Diagnosis of Knee Joint Problem in MRI - Essay Example

The use of magnetic resonance imaging emerged in the early 1980’s where its usefulness was highly rated. Most clinicians saw it as a way of gaining proper medication and diagnosis for the knee treatment and a clear indication of progress in the treatment of patients with different knee problems. However, with the high cost of the MRI, most of the surgeons reverted to the earlier and cheaper means of treatment which included the clinical examination findings. Despite the fact that the MRI was seen as a golden standard of accuracy and precision, it suddenly became very expansive for most patients to afford a scan which according to Rose & Gold (1996) was rated as costing $1000 or more per scan. Though this reason is enough to forego this important technological advancement, the question is what do other authors make of these findings? Logical enough, many studies have been carried out in this field and a great deal of views offered in respect to the importance and the flaws associated with this phenomenon. A critical evaluation of a few of the studies will eventually reveal what is the best way to go about the examination of the knee and which method is best when it comes to the different possibilities of knee infections and examinations. This will be based upon the consistency of the results, the methodologies applied therein and the value and cost-effectiveness of the processes in light of the clinical decisions for knee treatment (Cottrell, 2005). The references taken up for the evaluation range both from most recent ones to earlier ones and the content was mostly taken into consideration regardless of the year of publication. ‘The Magnetic Resonance Imaging for the Evaluation of Acute Posterolateral complex Injuries of the Knee’ authored by Ross et al (1997) is a study that was carried out to determine the effectiveness of the MRI in the diagnosis and possible treatment of knee injuries. The only way that MRI can assist in the treatment is by making the process of decision making easier and offering the best way out to the clinician or surgeon. The team opted to use the standard magnetic resonance imaging sequences in their study to check on the acute posterolateral knee trauma. They conducted their study on six patients who were seen within 72 hours of their initial injuries. The patients had their clinical histories and examinations consistent with the probable complex posterolateral injury using the 1.5T magnet. They compared results using the clinical examinations and varied the different views of the flexion, tenderness and through the gradual yet recorded increase in the thigh-foot angle (McGinty, 1988: Ireland, 1980: Insall, 1984). ‘A prospective arthroscopically controlled clinical study: 0.2-Tesla magnetic resonance imaging of internal lesions of the knee joint’ authored by Riel et al (1999) sought to compare the results of MRI with those of arthroscopy following a prospective series. They conducted their research on a total of 244 patients. They acquired results on axial views for the femoropatellar joints, T1-weighted spin-echo sagittal images, and T2-weighted gradient echo coronal images. This way, they were able to obtain excellent visualization of the cruciating ligaments and the lateral and the medial meniscus in almost all patients. The results found were then used in comparison to arthroscopy which was performed within 48 hours of imaging. ‘Poor agreement between clinical assessment and magnetic resonance imaging findings: Acute rotational trauma to the knee’ authored by Frobell, Lohmander and Roos (2006) sought to look at the credibility of the different results acquired by the clinicians and how well they tally with the technological results that have been tallied in the general population. They put 159 patients to test to determine just how well the clinicians would make better judgment provided with the different options that were available. Additionally, they sought to find out the verification of the anterior cruciate ligament injuries and the best way that they could be verified across different age groups (Hughston 1993, 1985, 1980),. A study done by Sanches vaz et al (2005) sought look for ways in which they could possibly come up with the general accuracy of the MRI in clinical use. In their study titled ‘Accuracy of Magnetic Resonance in Identifying Traumatic Intraarticular knee Lesion’, the authors took into account 300 patients who had previous clinical diagnosis of traumatic knee lesions and put them under prearthoscopic magnetic resonance imaging. They wanted to establish the sensitivity, accuracy and the likelihood for positive or negative predictive value of the magnetic resonance imaging (O’Brien, 1991: Noyes, 1995). ‘A comparison of Accuracy between Clinical Examination and Magnetic Resonance Imaging in the Diagnosis of Meniscal and Anterior cruciate Ligamnets authored by Rose and Gold (1996) compared the accuracy of the MRI with that of the ACL and then compared the two findings with those of the pathological examinations. They carried out their research on a group of 154 patients who were clinical diagnosed with either an ACL tear or a meniscal tear. They subjected 100 of them to both clinical and MRI inspections whereas the remaining 54 underwent just the clinical examination alone. The presence or absence of the meniscal and the ACL tear was confirmed via the se of arthroscopy (Hodler, 1992). CRITICAL REVIEW According to Ross et al (1997), the abstract of the general paper lacks lucidity. By the virtue of it being an abstract, the expected summary of the general paper is not presented. The scholarly type of paper that is generally expected is seen to be lacking in this particular paper. Furthermore, there is a need to check on the quality of the argument that is put across by the said authors. It has been noted that the authors neglected the fact that generalization of a particular issue does not make it a fact. They quote Kannus (1989) as having said that certain injuries required a more approach than the rest. This, in light of the modern ways of treatment available is a total disregard of the other findings that may well establish better methods of tackling problems. The belief that some require aggressiveness is not justified given the fact that any clinician operating on a patient must look for ways in which the operation can be done despite its extent. The narrow convictions held by the authors should not be passed on to the clinicians as there should be room for approval and different avenues to choose from before terming any injury as being major or not (Cottrell, 2005: Oberlander, 1993). The fact that some of the technological development show that some decisions made prior to the operations have led to amputations is clear enough a statement to show that any injury must be catered for before it is too late. They also concentrated on six patients to make a general conclusion on the importance of such an advanced tool as the MRI. This is not scientifically good given that results are found credible if at all they are repetitive and consistent in their general output. Time is of essence in any research. Putting 72 hours into account can leave a lot of desired data out of consideration (Ruiz, 1994: Korniuk, 1990). There should be flexibility of data and enough time to quantitatively look at ways in which they can both be interrelated into solving the inherent problems. The fact that they chose six patients could lead to the general population question the credibility and the validity of the data achieved and then look for ways in which they can make it useful in the clinic. This makes it vulnerable for the authors to justify their conclusions and convince the world of science that they did not generalize their facts (Brown & Keeley, 1997: Herman 1988). This might make one think that they gave their own opinions since there is no elaborate way in which they have conducted their research but have results and a conclusion justifying their work. However, one can credit the authors with their extensive knowledge of the different muscles in the knee and the way they can be ruptured, treated and distinguished. They have shown this extensive knowledge in the way they have presented the different pictures of the knee and how they have come up with different images that explain how the knee is viewed under MRI. They explain the complex injuries and how an individual can identify different perspectives of the injury at different levels. They have a good grasp of what their career entails in the sports world and have hence used this opportunity to express their concerns over particular practices that have been witnessed in the clinics. They expound on the different injuries with much mastery of content which leaves one with the concept of them being professionals in their field (Brown & Keeley, 1997). One however notices the fat that they use case referrals to determine their conclusion and to advance their argument. Though this is not unprofessional, some of the cases may be lacking in extensive need for creation of clear variation of results after particular periods of time. This is where the extensive researches earn more credit than the short, easily-generalizable researches that take up really little time and seem to be both time and cost effective (Brown & Keeley, 1997). Riel et al (1999) is another researcher that took knee diagnosis and put it under scrutiny. They operated with 244 patients for a period of sixteen months. The best thing about this particular study is the set of professionals involved in reading the MRI and using them to further determine the arthroscopic diagnosis. However, human error cannot be ignored in this particular case given the fact that the calculations done to compare the two readings (arthroscopic and MRI readings) were the same ones used to determine the specificity, accuracy and sensitivity of the recorded readings (Watanabe, 1989). The fact that they were using statistics to determine the way they were supposed to rate the variables mean that there is a need to come up with ways of avoiding flaws in the entire system. The number of “false” negative results could be wrongly interpreted to provide a balance for the “true” positive results expected. The nature of the evaluation leaves a lot to be desired from the study as the determination of a sensitive machine or mode of effective measurement needs to be done with great precision and accuracy. Given that the subject of study is the human body, one has to be precautious on the mode of communication needed and the ability of negative results being found should be minimized and not encouraged for whatever purpose (Ross et al 1997: Reicher 1985). They describe MRI as being unable to detect some of the most important injuries that need early treatment to avoid amputation of the legs should the injury get so severe. However, they go further to state that MRI has been able to save many knees from possible arthroscopy. They reckon that MRI can ably detect whole body internal derangement of the knee but under limited capacity (Adalberth, 1997). There is some discrepancy in the way they present their data and information given that the use of a higher definition MRI device can ably compliment the efforts of the clinicians. It has been found to meet the extremities of peripheral joints and musculoskeletal pathology. It must however be credited for the fact that it represents the low definition low-field MRI well and expresses its contentment in the way it functions given the size and capability of the health facility. Frobell, Lohmander and Roos (2006) chose to look at the whole issue from a different angle. By evaluating the effective way in which the general population can be cautioned against incidents of sprains and ACL’s, they took it as their responsibility to enlighten the public on the dangers of their way of life and ways in which they can protect themselves from further injuries. Their general look at sports in the files and its relationship with the injuries experiences got by players is very relevant to the topic of discussion. They have generally looked at the prospects of using MRI to deal with injuries found in the knee (Reicher, 1986: Patel 1990). It is commendable the way they have utilized known literature to look at the present ways of dealing with orthopedic cases as it has been noted to increase the rate of survival for the patients. It was further found to elicit patient satisfaction enabling management of cases. The way they have displayed their results is very consequential and very effective in stipulating the required effects on the minds of the people. Most of those included in the study were injured in sports and this was a good area to study as most of the injuries that occur around the knee and the thighs. They have great mastery of their working terms and are well versed with the goings-on in their field of study. They conclusively tackle the trends of study in a clear way from which any one studying this can use to conduct some training. However, that not withstanding, generalization of this phenomenon can be disastrous since it might send the wrong instructions and signals to the doctors in charge. Notably, the use of soccer is very general as to of the injuries, though good examples are negligent of the others who hurt their knees at lower levels of play or simple trips that hurt one’s knee a lot. Recording of the found results depended on the number of cases reported in the clinic not taking into considerations those that lack any plausible explanations of their injuries. Vaz et al (2005) contradict the fact MRI is expensive and state categorically that arthroscopy is more expensive and invasive a tool to use. They attribute this to the fact that one has to get hospitalized and thus presents all the potential complications of an open surgery. By virtue of utilizing the MRI, they suggest that it is a better way of confirming primary diagnosis on the traumatic intraarticular knee lesions. They term MRI as being fast, invasive and one that is applicable on an outpatient basis. Their use of several patients to test their hypothesis is a good indication that they believe in varied results that will be used to generally come up with results. The use of electronic software to stipulate the results is a clear indication of the need for precision and accuracy in their work. The research is basically a good way of doing cost effective estimations for patients looking for treatment from various clinics. It has an effective way in which one can readily count on the examinations to reduce the cost at the same time getting the appropriate ways in which they can make use of the information to acquire treatment. The most important thing is that they have actually made it easier for the both the patient and the clinician to utilize the available materials for their own benefits. They have actually outlined the benefits of the MRI over those of the clinical examination. They encourage the use of the arthro-resonance to make it easier for the patients to get better and more effective treatment without paying more than expected. The evaluation that 30% fewer arthroscopies could have saved a whooping $723,600 dollars for the US economy is eye-catching since it elicits more reactions from the patients. It however defies all odds and generally states that MRI is very accurate and can diagnose knee Meniscal and cruciate ligament lesions. This makes it impossible for one to imagine that the same report could discredit the same MRI it had credited beforehand (Adalberth et al. 1997). Of importance is the fact that there is always a need to have consistent results that will always make it possible for those going through the report to identify with it. They did not look at the possibility of handling as much content and taking into consideration those that could wish to use it as a manual for their treatment. By misleading the public that they so want to make believe that MRI is convenient for their lives. They also state that it offers a great deal of false negative results showing that is has low-sensitivity to the readings got. Thus, the report is much of a scum that if not well looked at can mislead the public. It has no coherence in facts: it looks at opinionated issues and looks for a way in which they can justify them. Rose and Gold (1996) based their sensitivity, accuracy, specificity, negative and positive values of examination on the arthroscopic findings that were taken from all the researches done. It is however commendable the way they “blinded” the radiologists by withholding the information on the patients to get very sincere results without any inference on the type of patient that they were handling. The ways in which they vary their results by subjecting most of the patients to different studies is a way in which they can be made easier to establish the correct and most coherent way of dealing with issues that come up during the research. Pathological changes in the tears and in the ACL are all taken into consideration making it possible for them to make plausible deductions from something that they can really trace the beginning and the end (DeLee, 1983). The use of many correspondents to tackle this particular research is commendable as there is a chance to tackle as many issues arising than if the research was done with fewer respondents. The use of comparison is also a commendable step given the fact that one is able to gauge the two and choose the most appropriate one to use. The fact that they are able to discredit a previous study due to its inability to compare MRI to any other in the same research situation is good. That shows that they took into account all the important aspects of any good research. However, the concept of blinding the radiologists may not fully give the intended results being looked for in this particular situation (Ferrari 1994). The radiologists, though he could be biased in this case, may do a little better with some prior information that would assist them to deal with the cases from a general to a specific case scenario. They recommend that any clinical examination should be done accurately to avoid the need for any of the other forms of examination (Baker, 1983). They term this as an inexpensive way to get treatment. The fact that they are able to manufacture their own formula and justify its use in effectively cutting costs can be misused to alter those that would have been better without the MRI or the arthroscopic. Clinical examination is duly abused by the clinicians. This means that the condition of the patient is dependent of the clinician’s feelings or mental status. Thus, if the clinician is feeling confident and willing to treat the patient, the patient will receive proper treatment and diagnosis; but if the clinician has other factors that are disturbing his cognitive, the likelihood of him/her making proper diagnosis is put into question (CCAANA, 1986: Clancy 1983). Conclusion: From the review of all those articles, one notes that there are many aspects that have been left behind. The important thing about these that have been chosen above is the fact that they outline the different ways in which the articles are lacking in having fine details that could actually change the way people think of certain issues. The fact that MRI is an effective and a modern way of dealing with the knee injuries, it is important to note that the current world needs cost-effective medication (Boden, 1992). This means that there must be an overall way in which the best can be chosen to effectively deal with these emerging cases (Ruwe, 1992: Garvin 1993). Professionals should be employed to look into these matters closely and come up with clear policies that will eventually see the country move from the current archaic modes of treatment to modern and more trusted methods of treatment. The involvement of professionals will ensure that they will look at different angles and make it possible for the world to come up with enough ways of handling knee injuries more effectively. The sports world is more affected in this area and the most affected age group is that of children and the baby-bloomers. Care should be accorded to avoid falls that could cost them more money than they wanted to be used. This way, effective means will be achieved when it comes to dealing with treatment of individuals (Sherman, 1986: Bruns, 2000). Reference list: Adalberth T. et al. 1997. Magnetic resonance imaging, arthroscopy, and scintilography evaluation of traumatic hemarthrosis of the knee. Am J Sports Med. 25 (2): 231-7. Baker C. L. Jr 1983. Norwood LA, Hughston JC: Acute posterolateral rotator instability of the knee J Bone Joint Surg 65A 614-618. Boden SD, Davis DO, Dina TS, Stoller DW, Brown SD, Vailas JC, Labropoulos PA. A prospective and blinded investigation of magnetic resonance imaging of the knee. CORR 1992; 282: 177-185. Brown N. & Keeley S., 1997. A Guide to Critical Thinking: Asking the Right Questions, Pearson: London Bruns W, Maffulli N. 2000. Lower limb injuries in children in sports. Clin Sports M ed. 19(4): 1-18. Clancy W. G. Jr 1983. Treatment of knee joint instability secondary to rupture of the posterior cruciate ligament. Report of a new procedure J Bone Joint Surg 65A 310-322. Committee on Complications of the Arthroscopy Association of North America (CCAANA) 1986. the knee and other joints: Complications in arthroscopy. Arthroscopy. 2 (4): 253-8. Cooper D. E. 1991. Tests for posterolateral instability of the knee in normal subjects Results of examination under anaesthesia J Bone Joint Surg 73A 30-36, Cottrell S. 2005. Critical Thinking Skills, Palgrave: Basingstoke DeLee J. C. 1983. Acute posterolateral rotator instability of the knee. Am J Sports Med 11. 199 207, Ferrari D. A. 1994. Posterolateral instability of the knee J Bone Joint Surg 76B 187-192, Frobell, Lohmander, and Roos H. P. 2006. Acute rotational trauma to the knee: Agreement between clinical assessment and magnetic resonance imaging findings, Scand J Med Sci Sports 17: 109-114 Garvin G. J. 1993. Tears of the medial collateral ligament: Magnetic resonance imaging findings and associated injuries. Can Assoc Radiol J 44 199-204, Garvin GJ, Munk PL, Vellet AD. Tears of the medial collateral ligament: Magnetic resonance imaging findings and associated injuries. Can Assoc Radiol J 1993; 44: 199-204. Haygood T. M. 1994. Magnetic resonance imaging of the knee Orthopaedics 17 1067-1072, Herman L. J, Beltran J. Pitfalls in MR imaging of the knee. Radiology 1988; 167:775-781. Hodler J, Haghighi P, Trudell D, Resnick D. The cruciate ligaments of the knee: Correlation between MR appearance and gross and histologic findings in cadaveric specimens. A JR Am J Roentgenol 1992; 159:357-360. Hughston J. C. 1980. The posterolateral drawer test and external rotational recurvatum test for posterolateral rotatory instability of the knee Clin Orthop 147 82-87, Hughston J. C. 1985. Chronic posterolateral rotatory instability of the knee J Bone Joint Surg 67A. 351-359, Hughston J. C. 1993. Posterolateral rotatory instability, in Knee Ligaments Injury and Repair. St Louis: Mosby-Year Book Inc, Insall J. N. 1984. Examination of the knee. New York: Churchill Livingstone. Ireland J, Trickey E. L, Stoker D. J. Arthroscopy and arthrography of the knee: a critical review. J Bone Joint Surg Am 1980; 62:3-6. Kannus P. 1989. Nonoperative treatment of grade II and III sprains of the lateral ligament compartment of the knee. Am J Sports Med 17 83-88, Kannus P. 1987. Conservatively treated tears of the anterior cruciate ligament. Long-term result. J Bone Joint Surg Am.; 69: 1007-12. Korniuk J, Trefelner E, McCarthy S, Lange R, Lynch K, Jokl P. Meniscal abnormalities in the asymptomatic population at MR imaging. Radiology 1990; 177:463-465. McGinty J. B. 1988 Complications of arthroscopy and arthroscopic surgery in Arthroscopic surgery. New York: MacGray-Hill. Noyes F. R. 1995. Surgical reconstruction of severe chronic posterolateral complex injuries of the knee using allograft tissues. Am J Sports Med 23 2-12, O’Brien S. J. 1991. Reconstruction of the chronically insufficient anterior cruciate ligament with the central third of the patellar ligament J Bone Joint Surg 73A 278-286, Oberlander M. A. 1993. A prospective study: The accuracy of the clinical knee examination documented by arthroscopy. Am J Sports Med. 21(6):773-8. Patel D. 1990. Complications in arthroscopic surgery. Baltimore: Williams and Wilkins Reicher MA, Bassett LW, Gold RH: High-resolution magnetic resonance imaging of the knee joint: Pathologic correlations. A JR Am J Roentgenol 1985; 145: 903-909. Reicher MA, Hartzman S, Duekwiler GR, Bassett LW, Anderson LJ, Gold RH. Meniscal injuries: Detection using MR imaging. Radiology 1986; 159:753-757. Rose N. E. and Gold S. M. 1996. A comparison of accuracy between clinical examination and magnetic resonance imaging in the diagnosis of Meniscal and anterior cruciate ligament tears, The Journal of Arthroscopic and Related Surgery, Vol 12, No 4 pp 398-405. Ross G. et al 1997. Magnetic resonance imaging for the evaluation of acute posterolateral complex injuries of the knee. The American journal of sports medicine. 25 (4): 444 Ruiz M. E. 1994. Medial and lateral supporting structures of the knee Normal MR imaging anatomy and pathologic findings Magn Reson Imaging Clin North Am 2 381-399, Ruwe P. A. Wright J. Randall R. L. Lynch J. K. Jokl P. McCarthy S. Can MRI imaging effectively replace diagnostic arthroscopy. Radiology 1992; 183:335-339. Sherman O. H, 1986. Arthroscopy - “no problem surgery”. An analysis of complications in two thousand six hundred cases. Bone Joint Surg Am. 68: 256-65. Vaz CES 2005. Accuracy of magnetic resonance in identifying traumatic intra-articular knee lesions. Clinics. 60(6): 445-50. Watanabe A. T, Carter B. C, Teitelbaum G. P, Seeger L. L, Bradley W. G. Normal variations in MR imaging of the knee: Appearance and frequency. Am J Radiol 1989; 153:341-344. Read More