MR imaging of the knee in primary care

Abstract

In this thesis we determined the added value of MR imaging

in primary care for patients with knee complaints. We conducted a randomised

controlled trial including patients with knee complaints after trauma, aged

18-45 year. Patients were randomised between usual care (no MR scan) or an MR scan within 2 weeks. MR imaging was bot non-inferior but also not superior to usual care. On the 1-year follow-up, patients in the MR group more often perceived themselves to be recovered and more often reported to be satisfied during the 1-year follow-up. However, the MR scan requested by the GP neither improved health outcomes, nor saved costs. Furthermore, in the MR group there was no reduction in the orthopaedic referral rate and a non-significantly higher proportion of patients underwent an arthroscopy. We also evaluated the added value of MR imaging for patients suspected to develop knee osteoarthritis. We combined early MR osteoarthritis features into a prediction model, resulting in moderate sensitivity and specificity rates for the development of radiographic knee osteoarthritis. We concluded that for the entire population seeking medical attention of the GP for knee complains, MR imaging does not contribute to an improved clinical outcome nor to cost containment.