Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-11T07:45:46.919Z Has data issue: false hasContentIssue false
  • English
  • Français

Magnetic resonance imaging, knee arthroscopy, and clinical decision making: A descriptive study of five surgeons

Published online by Cambridge University Press:  22 October 2009

Sarah Derrett ,
Gayle D. Walley ,
Stephen A. Bridgman ,
Paula Richards  and
Nicola Maffulli
Sarah Derrett
Affiliation:
University of Otago
Gayle D. Walley
Affiliation:
University Hospital of North Staffordshire
Stephen A. Bridgman
Affiliation:
Princess Elizabeth Hospital
Paula Richards
Affiliation:
University Hospital of North Staffordshire
Nicola Maffulli
Affiliation:
Queen Mary University of London, Barts and London School of Medicine and Dentistry
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: A randomized controlled trial (RCT) showed magnetic resonance imaging for patients waiting for knee arthroscopy did not reduce the number of arthroscopies. Our study aimed to identify decisions made by orthopedic surgeons about whether patients on a waiting list should proceed to arthroscopy, and to describe surgeons’ decisions.

Methods: Five surgeons were asked to Think Aloud (TA) as they made their decisions for twelve patients from the original RCT. Audiotapes of the decision making were transcribed for analysis.

Results: For five patients, surgeons agreed about proceeding with arthroscopy, although reasoning differed. In no cases did surgeons agree about not proceeding to arthroscopy. Agreement was more likely in patients with clinically diagnosed meniscal abnormality, and less likely in patients with osteoarthritis.

Conclusions: Surgeons’ decisions were influenced by patient wishes. For some patients, the decision to proceed with arthroscopy was based solely on clinical diagnosis; MRI may not be advantageous in these instances. Surgeons disagreed more often than they agreed about the decision to proceed with arthroscopy, particularly when OA was diagnosed. This has implications for decision making in the current NHS patient choice environment. Patients may choose a treatment provider from a list of available providers at time of original clinical assessment and diagnosis. The treating surgeon does not necessarily re-examine the patient until the day of surgery. Given the variation between surgeons about the merits of proceeding with arthroscopy, surgeons may end up in the invidious position of providing surgery to patients whom they do not believe will benefit from arthroscopy.

Keywords

MRIKneeArthroscopyDecision makingTrialDiagnosis
Type
Research Reports
Information
International Journal of Technology Assessment in Health Care , Volume 25 , Issue 4 , October 2009 , pp. 577 - 583
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Bridgman, S, Richards, P, Walley, G, et al. The effect of magnetic resonance imagining scans on knee arthroscopy: Randomized controlled trial. Arthroscopy. 2007;23:1167–1173.CrossRefGoogle Scholar
2. Crawford, R, Walley, G, Bridgman, S, Maffulli, N. Magnetic resonance imaging versus arthroscopy in the diagnosis of knee pathology, concentrating on meniscal lesions and ACL tears: A systematic review. Br Med Bull. 2007;84:5–23.CrossRefGoogle ScholarPubMed
3. Department of Health England. Hospital episode statistics. London: Department of Health England; 2005.Google Scholar
4. Elstein, A, Shulman, L, Sprafka, S. Medical problem solving: An analysis of clinical reasoning. Cambridge: Harvard University Press; 1978.CrossRefGoogle Scholar
5. Gilhooly, K, Green, C. Protocol analysis: Theoretical background. In: Ericsson, K, Simon, H, eds. Protocol analysis: Verbal reports as data. Revised ed. Cambridge: The MIT Press; 1993.Google Scholar
6. Green, C, Gilhooly, K. Protocol analysis: Practical implementation. In: Ericsson, K, Simon, H, eds. Protocol analysis: Verbal reports as data. Revised ed. Cambridge: The MIT Press; 1993.Google Scholar
7. Hollingworth, W, Todd, C, Bell, M, et al. The diagnostic and therapeutic impact of MRI: An observational multi-centre study. Clin Radiol. 2000;55:825–831.CrossRefGoogle ScholarPubMed
8. Igbokwe, O. Formal methods of decision making in the clinical domain. Biohealthmatics.com 2007.Google Scholar
9. Khan, K, Tress, B, Hare, W, Wark, J. Treat the patient, not the X-ray: Advances in diagnostic imaging do not replace the need for clinical interpretation. Clin J Sports Med. 1998;8:1–4.CrossRefGoogle Scholar
10. Kuipers, B, Kassirer, J. Causal reasoning in medicine: Analysis of a protocol. Cogn Sci. 1984;8:363–385.CrossRefGoogle Scholar
11. Kuipers, B, Moskowitz, A, Kassirer, J. Critical decisions under uncertainty: Representation and structure. Cogn Sci. 1988;12:177–210.CrossRefGoogle Scholar
12. Kuusela, H, Pallab, P. A comparison of concurrent and retrospective verbal protocol analysis. Am J Psychol. 2000;113:387–404.CrossRefGoogle ScholarPubMed
13. Laupattarakasem, W, Laopaiboon, M, Laupattarakasem, P, Sumananont, C. Arthroscopic debridement for knee osteoarthritis. Cochrane Database Syst Rev. 2008;1:CD005118.Google Scholar
14. Lawson, G, Nutton, R. A prospective audit of knee arthroscopy: A study of the accuracy of clinical diagnosis and therapeutic value of 325 knee arthroscopies. J R Coll Surg Edinb. 1995;40:135–137.Google ScholarPubMed
15. MacKenzie, R, Dixon, A, Keene, G, et al. Magnetic resonance imaging of the knee: Assessment of effectiveness. Clin Radiol. 1996;51:245–250.CrossRefGoogle ScholarPubMed
16. Marx, RG. Arthroscopic surgery for osteoarthritis of the knee? NEJM. 2008;359:1169–1170.CrossRefGoogle ScholarPubMed
17. Newell, A, Simon, H. Human problem solving. Englewood Cliffs, NJ: Prentice-Hall; 1972.Google Scholar
18. Oberlander, M, Shalvoy, R, Hughston, J. The accuracy of the clinical knee examination documented by arthroscopy. A prospective study. Am J Sports Med. 1993;21:773–778.CrossRefGoogle ScholarPubMed
19. Offredy, M. Decision-making in primary care: Outcomes from a study using patient scenarios. J Adv Nurs. 2002;40:532–541.CrossRefGoogle ScholarPubMed
20. Selesnick, F, Noble, H, Bachman, D, Steinberg, F. Internal derangement of the knee: Diagnosis by arthrography, arthroplasty, and arthrotomy. Clin Orthop Relat Res. 1985;198:26–30.CrossRefGoogle Scholar
21. Siparsky, P, Ryzewicz, M, Peterson, B, Bartz, R. Arthroscopic treatment of psteoarthritis of the knee: Are there any evidence-based indications? Clin Orthop Relat Res. 2007;455:107–112.CrossRefGoogle Scholar
22. Solomon, D, Simel, D, Bates, D, Katz, J, Schaffer, J. Does this patient have a torn meniscus or ligament of the knee: Value of the physical examination. JAMA. 2001;286:1610–1620.CrossRefGoogle ScholarPubMed
23. Stuart, M, Lubowitz, J. What, if any, are the indications for arthroscopic debridement of the osteoarthritic knee? Arthroscopy. 2006;22:238–239.CrossRefGoogle ScholarPubMed
24. Warwick, D, Cavanagh, P, Bell, M, Marsh, C. Influence of magnetic imaging on a knee arthroscopy waiting list? Injury. 1993;24:380–382.CrossRefGoogle ScholarPubMed
25. Weinstabl, R, Mueliner, T, Vecsei, V, Kainberger, F, Kramer, M. Economic considerations for the diagnosis and therapy of meniscal lesions: Can magnetic resonance imaging help reduce the expense. World J Surg. 1997;21:363–368.CrossRefGoogle ScholarPubMed
Supplementary material: File

Derrett supplementary material

Supplementary table 1

Download Derrett supplementary material(File)
File 86.5 KB
Supplementary material: File

Derrett supplementary materials

Supplementary table 2

Download Derrett supplementary materials(File)
File 69.1 KB
Supplementary material: File

Derrett supplementary materials

Supplementary table 3

Download Derrett supplementary materials(File)
File 93.2 KB