Assessing the benefit of multidisciplinary assessment centre in a military population sustaining knee injury

Abstract

ObjectiveTo evaluate the benefit of multidisciplinary assessment centres in the diagnosis of knee injury in military populations and assess the role of MRI as gold standard in the diagnosis of knee injury. DesignRetrospective epidemiological study. Setting122 servicemen attending the Multidisciplinary Injury Assessment Clinic (MIAC) at Redford Barracks, Edinburgh between January 2008 and January 2010. ResultsThe most common of these injuries were to the medial meniscus (30.3%), osteochondral defects (28.7%) and anterior cruciate ligament (25.4%). 45.6% of patient sustained injury to more than one structure.23% of the 122 servicemen were deemed fully fit for military duty following treatment; 41 (34%) were classed as partially fit, with 31 (25.4%) deemed not medically fit at the end of period of assessment. The MIAC team were both more sensitive and specific at picking up all forms of structural knee injury with the exception of meniscal injuries, where the MIAC was more sensitive (0.76 vs. 0.74) but less specific (0.53 vs. 0.62). MRI was shown to have a sensitivity of between 0.68 and 0.96 when compared against arthroscopy. Its specificity was poorest for picking up osteochondral defects (0.39). DiscussionThe MIAC diagnosis of knee injuries was shown to be more effective than that of non-specalised GPs. MIAC also had a good degree of clinical accuracy when compared to MRI. MRI was shown to be an effective investigation, although not 100% sensitive and specific, and was poor at picking up osteochondral defects. It is recommended that the use of systems such as MIAC be expanded in the civilian community and be used in conjunction with MRI for maximal diagnostic efficiency.