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Document Title: Boks-AJSM-Dec06.shtml
Article Title: Magnetic Resonance Imaging Abnormalities in Symptomatic and Contralateral Knees: Prevalence and Associations With Traumatic History in General Practice
Authors: Simone S. Boks, MD, Dammis Vroegindeweij, MD, PhD, Bart W. Koes, PhD, Myriam M.G.M. Hunink, MD, PhD and Sita M.A. Bierma-Zeinstra, PhD
Publication: American Journal of Sports Medicine, Baltimore, Maryland
Date: December 2006
Volume 34, pages 1984-1991
Keywords: MRI, magnetic resonance imaging, nuclear-magnetic-resonance imaging (NMR), non-invasive diagnostics, diagnostics without ionizing radiation.
(Reference-denoting numbers appear in the same font and point size as the document text. As with all Knee Library documents, this article is provided in full-text form. This article has no figures. The appendix is included.)
Comments: MRI (magnetic resonance, also known as nuclear magnetic resonance), which uses magnetic fields to excite hydrogen atoms in tissue, is an excellent tool for peering inside the knee noninvasively and without the dangers of ionizing radiation (as is used for standard X-rays and also CAT/CT scans). The latest MRI machines, using magnets of 3 Teslas or stronger, bring the sharpest images, although even a standard-issue 1-T machine can give excellent resolution of knee injuries. The problem with MRI scans is that they do not always reveal the full extent of knee-ligament injuries. But they provide a lot of insight, and are an excellent adjunct to the low-tech essential diagnostics of manual-manipulation testing and, of course, history-taking (i.e. gathering information on how the knee was injured, how it was forced, whether or not any loud noises were heard from the, whether or not it swelled up grotesquely, etc.). This study, done in Holland, found that comparing a recently-injured knee to the contralateral one provides helpful insight into whether certain MRI findings could be due to long-standing degeneration or old injuries.
Abstract
Background: After trauma, internal knee lesions are found in approximately two thirds of patients. However, magnetic resonance imaging abnormalities have also been described in asymptomatic volunteers.
Hypothesis: Not all visualized lesions in symptomatic posttraumatic knees are the result of recent trauma; there are subgroups of lesions that may be preexistent.
Study Design: Cross-sectional study (prevalence); Level of evidence, 2.
Methods: Patients visiting their general practitioners after knee trauma were invited for magnetic resonance imaging of both knees. Prevalence of knee abnormalities was compared between symptomatic and asymptomatic knees. Multivariable analysis was performed to investigate the association between lesions that were seen in symptomatic and asymptomatic knees (ie, effusion and meniscal tears) and recent trauma, history of old trauma, age, and osteoarthritis.
Results: In 134 participants, ligament lesions were found almost exclusively in symptomatic knees. Meniscal lesions and effusion were almost equally found in symptomatic and asymptomatic knees. Effusion was related to recent trauma (odds ratio, 14.0; 95% confidence interval, 5.0–39.6) and osteoarthritis (odds ratio, 4.7; 95% confidence interval, 1.4–15.5) but not to history of old trauma and age. Meniscal tears were more common in older patients (odds ratio, 1.09; 95% confidence interval, 1.05–1.12) but were not related to osteoarthritis. History of old trauma was more strongly related to the group of radial, longitudinal, and complex meniscal tears (odds ratio, 8.6; 95% confidence interval, 3.3–22.5) than to horizontal tears (odds ratio, 2.3; 95% confidence interval, 0.9–5.6). Recent trauma was not related to horizontal meniscal tears but was strongly related to other types of meniscal tears (odds ratio, 3.2; 95% confidence interval, 1.4–6.9).
Conclusion: Ligament knee lesions are most probably the result of recent trauma. Radial, longitudinal, and complex meniscal tears are strongly related to trauma, whereas horizontal meniscal tears and effusion may be preexistent in many cases.
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