TY - JOUR
T1 - Post-traumatic knee MRI findings and associations with patient, trauma, and clinical characteristics
T2 - A subgroup analysis in primary care in the Netherlands
AU - Van Oudenaarde, Kim
AU - Swart, Nynke M.
AU - Bloem, Johan L.
AU - Bierma-Zeinstra, Sita Ma
AU - Algra, Paul R.
AU - Koes, Bart
AU - Verhaar, Jan
AU - Nelissen, Rob Ghh
AU - Bindels, Patrick Je
AU - Luijsterburg, Pim Aj
AU - Reijnierse, Monique
N1 - Funding Information: This trial was financially supported by the Netherlands Organisation for Health Research and Development (ZonMW), (project number 171202005). Publisher Copyright: © 2017 British Journal of General Practice.
PY - 2017/12
Y1 - 2017/12
N2 - Background The added value of magnetic resonance imaging (MRI) in primary care is still being debated. A high diagnostic yield can be expected in young and active patients with post-traumatic knee complaints. Aim To determine the frequency of MRI abnormalities in young and active patients (aged 18-45 years) and the associations with patient, trauma, and clinical characteristics. Design and setting A subgroup analysis of 174 patients, aged 18-45 years with knee trauma of <6 months, allocated to MRI in a randomised controlled trial on the yield of MRI in primary care. Patients were recruited by 150 GPS in the Netherlands from October 2012 to November 2015. Method Associations were expressed using mean differences, odds ratio (OR) and predictive values. Results Sixty-seven out of 174 patients (39%) had a positive MRI finding, predominantly anterior cruciate ligament (ACL) ruptures (22%) and/or traumatic meniscal tears (15%). Patients with a pre-existing musculoskeletal comorbidity had a two-fold lower prevalence of positive MRI findings (21%), OR 3.0 (95% confidence interval [CI] = 1.3 to 7.0). A 'sports related trauma' showed the highest OR of 4.6 (95% CI = 2.2 to 9.3) for a positive MRI finding. Clinical scores were statistically, significantly worse in patients with positive MRI findings, with mean differences ranging from 10 to 20%. Furthermore, increasing duration of complaints was correlated with decreasing prevalence rates of positive MRI findings. Overall, a popping sound and direct swelling showed the highest positive predictive value of 65% for the presence of positive MRI findings. Conclusion The results from this study enable a preselection of patients to increase the diagnostic yield of MRI in primary care.
AB - Background The added value of magnetic resonance imaging (MRI) in primary care is still being debated. A high diagnostic yield can be expected in young and active patients with post-traumatic knee complaints. Aim To determine the frequency of MRI abnormalities in young and active patients (aged 18-45 years) and the associations with patient, trauma, and clinical characteristics. Design and setting A subgroup analysis of 174 patients, aged 18-45 years with knee trauma of <6 months, allocated to MRI in a randomised controlled trial on the yield of MRI in primary care. Patients were recruited by 150 GPS in the Netherlands from October 2012 to November 2015. Method Associations were expressed using mean differences, odds ratio (OR) and predictive values. Results Sixty-seven out of 174 patients (39%) had a positive MRI finding, predominantly anterior cruciate ligament (ACL) ruptures (22%) and/or traumatic meniscal tears (15%). Patients with a pre-existing musculoskeletal comorbidity had a two-fold lower prevalence of positive MRI findings (21%), OR 3.0 (95% confidence interval [CI] = 1.3 to 7.0). A 'sports related trauma' showed the highest OR of 4.6 (95% CI = 2.2 to 9.3) for a positive MRI finding. Clinical scores were statistically, significantly worse in patients with positive MRI findings, with mean differences ranging from 10 to 20%. Furthermore, increasing duration of complaints was correlated with decreasing prevalence rates of positive MRI findings. Overall, a popping sound and direct swelling showed the highest positive predictive value of 65% for the presence of positive MRI findings. Conclusion The results from this study enable a preselection of patients to increase the diagnostic yield of MRI in primary care.
KW - Anterior cruciate ligament injuries
KW - Early diagnosis
KW - Knee injuries
KW - Magnetic resonance imaging
KW - Tibial meniscus injuries
UR - http://www.scopus.com/inward/record.url?scp=85037028459&partnerID=8YFLogxK
U2 - https://doi.org/10.3399/bjgp17X693653
DO - https://doi.org/10.3399/bjgp17X693653
M3 - Article
C2 - 29158244
SN - 0960-1643
VL - 67
SP - e851-e858
JO - British journal of general practice
JF - British journal of general practice
IS - 665
ER -