| HOME | HELP | CONTACT US | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
Sign In to gain access to subscriptions and/or personal tools.
|
|
|
|||||||
Sign In to gain access to subscriptions and/or personal tools. |
|||||||||
,
,
Division of Sports Medicine, Department of Orthopaedic Surgery, Boston, Massachusetts
|| Department of Biostatistics, Children’s Hospital, Harvard Medical School, Boston, Massachusetts
Program in Clinical Effectiveness, Harvard School of Public Health, Boston, Massachusetts
Presented at the 68th annual meeting of the American Academy of Orthopaedic Surgeons, March 2001, and recipient of the 2000 President/Fellow Clinical Research Essay Award of the Arthroscopy Association of North America.
Address correspondence and reprint requests to Mininder S. Kocher, MD, MPH, Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115.
To determine the diagnostic performances of clinical examination and selective magnetic resonance imaging in the evaluation of intraarticular knee disorders in children and adolescents we compared them with arthroscopic findings in a consecutive series of pediatric patients (
16 years old). Stratification effects by patient age and magnetic resonance imaging center were examined. There were 139 lesions diagnosed clinically, 128 diagnosed by magnetic resonance imaging, and 135 diagnosed arthroscopically. There was no significant difference between clinical examination and magnetic resonance imaging with respect to agreement with arthroscopic findings (clinical examination, 70.3%; magnetic resonance imaging, 73.7%), overall sensitivity (clinical examination, 71.2%; magnetic resonance imaging, 72.0%), and overall specificity (clinical examination, 91.5%; magnetic resonance imaging, 93.5%). Stratified analysis by diagnosis revealed significant differences only for sensitivity of lateral discoid meniscus (clinical examination, 88.9%; magnetic resonance imaging, 38.9%) and specificity of medial meniscal tears (clinical examination, 80.7%; magnetic resonance imaging, 92.0%). For magnetic resonance imaging, children younger than 12 years old had significantly lower overall sensitivity (61.7% versus 78.2%) and lower specificity (90.2% versus 95.5%) compared with children 12 to 16 years old. There was no significant effect of magnetic resonance imaging center. In conclusion, selective magnetic resonance imaging does not provide enhanced diagnostic utility over clinical examination, particularly in children, and should be used judiciously in cases where the clinical diagnosis is uncertain and magnetic resonance imaging input will alter the treatment plan.
This article has been cited by other articles:
|
|
 |
|
  B. B. Meserve, J. A. Cleland, and T. R. Boucher A meta-analysis examining clinical test utilities for assessing meniscal injury Clinical Rehabilitation, February 1, 2008; 22(2): 143 - 161. [Abstract] [PDF]
|
|
|
|
 |
|
 G. P. Slobogean, K. Mulpuri, and C. W. Reilly The International Knee Documentation Committee Subjective Evaluation Form in a Preadolescent Population: Pilot Normative Data Am. J. Sports Med., January 1, 2008; 36(1): 129 - 132. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. S. Kocher, J. T. Smith, B. J. Zoric, B. Lee, and L. J. Micheli Transphyseal Anterior Cruciate Ligament Reconstruction in Skeletally Immature Pubescent Adolescents J. Bone Joint Surg. Am., December 1, 2007; 89(12): 2632 - 2639. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. S. Kocher, J. J. Czarnecki, J. S. Andersen, and L. J. Micheli Internal Fixation of Juvenile Osteochondritis Dissecans Lesions of the Knee Am. J. Sports Med., May 1, 2007; 35(5): 712 - 718. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. S. Kocher, S. Garg, and L. J. Micheli Physeal Sparing Reconstruction of the Anterior Cruciate Ligament in Skeletally Immature Prepubescent Children and Adolescents. Surgical Technique J. Bone Joint Surg. Am., September 1, 2006; 88(1_suppl_2): 283 - 293. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. S. Kocher, R. Tucker, T. J. Ganley, and J. M. Flynn Management of Osteochondritis Dissecans of the Knee: Current Concepts Review Am. J. Sports Med., July 1, 2006; 34(7): 1181 - 1191. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. S. Kocher, S. Garg, and L. J. Micheli Physeal Sparing Reconstruction of the Anterior Cruciate Ligament in Skeletally Immature Prepubescent Children and Adolescents J. Bone Joint Surg. Am., November 1, 2005; 87(11): 2371 - 2379. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. J. Luhmann, M. Schootman, J. E. Gordon, and R. W. Wright Magnetic Resonance Imaging of the Knee in Children and Adolescents. Its Role in Clinical Decision-Making J. Bone Joint Surg. Am., March 1, 2005; 87(3): 497 - 502. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. S. Kocher and D. Zurakowski Clinical Epidemiology and Biostatistics: A Primer for Orthopaedic Surgeons J. Bone Joint Surg. Am., March 1, 2004; 86(3): 607 - 620. [Full Text] [PDF]
|
|
|
|
 |
|
 R. S. Oeppen, S. A. Connolly, J. T. Bencardino, and D. Jaramillo Acute Injury of the Articular Cartilage and Subchondral Bone: A Common but Unrecognized Lesion in the Immature Knee Am. J. Roentgenol., January 1, 2004; 182(1): 111 - 117. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. L. Muscolo, M. A. Ayerza, A. Makino, M. Costa-Paz, and L. A. Aponte-Tinao Tumors About the Knee Misdiagnosed as Athletic Injuries J. Bone Joint Surg. Am., July 3, 2003; 85(7): 1209 - 1214. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. S. Kocher, L. J. Micheli, D. Zurakowski, and A. Luke Partial Tears of the Anterior Cruciate Ligament in Children and Adolescents Am. J. Sports Med., September 1, 2002; 30(5): 697 - 703. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. F. Luckstead MRI is NOT Better Than Clinical Exam for Knee Injuries AAP Grand Rounds, October 1, 2001; 6(4): 37 - 38. [Full Text] [PDF]
|
|
| HOME | HELP | CONTACT US | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
