MRI Can Reveal Unexpected Issues Among Middle-Aged Adults With Knee Pain

While meniscal tears are often suspected in patients with knee osteoarthritis (KOA), other underlying issues that may be contributing to their symptoms and require different management strategies can be detected with magnetic resonance imaging (MRI), wrote investigators of a recent study published in Arthritis Care & Research.

The researchers sought to assess the prevalence of unexpected but clinically significant findings on MRI in patients with KOA managed nonoperatively for suspected meniscal tears. While radiographs are typically used in KOA, MRI is often reserved for more complex cases. The study reviewed MRI images of 760 subjects aged 45-85 years with knee pain, mild to moderate osteoarthritis (Kellgren-Lawrence grades 0-3), and suspected meniscal tears, noting any significant incidental findings.

Results showed that 8.03% (95% CI: 6.09%, 9.96%) of patients had unexpected yet clinically relevant findings. These included 25 cases of subchondral insufficiency fractures of the knee (SIFK), 10 nonsubchondral fractures, 4 cases of avascular necrosis (AVN), 8 benign tumors, and 14 other notable findings.

The findings suggest MRI can reveal a range of incidental findings in patients with KOA, which may impact clinical decisions. Further research is recommended to identify patients at higher risk for these incidental findings to guide decisions on advanced imaging referrals.

Reference
Waddell LM, Opare-Addo MB, Shah N, et al. Prevalence of clinically relevant findings on MRI in middle-aged adults with knee pain and suspected meniscal tear: a follow-up. Arthritis Care Res (Hoboken). Published online September 29, 2024. doi:10.1002/acr.25444