[Radiological diagnostics of patellofemoral instability and patellar dislocation].

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Abstract

[Indexed for MEDLINE] 17. J Am Coll Radiol. 2015 Nov;12(11):1164-72. doi: 10.1016/j.jacr.2015.08.014. ACR Appropriateness Criteria Acute Trauma to the Knee. Tuite MJ(1), Kransdorf MJ(2), Beaman FD(3), Adler RS(4), Amini B(5), Appel M(6), Bernard SA(7), Dempsey ME(8), Fries IB(9), Greenspan BS(10), Khurana B(11), Mosher TJ(7), Walker EA(7), Ward RJ(12), Wessell DE(13), Weissman BN(11). Author information: (1)University of Wisconsin Hospital, Madison, Wisconsin. Electronic address: mtuite@uwhealth.org. (2)Mayo Clinic, Phoenix, Arizona. (3)University of Kentucky, Lexington, Kentucky. (4)New York University Center for Musculoskeletal Care, New York, New York. (5)University of Texas MD Anderson Cancer Center, Houston, Texas. (6)James J. Peters VA Medical Center, Bronx, New York, American Academy of Orthopaedic Surgeons. (7)Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania. (8)Texas Scottish Rite Hospital, Dallas, Texas. (9)Bone, Spine and Hand Surgery, Chartered, Brick, New Jersey. (10)Medical College of Georgia at Georgia Regents University, Augusta, Georgia. (11)Brigham & Women's Hospital, Boston, Massachusetts. (12)Tufts Medical Center, Boston, Massachusetts. (13)Mayo Clinic, Jacksonville, Florida. More than 500,000 visits to the emergency room occur annually in the United States, for acute knee trauma. Many of these are twisting injuries in young patients who can walk and bear weight, and emergent radiographs are not required. Several clinical decision rules have been devised that can considerably reduce the number of radiographs ordered without missing a clinically significant fracture. Although a fracture is seen on only 5% of emergency department knee radiographs, 86% of knee fractures result from blunt trauma. In patients with a fall or twisting injury who have focal tenderness, effusion, or inability to bear weight, radiographs should be the first imaging study obtained. If the radiograph shows no fracture, MRI is best for evaluating for a suspected meniscus or ligament tear, or the injuries from a reduced patellar dislocation. Patients with a knee dislocation should undergo radiographs and an MRI, as well as an angiographic study such as a fluoroscopic, CT, or MR angiogram. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures, by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved. DOI: 10.1016/j.jacr.2015.08.014