Department of Orthopaedics, University of Utah, Salt Lake City, Utah.
Sports Health. 2010 Sep;2(5):385-90. doi: 10.1177/1941738110377420.
Criteria are needed for primary care providers such that they can evaluate age-related knee pain in a cost-effective manner. This study examined (1) in what percentage of patients are appropriate radiographic views of the knee ordered before magnetic resonance imaging (MRI) for knee pain, (2) specialists' retrospective evaluation for appropriate utilization of MRI in knee pain, and (3) in what manner would the MRIs have altered diagnosis and management of knee disorders.
Primary care providers underuse appropriate radiographs-especially, flexion weightbearing posteroanterior films-and overuse MRIs when evaluating older patients with knee pain.
Case control.
The authors performed a retrospective analysis of 100 patients older than 40 years with knee MRIs. Patient encounters with primary care physicians were reviewed. Given available information, specialists then formulated a pre- and post-MRI diagnosis and treatment plan and indicated whether the MRI would have altered their treatment.
Only 12 of 100 MRIs would have been ordered by an orthopaedist given the documented data. No MRIs would have been ordered in the 19 patients aged 60 years or older. Among 44 radiographs ordered, only 7 were flexion weightbearing. The most common pre-MRI diagnoses made by primary care providers were joint pain (22%) and meniscus injury (24%); the most common post-MRI diagnoses were osteoarthritis (40%) and degenerative meniscus injury (23%). In contrast, the 2 most common pre- and post-MRI diagnoses by specialists were osteoarthritis (28% and 37%, respectively) and degenerative meniscus injury (23% and 24%, respectively). Also, referrals to specialists increased from 9% pre-MRI to 76% post-MRI.
Primary care providers may be overusing knee MRIs and underusing flexion weightbearing posteroanterior radiographs in patients older than 40 years with knee pain.
Primary care providers should strongly consider not ordering knee MRI in patients with radiographic evidence of degenerative changes.
初级保健提供者需要有一定的标准，以便能够以具有成本效益的方式评估与年龄相关的膝关节疼痛。本研究检查了（1）在膝关节疼痛接受 MRI 检查的患者中，有多少比例的患者需要进行适当的膝关节放射检查，（2）专家对膝关节 MRI 检查的适宜性进行回顾性评估，以及（3）MRI 将如何改变膝关节疾病的诊断和治疗。
在评估患有膝关节疼痛的老年患者时，初级保健提供者过度使用 MRI，而不是适当的 X 光片，特别是屈曲负重后前位 X 光片。
病例对照。
作者对 100 例年龄在 40 岁以上的膝关节 MRI 患者进行了回顾性分析。对初级保健医生的就诊记录进行了审查。根据现有资料，专家制定了 MRI 前后的诊断和治疗计划，并指出 MRI 是否会改变他们的治疗方案。
仅根据记录的数据，100 例 MRI 中有 12 例是由矫形外科医生开出的。在 19 名年龄在 60 岁或以上的患者中，没有进行 MRI 检查。在开具的 44 张 X 光片中，只有 7 张是屈曲负重位。初级保健提供者最常见的 MRI 前诊断是关节疼痛（22%）和半月板损伤（24%）；最常见的 MRI 后诊断是骨关节炎（40%）和退行性半月板损伤（23%）。相比之下，专家最常见的 MRI 前和后诊断分别是骨关节炎（分别为 28%和 37%）和退行性半月板损伤（分别为 23%和 24%）。此外，MRI 前的转诊率为 9%，MRI 后为 76%。
初级保健提供者可能过度使用膝关节 MRI，而对 40 岁以上膝关节疼痛患者的屈曲负重后前位 X 光片使用不足。
对于有退行性改变放射学证据的患者，初级保健提供者应强烈考虑不进行膝关节 MRI 检查。
