Next imaging procedure. Radiography Hip In patients with chronic knee pain, referred pain from the hip must be considered, especially if the knee radiographs are unremarkable and there is clinical evidence or concern for hip pathology [14]. Radiography Lumbar Spine In patients with chronic knee pain, referred pain from the lower back must be considered, especially if the knee radiographs are unremarkable and there is clinical evidence or concern for lumbar spine pathology. CT Knee CT without intravenous (IV) contrast may be indicated to evaluate the patellofemoral anatomy in the setting of chronic knee pain related to repetitive patellofemoral subluxation or maltracking [15]. CT can also be used to evaluate trochlear morphology and the tibial tubercle-trochlear groove distance. CT with IV contrast is usually not indicated when initial radiograph is negative or demonstrates a joint effusion. CT without and with IV contrast is not routinely performed when initial radiographs are negative. CT Arthrography Knee When an intra-articular abnormality is suspected, CT arthrography may be used instead of MRI to evaluate the menisci and articular cartilage [16]. MRI Knee When initial radiographs are normal or reveal a joint effusion but pain persists, the next indicated study is usually MRI without IV contrast, which is more sensitive than radiography [11]. MRI accurately depicts the extent of an effusion, presence of synovitis, and presence or rupture of a popliteal cyst [17]. Subchondral cysts, articular cartilage, and meniscal abnormalities are easily detected on MRI [13,18,19]. However, meniscal tears are often incidental findings in older patients with the majority of people over 70 years Chronic Knee Pain of age having an asymptomatic meniscal tear, and the likelihood of a meniscal tear being present in either a painful or asymptomatic knee not significantly different in patients 45 to 55 years of age [20,21].
Chronic Knee Pain. Next imaging procedure. Radiography Hip In patients with chronic knee pain, referred pain from the hip must be considered, especially if the knee radiographs are unremarkable and there is clinical evidence or concern for hip pathology [14]. Radiography Lumbar Spine In patients with chronic knee pain, referred pain from the lower back must be considered, especially if the knee radiographs are unremarkable and there is clinical evidence or concern for lumbar spine pathology. CT Knee CT without intravenous (IV) contrast may be indicated to evaluate the patellofemoral anatomy in the setting of chronic knee pain related to repetitive patellofemoral subluxation or maltracking [15]. CT can also be used to evaluate trochlear morphology and the tibial tubercle-trochlear groove distance. CT with IV contrast is usually not indicated when initial radiograph is negative or demonstrates a joint effusion. CT without and with IV contrast is not routinely performed when initial radiographs are negative. CT Arthrography Knee When an intra-articular abnormality is suspected, CT arthrography may be used instead of MRI to evaluate the menisci and articular cartilage [16]. MRI Knee When initial radiographs are normal or reveal a joint effusion but pain persists, the next indicated study is usually MRI without IV contrast, which is more sensitive than radiography [11]. MRI accurately depicts the extent of an effusion, presence of synovitis, and presence or rupture of a popliteal cyst [17]. Subchondral cysts, articular cartilage, and meniscal abnormalities are easily detected on MRI [13,18,19]. However, meniscal tears are often incidental findings in older patients with the majority of people over 70 years Chronic Knee Pain of age having an asymptomatic meniscal tear, and the likelihood of a meniscal tear being present in either a painful or asymptomatic knee not significantly different in patients 45 to 55 years of age [20,21].