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Is
Your Knee Pain
Diagnosis Correct?
Diagnosis of knee injuries
is, in my opinion, too dependant on
many large machines and invasive
techniques. Your knee hurts so you
visit the orthopedist, here he uses
his tools to figure out why your
knee hurts. While some of these
tools are very impressive indeed,
are they accurate?
Once X-rays rule out problems with
bones, a MRI (Magnetic Resonance
Imaging) is brought in because of
its ability to reveal soft tissue
damage, but problems with the knee,
especially the
cartilage, can still
be very evasive and hard to
pinpoint. Studies have shown that
the advanced technologies commonly
used to diagnosis injuries are
grievously insufficient to do the
job.
In one study conducted by Dr. J.A.
Lawrance of Oxford, England, MRIs
had a success rate of only 11% in
diagnosing partial anterior cruciate
ligament tears. In yet another
study, focusing on the knee, doctors
compared the findings of standard
x-ray tests and physical
examinations on 210 people—all of
whom were self-described as pain
free at the time of the testing.
Although none of the participants
exhibited any pain or other symptoms
of pathology, and considered
themselves completely healthy in
regard to their knees, the test
results yielded dramatic evidence of
physical problems and abnormalities,
including an incidence rate of 80%
or better for
arthritis, patellofemoral crepitus (grinding)
in 94% of the women, high
percentages of asymmetry and
hypermobility, and a dozen other
problems to varying degrees. As the
authors of the study noted: "Because
patellofemoral crepitus is so common
in both symptomatic and asymptomatic
volunteers, the importance of this
finding must be reevaluated as a
surgical indication."
The conclusion is obvious: by
offering "objective" evidence and a
technology based rationale to
over-eager surgeons, MRIs, X-rays
and other advanced diagnostic
techniques contribute greatly to
promoting cases of unnecessary or
even ill-advised surgery. The end
result is more problems for the
recipients of these surgeries.
Generally speaking, the most
efficient and safe method for
diagnosing a knee injury is a simple
manual examination, coupled with
extensive questioning of the patient
to determine exactly what happened
and where it hurts.
Research
Accuracy of magnetic resonance imaging of the knee and unjustified
surgery
Magnetic resonance
imaging of the knee is greater than 90% accurate in detecting
intraarticular disease when performed and interpreted by musculoskeletal
magnetic resonance imaging
specialists in specialized medical
centers. However, independent
imaging institutions often offer
less expensive services to health
insurers. We wondered if the
magnetic resonance imaging performed
in our community is of equivalent
quality and accuracy.
The results showed a false positive rate of 65% for the medial
meniscus, 43% for the lateral meniscus, 47.2% for the anterior cruciate
ligament, and 41.7% for articular cartilage disease when compared with
surgical findings. Accuracy rates were 52%, 82%, 80%, and 77%,
respectively.
Thirty-seven percent of the operations supported by a significant
disorder on magnetic resonance imaging were unjustified. Our findings
highlight the consequences that may occur when basing medical care on
cost rather than quality of care.
Ben-Galim P,
Steinberg EL, Amir H, Ash N, Dekel S, Arbel R. Accuracy of magnetic
resonance imaging of the knee and unjustified surgery. Clin Orthop Relat
Res. 2006 Jun;447:100-4.
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DARROW
WELLNESS INSTITUTE
