American Board of Internal Medicine (ABIM) Certification Practice Exam

When is MRI usually reserved in the context of meniscal tears?

1. For patients post-physical therapy

2. For surgery consideration or persistent locking

3. For patients with no symptoms

4. For patients prior to conservative management

The correct answer is: For surgery consideration or persistent locking

MRI is typically reserved for the evaluation of meniscal tears when surgery is being considered or when a patient experiences persistent locking of the knee. In these cases, MRI provides crucial information about the location and severity of the tear, as well as the integrity of associated structures in the knee, which can significantly influence the treatment plan. When a patient has persistent locking – a condition where the knee cannot fully extend due to a mechanical blockage, usually from a meniscal tear – it indicates a more serious issue that may require surgical intervention. In such circumstances, an MRI can help clarify whether surgery is necessary and can guide the choice between different surgical options. In contrast, MRI is not typically used for patients who have already undergone physical therapy (as they may not require further imaging unless there is a significant change in symptoms), those with no symptoms (as imaging would not provide useful information), or patients before conservative management (for whom the initial evaluation and clinical examination are usually sufficient). Thus, reserving MRI for situations where surgical intervention is being contemplated or where mechanical symptoms like locking occur is the most clinically appropriate approach.