ACR Appropriateness Criteria Acute Trauma to the Knee

Knee injuries are a common presentation to the ED and are often difficult to assess and definitively diagnose due to the patient's acute pain, effusion and guarding. The quality of ED care provided to patients with fractures or soft tissue injuries of the knee is critical to ensure the best possible outcomes for the patient. This rapid review investigated best practice for the assessment and management of common knee injuries in the ED. Databases were searched in 2017, including PubMed, CINAHL, EMBASE, TRIP and the grey literature, including relevant organisational websites. Primary studies, systematic reviews and guidelines were considered for inclusion. English-language articles published in the past 12 years that addressed the acute assessment, management, follow-up plan or prognosis were included. Data extraction of included articles was conducted, followed by quality appraisal to rate the level of evidence where possible. The search revealed 2250 articles, of which 54 were included in the review (n = 8 primary articles, n = 28 systematic reviews, n = 18 guidelines). This rapid review provides clinicians managing fractures and soft tissue injuries of the knee in the ED, a summary of the best available evidence to enhance the quality of care for optimal patient outcomes. There is consistent evidence to support undertaking a thorough history and physical examination, including the application of special tests and clinical decision rules for imaging. In the undifferentiated knee injury, expedited follow up and further imaging is recommended to improve patient outcomes and cost-effectiveness.

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“…). At full text nine primary articles, 28 systematic review (SR) articles and 18 guidelines were included.…”

Section: Resultsmentioning

confidence: 99%

Review article: Best practice management of common knee injuries in the emergency department (part 3 of the musculoskeletal injuries rapid review series)

Strudwick

McPhee

Bell

et al. 2017

Emerg Medicine Australasia

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“…T2 mapping is already of great interest for cartilage assessment and can thus be obtained without additional acquisition time. Moreover, the combination of quantitative T1 and T2 also reveals new information, completely independent of the MRI technique, and is expected to be more accurate and relevant than traditional MRI results according to a recent publication from the European Society of Radiology (3). Furthermore, the effect of contrast agents has not been studied.…”

Section: Discussionmentioning

confidence: 99%

“…It is a crucial tool in clinical applications for detecting bone, cartilage, and soft-tissue injuries, offering excellent anatomical details (1,2). MRI has been proven to shorten time to diagnosis and change knee trauma management (3). Numerous studies have demonstrated the high accuracy of MRI in the detection of meniscal and anterior cruciate ligament injury, reaching 95% in some (1,4–7).…”

Section: Introductionmentioning

confidence: 99%

Feasibility of synthetic MRI in knee imaging in routine practice

Boudabbous

Neroladaki

Bagetakos

et al. 2018

Acta Radiologica Open

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BackgroundSynthetic magnetic resonance (MR) is a method allowing reduction of examination time and access to quantitative imaging.PurposeThis study sought to assess the image quality and diagnostic accuracy of synthetic magnetic resonance imaging (MRI) compared to standard MRI in patients with knee pain.Material and MethodsIn total, 22 patients underwent standard 1.5 knee MRI with an added synthetic sequence. Quantitative T1, T2, and proton density (PD) images were generated synthetically; T1, PD, and short tau inversion recovery (STIR) weighted images were created with chosen echo time (TE), repetition time (TR), and inversion time (TI). Two blinded musculoskeletal radiologists evaluated the overall sequence quality, visualization of anatomic structures, and presence of artifacts using a 3-point score.ResultsThe synthetic sequence was acquired in 39% less time than the conventional MRI. Synthetic PD, T1, and STIR images were rated fair (2%, 5%, and 2%, respectively) or good quality (98%, 95%, and 98%, respectively), despite the presence of popliteal artery artifacts. Cartilage and meniscus were well visualized in all cases. Anterior cruciate ligament visualization was rated poor in 7%, 14%, and 30% of PD, STIR, and T1 images, respectively.ConclusionOur pilot study confirmed the feasibility of synthetic MRI in knee examinations, proving faster and achieving appropriate quality and good diagnostic confidence.

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“…The application and development of digital orthopedic technology might have great potential to facilitate intramedullary nailing in the treatment of tibial fractures [27–29]. Previously, CT with three-dimensional reconstruction was compared with knee radiographs and shown to be more sensitive for fractures (100% vs. 83% for radiographs), and to reflect the severity of tibial plateau fractures more accurately [30]. In this study, we preoperatively used high-speed multislice CT together with three-dimensional reconstruction to simulate and determine the size and insertion point of intramedullary nails, showing that the distance between the actual and planned insertion point were significantly lower using digital technology than conventional technology ( P <0.001), with an accuracy rate of the insertion point of 99.12%.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Tibial Intramedullary Nailing Guided by Digital Technology Versus Conventional Method: A Prospective Study

Liu

et al. 2017

Med Sci Monit

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BackgroundThis prospective study aimed to compare clinical effects of intramedullary nailing guided by digital and conventional technologies in treatment of tibial fractures.Material/MethodsThirty-two patients (mean age 43 years, 18 males and 14 females) who were treated for tibial fractures from October 2010 to October 2012 were enrolled. They were sequentially randomized to receive intramedullary nailing guided by either digital technology (digital group, n=16) or conventional technology (conventional group, n=16). The operation time, fluoroscopy times, fracture healing time, distance between the actual and planned insertion point, postoperative lower limb alignment, and functional recovery were recorded for all patients.ResultsThe mean operation time in the digital group was 43.1±6.2 min compared with 48.7±8.3 min for the conventional technology (P=0.039). The fluoroscopy times and distance between the actual and planned insertion point were significantly lower in the digital group than in the conventional group (both P<0.001). The accuracy rate of the insertion point was 99.12% by digital technology. No difference was found in fracture healing time and good postoperative lower limb alignment between the digital and conventional groups (P=0.083 and P=0.310), as well as the effective rate (100% vs. 87.50%, P=0.144).ConclusionsIntramedullary nailing guided by digital technology has many advantages in treatment of tibial fractures compared to conventional technology, including shorter operation time, reduced fluoroscopy times, and decreased distance between the actual and planned insertion point of the intramedullary nail.

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ACR Appropriateness Criteria Acute Trauma to the Knee

Cited by 55 publications

References 60 publications

Review article: Best practice management of common knee injuries in the emergency department (part 3 of the musculoskeletal injuries rapid review series)

Review article: Best practice management of common knee injuries in the emergency department (part 3 of the musculoskeletal injuries rapid review series)

Feasibility of synthetic MRI in knee imaging in routine practice

Comparison of Tibial Intramedullary Nailing Guided by Digital Technology Versus Conventional Method: A Prospective Study

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