Early MRI in acute knee haemarthrosis not supported by published evidence
Date First Published:
March 1, 2000
Last Updated:
April 11, 2001
Report by:
Ashes Mukerjee, Research Fellow (Manchester Royal Infirmary)
Search checked by:
Kevin Mackway-Jones, Manchester Royal Infirmary
Three-Part Question:
In [young adults with acute knee haemarthrosis with no obvious fracture] is [early MRI better than arthroscopy] in [diagnosing intra-articular pathology]?
Clinical Scenario:
A young man comes into the emergency department after sustaining a knee injury while playing football. Examination reveals a tense haemarthrosis; there is no evidence of fracture on x-ray. You wonder whether a MRI scan would be better than an arthroscopy to establish a diagnosis.
Search Strategy:
Medline 1966-12/98 using the OVID interface.
Search Details:
[{exp magnetic resonance imaging OR magnetic resonance image$.mp OR magnetic resonance imaging.mp OR MRI.mp OR exp nuclear magnetic resonance OR NMR.mp} AND (exp knee OR exp knee injuries OR exp knee joint OR knee$.mp} AND {exp hemarthrosis OR hemarthrosis.mp OR haemarthrosis.mp})] LIMIT to human and english language.
Outcome:
26 papers found of which 24 were irrelevant to the study question or of insufficient quality for inclusion.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| The diagnostic validity of magnetic resonance imaging in acute knee injuries with hemarthrosis. A single-blinded evaluation in 69 patients using high-field MRI before arthroscopy. Lundberg M, Odensten M, Thuomas KA et al. 1996 Sweden | 69 patients with unilateral knee haemarthrosis. MRI within days vs arthroscopy at a mean of 6 days |
Prospective single blind diagnostic | ACL tears | sensitivity 86%, specificity 92% | Small sample size |
| Medial meniscal tears | sensitivity 74%, specificity 66% | ||||
| Lateral meniscal tears | sensitivity 50%, specificity 84% | ||||
| Medial collateral ligament tears | sensitivity 56%, specificity 93% | ||||
| Magnetic resonance imaging, scintigraphy, and arthroscopic evaluation of traumatic hemarthrosis of the knee. Adalberth T, Roos H, Lauren M et al. 1997 Sweden | 40 patients with acute traumatic intra-articular haemorrhage. MRI within 1 week vs arthroscopy within 1 week |
Prospective diagnostic | Meniscal tears | sensitivity 76%, specificity 29%<br>sensitivity 97%, specificity 50% | Small sample size |
Author Commentary:
Arthroscopy was used as a gold standard in both selected studies. MRI lacks both the sensitivity required for a SnOut and specificity required for a SpIn on this evidence. The evidence only applies to the conditions stated (haemarthrosis and investigation within 1 week) and different results might be found at different times.
Bottom Line:
The evidence does not support early use of MRI scanning in acute knee haemarthrosis.
References:
- Lundberg M, Odensten M, Thuomas KA et al.. The diagnostic validity of magnetic resonance imaging in acute knee injuries with hemarthrosis. A single-blinded evaluation in 69 patients using high-field MRI before arthroscopy.
- Adalberth T, Roos H, Lauren M et al.. Magnetic resonance imaging, scintigraphy, and arthroscopic evaluation of traumatic hemarthrosis of the knee.