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SAT0520 Indications and Clinical Impacts of Magnetic Resonance Imaging of The Knee in Older Patients: Are We Choosing Wisely?
  1. M.-E. Parent1,
  2. F. Vézina2,
  3. N. Carrier3,
  4. C. Giguère4,
  5. A. Masetto3
  1. 1Department of Internal Medicine
  2. 2Department of Orthopaedic Surgery
  3. 3Department of Rheumatology
  4. 4Department of Radiology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada

Abstract

Background The use of magnetic resonance imaging (MRI) seems to be increasing in patients with gonalgia. Findings such as osteoarthritis and meniscal damages are very prevalent in older patients, often simultaneously [1–3]. These findings are of undetermined significance, as invasive therapeutic procedures provide no additional benefit [4].

Objectives The aim of this study is to analyze MRI indications and clinical impact in this population in our center.

Methods We retrospectively analyzed 215 medical records of patients older than 50 yo having undergone a knee MRI in 2009. Medical charts were reviewed up to 2014 for: patient characteristics, MRI indication, ordering physician specialty, radiography prior to MRI, MRI findings and clinical impacts of the MRI.

Results Patient's average age was 60.6±7.5. Main MRI indications were meniscopathy: 148 (68.8%) and chronic pain: 92 (42.8%). Most MRIs were ordered by general practitioners (GP): 148 (68.8%) and orthopedic surgeons (OS): 55 (25.6%). Chronic pain investigation was significantly higher in GPs than in OS (48.0% vs 27.3%, p=0.008). Findings show that 185 (86%) patients had osteoarthritis (OA) and 170 (79.1%) had meniscal lesions. Overall, 87 (40.5%) patients were seen by an OS and 27 (31%) of them underwent an invasive intervention. Among the 81 patients with moderate-to-severe OA on MRI, 36 (46%) had evidence of moderate-to-severe OA on a previous plain radiography, 28 (34.6%) were seen by an OS, and 3 (3,7%) underwent a meniscectomy.

Conclusions Our study reproduces the known association between OA and degenerative meniscal changes in older patients. About half of our cohort could have been appropriately diagnosed and treated based on available radiographic information, thus avoiding the MRI and subsequent OS evaluation. Meniscectomy - an MRI dependent procedure - was rare, particularly in patients with advanced OA. Educational and pragmatic measures must be emphasized to limit the inappropriate use of this costly imaging modality.

  1. Boden SD, Davis DO, Dina TS, Stoller DW, Brown SD, Vailas JC, et al. A prospective and blinded investigation of magnetic resonance imaging of the knee. Abnormal findings in asymptomatic subjects. Clin Orthop Relat Res. 1992 Sep;(282):177–85.

  2. Kornick J, Trefelner E, McCarthy S, Lange R, Lynch K, Jokl P. Meniscal abnormalities in the asymptomatic population at MR imaging. Radiology. 1990 Nov;177(2):463–5.

  3. Bhattacharyya T, Gale D, Dewire P, Totterman S, Gale ME, McLaughlin S, et al. The clinical importance of meniscal tears demonstrated by magnetic resonance imaging in osteoarthritis of the knee. J Bone Joint Surg Am. 2003;85-A:4–9.

  4. Katz JN, Brophy RH, Chaisson CE, de Chaves L, Cole BJ, Dahm DL, et al. Surgery versus physical therapy for a meniscal tear and osteoarthritis. N Engl J Med. 2013 May 2;368(18):1675–84.

Disclosure of Interest None declared

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