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Only MR can safely exclude patients from arthroscopy
Patrice W J Vincken1, Bert P M ter Braak, Arian R van Erkel
1Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. p.w.j.vincken@lumc.nl
Objective:
The aim of this study was to determine in patients with subacute knee complaints and normal standardized physical examination the fraction of magnetic resonance imaging (MRI) studies showing arthroscopically treatable intra-articular pathology.
Material And Methods:
There were 290 consecutive patients (between 16 and 45 years) with at least 4 weeks of knee complaints and low clinical suspicion of intra-articular pathology based on physical exam. Two hundred seventy-four patients were included. Sixteen patients with prior knee surgery, rheumatic arthritis, or severe osteoarthritis were excluded. MRI was used to assign patients to group 1 (treatable abnormalities) or group 2 (normal or no treatable findings), depending on whether MR demonstrated treatable pathology. Arthroscopy was performed in group 1 patients. If symptoms persisted for 3 months in group 2 patients, cross over to arthroscopy was allowed.
Results:
MR showed treatable pathology in 73 patients (26.6%). Arthroscopy was performed in 64 patients of 73 patients (group 1). In 52 patients (81.3%, 95% confidence interval (CI) 71.4-91.1%), arthroscopy was therapeutic. Of the 13 arthroscopies (6.5%) in group 2, four were therapeutic (30.8%, 95% CI 1.7-59.8). The highest fraction of MR studies showing treatable pathology was found in males, aged over 30 years, with a history of effusion (54.5%, six of 11 patients).
Conclusion:
Authors believe that the negative predictive value of clinical assessment in patients with subacute knee complaints is too low to exclude these patients from MR. MR should at least be considered in male patients aged 30 years and over with a history of effusion.
Insights
In patients with subacute knee complaints, clinical assessment alone is insufficient to rule out treatable intra-articular pathology. Magnetic resonance imaging (MRI) is valuable, especially for males over 30 with effusion history.
Area of Science:
- Orthopedic Surgery
- Radiology
- Sports Medicine
Background:
- Subacute knee complaints often present with low clinical suspicion of intra-articular pathology.
- Standardized physical examination may not accurately identify all patients requiring intervention.
Purpose of the Study:
- To determine the rate of arthroscopically treatable intra-articular pathology detected by magnetic resonance imaging (MRI) in patients with subacute knee complaints and normal physical exams.
- To evaluate the utility of MRI in guiding treatment decisions for knee pain.
Main Methods:
- 274 patients (16-45 years) with subacute knee complaints and low clinical suspicion underwent MRI.
- Patients were categorized based on MRI findings: Group 1 (treatable pathology) or Group 2 (no treatable findings).
- Arthroscopy was performed for Group 1, and selectively for Group 2 if symptoms persisted.
Main Results:
- MRI revealed treatable pathology in 26.6% of patients.
- Arthroscopy was therapeutic in 81.3% of Group 1 patients.
- Treatable pathology on MRI was most common in males over 30 with a history of effusion (54.5%).
Conclusions:
- Clinical assessment has a low negative predictive value for excluding treatable intra-articular pathology in this patient group.
- MRI should be considered for subacute knee complaints, particularly in males aged 30 and above with a history of effusion.
- Further investigation with MRI can improve diagnostic accuracy and guide timely therapeutic interventions.
