RT Journal Article
SR Electronic
T1 Post-traumatic knee MRI findings and associations with patient, trauma, and clinical characteristics: a subgroup analysis in primary care in the Netherlands
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP e851
OP e858
DO 10.3399/bjgp17X693653
VO 67
IS 665
A1 Kim van Oudenaarde
A1 Nynke M Swart
A1 Johan L Bloem
A1 Sita MA Bierma-Zeinstra
A1 Paul R Algra
A1 Bart Koes
A1 Jan Verhaar
A1 Rob GHH Nelissen
A1 Patrick JE Bindels
A1 Pim AJ Luijsterburg
A1 Monique Reijnierse
YR 2017
UL http://bjgp.org/content/67/665/e851.abstract
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.