# Evaluating the diagnostic performance of MRI-based signs for identification of meniscus posterior root tears: a systematic review and meta-analysis

## TL;DR

This study evaluates how well MRI-based signs can diagnose meniscus posterior root tears, finding that the cleft sign is most effective.

## Contribution

The study systematically reviews and quantifies the diagnostic accuracy of nine MRI-based signs for identifying meniscus posterior root tears.

## Key findings

- The cleft sign showed the highest sensitivity and diagnostic odds ratio for identifying meniscus posterior root tears.
- The radial tear sign had the highest specificity but lower sensitivity compared to the cleft and ghost signs.
- The ghost sign demonstrated the highest area under the summary receiver operating characteristic curve.

## Abstract

To investigate the diagnostic performance of magnetic resonance imaging (MRI)-based signs for meniscus posterior root tears (MPRTs).

A literature search was performed to identify original studies published prior to May 15, 2025 that evaluated the diagnostic accuracy of MRI-based signs for MPRTs. All meta-analyses were performed using Meta-DiSc 1.4 software and StataMP 18.

This meta-analysis evaluated 9 MRI-based signs across 8 studies (1430 patients, 1,533 MRI examinations). In terms of pooled sensitivity, the cleft sign and ghost sign were ≥  0.8, while the radial tear sign was only 0.6. The cleft sign and/or truncated triangle sign showed the highest sensitivity (0.91). In terms of pooled specificity, the cleft sign and ghost sign were ≥ 0.85. The radial tear sign showed the highest specificity (0.97). In terms of pooled positive likelihood ratio (PLR), the radial tear sign was the highest (18.56). The cleft sign and ghost sign were ≥  10. In terms of pooled negative likelihood ratio (NLR), the cleft sign and/or truncated triangle sign was the lowest (0.13). The cleft sign and ghost sign were ≤ 0.21, while the radial tear sign was 0.41. In the area under the summary receiver operating characteristic curve (AUC), the ghost sign was the highest (0.97). The cleft sign and radial tear sign were ≥  0.9. In the diagnostic odds ratio (DOR), the cleft sign was the highest (85.32). The ghost sign, radial tear sign and the cleft sign and/or truncated triangle sign were all ≥  50. Subgroup analyses revealed no statistically significant differences (P > 0.05).

The cleft sign demonstrated the best overall diagnostic performance. High-sensitivity signs are recommended for initial screening, whereas high-specificity signs are indicated for diagnostic confirmation. The ghost sign and cleft sign, with their high AUC and DOR, serve as core diagnostic criteria.

The online version contains supplementary material available at 10.1186/s13018-025-06592-4.