Department of Radiology, The National Orthopaedic Hospital Cappagh, Finglas, Dublin, Ireland.
Department of Orthopaedic Surgery, The National Orthopaedic Hospital Cappagh, Finglas, Dublin, Ireland.
J Knee Surg. 2023 May;36(6):584-590. doi: 10.1055/s-0041-1740390. Epub 2021 Dec 8.
Knee osteoarthritis (OA) is a significant cause of pain and disability worldwide. Imaging provides diagnosis, prognostication, and follow-up. Radiographs are first line, useful, and inexpensive. Magnetic resonance imaging (MRI) can detect additional features not seen on radiograph, but it is of questionable usefulness in the management of knee OA. Our aim was to investigate the usefulness of MRI in the workup of knee OA and whether MRI alters management in knee OA. A retrospective review was performed of consecutive MRI knees performed for knee pain in those over 50 years. Clinical information and documentation of management plan pre- and post-MRI were collected. Assessment was made whether the MRI results influenced the final management plan. Of the 222 MRI knees included for study, the majority (62.2%) had not had a recent radiograph. OA was reported in 86.9% of radiographs and 89.6% of MRI. On MRI, the most prevalent finding was tearing/abnormality of the medial meniscus, seen in 47% of MRIs overall, increasing to all in severe OA. MRI assisted with management in 9.5% of all (21/222) patients, and changed management plans in 23% of those that had documented management plans prior to the MRI (6/26 patients). MRIs can guide tailored management in knee OA and are useful for surgical planning; however, they should only be ordered in certain cases, and a radiograph should always be performed first. MRI should be considered if symptoms are not explained by OA alone or the appropriate treatment option requires MRI.
膝骨关节炎（OA）是全球范围内导致疼痛和残疾的重要原因。影像学检查可提供诊断、预后和随访。X 线摄影是首选的、有用的、且价格低廉的方法。磁共振成像（MRI）可以检测到 X 线摄影无法发现的其他特征，但在膝骨关节炎的管理中其作用存在争议。我们的目的是研究 MRI 在膝骨关节炎检查中的作用，以及 MRI 是否会改变膝骨关节炎的管理方式。对 50 岁以上因膝关节疼痛而进行的连续 MRI 膝关节进行了回顾性研究。收集了临床信息和 MRI 前后管理计划的记录。评估 MRI 结果是否会影响最终的管理计划。在纳入研究的 222 例 MRI 膝关节中，大多数（62.2%）近期未进行 X 线摄影。X 线摄影报告 OA 发生率为 86.9%，MRI 报告 OA 发生率为 89.6%。在 MRI 上，最常见的发现是内侧半月板撕裂/异常，总体上见于 47%的 MRI，在严重 OA 中则见于所有 MRI。MRI 有助于管理 9.5%（21/222）的患者，改变了 23%（6/26）有记录的 MRI 前管理计划的患者的管理计划。MRI 可以指导膝骨关节炎的个体化管理，并有助于手术计划；但是，只有在某些情况下才应进行 MRI，并且应始终先进行 X 线摄影。如果症状不能仅用 OA 解释，或者需要 MRI 来确定合适的治疗方案，则应考虑进行 MRI。
