title: The use of magnetic resonance imaging in acute knee injuries can be reduced by non-physician expert clinics.
abstract: BACKGROUND
  The routine use of magnetic resonance imaging (MRI) for the assessment of acute knee injuries is controversial. The goal of this study is to present an audit of patients seen in a dedicated Acute Knee Injury Clinic (AKIC) to determine the frequency and appropriateness of MRI utilization.
  
  
  METHODS
  A retrospective review identified all patients who had an MRI and a randomly selected control group without MRI. The MRI was classified based on whether it was ordered by the AKIC team or by an external clinician. The consensus-based 'Indications for Urgent MRI in Acute Soft Tissue Knee Problems' were applied to both groups. An MRI was considered appropriate if any of the indications were met.
  
  
  RESULTS
  The overall MRI utilization rate was 23% (142/611). Of the MRIs performed, 32% (46/142) met the indications. About 94% (33/35) of the MRIs ordered by the AKIC experts met the indications, compared to only 12% (13/107) of those ordered externally. No patients in the control group met the indications. Diagnoses were similar between groups.
  
  
  CONCLUSIONS
  These results suggest that application of guidelines by experts in knee evaluation can significantly reduce expensive MRI utilization in patients with acute knee injuries without negatively impacting the appropriate diagnosis and disposition.
authors.affiliation: Orthopedic Surgery, University of Calgary , 731 35th St NW, Calgary, Alberta T2N 2Z6 , Canada.
authors.forename: Michaela
authors.initials: M
authors.lastname: Kopka
authors.forename: Nick
authors.initials: N
authors.lastname: Mohtadi
authors.forename: Alexandra
authors.initials: A
authors.lastname: Naylor
authors.forename: Richard
authors.initials: R
authors.lastname: Walker
authors.forename: Maoliosa
authors.initials: M
authors.lastname: Donald
authors.forename: Cy
authors.initials: C
authors.lastname: Frank
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007718:Knee Injuries / Q000175:diagnosis* / Q000473:pathology; D007719:Knee Joint / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D012189:Retrospective Studies; D055815:Young Adult
keywords: Acute knee injury; MRI; primary care