Association of MRI findings and expert diagnosis of symptomatic meniscal tear among middle-aged and older adults with knee pain

BMC Musculoskeletal Disorders

Research Article

Bhushan R. Deshpande¹  Savannah R. Smith¹  Elena Losina²  Jeffrey N. Katz³  Scott D. Martin⁴  R. John Wright⁴ 

[1] Department of Orthopaedic Surgery, Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, 75 Francis Street, BC-4-016, 02115, Boston, MA, USA;Department of Orthopaedic Surgery, Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, 75 Francis Street, BC-4-016, 02115, Boston, MA, USA;Division of Rheumatology, Section of Clinical Sciences, Immunology and Allergy, Brigham and Women’s Hospital, Boston, MA, USA;Harvard Medical School, Boston, MA, USA;Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA;Department of Orthopaedic Surgery, Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, 75 Francis Street, BC-4-016, 02115, Boston, MA, USA;Division of Rheumatology, Section of Clinical Sciences, Immunology and Allergy, Brigham and Women’s Hospital, Boston, MA, USA;Harvard Medical School, Boston, MA, USA;Departments of Epidemiology and Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA;Harvard Medical School, Boston, MA, USA;Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA;

关键词: Knee pain;    Meniscal tear;    MRI;    Diagnosis;   

DOI  :  10.1186/s12891-016-1010-2

 received in 2016-02-03, accepted in 2016-04-01,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundOur aim was to examine the association between an expert clinician’s impression of symptomatic meniscal tears and subsequent MRI in the context of middle-aged and older adults with knee pain.MethodsPatients older than 45 were eligible for this IRB-approved substudy if they had knee pain, had not undergone MRI and saw one of two orthopaedic surgeons experienced in the diagnosis of meniscal tear. The surgeon rated their confidence that the patient’s symptoms were due to meniscal tear. The patient subsequently had a 1.5 or 3.0 T MRI within 6 months. We examined the association between presence of meniscal tear on MRI and the surgeon’s confidence that the knee pain was due to meniscal tear using a χ2 test for trend.ResultsOf 84 eligible patients, 63 % were female, with a mean age of 64 years and a mean BMI of 27. The surgeon was confident that symptoms emanated from a tear among 39 %. The prevalence of meniscal tear on MRI overall was 74 %. Among subjects whose surgeon indicated high confidence that symptoms were due to meniscal tear, the prevalence was 80 % (95 % CI 63–90 %). Similarly, the prevalence was 87 % (95 % CI 62–96 %) among those whose surgeon had medium confidence and 64 % (95 % CI 48–77 %) among those whose surgeon had low confidence (p = 0.12).ConclusionMeniscal tears were frequently found on MRI even when an expert clinician was confident that a patient’s knee symptoms were not due to a meniscal tear, indicating that providers should use MRI sparingly and cautiously to confirm or rule out the attribution of knee pain to meniscal tear.

【 授权许可】

CC BY   
© Deshpande et al. 2016