Abstract
Chronic knee pain is a common complaint among the elderly and appears in 30%–40% of the population over the age of 65. This study was performed in order to evaluate correlation between clinical presentation of chronic knee pain and the imaging findings of SPECT and planar bone scintigraphy. Methods. We prospectively recruited 116 patients over the age of 50 who had neither knee surgery nor trauma. Patients were divided into symptomatic and asymptomatic groups. All patients were examined by an experienced orthopedic surgeon; on the same day imaging was performed. Statistical analysis was performed to correlate physical examination findings with planar scintigraphy and SPECT findings and blood pool images. Results. In symptomatic patients, planar scintigraphy correlated significantly (P < 0.01) with the presence of excessive joint fluid, synovial condensation, and decrease in range of motion as measured in extension and flexion and patellar grinding test. SPECT findings correlated with all of the above tests as well as with medial and patellofemoral joint tenderness. Conclusions. We believe a finding of tenderness at the medial articular crease or of the patellofemoral compartment of the knee should be considered an indication for the use of SPECT scintigraphy rather than planar scintigraphy.
Highlights
Bone scans have become a key tool in assessing musculoskeletal pathology [1, 2]
Planar and Single Photon Emission Computerized Tomography (SPECT) scintigraphy results were assessed according to the localization and intensity of the mapping in the respective compartments of the knee. e lateral compartment was divided into areas rendered as the Lateral Femoral Condyle and Lateral Tibial Plateau. e medial compartment was divided into areas rendered as the Medial Femoral Condyle and Medial Tibial Plateau. e patellofemoral compartment was divided into areas rendered Patellomedial and Patellolateral, whilst in the SPECT scans an area rendered Retropatellar was assigned
Published studies stated that SPECT scintigraphy is superior to planar scintigraphy when osteoarthritis of the patellofemoral compartment is present concomitantly with osteoarthritis in the medial or lateral compartments of the knee [1, 16, 17]
Summary
Bone scans have become a key tool in assessing musculoskeletal pathology [1, 2]. Use of Single Photon Emission Computerized Tomography (SPECT) is becoming more common over the years as well [3]. An important tool in assessment of knee osteoarthritis is planar scintigraphy performed following instillation of marked Technitium [11] In these patients an enhanced uptake in subarticular bone during the late phase may precede the roentgenogrphic changes by many years and relays the changes in local vascularity and the osteoblastic actitivity which mark the initial stages of osteoarthritis [11]. O en, the roentgenographic appearance does not add to the con rmation of the suspected diagnosis since changes are late in most clinical pictures that is, osteoarthritic changes, avascular necrosis, and meniscal tears In his effort to afford an objective nding to the elderly patients knee pain, a growing number of diagnostic tests are performed, planar scintigraphy and SPECT becoming ever so popular. In his effort to afford an objective nding to the elderly patients knee pain, a growing number of diagnostic tests are performed, planar scintigraphy and SPECT becoming ever so popular. is study was performed in an effort to correlate ndings in physical assessment of the knee with those in planar and SPECT scintigraphy, in an effort to better delineate the clinical value of each of these studies in the elderly with knee pain
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