Diagnostic Accuracy of Musculoskeletal Ultrasound in Detecting Knee Pathologies among Diabetic Patients: A Systematic Review

Abstract

Background: Diabetes mellitus is a causative factor for musculoskeletal complications, including knee disorders like thinning of cartilage, synovitis, tendinopathy, and bursitis [1–3]. Musculoskeletal ultrasound (MSK US) is widely utilized to assess knee pathology, but its diagnostic performance in diabetic patients is unknown [2, 4].

Purpose: To review systematically the diagnostic performance of musculoskeletal ultrasound to detect knee pathologies in diabetic patients.

Materials and Methods: Literature search on PubMed, Embase, Scopus, Web of Science, and Cochrane Library (January 2010–March 2025) retrieved studies evaluating MSK US accuracy in diabetic patients with knee pathologies as a reference standard using MRI, arthroscopy, or clinical diagnosis [5]. Information collected included study design, sample size, sensitivity, and specificity [5].
Results: Accuracy of MSK ultrasound in diabetic knees was reported in four studies (n = 285 diabetic patients) [6–9]. MSK ultrasound was moderately to highly accurate for thinning of cartilage (sensitivity 75–88%; specificity 72–90%) [6, 7], synovitis (80–95%; 78–92%) [8], tendinopathy (82–93%; 79–95%) [9], and bursitis (90–98%; 85–95%) [8,9]. Meniscal pathology was less sensitive (45–67%) [10, 11]. General-population studies reaffirm high ultrasound accuracy for structures on or near the surface but poor performance with deep intra-articular lesions [10–19].
Conclusion: MSK ultrasound is useful for the assessment of various knee pathologies in diabetic patients, including superficial and inflammatory conditions [6–9]. More studies are required to confirm its application in this population [2,4].

Key words: knee ultrasound," "musculoskeletal ultrasound," "diabetes mellitus," "cartilage," "synovitis," "effusion," "tendinopathy," "bursitis," "meniscus," and "diagnostic accuracy"