Clear information makes MRI superior to in-office arthroscopy for knee diagnosis
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KOLOA, Hawaii — Regardless of whether it is used inside or outside the office, the key to the best imaging modality to use for an articular knee condition, such as damaged articular cartilage, is how detailed the information it provides is, a speaker at Orthopedics Today Hawaii said.
According to Hollis G. Potter, MD, MRI has a better chance than in-office needle arthroscopy of helping the orthopedic surgeon identify the full extent of the patient’s problem.
However, “you need the appropriate protocols” to obtain optimal MR imaging of the knee, she said.
A systematic review from 2019 that was discussed during the session showed the superiority of in-office needle arthroscopy to MRI in terms of its positive predictive value when evaluating knee osteoarthritis, ACL tears and meniscal tears. The same study findings, to which Potter responded, showed the in-office arthroscopy was less accurate for identifying osteochondritis dissecans (OCD), for example.
With in-office needle arthroscopy, “you are seeing the tip of the iceberg. So you are going to miss stable OCD lesions. You are going to miss subchondral fracture,” she said.
In making her argument against relying on findings from an in-office needle arthroscopy, Potter discussed her concerns about getting adequate visualization of key areas of the anatomy and problems simply being able to fit the arthroscope in areas of the knee that a surgeon should see to make a diagnosis and the best determination of the need for possibly more surgery.
“I would argue in an office setting, in hemarthrosis, are you going to get enough visualization with saline on-board? Are you going to get enough valgus to see the real posterior horn of the medial meniscus and can you get an office scope down the popliteal sleeve to see the fascicles?” Potter said. – by Susan M. Rapp
Reference:
Potter HG. Is in-office arthroscopy helpful compared to MRI to diagnose and determine further knee surgery? Presented at: Orthopedics Today Hawaii; Jan. 12-16, 2020; Koloa, Hawaii.
Disclosure: Potter reports she receives research support from GE Healthcare and GE/NBA; has stock or stock options with Imagen; and is a paid consultant for Ortho RTI.