourt D, Bertuch T et al. Improving magnetic resonance imaging with smart and thin metasurfaces. Sci Rep [Internet]. 2021;1\u0026ndash;12. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1038/s41598-021-95420-w\u003c/span\u003e\u003cspan address=\"10.1038/s41598-021-95420-w\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCook JL, Cook CR, Stannard MSJP, Vaughn G. MRI versus Ultrasonography to Assess Meniscal Abnormalities in Acute Knees MRI versus Ultrasonography to Assess Meniscal Abnormalities in Acute Knees. 2014; (May 2015).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlizadeh A, Babaei A. Knee sonography as a diagnostic test for medial meniscal tears in young patients. 2013;927\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUnlu EN, Ustuner E, Saylisoy S, Yilmaz O, Ozcan H, Erden I. The role of ultrasound in the diagnosis of meniscal tears and degeneration compared to. MRI Arthrosc. 2014;2(3).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Images","content":"\u003cp\u003eImages are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-imaging","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmim","sideBox":"Learn more about [BMC Medical Imaging](http://bmcmedimaging.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmim/default.aspx","title":"BMC Medical Imaging","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"knee injuries, ultrasonography, MRI, meniscal injury, ligamentous injury, Muhimbili Orthopaedic Institute, Tanzania","lastPublishedDoi":"10.21203/rs.3.rs-8916716/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8916716/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eLigamentous and meniscal knee injuries are among the most common conditions managed at MOI and represent a significant burden primarily among the young adult population. Magnetic resonance imaging (MRI) has served as the key diagnostic investigation and basis for management decisions, yet it is expensive and less available in peripheral hospitals. Ultrasonography, which is readily available and affordable, remains underutilised and sonographic patterns of knee trauma in our setting are poorly described. Expanded use of ultrasonography could reduce the number of unnecessary referrals and lower treatment costs.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis was a prospective descriptive hospital-based cross-sectional study involving 100 consecutive patients with clinically suspected ligamentous and/or meniscal knee injuries referred for MRI at MOI between December 2022 and March 2023. All participants underwent standardised knee ultrasonography before MRI. A structured checklist captured sociodemographic data, clinical presentations, and imaging features. Statistical analysis was performed using SPSS version 23. Descriptive statistics were used for categorical and continuous variables. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy (DA) of ultrasonography were calculated against MRI as the reference standard using 2\u0026times;2 contingency tables. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe study included 100 participants with a mean age of 43.88 years (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;13.9); the majority (46%) fell within the 31\u0026ndash;50 age group. Gender distribution was nearly equal (52% male). The most common mechanism of injury was falling (45%), followed by sports activities (33%). Medial meniscal injury was most prevalent (57%), followed by lateral meniscal injury (43%). The most frequent ultrasonographic feature was loss of uniform echopattern throughout the meniscus (68% for MM injuries). The sensitivity, specificity, and diagnostic accuracy of ultrasonography were: medial meniscus 90.5%, 70.3%, 83%; lateral meniscus 71.7%, 87.5%, 78%; medial collateral ligament 25%, 100%, 97%; lateral collateral ligament 0%, 100%, 99%; anterior cruciate ligament 14.3%, 100%, 82%; and posterior cruciate ligament 20%, 100%, 96%, respectively.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eUltrasonography demonstrated significant diagnostic agreement with MRI for medial and lateral meniscal injuries, with high sensitivity and specificity. High specificity (100%) was observed for all ligamentous injuries, though sensitivity was limited for collateral and cruciate ligaments, likely due to small sample sizes. Ultrasonography shows promise as a cost-effective, accessible first-line or adjunct imaging tool for knee injury assessment in resource-limited settings.\u003c/p\u003e","manuscriptTitle":"The Accuracy of Ultrasonography in the Diagnosis of Ligamentous and Meniscal Injuries of the Knee among Patients Attending Muhimbili Orthopaedic Institute (MOI)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-24 10:27:25","doi":"10.21203/rs.3.rs-8916716/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"142051664436244589844414531682264141832","date":"2026-03-23T22:07:29+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-19T11:35:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"54109723122404968821229583443744641157","date":"2026-03-19T03:35:04+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-18T15:14:33+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-23T09:44:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-23T08:05:01+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-23T07:59:28+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Imaging","date":"2026-02-19T10:50:39+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-imaging","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmim","sideBox":"Learn more about [BMC Medical Imaging](http://bmcmedimaging.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmim/default.aspx","title":"BMC Medical Imaging","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"40a76862-a6a7-409c-8dc9-88013002eccf","owner":[],"postedDate":"March 24th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-24T10:27:25+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-24 10:27:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8916716","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8916716","identity":"rs-8916716","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}