ACR Appropriateness Criteria® Chronic Knee Pain

Fox, Michael G.; Chang, Eric Y.; Amini, Behrang; Bernard, Stephanie A.; Gorbachova, Tetyana; Ha, Alice S.; Iyer, Ramesh S.; Lee, Kenneth S.; Metter, Darlene F; Mooar, Pekka A.; Shah, Nidhi; Singer, Adam D.; Smith, Stacy E.; Taljanovic, Mihra S.; Thiele, Ralf; Tynus, Kathy M.; Kransdorf, Mark J.

doi:10.1016/j.jacr.2018.09.016

Cited by 34 publications

(48 citation statements)

References 64 publications

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“…Although newer imaging techniques that merge nuclear medicine with CT or MRI (e.g., SPECT-CT, PET-MRI) substantially enhance anatomical resolution, there is currently no strong evidence for their clinical utility in OA diagnosis and management, as reported in a systematic review (Zarringam, Saris, & Bekkers, 2019 The recently updated EULAR and ACR guidelines provide recommendations on the clinical application of imaging modalities for knee OA. In accordance with current evidence, there is a broad consensus in favour of radiography and MRI as first-and second-line diagnostic imaging modalities respectively, while discrepancies exist regarding the use of ultrasound and CT due to limited evidence for their clinical utility (Fox et al, 2018;Sakellariou et al, 2017). For research, the OARSI guidelines recommend radiographic and MRI outcome measures as structural and morphological endpoints for clinical trials of OA treatment (Hunter et al, 2015), while the US Food and Drug Administration (FDA) is now in the process of developing a guidance document for structural endpoints in clinical trials of OA treatment (osteoarthritis: structural endpoints for the development of drugs, devices and biological products for treatmentguidance for industry U.S. Food and Drug Administration, 2018).…”

Section: Other Imaging Modalitiesmentioning

confidence: 68%

“…However, the role of imaging in the clinical management of OA is not clearly defined, with imaging not typically used except for surgical procedures (Sakellariou et al, 2017 (Sakellariou et al, 2017). By contrast, the ACR Appropriateness Criteria consider initial imaging appropriate for patients with chronic knee pain (Fox et al, 2018). For patients with atypical presentations, both EULAR and ACR support the use of imaging to confirm the diagnosis of OA with conventional radiography as the first-line imaging modality.…”

Section: Current Practice and International Guidelines On Imaging In Knee Osteoarthritis (Oa)mentioning

confidence: 99%

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Imaging of knee osteoarthritis: A review of current evidence and clinical guidelines

Lee

Chan

Fung

et al. 2021

Musculoskeletal Care

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Background: Knee osteoarthritis (OA) is one of the most common and debilitating degenerative joint diseases worldwide. While radiography is the most commonly used imaging modality, it is associated with drawbacks which newer modalities such as magnetic resonance imaging (MRI) and ultrasound could overcome. Nevertheless, the role of imaging in clinical practice and research in knee OA has not been clearly defined. Furthermore, guidelines on imaging in knee OA from different authoritative bodies have not been compared in previous studies. Therefore, the present review aims to summarise existing evidence and compare guidelines on the use of different imaging modalities in evaluating knee OA.Methods: This is a narrative review based on a search of published clinical guidelines and the PubMed database for articles published between 1 January 1990 and 31 May 2020. Results:There is no broad consensus on the value of imaging in patients with typical OA presentation. If imaging is required, current evidence and clinical guidelines support the use of radiography and MRI as first-and second-line diagnostic modalities respectively. Since radiographic OA features have limited sensitivity and do not manifest in early stages, MRI is the preferred option for whole-joint evaluation in OA research. Discrepancies exist regarding the use of alternative imaging modalities including ultrasound, computed tomography and nuclear medicine. Conclusion:Radiography and MRI are the imaging modalities of choice. Other modalities have their respective advantages, and more research is warranted for the standardisation of image acquisition and interpretation methodology, in order to evaluate their validity, reliability and responsiveness in OA research. K E Y W O R D S clinical guidelines, imaging, knee osteoarthritis 1 | INTRODUCTION Knee osteoarthritis (OA) is one of the most common and debilitating degenerative joint diseases worldwide, with 80% of OA patients suffering from movement limitations and 25% of them being unable to carry out major activities in their daily lives (Neogi, 2013).Although cartilage degeneration and osteophyte formation remain the structural hallmarks of knee OA, the disease is now increasingly recognised as a whole-organ disorder affecting tissues in the entire knee joint, such as the meniscus and synovium (Hayashi, Guermazi, & Hunter, 2011). Its clinical presentation is heterogeneous, with typical symptoms including pain, stiffness and movement restriction.

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Section: Other Imaging Modalitiesmentioning

confidence: 68%

Section: Current Practice and International Guidelines On Imaging In Knee Osteoarthritis (Oa)mentioning

confidence: 99%

Imaging of knee osteoarthritis: A review of current evidence and clinical guidelines

Lee

Chan

Fung

et al. 2021

Musculoskeletal Care

View full text Add to dashboard Cite

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“…These include subchondral insufficiency fractures and avascular necrosis, which are more common in elderly females (aged >65 years; Figures 10A and 10B). 12 Pain is associated with moderate-to-large effusions and synovial hypertrophy. Baker's cysts (a posterior extension of synovial fluid into the popliteal fossa) are present in 20% of patients with osteoarthritis.…”

Section: Osteoarthritismentioning

confidence: 99%

Imaging of the knee: Common acute presentations to general practice

Ridley

2020

Aust J Gen Pract

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BackgroundKnee pain is a common symptom in the community. There is a wide range of conditions that can cause pain. Identifying the type and severity of the condition is important for effective management. There are several guidelines for the appropriate imaging of patients presenting with knee pain. Presentation is generally divided into a post-traumatic group and those without known trauma (including arthritis). ObjectiveThe aim of this article is to discuss the approach to imaging of the knee with reference to Diagnostic Imaging Pathways and illustrate some of the conditions that may be encountered. DiscussionThe initial workup is typically done in general practice to determine which patients require referral for specialist management and which patients can be cared for in the community. Most cases presented in this article are patients referred from primary care to a metropolitan radiology practice during a six-month period, and they represent examples of some of the more common pathologies.KNEE PAIN affects 25% of adults, and the prevalence has increased by 65% in the past 20 years. 1 Many patients with pain have a history of trauma. In older patients, acute pathology is usually superimposed on chronic degeneration/osteoarthritis. This article focuses on post-traumatic pain and monoarticular arthritis, describing some of the common findings and disease patterns shown on imaging.While there are several guidelines for the appropriate use of imaging, the Australian website Diagnostic Imaging Pathways will be used as the standard for this narrative. 2

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“…19 Furthermore, knee MRI is not indicated in patients with XRs diagnostic of osteoarthritis, further supporting that XRs should be obtained prior to MRI in most cases. 20 Time to acquisition of MRI should also be scrutinized, since MRI is not as readily accessible as XRs, and it has been shown to delay care of patients with anterior cruciate ligament tears by 89 days in one study in England. 21 To our knowledge, this is the first study assessing the application of MRI in the evaluation of knee pain in veterans, focusing on inappropriate resource utilization and delay in care.…”

mentioning

confidence: 99%

Is MRI Overutilized for Evaluation of Knee Pain in Veterans?

et al. 2021

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MRI is an essential diagnostic imaging modality for many knee conditions; however, it is not indicated in the setting of advanced knee arthritis. Inappropriate MRI imaging adds to health care costs and may delay definitive management for many patients. The primary purpose of this study was to ascertain the frequency of inappropriate MRI scans performed at one Veterans' Administration Medical Center (VAMC). We performed a retrospective chart review of all knee MRIs ordered over a 6-month period. Inappropriate MRI was defined as MRI performed prior to radiographs (XRs), or in the presence of XRs demonstrating severe osteoarthritis, without leading to a nonarthroplasty procedure of the knee. Of the 304 cases reviewed, 36.8% (112) of the MRIs were deemed inappropriate, 33 were ordered by orthopedists, and 79 were ordered by other health care providers. Of the 33 ordered by orthopedists, 25 were ordered by retired/nonsurgical orthopedists. Obtaining an MRI delayed care by an average of 29.2 days. Of the 252 cases that had XR prior to MRI, none included all four views in the standard knee XR series and only four had weightbearing images. Over a third of knee MRIs performed at this VAMC were inappropriate and delayed care. Additionally, no XRs in our study contained all the necessary views to properly assess knee arthritis. These concerning findings signify a potential opportunity for education in diagnostic strategies, to better patient care and resource utilization in the VAMC.

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ACR Appropriateness Criteria® Chronic Knee Pain

Cited by 34 publications

References 64 publications

Imaging of knee osteoarthritis: A review of current evidence and clinical guidelines

Imaging of knee osteoarthritis: A review of current evidence and clinical guidelines

Imaging of the knee: Common acute presentations to general practice

Is MRI Overutilized for Evaluation of Knee Pain in Veterans?

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