RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA
ANNEXURE-II
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. NAME OF THE CANDIDATE DR. VINAYARAJ M.K.
AND ADDRESS EXTENSION TAGORE ROAD
NEAR CO-OP-UNION
GADAG-582101
2. NAME OF THE INSTITUTION BANGALORE MEDICAL COLLEGE
AND RESEARCH INSTITUTE
BANGALORE
3. COURSE OF STUDY AND SUBJECT M.S. IN ORTHOPAEDICS
4. DATE OF ADMISSION 31st MAY 2008
5. TITLE OF THE TOPIC A COMPARATIVE STUDY OF MRI
AND ARTHROSCOPY IN DIAGNOSIS
OF INTERNAL DERANGEMENTS OF
THE KNEE
6. BRIEF RESUME OF INTENDED WORK
6.1. NEED FOR STUDY
ARTHROSCOPY is considered as ‘GOLD STANDARD’ for diagnosis of intra articular knee lesions7.
Though MRI has gained popularity as a diagnostic tool of the musculoskeletal disorders, taking in account that health-economics play important role in patients management, many questions arise regarding when and how often one must ask for a MRI when clinical examinations help in clinching the diagnosis of most IDK,s.7
Associated with this, many times MRI is being advised injudiciously by even general practitioners without proper clinical knowledge.
In view of the many number of cases with suspected INTERNAL DERANGEMENTS OF KNEE, coming to our hospital, I intend to study the accuracy of MRI diagnosis in comparison with the findings obtained by subsequent ARTHROSCOPIES in same patients; and also the cost effectiveness of a direct arthroscopy without prior MRI.
6.2. REVIEW OF LITERATURE
INTERNAL DERANGEMENTS OF KNEE is a commonly presenting clinical condition to the orthopaedic practitioner.
They account for a large number of referrals to hospitals, not only from the peripherals and general practitioners but also from accident and emergency centres. Other than being very troublesome for the patients’ day to day activities, it has a very significant financial and medicolegal implication.5
MRI accuracy in detecting knee lesions is a discussed controversy, and the delay caused in proper diagnosis and subsequent treatment may thus lead to irreversible and severe degree of damage. MRI can also be misleading, approximately 20% of patients with Type II ( incomplete tears) signals have been found to have complete tears at ARTHROSCOPY. MRI is infrequently helpful in assessment of healing
Though MRI has advantages of being non-invasive and a highly sensitive tool of investigation; the financial problems need consideration.
Taking into account that MRI false or misleading results can be as high as 20%-30% in specific knee pathologies, it is concluded that ARTHROSCOPY still remains the ‘GOLD STANDARD’ in diagnosing internal knee lesions.7
6.3. OBJECTIVES OF THE STUDY
1. To compare the diagnosis of IDK’s done by non-invasive MRI to invasive ARTHROSCOPY.
2. To study if arthroscopy can be done directly without prior MRI and to study the cost effectiveness of direct Arthroscopy.
7. Materials and Methods
7.1. Source of data;
1. Patients attending OPD/IPD in VICTORIA HOSPITAL and BOWRING & LADY CURZON HOSPITAL.
2. Patients referred from peripherals to these hospitals suspecting knee disorders.
3. Patients who have got investigations like X-Rays, MRI outside and have come to these hospitals for internal knee problems.
All such patients will be taken up for study after obtaining their consent.
7.2. Method of collection of data
Collection of data for patients coming with internal knee problems is as follows.
Ø History by verbal communication
Ø Clinical examination, both local and systemic
Ø Baseline investigations
Ø Radiological examination, routine and other imaging modalities
Ø Diagnostic arthroscopy and arthroscopic procedures
Ø Comparison of diagnosis obtained by MRI and ARTHROSCOPY.
MRI is done after assessing the affordability of the patient as the institution does not have the facility, if not arthroscopy is done directly.
Patients are admitted and investigated as situation permits.
Ø Routinely diagnostic arthroscopy is done and lesions that can be treated are continued with further treatment in the same sitting.
Ø Follow up protocol is made based on KNEE SCORING INDEX and patient advised follow up for
--Assessment at 1 week
a)Pain
b)Range of motion
c)Complications
--Assessment at 4 weeks
a)Pain
b)Range of motion
c)Stability
--Assessment at 8 weeks
a)Stability
b)Mobility
c)Return to activity
--Assessment at 12 weeks
a)Investigations if needed
b)Functional ability
--Assessment at 6 and 12 months
a)Activity
b)Pain with activity
c)Stability
INCLUSION CRITERIA
1. Patients suffering knee problems for >than 6weeks duration
2. Patients with recent symptoms of locking of knee.
3. Patients with MRI suggestive of IDK.
4. Children with undiagnosed knee pain and doubtful knee injury.
EXCLUSION CRITERIA
1. Patients with signs of acute infection.
2. Cases with severe osteoarthritis.
3. Cases with ankylosed knee.
4. Cases who have undergone previous arthroscopy
5. Cases treated with Anti-tubercular-treatment as doubtful TB.
7.3. Does the study require any investigations or interventions to be conducted on Patients or other humans or animals? If so, please describe briefly.
Investigations include routine blood, urine examinations, ECG, X-Rays.
No animal studies are required.
7.4. Has the ethical clearance been obtained from your institution?
Will be furnished by the principal of BANGALORE MEDICAL
COLLEGE & RESEARCH INSTITUTE.
8. List of references:
1. Miller-Cole Textbook of Arthroscopy
2. Chapman’s ORTHOPAEDIC surgery, 3rd Edition, Volume 2
3. Campbell’s Operative orthopaedics, volume-3, 11th Edition
4. Operative Arthroscopy-2nd Edition;John B McGINTY pp-175-188
5. A Comparative study of MRI & Clinical findings in Diagnosis of INTERNAL DERANGEMENTS OF THE KNEE. Journal of Orthopaedics 2005;2(4) e 5
6. Accuracy of MRI in meniscal and ACL injuries. A Prospective comparative study. JBJS, Lisbon 4-7 June, 2005,British volume-88
7. Journal of trauma management and outcomes. MRI efficacy in diagnosing internal lesions of knee: A retrospective analysis, DOI 10, 1186/1752-2897-2-4
8. Journal of Pediatric Orthopaedics, Correlation of MRI & Arthroscopic diagnosis of knee pathology in children & adolescents
volume 8 (5), September / October 1998, pp 675 – 678
9. Journal of applied science 5 (4), 6868 – 688, 2005
The accuracy of MRI compared arthroscopic findings in intra-articular traumatic knee injury
10. Journal of orthopaedic surgery and research 2008, 3:19
Clinical examination, MRI and arthroscopy in meniscal and ligamentous knee injuries- A prospective study
DOI : 10,1186/1749 – 799x 3-19
9. Signature of the candidate
10. Remarks of the Guide
We are having inflow of patients referred from all major hospitals including CGHS, ESI and even superspeciality hospitals because of various reasons. MRI is not available presently in our hospital. Arthroscopy is being carried out on patients with prior MRI or directly without subjecting to MRI. The study aims at accuracy of clinical diagnosis and cost effectiveness of direct Arthroscopy. Hence it is appropriate to take this subject as a thesis.
11. Name & Designation of
11.1. Guide Prof DR A. RAMALINGAIAH
M.S.ORTHO
Professor of Orthopaedics
Department of Orthopaedics
BMC-RI
SIGNATURE:
11.2. Head of The Department Prof. DR. N. VIJAYAKUMAR
M.S. ORTHO
Professor & Head of The Department
Department of Orthopaedics
BMC-RI
Signature:
12. REMARKS OF THE CHAIRMAN AND PRINCIPAL:
Signature:
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