The use of magnetic resonance imaging in acute knee injuries can be reduced by non-physician expert clinics

Abstract

Introduction. The routine use of magnetic resonance imaging (MRI) for the assessment of acute knee injuries is controversial. The goal of this study is to present an audit of patients seen in a dedicated Acute Knee Injury Clinic (AKIC) to determine the frequency and appropriateness of MRI utilization. Methods. A retrospective review identified all patients who had an MRI and a randomly selected control group without MRI. The MRI was classified based on whether it was ordered by the AKIC team or by an external clinician. The consensus-based ‘Indications for Urgent MRI in Acute Soft Tissue Knee Problems’ were applied to both groups. An MRI was considered appropriate if any of the indications were met. Results. The overall MRI utilization rate was 23% (142/611). Of the MRIs performed, 32% (46/142) met the indications. About 94% (33/35) of the MRIs ordered by the AKIC experts met the indications, compared to only 12% (13/107) of those ordered externally. No patients in the control group met the indications. Diagnoses were similar between groups. Discussion. These results suggest that application of guidelines by experts in knee evaluation can significantly reduce expensive MRI utilization in patients with acute knee injuries without negatively impacting the appropriate diagnosis and disposition.

Keywords:

• Acute knee injury
• MRI
• primary care

Acknowledgments

The authors would like to acknowledge the Alberta Health Services for funding the Soft Tissue Injury Working Group of the Alberta Bone and Joint Clinical Network.

Declaration of interest

No direct funding or industry support was provided for this study. Indirect funding and in-kind support was received through the AKIC from the University of Calgary Sport Medicine Centre, the Knee Injury Working Group of the Alberta Bone and Joint Clinical Network, and Alberta Health Services. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

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