Arthroskopie ohne vorherige MRT

Abstract

As a result of the widespread establishment of magnetic resonance tomography (MRT) in diagnostics, arthroscopy, as well as clinical and radiological examinations, have lost their significance as primary diagnostic modalities. However, due to the use of MRT in non-critical cases, unnecessary costs are produced, therapy is delayed and, in some cases, periods of disability are extended. Diseases of the palmar ligaments are straightforward for the practiced examiner to diagnose by means of structured clinical diagnostic steps; diagnosis with MRT is unnecessary in the presence of positive findings and prompt surgical therapy. In the case of delayed definitive treatment, concomitant injuries which are critical in terms of time need to be excluded. Accuracy in the clinical diagnosis of meniscus injury is less dependable, while on the other hand, sensitivity and specificity in MRT, when the appropriate protocols are used, reach high values. In the case of negative MRT findings, additional arthroscopy can be dispensed with. Cartilage lesions are more difficult to assess, in particular in terms of depth and extent. MRT provides helpful values in terms of specificity when sensitivity is poor, showing at the same time a tendency to overestimate degree of lesions. © 2008 Springer Medizin Verlag.