MRI for the Evaluation of Knee Pain

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SCIENCE
MRI for the Evaluation of Knee Pain
Key Take-Away: 

The stigma of knee pain is most prevalent in the society from ages. This particular hypothesis has emphasized on the exercise of MRI by the primary care physicians (PCPs) and the orthopedic surgeons paving a more favorable response towards the later.

Knee pain is one of the most common reasons for outpatient visits in the U.S.

ABSTRACT: 
Background: 

Knee pain is one of the most common reasons for outpatient visits in the U.S. The great majority of such cases can be effectively evaluated through physical examination and judicious use of radiography.

Despite this, an increasing number of magnetic resonance images (MRIs) of the knee are being ordered for patients with incomplete work-ups or for inappropriate indications. We hypothesized that MRIs ordered by orthopedic providers were more likely to result in changes in diagnoses and/or plans for care than those ordered by non-orthopedic providers.

Methods: 

We reviewed the charts of all consecutive new patients seen at our orthopedic outpatient office between January 1, 2010, and December 31, 2011, with International Classification of Diseases, Ninth Revision (ICD-9) codes for meniscal or unspecific sprains and strains of the knee.

A total of 1592 patients met our inclusion criteria and were divided into two groups: those initially evaluated and referred by their primary care physician (PCP) (n = 747) and those initially evaluated by one of our staff orthopedic surgeons (n = 845).

Results: 

MRI-ordering rates were nearly identical between orthopedic surgeons and PCPs (25.0% versus 24.8%; p = 0.945).

MRIs ordered by orthopedic surgeons, however, resulted in significantly more arthroscopic interventions than those ordered by PCPs (41.2% versus 31.4%; p = 0.042). Orthopedic surgeons ordered MRIs for patients who were more likely to benefit from arthroscopic intervention, including patients who were younger (mean age, 45.1 years versus 56.5 years for those with PCP-ordered MRIs; p < 0.001), patients with acute symptoms (39.3% versus 22.2%; p < 0.001), and patients with a history of trauma (49.3% versus 36.2%; p = 0.019). Finally, orthopedic surgeons were less likely than PCPs to order MRIs for patients with substantial osteoarthritis who subsequently underwent total knee arthroplasty (4.3% versus 9.2%; p = 0.048).

Conclusion: 

MRI utilization by orthopedic surgeons results in more appropriate interventions for patients with symptoms and findings most amenable to surgical intervention.

J Bone Joint Surg Am, 2015 May 06; 97 (9): 709 -714
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