NEW GP MRI INDICATIONS…WHAT DOES IT ALL MEAN (PART 3)

As of 1 November 2013, the GP MRI requesting rights have been extended to include indications for patients aged 16 years and over. These indications include Brain, Cervical spine and Knee.

This 3 part series will include case studies to help identify and highlight some appropriate senarios that MRI would be most useful. For more information please call our Randwick or Liverpool sites on 9399 5357 or 9600 9552.

PART 3 – MRI KNEE

GPs can refer for a Medicare funded MRI Knee for suspected acute ACL tear following acute trauma or the inability to extend the knee suggesting possible acute meniscal tear following acute trauma.

acute knee trauma

Case History 1

A 40 year old woman presents with a swollen left knee which keeps ‘locking’.

This began after twisting while gardening a couple of days ago. Her knee is mildly swollen and she unable to fully extend the knee but can ambulate. There was joint line tenderness, but no tenderness at the head of the fibula or over the patella. However Thessaly and Apley tests were negative.

Case History 2

A 26 year old women complains of a ‘popping’ sensation in her right knee during a game of netball.

She needed to be helped off the netball court but was able to walk unassisted into the GP. Her right knee is acutely swollen, without tenderness at the head of the fibula or over the patella. The anterior drawer test positive but Lachman test negative.

Discussion

MRI is the imaging of choice for the diagnosis of acute meniscal tears and acute ACL tears. X Ray and ultrasound are not useful in the evaluation of soft tissue knee injury. It decreases the need for invasive diagnostic arthroscopy. MRI is a useful diagnostic tool when diagnosis is uncertain, and can help clinical decision making particularly when determining surgical or conservative management

1. Clinical Guidance for MRI referral. East Melbourne: Royal Australian College of General Practitioners, 2013.