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Does MRI alter management in patients 60 years and older with chronic knee pain: correlation with radiographs and clinical parameters

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Abstract

Objective

To determine if MRI altered management in patients ≥ 60 years old with chronic knee pain.

Materials and methods

Consecutive patients ≥ 60 years old with knee MRI and radiographs within 90 days were included. Exclusion criteria included mass/malignancy, recent trauma, and infection. Standing AP and PA flexion views were evaluated using Kellgren-Lawrence (KL) and International Knee Documentation Committee (IKDC) scales. Pertinent clinical history was recorded. MRIs were considered to alter management if subchondral fracture was identified or subsequent arthroscopy was performed due to an MRI finding.

Results

Eighty-five knee MRI/radiograph exams were reviewed; mean 68.2 years (60–88), 47:38 F:M. Twenty knee MRIs (24%) had either a subchondral fracture (n = 9) or meniscal tear (n = 11) prompting arthroscopy. On PA flexion view, 0/20 of these studies had KL grade 4 and 70% (14/20) had KL grade 0–1 compared to the remaining MRIs having 15.4% (10/65) KL grade 4 and 38.5% (25/65) KL grade 0–1 (p = 0.03). A 10-pack-year tobacco history, 38% vs 18%, was associated with a subchondral fracture or arthroscopy (p = 0.06). Subchondral fractures were more prevalent in older patients (mean 72.4 vs 67.7 years; p = 0.03).

Conclusion

In patients ≥ 60 years old with chronic knee pain, MRI altered management in ~ 24% of cases; 70% in patients with KL grade 0–1, and none in patients with KL grade 4. MRI may benefit older patients with minimal osteoarthritis but not those with end-stage disease. Patients with ≥ 10 pack years of smoking may also benefit from MRI.

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Authors and Affiliations

  1. Mayo Clinic Arizona, Phoenix, AZ, USA

    Roman Shrestha, Angela H. Tulk, Amar S. Shah, Skye A. Buckner-Petty, Jeremiah R. Long & Michael G. Fox

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  1. Roman Shrestha
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  2. Angela H. Tulk
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Correspondence to Michael G. Fox.

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Abstracts related to this manuscript were presented at the Society of Skeletal Radiology annual meetings in 2019 and also in 2021 (accepted in 2020).

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Shrestha, R., Tulk, A.H., Shah, A.S. et al. Does MRI alter management in patients 60 years and older with chronic knee pain: correlation with radiographs and clinical parameters. Skeletal Radiol (2024). https://doi.org/10.1007/s00256-024-04691-7

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  • DOI: https://doi.org/10.1007/s00256-024-04691-7

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