 Variant 2: Adult or child greater than or equal to 5 years of age. Chronic knee pain. Initial knee radiograph negative or demonstrates joint effusion. Next imaging procedure. Chronic Knee Pain Variant 3: Adult or child greater than or equal to 5 years of age. Chronic knee pain. Initial knee radiograph demonstrates osteochondritis dissecans (OCD), loose bodies, or history of cartilage or meniscal repair. Next imaging procedure. Variant 4: Adult or child greater than or equal to 5 years of age. Chronic knee pain. Initial knee imaging radiograph demonstrates degenerative changes or chondrocalcinosis. Next procedure. Chronic Knee Pain Variant 5: Adult or child greater than or equal to 5 years of age. Chronic knee pain. Initial knee radiograph demonstrates signs of prior osseous injury (ie, Segond fracture, tibial spine avulsion, etc). Next imaging procedure. Chronic Knee Pain CHRONIC KNEE PAIN Expert Panel on Musculoskeletal Imaging: Michael G. Fox, MD, MBAa; Eric Y. Chang, MDb; Behrang Amini, MD, PhDc; Stephanie A. Bernard, MDd; Tetyana Gorbachova, MDe; Alice S. Ha, MDf; Ramesh S. Iyer, MDg; Kenneth S. Lee, MD, MBAh; Darlene F. Metter, MDi; Pekka A. Mooar, MDj; Nehal A. Shah, MDk; Adam D. Singer, MDl; Stacy E. Smith, MDm; Mihra S. Taljanovic, MD, PhDn; Ralf Thiele, MDo; Kathy M. Tynus, MDp; Mark J. Kransdorf, MD. q Typically, radiography is the initial imaging study used to evaluate chronic pain in a native knee. When pain persists but the initial radiographs are normal or demonstrate a joint effusion, MRI is usually considered the next imaging study. However, the use of MRI may be premature and unnecessary in some patients, as it is estimated that approximately 20% of patients with chronic knee pain have had an MRI performed without recent (within the prior year) radiographs [2].
Chronic Knee Pain.  Variant 2: Adult or child greater than or equal to 5 years of age. Chronic knee pain. Initial knee radiograph negative or demonstrates joint effusion. Next imaging procedure. Chronic Knee Pain Variant 3: Adult or child greater than or equal to 5 years of age. Chronic knee pain. Initial knee radiograph demonstrates osteochondritis dissecans (OCD), loose bodies, or history of cartilage or meniscal repair. Next imaging procedure. Variant 4: Adult or child greater than or equal to 5 years of age. Chronic knee pain. Initial knee imaging radiograph demonstrates degenerative changes or chondrocalcinosis. Next procedure. Chronic Knee Pain Variant 5: Adult or child greater than or equal to 5 years of age. Chronic knee pain. Initial knee radiograph demonstrates signs of prior osseous injury (ie, Segond fracture, tibial spine avulsion, etc). Next imaging procedure. Chronic Knee Pain CHRONIC KNEE PAIN Expert Panel on Musculoskeletal Imaging: Michael G. Fox, MD, MBAa; Eric Y. Chang, MDb; Behrang Amini, MD, PhDc; Stephanie A. Bernard, MDd; Tetyana Gorbachova, MDe; Alice S. Ha, MDf; Ramesh S. Iyer, MDg; Kenneth S. Lee, MD, MBAh; Darlene F. Metter, MDi; Pekka A. Mooar, MDj; Nehal A. Shah, MDk; Adam D. Singer, MDl; Stacy E. Smith, MDm; Mihra S. Taljanovic, MD, PhDn; Ralf Thiele, MDo; Kathy M. Tynus, MDp; Mark J. Kransdorf, MD. q Typically, radiography is the initial imaging study used to evaluate chronic pain in a native knee. When pain persists but the initial radiographs are normal or demonstrate a joint effusion, MRI is usually considered the next imaging study. However, the use of MRI may be premature and unnecessary in some patients, as it is estimated that approximately 20% of patients with chronic knee pain have had an MRI performed without recent (within the prior year) radiographs [2].