Deep learning techniques have emerged as a promising approach to highly accelerated MRI. However, recent reconstruction challenges have shown several drawbacks in current deep learning approaches, including the loss of fine image details even using models that perform well in terms of global quality metrics. In this study, we propose an end-to-end deep learning framework for image reconstruction and pathology detection, which enables a clinically aware evaluation of deep learning reconstruction quality. The solution is demonstrated for a use case in detecting meniscal tears on knee MRI studies, ultimately finding a loss of fine image details with common reconstruction methods expressed as a reduced ability to detect important pathology like meniscal tears. Despite the common practice of quantitative reconstruction methodology evaluation with metrics such as SSIM, impaired pathology detection as an automated pathology-based reconstruction evaluation approach suggests existing quantitative methods do not capture clinically important reconstruction outcomes.