MR imaging in patients with knee injury: an observational study in general practice

Knee trauma is often seen in general practice. The availability of magnetic resonance (MR) imaging has improved the diagnostic possibilities after knee trauma. Nevertheless, little is known about the findings on MR imaging after knee trauma in general practice. Especially, there is little known about bone bruise (a finding seen on MR imaging, but not on conventional radiographs). In this thesis the available knowledge on the natural course of posttraumatic knee lesions and bone bruise is summarized in two systematic reviews. This shows that, with conservative treatment, the anterior and posterior cruciate ligament can regain continuity after suffering partial or complete rupture. A natural healing response is described after sustained posttraumatic bone bruise. Next, the results of a study on 134 patients visiting their general practitioner for posttraumatic knee symptoms are presented in this thesis. These patients completed standardised questionnaires and underwent MR imaging of both knees. From the analyses it appears that ligamenteous lesions (cruciate and collateral ligaments) in posttraumatic knees are most probably the result of recent trauma, whereas horizontal meniscal tears and effusion may be pre-existent in many cases. Bone bruises were encountered in 60% of patients and were related to concomitant knee lesions. Median healing time of these bone bruises was 42 weeks, which is longer than previously described in the literature. Prognosis is particularly influenced by the presence of osteoarthritis. There is no relationship between the presence of bone bruise and pain severity. Hence, the clinical relevance of bone bruise after knee trauma seems small.

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