43% of knee MRIs useless in helping patient - Magaziner Center for Wellness

43% of knee MRIs useless in helping patient

Research says that the knee ligament complex may be too complex to depend on an MRI recommendation for surgery.1 New research agrees and says 43% of knee MRIs are basically useless.

Investigators found that knee MRIs used for assessment of a patients condition were:
– 39% useful
– 18% inconclusive
– 43% useless

They suggested that doctors should advise patients on the expected utility of getting a knee MRI. Basically, it may not be helpful.2

MRI for knee surgery recommendation

Before you consider the surgical option based on an MRI, a consultation with a doctor trained in non-surgical trea tment of ligament and tendon injuries, such as Prolotherapy, PRP (Platelet Rich Plasma) Therapy, and Stem Cell Therapy may be an option to explore.

“Careful clinical examination is much better than MRI with regard to the diagnosis of medial meniscus injury and is as reliable as MRI with regard to diagnosis of lateral meniscus injury and ACL tears. MRI should be used to rule out such injuries rather than to diagnose them.”3

Does an MRI help treatment of knee injuries or confuse it?

Research is saying that MRI findings are often confusing and conflict with the physical examination. Enough so that the research is recommending the physical examination to determine treatment.4

In other research
“Magnetic resonance imaging (MRI) has the highest sensitivity of all methods for the diagnosis of intra-articular knee injuries. In spite of this, its benefit for the decision-making algorithm is questionable.”

Researchers in the Czech republic looked at the medical records of patients who underwent knee arthroscopy in 2008 and 2009, and had pre-operative MRI examination. They examined patients who had lateral meniscus (LM) tears, anterior cruciate ligament (ACL) tears, and articular chondral lesions, with the diagnostic value of MRI the lowest for cartilage damage. They concluded “There is no consensus regarding the role of MRI in the diagnosis of intra-articular lesions of the knee. To a certain extent, its use is related to local conditions. It can be concluded that MRI examination is not currently as important for the diagnosis of knee injuries as expected by both medical and lay communities.”5

In another study, researchers noted: “Specialist radiological imaging is specific for cartilage disease in the knee but has poorer sensitivity to determine the therapeutic options in this population. Due to this limitation, there remains little indication to replace the ‘gold-standard’ arthroscopic investigation with MRI, MRA or CTA for the assessment of adults with chondral lesions of the knee.”6

Arthroscopic procedures can be very invasive. They can be great at finding damage, but what they do with the damage once found can be at issue, especially in instances of osteoarthritis. “Arthroscopy of the osteoarthritic knee is a common and costly practice with limited and specific indications.”7

Prolotherapy, PRP, and Stem Cells Therapy

Most of the patients we see in our office are patients that have already been to many different doctors with varying degreess of success or failure in their knee pain treatments. While we are in New jersey, we see patients from all over the work looking for the “answer” to their knee osteoarthritis.

In Prolotherapy, we use a dextrose based solution and for many this offers the desired results of ligament, tendon and cartilage rebuild. Sometimes we offer the patient Prolotherapy in the form of Platelet Rich Plasma Therapy. Here we draw the patients blood, spin it, until we can harvest the blood platelets, which are rich in healing cells. Sometimes we offer Stem Cell Therapy to the patient, where stem cells from the patient’s body fat are introduced into the knee. Stem cells have the capability to mimic the building blocks of proteins to help the knees.

Questions ? email magazinercenter@gmail.com

Dr. Allan Magaziner & Dr. Scott Greenberg

1. Bonadio MB, Helito CP, Gury LA, Demange MK, Pécora JR, Angelini F. Correlation between magnetic resonance imaging and physical exam in assessment of injuries to posterolateral corner of the knee. Acta Ortop Bras. 2014;22(3):124-6. doi: 10.1590/1413-78522014220300928.

2. Song YD, Jain NP, Kim SJ, Kwon SK, Chang MJ, Chang CB, Kim TK. Is Knee Magnetic Resonance Imaging Overutilized in Current Practice? Knee Surg Relat Res. 2015 Jun;27(2):95-100. doi: 10.5792/ksrr.2015.27.2.95. Epub 2015 Jun 1.

3. Siddiqui MA, Ahmad I, Sabir AB, Ullah E, Rizvi SA, Rizvi SW Clinical examination vs. MRI: Evaluation of diagnostic accuracy in detecting ACL and meniscal injuries in comparison to arthroscopy. Pol Orthop Traumatol. 2013 Feb 18;78:59-63.

4. Cubukcu D, Sarsan A, Alkan H. Relationships between Pain, Function and Radiographic Findings in Osteoarthritis of the Knee: A Cross-Sectional Study. Arthritis. 2012;2012:984060. doi: 10.1155/2012/984060. Epub 2012 Nov 19.

5. Cellár R, Sokol D, Lacko M, et al. Magnetic resonance imaging in the diagnosis of intra-articular lesions of the knee. Acta Chir Orthop Traumatol Cech. 2012;79(3):249-54.

6. Smith TO, Drew BT, Toms AP, Donell ST, Hing CB. Accuracy of magnetic resonance imaging, magnetic resonance arthrography and computed tomography for the detection of chondral lesions of the knee. Knee Surg Sports Traumatol Arthrosc. 2012 Jan 24. [Epub ahead of print]

7. Howell SM. The role of arthroscopy in treating osteoarthritis of the knee in the older patient. Orthopedics. 2010 Sep 7;33(9):652. doi: 10.3928/01477447-20100722-34.

You can visit these links on our website that will explain these various forms of Prolotherapy to the knee in depth.

Osteoarthritis

Meniscal surgery and ligament laxity

PRP Platelet Rich Plasma therapy