Accuracy of Magnetic Resonance Imaging of the Knee and... : Clinical Orthopaedics and Related Research® (original) (raw)
SECTION II: ORIGINAL ARTICLES: Knee
Accuracy of Magnetic Resonance Imaging of the Knee and Unjustified Surgery
Ben-Galim, Peleg MD*; Steinberg, Ely L MD*; Amir, Hagai MD†; Ash, Nachman MD†; Dekel, Shmuel MD, PhD*; Arbel, Ron MD*
From the *Department of Orthopedic Surgery “B,” Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; and the †Medical Corps, Israel Defense Forces, Tel-Hashomer, Israel.
Received: December 21, 2004
Revised: June 13, 2005, November 1, 2005
Accepted: December 5, 2005
Each author certifies that he has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Each author certifies that his institution has waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.
Correspondence to: Peleg Ben-Galim, MD, Department of Orthopedic Surgery “B,” Tel-Aviv Sourasky Medical Center, 6 Weizman Street, Tel-Aviv 64239, Israel. Phone: 972-3-697-4720; Fax: 972-3-697-4546; E-mail: [email protected].
Clinical Orthopaedics and Related Research 447():p 100-104, June 2006. | DOI: 10.1097/01.blo.0000203471.50808.b7
Abstract
Magnetic resonance imaging of the knee is greater than 90% accurate in detecting intraarticular disease when performed and interpreted by musculoskeletal magnetic resonance imaging specialists in specialized medical centers. However, independent imaging institutions often offer less expensive services to health insurers. We wondered if the magnetic resonance imaging performed in our community is of equivalent quality and accuracy. We studied a homogenous group of healthy, young, and fit military recruits to represent a cross section of our country's population. We analyzed all knee magnetic resonance images of soldiers who subsequently had primary arthroscopic knee surgery within a 3-month period from 1997-1998. The results were compared with surgical findings of four structures: medial meniscus, lateral meniscus, anterior cruciate ligament, and articular cartilage. Of the 1185 arthroscopies and 633 magnetic resonance images of the knee performed in 14 institutions, 139 paired magnetic resonance imaging arthroscopic reports met our inclusion criteria. The results showed a false positive rate of 65% for the medial meniscus, 43% for the lateral meniscus, 47.2% for the anterior cruciate ligament, and 41.7% for articular cartilage disease when compared with surgical findings. Accuracy rates were 52%, 82%, 80%, and 77%, respectively. Thirty-seven percent of the operations supported by a significant disorder on magnetic resonance imaging were unjustified. Our findings highlight the consequences that may occur when basing medical care on cost rather than quality of care.
Level of Evidence: Diagnostic study, Level III (study of nonconsecutive patients; without consistently applied reference “gold” standard). See the Guidelines for Authors for a complete description of levels of evidence.
© 2006 Lippincott Williams & Wilkins, Inc.