PURPOSE:Acute knee injury is common, and MRI is often only used when non-operative management fails because of limited availability. We investigated whether early MRI in acute knee injury is more clinically and cost-effective compared to conventional physiotherapy and reassessment. METHODS:All patients with acute indirect soft tissue knee injury referred to fracture clinic were approached. Recruited patients were randomised to either the MRI group: early MRI within 2 weeks or the control group: conventional management with physiotherapy. Patients were assessed in clinic initially, at 2 weeks and 3 months post-injury. Management costs were calculated for all patients until surgical treatment or discharge. RESULTS:Forty-six patients were recruited: 23 in the MRI and 23 in the control group. Male sex and mean age were similar in the two groups. The total management cost of the MRI group was £16,127 and control group was £16,170, with a similar mean cost per patient (NS). The MRI group had less mean physiotherapy (2.5 ± 1.9 vs. 5.1 ± 3.5, p < 0.01) and outpatient appointments (NS). Median time to surgery and time off work was less in the MRI group (NS). The MRI group had less pain (p < 0.05), less activity limitation (p = 0.04) and better satisfaction (p = 0.04). CONCLUSIONS: Early MRI in acute knee injury facilitates faster diagnosis and management of internal derangement at a cost comparable to conventional treatment. Moreover, patients had significantly less time off work with improved pain, activity limitation and satisfaction scores. LEVEL OF EVIDENCE: II.
RCT Entities:
PURPOSE: Acute knee injury is common, and MRI is often only used when non-operative management fails because of limited availability. We investigated whether early MRI in acute knee injury is more clinically and cost-effective compared to conventional physiotherapy and reassessment. METHODS: All patients with acute indirect soft tissue knee injury referred to fracture clinic were approached. Recruited patients were randomised to either the MRI group: early MRI within 2 weeks or the control group: conventional management with physiotherapy. Patients were assessed in clinic initially, at 2 weeks and 3 months post-injury. Management costs were calculated for all patients until surgical treatment or discharge. RESULTS: Forty-six patients were recruited: 23 in the MRI and 23 in the control group. Male sex and mean age were similar in the two groups. The total management cost of the MRI group was £16,127 and control group was £16,170, with a similar mean cost per patient (NS). The MRI group had less mean physiotherapy (2.5 ± 1.9 vs. 5.1 ± 3.5, p < 0.01) and outpatient appointments (NS). Median time to surgery and time off work was less in the MRI group (NS). The MRI group had less pain (p < 0.05), less activity limitation (p = 0.04) and better satisfaction (p = 0.04). CONCLUSIONS: Early MRI in acute knee injury facilitates faster diagnosis and management of internal derangement at a cost comparable to conventional treatment. Moreover, patients had significantly less time off work with improved pain, activity limitation and satisfaction scores. LEVEL OF EVIDENCE: II.
Authors: Edwin H G Oei; Jeroen J Nikken; Abida Z Ginai; Gabriel P Krestin; Jan A N Verhaar; Arie B van Vugt; M G Myriam Hunink Journal: Radiology Date: 2005-01 Impact factor: 11.105
Authors: B Munk; F Madsen; E Lundorf; H Staunstrup; S A Schmidt; L Bolvig; M B Hellfritzsch; J Jensen Journal: Arthroscopy Date: 1998-03 Impact factor: 4.772
Authors: Mike Tengrootenhuysen; Geert Meermans; Kathleen Pittoors; Roger van Riet; Jan Victor Journal: Knee Surg Sports Traumatol Arthrosc Date: 2010-10-15 Impact factor: 4.342
Authors: J Le Vot; J C Solacroup; P Leonetti; P Nun; E Gueguen; E Le Bihan; J H Tourrette; J F Gadea; P Germanetto Journal: J Chir (Paris) Date: 1994-03
Authors: B Friemert; Y Oberländer; W Schwarz; H J Häberle; W Bähren; H Gerngross; B Danz Journal: Knee Surg Sports Traumatol Arthrosc Date: 2003-08-05 Impact factor: 4.342
Authors: Nynke M Swart; Kim K van Oudenaarde; Paul R Algra; Partick J E Bindels; Wilbert B van den Hout; Bart W Koes; Rob G H H Nelissen; Jan A N Verhaar; Hans J L Bloem; Sita M A Bierma-Zeinstra; Monique M Reijnierse; Pim A J Luijsterburg Journal: BMC Musculoskelet Disord Date: 2014-03-03 Impact factor: 2.362