The utility of plain radiographs in the initial evaluation of knee pain amongst sports medicine patients.
OBJECTIVE
To evaluate whether screening radiographs as part of the initial workup of knee pain impacts clinical decision-making in a sports medicine practice.


METHODS
A questionnaire was completed by the attending orthopaedic surgeon following the initial office visit for 499 consecutive patients presenting to the sports medicine centre with a chief complaint of knee pain. The questionnaire documented patient age, duration of symptoms, location of knee pain, associated mechanical symptoms, history of trauma within the past 2 weeks, positive findings on plain radiographs, whether magnetic resonance imaging was ordered, and whether plain radiographs impacted the management decisions for the patient. Patients were excluded if they had prior X-rays, history of malignancy, ongoing pregnancy, constitutional symptoms as well as those patients with prior knee surgery or intra-articular infections. Statistical analyses were then performed to determine which factors were more likely do correspond with diagnostic radiographs.


RESULTS
Overall, initial screening radiographs did not change management in 72 % of the patients assessed in the office. The mean age of patients in whom radiographs did change management was 57.9 years compared to 37.1 years in those patients where plain radiograph did not change management (p < 0.0001). Plain radiographs had no impact on clinical management in 97.3 % of patients younger than 40. In patients whom radiographs did change management, radiographs were more likely to influence management if patients were over age forty, had pain for over 6 months, had medial or diffuse pain, or had mechanical symptoms. A basic cost analysis revealed that the cost of a clinically useful radiographic series in a patient under 40 years of age was $7,600, in contrast to $413 for a useful series in patients above the age of 40.


CONCLUSIONS
Data from the current study support the hypothesis that for the younger patient population, routine radiographic imaging as a screening tool may be of little clinical benefit. Factors supporting obtaining screening radiographs include age greater than 40, knee pain for greater than 6 months, the presence of medial or diffuse knee pain, and the presence of mechanical symptoms.


METHODS
II.
Division of Sports Medicine, NYU Hospital for Joint Diseases, 333 East 38th Street, 4th Floor, New York, NY, 10016, USA. mja267@nyumc.org.
Michael J
MJ
Alaia
Division of Sports Medicine, NYU Hospital for Joint Diseases, 333 East 38th Street, 4th Floor, New York, NY, 10016, USA.
Omar
O
Khatib
Division of Sports Medicine, NYU Hospital for Joint Diseases, 333 East 38th Street, 4th Floor, New York, NY, 10016, USA.
Mehul
M
Shah
Division of Sports Medicine, NYU Hospital for Joint Diseases, 333 East 38th Street, 4th Floor, New York, NY, 10016, USA.
Joseph
J
A Bosco
Division of Sports Medicine, NYU Hospital for Joint Diseases, 333 East 38th Street, 4th Floor, New York, NY, 10016, USA.
Laith
L
M Jazrawi
Division of Sports Medicine, NYU Hospital for Joint Diseases, 333 East 38th Street, 4th Floor, New York, NY, 10016, USA.
Eric J
EJ
Strauss
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018771:Arthralgia / Q000000981:diagnostic imaging* / Q000209:etiology; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007717:Knee / Q000000981:diagnostic imaging; D007719:Knee Joint / Q000000981:diagnostic imaging*; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011859:Radiography; D013178:Sports Medicine; D011795:Surveys and Questionnaires; D055815:Young Adult