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Investigating meniscal symptoms in patients with knee osteoarthritis--is MRI an unnecessary investigation?
1Department of Orthopaedics, Musgrove Park Hospital, Taunton, Somerset, Taunton, TA1 5DA, United Kingdom. mark.kemp@doctors.org.uk
Abstract:
The aim of this study was to evaluate the relationship between radiographic knee osteoarthritis and the presence of a relevant meniscal tear detected on MRI in symptomatic patients over the age of 60. Seventy seven patients over the age of 60 who had been investigated with a knee MRI over a 1-year period were identified. Sixty patients had a full set of data available for analysis. Their plain radiographs were blindly graded for osteoarthritis using the Kellgren-Lawrence (K-L) scale. The indications for the MRI were subdivided into: meniscal symptoms, general knee pain and "other". These indications were correlated with the K-L grade and result of the MRI. Overall, 40% of patients with a K-L grade of 0 had a meniscal tear compared to 89% of patients with a K-L score of 3, and 88% with a K-L score of 4. The indications for an MRI were grouped into meniscal symptoms (49), general pain (6) and other (5). In the group investigated for meniscal symptoms, the incidence of meniscal tears was 92% and 100% with a K-L grade of 3 and 4 respectively. This equated to a positive predictive value of 93% for K-L grade 3 and above, and 100% for K-L grade 4 alone. Given the predictability of the MRI findings in patients with significant osteoarthritis as well as meniscal symptoms, we conclude that this is an unnecessary investigation when used for this indication.
Insights
For patients over 60 with knee pain, magnetic resonance imaging (MRI) for meniscal tears is often unnecessary when significant osteoarthritis is present on X-ray. High-grade osteoarthritis strongly predicts meniscal tears, making MRI redundant in these cases.
Area of Science:
- Orthopedics
- Radiology
- Sports Medicine
Background:
- Knee osteoarthritis is a common degenerative joint disease.
- Meniscal tears frequently coexist with knee osteoarthritis.
- Magnetic resonance imaging (MRI) is often used to diagnose meniscal tears.
Purpose of the Study:
- To investigate the relationship between radiographic knee osteoarthritis severity and MRI-detected meniscal tears in patients over 60.
- To assess the diagnostic utility of MRI for meniscal tears in this demographic based on osteoarthritis grade.
Main Methods:
- Retrospective analysis of 60 patients over 60 who underwent knee MRI.
- Radiographs were graded for osteoarthritis using the Kellgren-Lawrence (K-L) scale.
- MRI findings for meniscal tears were correlated with K-L grades and indications for MRI.
Main Results:
- 40% of patients with K-L grade 0 had meniscal tears, compared to 89% with K-L grade 3 and 88% with K-L grade 4.
- In patients with meniscal symptoms, MRI detected tears in 92% (K-L 3) and 100% (K-L 4).
- Positive predictive value for K-L grade 3+ was 93%, and for K-L grade 4 alone was 100%.
Conclusions:
- Radiographic osteoarthritis severity, particularly K-L grade 3 or 4, strongly predicts the presence of meniscal tears.
- MRI may be an unnecessary investigation for meniscal tears in patients over 60 with significant radiographic knee osteoarthritis.
- Clinical assessment and radiographic findings can guide the need for MRI in this patient population.
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