Fri., 10/14/11 Knee, Foot & Ankle, Paper #57, 3:36 pm OTA-2011
Computed Tomography (CT) Scan to Detect Traumatic Arthrotomies of the Knee Joint
Sanjit R. Konda, MD; Roy I. Davidovitch, MD; Kenneth A. Egol, MD;
NYU Hospital for Joint Diseases, New York, New York, USA
Purpose: This study was undertaken to determine the efficacy of the use of CT scans to detect traumatic arthrotomies of the knee joint.
Methods: A standardized protocol was developed to evaluate patients presenting to the emergency department (ED) with a laceration about the knee suspicious for a traumatic arthrotomy with a CT scan of the knee. We identified 62 patients with 63 knees who underwent this protocol. A traumatic arthrotomy of the knee (TAK) was defined as the presence of intra-articular air on the CT scan as viewed on either 2.0-mm axial slices or 2.0-mm sagittal or coronal reconstruction slices on either bone and/or lung viewing windows. All patients with intra-articular air on the CT scan (+iaCT) were taken to the operating room (OR) for the “gold-standard” diagnostic test of direct visualization of joint capsule integrity. Otherwise, if no intra-articular air was evident on the CT scan, then these patients were discharged from ED after routine bedside irrigation and débridement and primary closure. Follow-up information regarding development of knee complications were recorded for these patients.
Results: There were 49 males and 13 females with a mean age of 28.0 ± 15.0 years. 21 knees (33%) had associated periarticular fractures of the knee. The average skin wound size was 3.6 ± 3.9 cm. All 32 knees with +iaCT had OR confirmation of a TAK. Six of the 31 knees with –iaCT had concomitant injuries that required surgical repair in the OR and wound exploration revealed no TAK. None of the remaining 25 knees with –iaCT who were discharged from the ED had complications of their injured knee at a mean follow-up of 22.0 ± 33.8 days. Based on these results, the sensitivity and specificity of the CT scan to diagnose a TAK based on the presence of intra-articular air is 100%.
Conclusion: CT scan is a sensitive and specific test to diagnose traumatic arthrotomies of the knee joint. Consideration should be given to utilizing this test as the primary diagnostic modality for detecting TAKs in the appropriate clinical setting.
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• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.