Abstract：
OBJECTIVE: To determine if MRI altered management in patients ≥ 60 years old with chronic knee pain.
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).
CONCLUSIONS: 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.
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).
CONCLUSIONS: 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.
摘要：
目的：确定MRI是否改变了≥60岁慢性膝关节疼痛患者的治疗。
方法：纳入90天内连续60岁以上膝关节MRI和X线照片的患者。排除标准包括肿块/恶性肿瘤，最近的创伤,和感染。使用Kellgren-Lawrence（KL）和国际膝关节文献委员会（IKDC）量表评估了站立的AP和PA屈曲视图。记录相关的临床病史。如果确定了软骨下骨折或由于MRI发现而进行了后续关节镜检查，则认为MRI会改变治疗方法。
结果：回顾了85次膝关节MRI/X光检查；平均68.2年（60-88年），47:38F:M.20个膝关节MRI（24％）有软骨下骨折（n=9）或半月板撕裂（n=11）提示关节镜检查。从PA弯曲的角度来看，与具有15.4%(10/65)KL等级4和38.5%(25/65)KL等级0-1(p=0.03)的其余MRI相比,这些研究中的0/20具有KL等级4和70%(14/20)具有KL等级0-1(p=0.03)。10年的烟草历史，38%vs18%，与软骨下骨折或关节镜检查有关（p=0.06）。软骨下骨折在老年患者中更为普遍（平均72.4vs67.7岁；p=0.03）。
结论：在≥60岁的慢性膝关节疼痛患者中，MRI改变了约24％的病例的管理；KL0-1级患者为70％，KL4级患者则无。MRI可能使患有轻度骨关节炎的老年患者受益，但对终末期疾病患者不利。吸烟≥10包年的患者也可以从MRI中受益。
方法：纳入90天内连续60岁以上膝关节MRI和X线照片的患者。排除标准包括肿块/恶性肿瘤，最近的创伤,和感染。使用Kellgren-Lawrence（KL）和国际膝关节文献委员会（IKDC）量表评估了站立的AP和PA屈曲视图。记录相关的临床病史。如果确定了软骨下骨折或由于MRI发现而进行了后续关节镜检查，则认为MRI会改变治疗方法。
结果：回顾了85次膝关节MRI/X光检查；平均68.2年（60-88年），47:38F:M.20个膝关节MRI（24％）有软骨下骨折（n=9）或半月板撕裂（n=11）提示关节镜检查。从PA弯曲的角度来看，与具有15.4%(10/65)KL等级4和38.5%(25/65)KL等级0-1(p=0.03)的其余MRI相比,这些研究中的0/20具有KL等级4和70%(14/20)具有KL等级0-1(p=0.03)。10年的烟草历史，38%vs18%，与软骨下骨折或关节镜检查有关（p=0.06）。软骨下骨折在老年患者中更为普遍（平均72.4vs67.7岁；p=0.03）。
结论：在≥60岁的慢性膝关节疼痛患者中，MRI改变了约24％的病例的管理；KL0-1级患者为70％，KL4级患者则无。MRI可能使患有轻度骨关节炎的老年患者受益，但对终末期疾病患者不利。吸烟≥10包年的患者也可以从MRI中受益。
