No abstract

The aim of this study is to evaluate the relation between bone bruise and (peri-)articular derangement and to assess the impact of bone bruise on presentation and short term course of knee complaints. We recorded MR abnormalities in 664 consecutive patients with sub-acute knee complaints. Patients were divided in four groups: patients with and without intra-articular knee pathology, subdivided in patients with and without bone bruise. We assessed function and symptoms at the time of MR and 6 months thereafter. Bone bruises were diagnosed in 124 of 664 patients (18.7%). Patients with bone bruise had significantly more complete ACL, lateral meniscal, MCL and LCL tears. Both with and without intra-articular pathology patients with bone bruise had a significantly poorer function at the time of MR (Noyes score of, respectively, 313.21 versus 344.81 and 306.98 versus 341.19). Patients with bone bruise and intra-articular pathology showed significantly more decrease in activity (decrease of Tegner score from 6.28 to 2.12 versus 5.70-2.55). At 6 months there were no significant differences in clinical parameters between the four groups. We concluded that bone bruise in combination with MCL tear is an important cause of initial clinical impairment in patients with sub-acute knee complaints. Clinical improvement within 6 months is more pronounced than in patients without bone bruise.

MR imaging is an effective tool in the selection of patients for arthroscopy from among a general population.

Because of its limited reliability and the high prevalence of labral lesions, magnetic resonance arthrography provides a limited complementary benefit in the detection of labral lesions in patients with a high clinical suspicion of labral pathology. When there is a high clinical suspicion of a labral lesion, magnetic resonance arthrography has a poor negative predictive value and cannot be used to rule out a labral lesion. Physicians should critically consider whether the findings on a magnetic resonance arthrogram will alter the treatment strategy for an individual patient with a clinical suspicion of labral pathology.

MR imaging can be used without additional costs or disadvantageous effects on function to obviate arthroscopy in patients with nonacute knee symptoms who are highly suspected of having intraarticular knee abnormality.

Background and purpose — A guideline committee of medical specialists and a physiotherapist was formed on the initiative of the Dutch Orthopedic Association (NOV) to update the guideline Arthroscopy of the Knee: Indications and Treatment 2010. This next guideline was developed between June 2017 and December 2019. In this Part 1 we focus on the meniscus, in Part 2 on all other aspects of knee arthroscopy. Methods — The guideline was developed in accordance with the criteria of the AGREE instrument (AGREE II: Appraisal of Guidelines for Research and Evaluation II) with support of a professional methodologist from the Dutch Knowledge Institute of Medical Specialists. The scientific literature was searched and systematically analyzed. Conclusions and recommendations were formulated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. Recommendations were developed considering the balance of benefits and harms, the type and quality of evidence, the values and preferences of the people involved, and the costs.

Diagnosis, level 3b.

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.