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The effect of magnetic resonance imaging scans on knee arthroscopy: randomized controlled trial
Stephen Bridgman1, Paula J Richards, Gayle Walley
1Keele University Medical School, Stoke-on-Trent, England.
Purpose:
The purpose of this study was to investigate whether magnetic resonance imaging (MRI) in patients waiting for knee arthroscopy could reduce arthroscopy rates and improve patient outcome.
Methods:
A prospective randomized controlled trial was conducted in a teaching hospital setting. All participating patients had knee MRI before arthroscopy. In the intervention group the MRI report was seen by surgeons, and in the control group it was not. The primary outcome measure was the proportion of patients who did not have an arthroscopy. Secondary outcome measures included the Short Form 36, EuroQol EQ-5D, Knee Injury and Osteoarthritis Score, and Knee Society Score.
Results:
Surgeons changed both their diagnosis and management plan in 47% of patients in the intervention group compared with 1% in the control group, with no difference between groups in the proportion of patients who underwent an arthroscopy. In the intervention group 7 of 125 patients (5.6%) did not have an arthroscopy compared with 8 of 127 patients (6.3%) in the control group. In one instance a surgeon decided against arthroscopy based on the MRI report. There was no significant difference between groups in other outcome measures.
Conclusions:
We found no effect of MRI on the decision to perform arthroscopy or patient outcome. Performing MRI in patients already on the waiting list for arthroscopy may not be effective in reducing utilization of surgery.
Level Of Evidence:
Level I, therapeutic randomized controlled trial with no statistically significant difference but with narrow confidence intervals.
Insights
Magnetic resonance imaging (MRI) did not reduce knee arthroscopy rates or improve patient outcomes in this randomized controlled trial. Pre-operative MRI scans did not significantly alter surgical decisions or patient-reported results.
Area of Science:
- Orthopedic Surgery
- Radiology
- Health Services Research
Background:
- Knee arthroscopy is a common surgical procedure.
- The utility of pre-operative magnetic resonance imaging (MRI) in patients awaiting knee arthroscopy is debated.
- Optimizing surgical indications and patient selection is crucial for effective healthcare delivery.
Purpose of the Study:
- To determine if magnetic resonance imaging (MRI) influences arthroscopy rates in patients on the waiting list for knee surgery.
- To assess the impact of pre-operative MRI on patient outcomes following knee arthroscopy.
Main Methods:
- A prospective randomized controlled trial was conducted.
- Patients awaiting knee arthroscopy were randomized into two groups: one where MRI reports were reviewed by surgeons (intervention) and one where they were not (control).
- Primary outcome was the proportion of patients not undergoing arthroscopy; secondary outcomes included various patient-reported outcome measures.
Main Results:
- Surgeons altered diagnosis and management in 47% of the intervention group versus 1% in the control group.
- There was no significant difference in the proportion of patients undergoing arthroscopy between the groups (5.6% vs 6.3%).
- No significant differences were observed in patient-reported outcome measures between the intervention and control groups.
Conclusions:
- Pre-operative MRI did not significantly affect the decision to perform knee arthroscopy or improve patient outcomes.
- Utilizing MRI for patients already scheduled for arthroscopy may not be an effective strategy to reduce surgical rates.
- Further research may be needed to identify optimal patient selection criteria for MRI in knee conditions.
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Description of the Procedures
Computed Tomography (CT) scan:
Computed Tomography (CT) scans use X-ray technology to generate detailed images of bones, organs, and tissues. During the scan, the patient lies on a moving table...