Comparing Point-of-care-ultrasound (POCUS) to MRI for the Diagnosis of Medial Compartment Knee Injuries

Ghosh, Nina; Kruse, David; Subeh, Mohammad; Lahham, Shadi; Fox, J. Christian

doi:10.1016/j.jmu.2017.06.004

Cited by 21 publications

(39 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Radial tearing will cause more damage to peripheral fibrils running from the inner to outer surface [6,15,16,37,40]. MRI affords a 90-95% diagnostic success rate, although MRI data should be combined with clinical findings [12,44]. We showed a 35-year-old male patient with a degenerative horizontal tear of the medial meniscus rim of the left knee (Fig.…”

Section: Discussionmentioning

confidence: 89%

Expression of matrix metalloproteinase-9 and tumour necrosis factor-alpha in the synovial cells of patients with meniscus tears

Atiç

Deveci

2019

Folia Morphol

View full text Add to dashboard Cite

Background: A meniscus tear is a serious trauma that develops during swinging motion of the fixed foot. Meniscus tears may also be accompanied by divergence of the lateral ligaments of the knee joint. Materials and methods: We enrolled 45 males and 35 females with meniscal tears in the present study. Patients with local joint pain, swelling, difficulty climbing stairs, patellar creeping, difficulties with daily living activities, local pain on palpation, and walking and running complaints, were included. We performed preoperative magnetic resonance imaging. Synovial fluid (5 mL) was aspirated from the lateral suprapatellar pouch of each knee with meniscal pain with the patient in the supine position. Blood samples were taken and biochemical parameters were analysed. The Harris haematoxylin and eosin staining protocol was used to evaluate tissue samples, and the levels of anti-matrix metalloproteinase (MMP)-9 and anti-tumour necrosis factor alpha (TNF-α) antibodies were measured immunohistochemically. Results: Increased numbers of lymphocytes and neutrophils, hyperplastic erythrocytes, and fibroblasts were observed in the joint fluid of females. In males, the fibroblast cells were hyperplastic and plasma cell numbers were increased. MMP-9 expression was elevated in plasma cells, fibroblasts, and neutrophils; and TNF-α expression was observed in lymphocytes and polymorphic nucleated cells. We suggest that increased fluid levels in inflamed joints with meniscal tears, and the associated inflammation, disrupt the cartilage matrix and elevate the production of cytokines such as TNF-α and MMP-9 via release from cells such as fibroblasts that synthesise these mediators. Conclusions: Anti-TNF-α treatment may prevent meniscal tears and prevent or slow the development of osteoarthritis.

show abstract

Section: Discussionmentioning

confidence: 89%

Expression of matrix metalloproteinase-9 and tumour necrosis factor-alpha in the synovial cells of patients with meniscus tears

Atiç

Deveci

2019

Folia Morphol

View full text Add to dashboard Cite

show abstract

“…The most common system, according to Hughston and the American Medical Association (AMA), uses a three-point scale of medial gapping in 20-30° flexion of the knee [20,22]. Other classification systems differ with respect to clinical symptoms at different flexion angles and different valgus loads, which are highly examiner-dependent and make reliable comparison difficult [21,25,27,[31][32][33]42]. Hence, stress radiography, ultrasonography, and magnetic resonance imaging are supposed to help guide further treatment recommendations.…”

Section: Discussionmentioning

confidence: 99%

Imaging of the medial collateral ligament of the knee: a systematic review

Meyer

Reiter

Akoto

et al. 2021

Arch Orthop Trauma Surg

View full text Add to dashboard Cite

Introduction The primary aim of this investigation was to systematically review relevant literature of various imaging modalities (magnetic resonance imaging (MRI), stress radiography and ultrasonography) in the assessment of patients with a medial collateral ligament (MCL) injury. Materials and methods A systematic literature review of articles indexed in PubMed and Cochrane library was performed. Original research reporting data associated with medial gapping, surgical, and clinical findings associated with MCL injuries were considered for inclusion. The methodological quality of each inclusion was also assessed using a verified tool. Results Twenty-three imaging studies (magnetic resonance imaging (MRI) n = 14; ultrasonography n = 6; radiography n = 3) were ultimately included into the review. A total of 808 injured, and 294 control, knees were assessed. Interobserver reliabilities were reported in radiographic and ultrasonographic investigations with almost perfect agreement. MRI studies demonstrated agreement ranging between substantial to almost perfect. Intraobserver reliability was only reported in radiographic studies pertinent to medial gapping and was found to be almost perfect. Correlation of MRI with clinical findings was moderate to strong (65–92%). Additionally, MRI imaging was more sensitive in the detection of MCL lesions when compared to clinical examination. However, when compared to surgical findings, MRI underestimated the grade of instability in up to 21% of cases. Furthermore, MRI showed relatively inferior performance in the identification of the exact MCL-lesion location when compared to surgical findings. Interestingly, preoperative clinical examination was slightly inferior to stress radiography in the detection of MCL lesions. However, clinical testing under general anaesthesia performed similar to stress radiography. The methodological quality analysis showed a low risk of bias regarding patient selection and index testing in each imaging modality. Conclusion MRI can reliably diagnose an MCL lesion but demonstrates limitations in its ability to predict the specific lesion location or grade of MCL instability. Ultrasonography is a widely available, radiation free modality, but is rarely used in clinical practice for detecting MCL lesions and clinical or surgical correlates are scarce. Stress radiography findings correlate with surgical findings but clinical correlations are missing in the literature. Level of evidence IV.

show abstract

“…There is some literature available for abdominal and pleural US on the non-inferiority of POCUS, but little in the Orthopedic realm [ 21 ]. A study by Ghosh et al has demonstrated higher positive and negative predictive values in diagnosing medial compartment knee injuries using POCUS when compared to MRI [ 22 ]. Nonetheless, future research comparing POCUS to the traditional US is needed to understand further the role of POCUS in the care of DDH.…”

Section: Discussionmentioning

confidence: 99%

Point-of-Care Ultrasound Reduces Visit Time and Cost of Care for Infants with Developmental Dysplasia of the Hip

Herrero

Colon

Nagapurkar

et al. 2021

JOIO

View full text Add to dashboard Cite

Background Healthcare institutions and policymakers are searching for system-wide approaches to reduce costs while maintaining quality and improving patient outcomes. In most healthcare systems infants referred for the detecting or treating developmental dysplasia of the hip (DDH) are sent to a radiology department for sonographic evaluation. The total duration of visit and cost of visit are essential variables in any healthcare setting and affect both efficiency and “the bottom line”. By having the treating clinician perform point-of-care ultrasound (POCUS) for the detection and follow-up of patients with DDH, we hypothesize that there would be a significant reduction in the time spent on the visit and the cost incurred without compromising quality or patient satisfaction. To our knowledge, no prior study has examined the effect of incorporating POCUS on the duration and cost of the visit in patients with DDH. Purpose To determine if there was a difference in the duration of the visit for patients with DDH when POCUS was performed compared to when traditional “formal” sonography was performed. To determine if there was a difference in the cost of the visit for patients with DDH when POCUS was performed compared to when traditional “formal” sonography was performed. Methods Data for visits to a specialized outpatient office were collected over two years at a single-specialty orthopedic hospital, comparing the duration and cost of the visit between patient encounters for infants who had “formal” sonograms performed in the radiology suite to infants who underwent POCUS of the hip. In all, we included 532 patient encounters, 326 patients had POCUS performed, and 206 had a “formal” ultrasonographic evaluation performed. Of these, 140 were new evaluations and 392 were follow-up evaluations for treatment. Of the 140 new patients, 80 were in the POCUS group, and 60 were in the “formal” US group. Of the 392 follow-ups, 246 were in the POCUS group, and 146 were in the “formal” US group. Results The mean duration of the encounter for the POCUS group was 42 min (range 16–75 min), and for the “formal” US group, it was 92 min (range 36–163 min). This difference was statistically significant ( p = 0.002). The mean cost of the encounter for the POCUS group was $121.13, and for the “formal” US group, it was $339.38. This difference was statistically significant ( p = 0.002). Conclusion Ultimately, our study demonstrated a statistically significant reduction in the duration and cost of a patient encounter for infants with DDH when they undergo POCUS rather than “formal” sonographic evaluation.

show abstract

Comparing Point-of-care-ultrasound (POCUS) to MRI for the Diagnosis of Medial Compartment Knee Injuries

Cited by 21 publications

References 17 publications

Expression of matrix metalloproteinase-9 and tumour necrosis factor-alpha in the synovial cells of patients with meniscus tears

Expression of matrix metalloproteinase-9 and tumour necrosis factor-alpha in the synovial cells of patients with meniscus tears

Imaging of the medial collateral ligament of the knee: a systematic review

Point-of-Care Ultrasound Reduces Visit Time and Cost of Care for Infants with Developmental Dysplasia of the Hip

Contact Info

Product

Resources

About