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MRI for degenerative meniscal lesions: cease and desist! A three-step action plan
  1. Dylan Meng1,
  2. Kieran O’Sullivan2,3,
  3. Ben Darlow4,
  4. Peter B O’Sullivan5,
  5. Guri Ranum Ekås6,7,
  6. Bruce B Forster8
  1. 1 Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  2. 2 School of Allied Health, University of Limerick, Limerick, Ireland
  3. 3 Sports Spine Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  4. 4 Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
  5. 5 School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
  6. 6 Division of Orthopaedic Surgery, Oslo University Hospital/University of Oslo, Oslo, Norway
  7. 7 Oslo Sports Trauma Research Centre (OSTRC), Norwegian School of Sport Sciences, Oslo, Norway
  8. 8 Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to Dylan Meng, Department of Medicine, University of British Columbia, Richmond, V6V 2R9, Canada; dylan.meng{at}alumni.ubc.ca

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An increasingly common clinical situation is a middle-aged to elderly patient presenting with knee pain with no major inciting event. Although many of these patients end up with a diagnosis of a degenerative meniscal lesion, meniscal lesions are equally prevalent in patients with or without knee pain1 and therefore offer a poor explanation for knee pain.

Meniscal lesions are often comorbid with other knee joint pathology which complicates investigating the underlying cause behind the patient’s symptoms.2 Despite this, MRI of the knee is frequently used to confirm the presence of meniscal lesions, attribute them as the cause of the patient’s knee pain and conclude that knee arthroscopic surgery is required.3

Guidelines now recommend against arthroscopy for patients with degenerative knee conditions2 4 so the utility of MRI in this common clinical scenario is increasingly questionable, with the exception of those cases in which red flags such as sarcoma or infection are suspected. In a previous editorial,5 we discussed the negative effects of lumbar spine over-imaging, including additional cost, downstream testing, risks associated with …

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