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J Knee Surg 2019; 32(03): 280-283
DOI: 10.1055/s-0038-1641154
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Role of Clinical Examination in Predicting Relevant MRI Findings in Acute Knee Injuries: A Retrospective Study

Daoud Makki
1   Department of Trauma and Orthopaedics, Stepping Hill Hospital, Stockport, United Kingdom
,
Saleem Mastan
2   Department of Trauma and Orthopaedics, Manchester Royal Infirmary, Manchester, United Kingdom
,
Daniel Ness
3   Department of Trauma and Orthopaedics, Countess of Chester Hospital NHS Foundation Trust, Chester, Cheshire West and Chester, United Kingdom
,
Raghuram Thonse
3   Department of Trauma and Orthopaedics, Countess of Chester Hospital NHS Foundation Trust, Chester, Cheshire West and Chester, United Kingdom
› Author Affiliations
Further Information

Publication History

12 September 2017

25 February 2018

Publication Date:
13 April 2018 (online)

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Abstract

The objective of this study was to delineate the usefulness of clinical examination and magnetic resonance imaging (MRI) in acute knee injuries. We aim to establish whether the time period post acute knee injury is related to the diagnostic accuracy of clinical examination and to investigate the strength of specific clinical examination findings in predicting a clinically relevant MRI abnormality. Seventy patients were referred to fracture clinic with an acute knee injury who subsequently went on to be investigated with MRI over 12 months. These patients were retrospectively analyzed looking at the time period they were reviewed, the components that were assessed at physical examination, and the results of their eventual MRI scan looking for any correlation. A greater proportion of patients who were examined at 2 weeks had relevant positive findings on MRI scan, p = 0.03. Range of movement and lateral joint line tenderness were not associated with a positive MRI scan at any period after injury. The presence of a moderate to large effusion was not associated with an MRI abnormality if the examination was within 2 weeks of injury but was if present 2 weeks after injury, p = 0.0001. Range of movement should not form part of the decision making on whether an injury should be investigated with MRI. Joint effusion in isolation within 2 weeks after injury should not be an indication for MRI but a repeat clinical examination in 2 weeks, where if still present, should be investigated with MRI.

Keywords

acute knee injury - MRI - clinical examination
 

  • References

  • 1 Rayan F, Bhonsle S, Shukla DD. Clinical, MRI, and arthroscopic correlation in meniscal and anterior cruciate ligament injuries. Int Orthop 2009; 33 (01) 129-132
    CrossrefPubMedSearch in Google Scholar
  • 2 Felli L, Garlaschi G, Muda A. , et al. Comparison of clinical, MRI and arthroscopic assessments of chronic ACL injuries, meniscal tears and cartilage defects. Musculoskelet Surg 2016; 100 (03) 231-238
    CrossrefPubMedSearch in Google Scholar
  • 3 Malanga GA, Andrus S, Nadler SF, McLean J. Physical examination of the knee: a review of the original test description and scientific validity of common orthopedic tests. Arch Phys Med Rehabil 2003; 84 (04) 592-603
    CrossrefPubMedSearch in Google Scholar
  • 4 Sternbach GL. Evaluation of the knee. J Emerg Med 1986; 4 (02) 133-143
    CrossrefPubMedSearch in Google Scholar
  • 5 Dufka FL, Lansdown DA, Zhang AL, Allen CR, Ma CB, Feeley BT. Accuracy of MRI evaluation of meniscus tears in the setting of ACL injuries. Knee 2016; 23 (03) 460-464
    CrossrefPubMedSearch in Google Scholar
  • 6 Nam TS, Kim MK, Ahn JH. Accuracy of MRI evaluation of 206 meniscal tears in acute anterior cruciate ligament injuries. Arthroscopy 2014; 30: 475-482
    CrossrefPubMedSearch in Google Scholar