Direct access to magnetic resonance imaging improved orthopaedic knee referrals in the Netherlands

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The use of magnetic resonance imaging (MRI) in primary care is under debate, and the majority of GPs have no experience with MRI.


To examine for which patients with knee injury an MRI is ordered and does direct access to MRI in primary care influence the GP referral to an orthopaedic surgeon?


Consecutive patients with knee injury who underwent an MRI examination ordered by their GP were included. On the application form for MRI, the GPs indicated their referral intention in advance, as if MRI had not been available. Six months after the MRI scan, written interviews with the GPs were used to collect data on referrals and orthopaedic intervention. The number of patients finally referred to an orthopaedic surgeon in secondary care after MRI was compared with the number of intended referrals.


Of the 588 included, GPs referred fewer patients to the orthopaedic surgeon after receiving the MRI results than they would have done prior to MRI (60% versus 82.8%, P < 0.0001). The reduction was 16.1% for patients older than 50 years and 28.1% for patients younger than 50 years. Orthopaedic intervention was performed in 62.9% of all referred patients. Of the 101 patients whom the GP did not intend to refer prior to MRI, 48 were referred to an orthopaedic surgeon based on the MRI findings.


In patients with knee injury, direct access to MRI of the knee in a primary care setting significantly reduced referrals to an orthopaedic surgeon.


Level of evidence. Three prospective cohort.

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