Post -trauma MRI knee interpretation: our experience with a mechanism-based approach in South African setting.
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A mechanism-based approach to the interpretation of complex knee injuries at magnetic resonance imaging (MRI) is cited by several authors to provide increased reporting accuracy and efficiency by allowing accurate prediction of injury to at-risk structures. We took interest in the clinical benefits proposed for such an approach, and set out to assess the approach’s validity in our local South African setting. We identified in the recent literature a consolidated mechanism-based pattern approach to complex post-trauma MRI knee interpretation compiled by Hayes et al., which showed high validity of 85% in a North American setting, and set out to test this approach in our resource-constrained South African setting. We found a low percentage (average 19%) of knee injuries classifiable by mechanism using the Hayes et al. classification. Statistically there was fair agreement between the two observers. We conclude, based on remediable limiting factors, that the clinical benefit of a mechanism-based interpretation approach could be optimised in our resource constrained setting by focusing its application on cases imaged within a time window when key injury findings such as bone bruising and soft tissue injury will be optimally detectable, as well as in patients injured in sporting and similar athletic activities. We advocate that the development of a digital MRI image reference tool for the implementation of the Hayes et al. classification could simplify and enhance its application.