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Changing Perspectives: MRI and arthroscopy of the knee in patients over 50 years of age

MRI and arthroscopy of the knee in patients over 50 years of age

In the Netherlands knee injuries occur approximately 300,000 times a year.1 Meniscal tears are among the most common knee injuries with an incidence of 2 per 1,000 patients a year.2 As a result arthroscopic meniscectomy is performed nearly 30,000 times a year in patients over 50 years of age.3 In over half of these patients magnetic resonance imaging (MRI) was performed prior to surgery.  However, multiple randomized controlled trial observed no significant difference between knee function, pain relief and patient satisfaction when comparing arthroscopy to conservative treatment.4,5 In addition, the amount of knee arthroscopies where no therapeutic intervention was conducted during surgery ranges from 27 to 61%.1

Consequently, it is questioned whether these procedures benefit healthcare efficacy. Especially when taking into account that patients over 50 years of age are at risk of having existing osteoarthritis (OA) of the knee.6 This is accompanied by degenerative meniscal tears in up to 80%.7 Therefore, differentiating whether the symptoms are caused by the meniscal tear or developing OA is quite challenging. As a result, there is no indication to perform MRI in patients over 50 years of age according to the Netherlands Orthopedic Association (NOV). On that account, it is advised only to perform knee arthroscopy in case of locking of the knee caused by mechanical obstruction in these patients. This is without performing MRI prior to surgery.1

Therefore a substantial reduction of MRI and knee arthroscopies in patients over 50 years of age is warranted, especially in these times of increasing awareness of cost-effectiveness.6

S.W. Hoeffelman & Dr. M.U. Schafroth

References

  1. Richtlijn Artroscopie van de knie, 2010
  2. Van der Linden, M. W., Westert, G. P., de Bakker, D. H., & Schellevis, F. G. Tweede Nationale Studie naar ziekten en verrichtingen in de huisartspraktijk: klachten en aandoeningen in de bevolking en in de huisartspraktijk. Utrecht/Bilthoven: NIVEL/RIVM;2004.
  3. Operaties in het ziekenhuis; soort opname, leeftijd en geslacht, 1995-2010. Available here.
  4. Crevoisier, X., Munzinger, U., & Drobny, T. Arthroscopic partial meniscectomy in patients over 70 years of age. Arthroscopy, 17, 2001. p.732-736.
  5. Herrlin, S., Hallander, M., Wange, P., Weidenhielm, L., & Werner, S. Arthroscopic or conservative treatment of degenerative medial meniscal tears: a prospective randomised trial. Surg.Sports Traumatol.Arthrosc., 15, 2007. p. 393-401.
  6. Van Bodegom-Vos, L., Nelissen, R.G.H.H., Diercks, R.L. Project: Step-down knee MRI and ARThroscopy for orthopaedic patients > 50 years (SMART).
  7. Suter, L. G., Fraenkel, L., Losina, E., Katz, J. N., Gomoll, A. H., & Paltiel, A. D. Medical decision making in patients with knee pain, meniscal tear, and osteoarthritis. Arthritis Rheum., 61, 2009. p.1531-1538.

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