An article recently published in The American Journal of Sports Medicine analyzes the cost-effectiveness of meniscal tear diagnosis.
The study examined treatment for meniscal tears at primary care facilities and sports medicine clinics. They compared using a history and physical with and without MRI for diagnosing patients. Here are five findings from the study:
1. The history and physical examination was widely preferred for degenerative meniscal tears in both practice settings. The MRI was preferred to confirm traumatic tears in both practice settings. The MRI was preferred when prevalence was less than 46.7 percent among traumatic patients.
2. There was a willingness to pay less than $50,000 per quality-adjusted life-years. Performing MRI for all patients was not preferred in any clinical scenario.
3. Among degenerative tears, history and physical examination was preferred until the prevalence reaches 74.2 percent, and then an MRI is likely used to confirm a negative.
4. When MRI was used to confirm the positive physical examination, there was more than a 10-fold lower rate of unnecessary surgery than any other strategy. This was true for both settings.
5. The MRI to confirm negative physical examination led to a 2.08 higher rate than history and physical examination alone in primary care settings. In orthopedic clinics, the same activity led to a 2.26 higher rate.
"Consideration should be given to implementing alternative diagnostic strategies as well as enhancing provider education in physical examination skills to improve the reliability of H&P as a diagnostic test," concluded the study authors.