Magnetic resonance imaging in musculoskeletal assessment: a surgeon's perspective.

Magnetic resonance (MR) imaging is a significant advance in musculoskeletal noninvasive visualization, especially for the soft tissues including the menisci. The purpose of this article is to give the radiologist a surgeon's perspective on the role of this technology in clinical practice. For MR imaging to be cost effective, it must accurately define anatomy, and reveal changes that have an impact on patient care--i.e., be clinically relevant. For MR imaging to be accurate, optimum software, hardware, and an experienced radiologist are essential. However, even if an MR examination has high accuracy, the abnormal findings of this evaluation may not be related to the clinical problem that the patient presents with. This is supported by the demonstration that asymptomatic patients may have grade 3 meniscal tears, herniated discs, and rotator cuff changes. The MR examination may not change patient management even if it demonstrates pathologies such as a meniscal tear. The patient may tolerate the dysfunction and pain. The most cost-effective method of providing musculoskeletal care is still a careful history and competent physical examination.