What is the best way to evaluate an acute traumatic knee injury?

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What is the best way to evaluate an acute traumatic knee injury?

J Fam Pract. 2008 February;57(2):116-118

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References

1. Stiell IG, Greenberg GH, Wells GA, et al. Derivation of a decision rule for the use of radiography in acute knee injuries. Ann Emerg Med 1995;26:405-413.

2. Bachmann LM, Haberzeth S, Steurer J, ter Riet G. The accuracy of the Ottawa Knee Rule to rule out knee fractures: a systematic review. Ann Intern Med 2004;140:121-124.

3. Khine H, Dorfman DH, Avner JR. Applicability of Ottawa Knee Rule for knee injury in children. Pediatr Emerg Care 2001;17:401-404.

4. Jackson JL, O’Malley PG, Kroenke K. Evaluation of acute knee pain in primary care. Ann Intern Med 2003;139:575-588.

5. Wang C-Y, Wang H-K, Hsu C-Y, Shieh J-Y, Wang TG, Jiang C-C. Role of sonographic examination in traumatic knee internal derangement. Arch Physical Med Rehab 2007;88:984-987.

6. Vaz CE, Camargo OP, Santana PJ, Valezi AC. Accuracy of magnetic resonance in identifying traumatic intraarticular knee lesions. Clinics 2005;60:445-450.

7. Major NM, Beard LN, Jr, Helms CA. Accuracy of MR imaging of the knee in adolescents. AJR Am J Roentgenol 2003;180:17-19.

8. University of Michigan Health system Knee pain or swelling: acute or chronic. Ann Arbor: University of Michigan Health System; 2005. Available at: cme.med.umich.edu/pdf/guideline/knee.pdf. Accessed January 7, 2008.

TABLE 2
MRI compares well with operative Dx in identifying knee lesions in adolescents

INJURY	LR+ (95% CI)	LR– (95% CI)
Medial meniscus	7.18 (3.34–15.46)	0.10 (0.01–0.63)
Lateral meniscus	20.53 (5.27–80.07)	0.07 (0.01–0.46)
Anterior cruciate ligament	100	0
*Adapted from Major et al, 2003.⁷
MRI, magnetic resonance imaging; LR, likelihood ratio; CI, confidence interval.

Recommendations from others

University of Michigan Health System⁸ guidelines indicate the following:

Most knee pain is caused by patellofemoral syndrome and osteoarthritis.
MRI of the knee has not been proven to be superior to the clinical exam by an experienced examiner in the evaluation of acute knee injuries.
MRI may be useful to assess bone pathology underlying chronic knee pain.
Differentiating between knee pain without constitutional symptoms, knee pain with constitutional symptoms, and traumatic knee pain is helpful in determining a diagnosis.
Patients with knee pain and swelling who have non-bloody aspirates may also have serious knee pathology.

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What is the best way to evaluate an acute traumatic knee injury?

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