The Effect of Magnetic Resonance Imaging Scans on Knee Arthroscopy: Randomized Controlled Trial

Bridgman, Stephen; Richards, Paula J.; Walley, Gayle; MacKenzie, Gilbert; Clement, Darren; McCall, I.; Griffiths, David; Maffulli, Nicola

doi:10.1016/j.arthro.2007.05.020

Cited by 23 publications

(24 citation statements)

References 19 publications

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“…The value of MRI of the knee joint as a tool of preoperative diagnosis is controversially rated in the published literature [1][2][3][4][5][6][7][8], ranging from a sensitivity of 45% for cartilaginous lesions [7] to 97.5% for defects of the inner meniscus [8]. In the current study, very low agreement between observers was found for the assessment of preoperative menisci.…”

Section: Discussioncontrasting

confidence: 63%

MRI of the knee: how do field strength and radiologist’s experience influence diagnostic accuracy and interobserver correlation in assessing chondral and meniscal lesions and the integrity of the anterior cruciate ligament?

et al. 2009

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Accuracy of MRI reports is taken for granted. In this paper the inter-observer reliability in the interpretation of meniscal lesions, degree of chondropathy, and integrity of the ACL was analyzed while taking the radiologist's experience and field strength into account. Fifty-two MRI studies of knees were interpreted by 11 radiologists independently. Twenty-two were acquired on 1.0-T, 20 on 1.5-T, and 10 on 3.0-T systems. Four of the radiologists had more than 5 years and seven had 3 to 5 years of experience in interpreting MRI studies. The findings were compared with the intra-operative findings. Inter-observer variance, specificity, and sensitivity were evaluated for each field strength. Inter-observer correlation ranged between 0.370 for cartilage lesions and 0.597 for meniscal tears. Correlation values did not increase with experience or field strength. The number of false reports was dependent on the observer, but not on field strength. The rate of false interpretations was significantly higher for most criteria in the less experienced group. In conclusion, inter-observer correlation was low, although the diagnostic criteria were defined. The use of the classification scheme should be standardized by uniform training. Radiologist experience seems to be more important than field strength.

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Section: Discussioncontrasting

confidence: 63%

MRI of the knee: how do field strength and radiologist’s experience influence diagnostic accuracy and interobserver correlation in assessing chondral and meniscal lesions and the integrity of the anterior cruciate ligament?

et al. 2009

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“…The NWAHS data also showed that approximately 1/3 of participants who underwent knee arthroscopy also had a knee MRI performed. Clinical guidelines for investigation of knee pain do not support the routine use of arthroscopy, nor MRI and arthroscopy in combination to investigate subacute knee pain . Therefore, if even 1/3 of the 7888 knee arthroscopies performed in SA in 2015 were unnecessary procedures, at a cost to Medicare of $272–796 per procedure, excess costs incurred by unnecessary knee arthroscopies could conservatively exceed $715 000–$2 000 000 per year in SA.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and healthcare usage of knee pain in South Australia: a population‐based study

Blacketer

Gill

Taylor

et al. 2019

Internal Medicine Journal

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Background: It is known that South Australia (SA) has the highest rate of knee arthroscopy use of any state in Australia; however, Level 1 evidence demonstrates that knee arthroscopy in patients with uncomplicated knee osteoarthritis confers no benefit. In SA, which patients are presenting with knee pain and what treatments are they receiving?Aims: To determine the prevalence, persistence and treatment modalities of knee pain in SA.Methods: This study analysed data from the North-West Adelaide Health Study (1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015), a longitudinal, population-based cohort study of people aged 18 years and over (n = 4060), initially randomly selected from the north-west region of Adelaide, SA. It incorporated clinic assessments, self-completed questionnaires and telephone interviews to collect demographic, anthropometric and biochemical data over four main stages (1, 2, 3 and North-West 15 (NW15)). Data were linked to Medical Benefits Scheme data. Results:In stages 3 and NW15 of the North-West Adelaide Health Study, 30-35% of participants reported knee pain (n = 803, 452). Demographic variables associated with knee pain included older age and lower educational level, while risk factors included obesity and high waist circumference. In the 12 months preceding NW15, 33% of participants with knee pain/stiffness consulted a general practitioner for their knee pain, 10.2% an orthopaedic surgeon, and 12.6% a physiotherapist. Between 2011 and 2015, 3.0% the cohort underwent a knee arthroscopy, and 3.1% underwent knee magnetic resonance imaging.Conclusions: Knee pain affects large proportions of the SA population. Knee pain was persistent with underuse of non-pharmacological treatments and high use of specialist referral. These data support the need for a national strategy to manage osteoarthritis effectively.Funding: None.

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“…Given the long waiting lists, the NHS in our region decided to undertake a randomized controlled trial (RCT; 252 participants) to test whether MRI scanning in patients waiting for knee arthroscopy reduced the need for arthroscopy (1). In the intervention arm, surgeons were provided with the patients' orthopedic clinical notes, which included the original management plan and a completed MRI report card.…”

Section: Abstract: Mri Knee Arthroscopy Decision Making Trial DImentioning

confidence: 99%

Magnetic resonance imaging, knee arthroscopy, and clinical decision making: A descriptive study of five surgeons

Derrett

Walley

Bridgman³

et al. 2009

Int J Technol Assess Health Care

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Surgeons' decisions were influenced by patient wishes. For some patients, the decision to proceed with arthroscopy was based solely on clinical diagnosis; MRI may not be advantageous in these instances. Surgeons disagreed more often than they agreed about the decision to proceed with arthroscopy, particularly when OA was diagnosed. This has implications for decision making in the current NHS patient choice environment. Patients may choose a treatment provider from a list of available providers at time of original clinical assessment and diagnosis. The treating surgeon does not necessarily re-examine the patient until the day of surgery. Given the variation between surgeons about the merits of proceeding with arthroscopy, surgeons may end up in the invidious position of providing surgery to patients whom they do not believe will benefit from arthroscopy.

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The Effect of Magnetic Resonance Imaging Scans on Knee Arthroscopy: Randomized Controlled Trial

Cited by 23 publications

References 19 publications

MRI of the knee: how do field strength and radiologist’s experience influence diagnostic accuracy and interobserver correlation in assessing chondral and meniscal lesions and the integrity of the anterior cruciate ligament?

MRI of the knee: how do field strength and radiologist’s experience influence diagnostic accuracy and interobserver correlation in assessing chondral and meniscal lesions and the integrity of the anterior cruciate ligament?

Prevalence and healthcare usage of knee pain in South Australia: a population‐based study

Magnetic resonance imaging, knee arthroscopy, and clinical decision making: A descriptive study of five surgeons

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