Don’t perform routine magnetic resonance imaging (MRI) of the knee in the event of acute pain from trauma or chronic pain.

Oct 17, 2018

Don’t perform routine magnetic resonance imaging (MRI) of the knee in the event of acute pain from trauma or chronic pain.

Type of practice

Imaging

Age

Adult, Geriatric

Topic Area

Medical Radiology

MRI of the knee is often prescribed before an orthopaedic clinical examination or specialist request, to patients of any age.
Patient history, accurate physical examination and knee radiography, appropriate as a first-line diagnostic examination if an imaging evaluation is deemed necessary, are usually sufficient for diagnosing most of knee injuries that will benefit from a conservative medical and physical treatment.
In the absence of clinical signs of alarm, performing a MRI of the knee in the first 4-6weeks in acute pain from trauma or early in chronic pain, does not modify the therapeutic approach, but could lead to incidental findings, to further tests and even to unnecessary surgery; all representing a high cost for society and environmental harm.
MRI should be considered after assessment by radiological examination, only when it is intended to guide the choice between effective therapeutic alternatives deemed reasonable based on clinical data and the patient’s age, always exercising the utmost caution regarding surgical indication in elderly patients, in view of the more limited therapeutic outcomes and the higher risk of postoperative complications.

Sources

1. Gonzales FM, Kerchberger JM, Robertson DD, et al. MRI Primary Care Ordering Practices for Nontraumatic Knee Pain: Compliance With ACR Appropriateness Criteria and Its Effect on Clinical Management. J Am Coll Radiol 2019; 16: 289-94. doi:10.1016/j.jacr.2018.10.006.
2. Sims JI, Chau MT, Davies JRl. Diagnostic accuracy of the Ottawa Knee Rule in adult acute knee injuries: a systematic review and meta-analysis. Eur Radiol. 2020; 30:4438-46. doi:10.1007/s00330-020-06804.
3. Taljanovic MS, Chang EY, Ha AS, et al. ACR Appropriateness Criteria® Acute Trauma to the Knee. J Am Coll Radiol 2020;17(5S):S12-S25. doi:10.101 6/j.jacr.2020.01.041. https://acsearch.acr.org/docs/69419/narrative/ (ultimo accesso: gennaio 2026).
4. Fox MG, Chang EY, Amini B, et al. ACR Appropriateness Criteria® Chronic Knee Pain J Am Coll Radiol 2020; 17(5S):S12-S25. doi:10.1016/j.jacr.2020.01.041. https://acsearch.acr.org/docs/69432/Narrative/ (ultimo accesso: gennaio 2026).
5. Naqvi SR, Beavis RC, Mondal P, et al. Incidence Rates of Surgery After Knee MRI. Association According to Referring Physician Type and Patient’s Age and Sex. The Orthopaedic Journal of Sports Medicine 2021; 9:23259671211052560. doi:10.1177/23259671211052560.

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Attention. Please note that these items are provided only for information and are not intended as a substitute for consultation with a clinician. Patients with any specific questions about the items on this list or their individual situation should consult their clinician.