Study: MRIs often unnecessary for knee pain — 7 takeaways

Orthopedic Sports Medicine

MRIs are expensive, time-consuming and unnecessary for patients 40-years-old or older who are suffering from knee pain, according to a study in the Journal of the American Academy of Orthopaedic Surgeons, Medscape reports.

Here’s seven things to know.


1. The study claims that weight-bearing X-rays are "sufficient."


"Plain radiographic studies" can diagnosis significant osteoarthritis, Muyibat Adelani, MD, assistant professor of orthopedic surgery at the Washington University School of Medicine, in Saint Louis, wrote.


2. The study authors note that MRIs are 12 times more expensive, and do not provide any more useful information. In fact, the incidental findings MRI could reveal may not be the cause of patient’s pain.


3. Previous studies show physicians do not order weight-bearing X-rays before ordering MRIs, and that orthopedic surgeons deem the MRIs unnecessary.


4. Dr. Adelani and his colleagues analyzed 599 patients 40-years-old or older. Osteoarthritis was the most common diagnosis in 39 percent of patients. Meniscal tear was second with 29 percent.


5. Of the 599, 130 of the patients had a prereferral MRI. Among those patients, the most common diagnosis was a meniscal tear with 38 percent. Osteoarthritis was diagnosed in 37 percent of the patients.


However only 76 of the 130 patients had a plain radiographic X-ray, and only 17 of them had a weight-bearing X-ray. Yet, evaluations showed 45 percent of patients had joint space loss, and 17 percent lost more than half of their joint space, indicators of osteoarthritis.


6. According to specialists, only 48 percent of the prereferral MRIs had information useful for treatment recommendations, and "MRIs were unnecessary for 95 percent of the patients who lost more than half of their joint space."


7. The authors did note the study was limited because of it being conducted at one site, and it used "very strict exclusion criteria that may have resulted in an underestimation of prereferral MRIs."


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