Resident in the Department of Rheumatology at the Centre hospitalier universitaire de Sherbrooke in Quebec.
Adjunct Professor in the Department of Orthopaedic Surgery at the Centre hospitalier universitaire de Sherbrooke.
Can Fam Physician. 2018 Mar;64(3):e126-e132.
To analyze the indications for and clinical procedures resulting from knee magnetic resonance imaging (MRI) in older patients.
We retrospectively analyzed 215 medical records of patients 50 years of age and older who had undergone a unilateral knee MRI in 2009.
Centre hospitalier universitaire de Sherbrooke in Quebec.
Patients 50 years of age and older who underwent a knee MRI in 2009.
The main outcome measure was an invasive procedure in the same knee that underwent an MRI. Medical charts were reviewed up to 2014 for patient characteristics, MRI indication, ordering physician specialty, radiography before MRI, MRI findings, and clinical procedures resulting from the MRI.
The patients' mean (SD) age was 60.6 (7.5) years. The main MRI indications were meniscopathy (148 [68.8%]) and chronic pain (92 [42.8%]). The main MRI findings were osteoarthritis (OA) (185 [86.0%]) and meniscal lesions (170 [79.1%]). Only 82 (38.1%) patients had a plain radiograph in the 24 months preceding the MRI, usually without a standing anteroposterior view. Findings on pre-MRI radiography (n = 201) demonstrated OA in 144 (71.6%) patients. Overall, 87 (40.5%) patients were seen by an orthopedic surgeon and 27 (31.0%) of these patients underwent an invasive intervention. Among the 81 patients with moderate to severe OA on MRI, 36 (44.4%) had radiographic evidence of moderate to severe OA and only 3 (3.7%) underwent arthroscopic meniscectomy.
Our study reproduces the known association between OA and degenerative meniscal changes in older patients. We have found a surprising underuse of the standing anteroposterior view on radiography. Most patients in our cohort could have been appropriately diagnosed and treated based on such radiographic information, as demonstrated by pre-MRI findings, thus avoiding the MRI and subsequent evaluation by an orthopedic surgeon. Meniscectomy was rarely performed, particularly in patients with advanced OA. Educational and pragmatic measures must be emphasized to encourage the use of radiography and to limit the inappropriate use of MRI, a costly technique.
分析老年患者膝关节磁共振成像（MRI）的适应证和临床操作。
我们回顾性分析了 2009 年在魁北克舍布鲁克大学中心医院进行单侧膝关节 MRI 的 215 名 50 岁及以上患者的病历。
魁北克舍布鲁克大学中心医院。
2009 年进行膝关节 MRI 的 50 岁及以上患者。
主要观察指标为同一膝关节的侵入性操作，对患者特征、MRI 适应证、开单医生专科、MRI 前 X 线摄影、MRI 结果和 MRI 后临床操作进行病历回顾。
患者的平均（SD）年龄为 60.6（7.5）岁。主要 MRI 适应证为半月板病变（148 例[68.8%]）和慢性疼痛（92 例[42.8%]）。主要 MRI 结果为骨关节炎（OA）（185 例[86.0%]）和半月板病变（170 例[79.1%]）。只有 82 例（38.1%）患者在 MRI 前 24 个月内进行了 X 线摄影，通常没有站立前后位。201 例 MRI 前 X 线摄影结果显示，144 例（71.6%）患者存在 OA。总体而言，87 例（40.5%）患者由矫形外科医生就诊，其中 27 例（31.0%）患者接受了侵入性干预。在 81 例 MRI 显示中至重度 OA 的患者中，36 例（44.4%）有中至重度 OA 的放射学证据，只有 3 例（3.7%）接受了关节镜半月板切除术。
本研究再现了老年患者 OA 与退行性半月板改变之间的已知关联。我们发现 X 线摄影中对站立前后位的使用令人惊讶地不足。我们研究队列中的大多数患者可以根据放射学信息进行适当诊断和治疗，正如 MRI 前发现所示，从而避免 MRI 和随后由矫形外科医生进行评估。半月板切除术很少进行，特别是在 OA 进展患者中。必须强调教育和实用措施，以鼓励使用 X 线摄影，并限制 MRI 的不当使用，因为 MRI 是一种昂贵的技术。
