This Article Full Text Full Text (PDF) CME: Take the activity for this article: Pediatrics Test 7: Spring 2005 [Supplementary Material] Letters to the Editor: Submit a response Letters to the Editor: View responses Alert me when this article is cited Alert me when Letters to the Editor are posted Alert me if a correction is posted Services E-mail this article to a friend Related articles in JBJS Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Luhmann, S. J. Articles by Wright, R. W. Search for Related Content PubMed PubMed Citation Articles by Luhmann, S. J. Articles by Wright, R. W. Related Collections Sports Pediatrics Social Bookmarking                   What's this?

Magnetic Resonance Imaging of the Knee in Children and Adolescents

Its Role in Clinical Decision-Making

¹ St. Louis Children's Hospital, One Children's Place, Suite 4S20, St. Louis, MO 63110. E-mail address for S.J. Luhmann: luhmanns{at}msnotes.wustl.edu

Investigation performed at St. Louis Children's Hospital and Shriners Hospital for Children, St. Louis, Missouri

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Methods: A three-year prospective study of all patients who underwent knee arthroscopy performed by a single surgeon, at two children's hospitals, was completed. The analysis focused on the six most common diagnoses: anterior cruciate ligament tear, lateral meniscal tear, medial meniscal tear, osteochondritis dissecans, discoid lateral meniscus, and osteochondral fracture. The preoperative diagnosis of the surgeon was determined by integrating the history and the findings on the clinical examination, plain radiographs, and magnetic resonance imaging scans (including the radiologist's interpretation).

Results: Ninety-six patients with ninety-six abnormal knees were included. The mean age was 14.6 years at the time of surgery. Relative to operative findings, kappa values for the formal interpretations of the magnetic resonance imaging scans by a radiologist were 0.78 for an anterior cruciate ligament tear, 0.76 for a medial meniscal tear, 0.71 for a lateral meniscal tear, 0.70 for osteochondritis dissecans, 0.46 for discoid lateral meniscus, and 0.65 for osteochondral fracture. Relative to operative findings, kappa values for the preoperative diagnoses by the surgeon were 1.00 for an anterior cruciate ligament tear, 0.90 for a medial meniscal tear, 0.92 for a lateral meniscal tear, 0.93 for osteochondritis dissecans, 1.00 for discoid lateral meniscus, and 0.90 for osteochondral fracture. The preoperative diagnosis by the surgeon was better (p < 0.05) than the formal interpretation of the magnetic resonance imaging scans by the radiologist with respect to an anterior cruciate ligament tear, lateral meniscal tear, osteochondritis dissecans, and discoid lateral meniscus.

Conclusions: Integration of patient information with an orthopaedic surgeon's review of the magnetic resonance imaging scan of the knee in children and adolescent patients improves the identification of pathological disorders in four of the six categories evaluated. This study questions the necessity for and appropriateness of a routine interpretation of a magnetic resonance imaging scan of the knee in children and adolescents by a radiologist.

Level of Evidence: Diagnostic Level I. See Instructions to Authors for a complete description of levels of evidence.

CiteULike    Connotea    Del.icio.us    Facebook    Technorati    Twitter    What's this?

Related articles in JBJS:

Radiologists' Interpretations of Magnetic Resonance Images of the Knee • S.J. Luhmann replies:

Shigeru Ehara and Scott J. Luhmann
JBJS 2005 87: 1884-1885. [Extract] [Full Text]  

This article has been cited by other articles:

				D. E. Kramer and L. J. Micheli Meniscal Tears and Discoid Meniscus in Children: Diagnosis and Treatment J. Am. Acad. Ortho. Surg., November 1, 2009; 17(11): 698 - 707. [Abstract] [Full Text] [PDF]

				J. H. Ahn, Y. S. Lee, H. C. Ha, J. S. Shim, and K. S. Lim A Novel Magnetic Resonance Imaging Classification of Discoid Lateral Meniscus Based on Peripheral Attachment Am. J. Sports Med., August 1, 2009; 37(8): 1564 - 1569. [Abstract] [Full Text] [PDF]

Letters to the Editor:

Stanford University Libraries' HighWire Press (TM) assists in the publication of JBJS Online.
Copyright © 2005 by The Journal of Bone and Joint Surgery, Inc. Online ISSN: 1535-1386.
The Journal of Bone and Joint Surgery®, JBJS®, JB&JS®, and eJBJS® are registered in the U.S. Patent and Trademark Office.