Introduction: The use of MRI is increasing when evaluating patients with knee pain because it is highly sensitive for detecting intra-articular pathology. However, such changes can be associated with degenerative joint disease, which may be demonstrated with weight-bearing radiographs. The purpose of this study was to determine how often MRI was obtained before orthopaedic referral in patients aged ≥40 years with knee pain, how often weight-bearing radiographs were obtained before MRI, and whether such imaging influenced treatment recommendations.
Methods: In a study of 599 new patients, participating physicians documented the presence of a prereferral MRI and/or plain radiographic studies, the results of weight-bearing radiographs, treatment recommendations, and the impact of any prereferral imaging.
Results: Prereferral use of MRI occurred in 130 patients (22%). Of these patients, plain radiographic studies were obtained for 58% before MRI and 13% had weight-bearing radiographs. Ultimately, 17% had weight-bearing radiographs that demonstrated >50% loss of joint space. Forty-eight percent of prereferral MRIs did not contribute to treatment recommendations. In patients with >50% loss of joint space, MRI was considered unnecessary in 95% of the cases.
Discussion: Many prereferral MRIs do not contribute to clinical decision making. Weight-bearing radiographs can help identify those patients in whom MRI is unlikely to be helpful.
Level of Evidence: Level III
From the Department of Orthopedics, Washington University, St. Louis, MO (Dr. Adelani, Dr. Brophy, Dr. Halstead, Dr. Smith, and Dr. Wright) and St. Louis Center for Cartilage Restoration and Repair, St. Louis (Dr. Mall).
Correspondence to Dr. Adelani: firstname.lastname@example.org
Dr. Mall or an immediate family member is a member of a speakers’ bureau or has made paid presentations on behalf of Arthrex. Dr. Brophy or an immediate family member has stock or stock options held in Ostesys, and serves as a board member, owner, officer, or committee member of The American Orthopaedic Association, the American Orthopaedic Society for Sports Medicine, and the Orthopaedic Research Society. Dr. Halstead or an immediate family member serves as a board member, owner, officer, or committee member of the American Medical Society for Sports Medicine. Dr. Smith or an immediate family member is a member of a speakers’ bureau or has made paid presentations on behalf of Arthrex. Dr. Wright or an immediate family member has received research or institutional support from the National Institutes of Health (NIAMS and NICHD) and serves as a board member, owner, officer, or committee member of the American Board of Orthopaedic Surgery, The American Orthopaedic Association, and the American Orthopaedic Society for Sports Medicine. Neither Dr. Adelani nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article.
Received December 14, 2015
Accepted May 29, 2016