Efficacy of MRI in primary care for patients
with knee complaints due to trauma.

Rationale:

General practitioners are regularly consulted by patients with traumatic knee complaints. The Dutch clinical guideline ‘traumatic knee complaints’ for general practitioners at present does not recommend referral to MRI because lack of evidence. Direct referral to MRI might be a valuable tool for general practitioners in making appropriate and informed
decisions, depending on whether it improves patient outcomes, reduces costs and affects
subsequent diagnosis and management.



Objective:

What is the cost-effectiveness of referral to MRI by the general practitioner
compared to usual care in patients with persistent traumatic knee complaints.



Study design:

A multi-centre, open labeled randomized controlled noninferiority trial in
combination with a concurrent observational cohort study.



Study population:

Patients (aged between 18 and 45 years) with traumatic knee complaints will be eligible if they have consulted their general practitioner and and report persistent knee complaints till 6 months.



Intervention:

Participating patients will be randomized into two groups:

1. MRI group; the patients will be referred for MRI of the knee by the general practitioner, or;

2. Usual care group; the patients will receive care conform the Dutch general practitioners’
clinical guideline and will not receive an MRI referral by the general practitioner.



Main study parameters/endpoints:

The primary outcomes are self reported knee related daily function (Lysholm), health care and productivity costs (PRODISQ/TIC-P), and quality of life (EuroQol) over a 12 months follow-up period (measured at 0,1.5, 3, 6, 9, 12 months).

Secondary outcomes are patient related health gain measured with function (KOOS),
severity of knee pain (NRS) and perceived recovery and satisfaction with management by patient and general practitioner.

Over a period of 12 months follow-up:

1. What is the cost-effectiveness of MRI referral by the general practitioner compared to usual care in patients with persistent traumatic knee complaints?

2. Is MRI referral by the general practitioner noninferior compared to usual care in
patients with persistent traumatic knee complaints regarding self reported knee
related daily function?

All participating patients will fill in the questionnaires at baseline and at 1.5, 3, 6, 9 and 12 months follow-up.

Group 1; the MRI group:

Patients will be referred for MRI scan (1.5 T) of the affected knee at a participating MRI
center within 4 weeks after referral.



Group 2; the usual care group:

These patients will be managed conform the care recommended by the Dutch clinical
guideline ‘traumatic knee complaints’.