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Author Topic: two MRIs. Do I need artho or total knee replacement.  (Read 3785 times)

Offline blackgrapes

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two MRIs. Do I need artho or total knee replacement.
« on: October 20, 2011, 05:57:35 AM »
I am a NEWBIE, looking for advice from the knee experts.

I  had (12/20/10) arthroscopic surgery for repairing two tendons in my right knee. I tore last August. Unfortunately I was in a bad car accident this past July and smashed both knees. I tore my labram hip as well. I am hoping someone can look at the attached report I received for my knee MRIs and give me some insight to what it may mean. My DR. appt isn't for two weeks.
 I had a hard time healing after the last surgery. If I have to have surgery again, should I have a total knee replacement? Also any advice on what are the best types of materials used and best DRS. I live in VA. but I am willing to travel.

Thank you, anyone and everyone who is willing to take the time to read the report and reply. I need to send the MRIs in a couple different posts.

ARRRRRGGGGHHHH. I can't upload the MRI report. ???????

Heidi
« Last Edit: October 20, 2011, 06:08:44 AM by blackgrapes »

Offline blackgrapes

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I typed out the report. Please help me.
« Reply #1 on: October 20, 2011, 07:16:12 AM »
I guess I will just type it. Here goes. I will leave out some of it.
left knee. (less injured).  As there is prominent undersurface tear defect at the posterior horn and body of the medial meniscus. A 12mm x 15 mm parameniscal cyst note at the posterior meniscocapsular junction extending to the inter- condylar notch. There is moderate chondral wear at the central weight-bearing surface of the medial femoral condyle with partial thickness chondral delamination and fibrillarion; A 6 mm x 8 mm chandral flap noted. Superficial fibrillation noted at the medial tibial plateau.
  There is a 14mm x 10mm region of moderate chondral wear at the posterior weight bearing surface of the lateral femoral condyle with fibrillation of the remaining cartilage. There is similar near full thickness chondral wear  ar the posterior half of the lateral tibial plateau. Fraying and shallow tearing is also noted a the free edge of the posterior horn and body of the lateral meniscus.
  There is full thickness chondral denudation at the superior aspect of the medial patellar facet with subchondral denudation at the superior aspect of the medial patellar facet with sub chondral edema. Shallow 3 mm chondral flap formation seen at the inner aspect of the lateral patellar facet.  there is 3 mm by 7 mm region of full thickness chondral fibrillation at the medial trochlea.
  There is a small joint effusion. There is a partially ruptured Baker's cyst.

Impression:
Prominent undersurface tear defect at the medial meniscal body and posterior horn with parameniscal cysts.  there is associated grade II chondromalacia at the medial femoral condyle.

Grade III chondromalacia of the posterior labrum surfaces of the lateral femorotibial compartment with shallow tear at the free edge of the lateral meniscal body and posterior horn.

Grade IV chondromalcia at the meial patellar facet with focal grade III chondromalcia at the medial trochlea.

Small joint effusion.


I will post the right knee next. ppppppppllllllleeeeaaaasse someone help me figure this out.

Heidi



Gr

Offline blackgrapes

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Re: two MRIs. Do I need artho or total knee replacement.
« Reply #2 on: October 20, 2011, 07:51:46 AM »
Second knee MRI Report typed. I couldn't figure out how to attach the darn thing.
Right Knee:

There is increased signal at the posterior horn of the medial meniscus center on the undersurface which may reflect undersurface tear defect. There is a discrete radial truncation defect at medial meniscal body free edge spanning aprox.. 3 mm in maximal transverse dimension and is seen in the axial sequences, image #21; this finding may reflect a tear versus focal meniscal debridgement. There is near full thickness chondral loss at the inner third of the weight bearing surface of the medial femoral condyle with superfifial fibrillation note is peripherally. Chondral wear and superficial fibrillation noted at the articular surfaces of the medial tibial plateau.
  Truncation defect noted at the posterior horn and body free edge of the lateral meniscus. Fraying noted at the anterior horn free edge. There is full thickness fibrillation a the ccental weight bearing surface of the lateral femoral condyle spanning a 12mm x 6 mm region. Near full thickness chondral wear noted at the posterior third of the lateral tibial plateau.
   There is full thickness chondral loss at the medial patella facet . Mild chondral wear noted in the lateral patella facet with subchondral proud bone formation. There is focal 6mm x 6mm region of full thickness chondral loss at the inferior aspect of the medial trochlear with cental ostephyte formation. The extensor mechanism is maintained.
  There is small joint effusion. EXtensive arthrofibrosis scarring noted within Hoffa's fat pad, most pronounced mediallly and centally spanning 2 cm x 5 mm distribution. A Baker's cyst is not identified. There is no stress fracture of osteonecrosis.

IMPRESION:
1. Post surgical changes medial meniscal debridement with undersurface fraying/shallow tear at the posterior horn meniscal undersurface. Radial truncation defect at the medial menicsal body may also represent sequela of previous surgical intervention. There is grade III chondromalacia at the medial femoral condyle, most pronounced at the inner lateral margins.
2. Truncation tear defects at the posterior horn and body of the lateral meniscus with fraying of the anterior horn free edge. Grade III chondromalacia noted at the central weight bearing surface of the lateral femoral condyle.
3. GRADE 4 chondromalacia at the medial patellar facet with more focal great 4 chondromalacia at the mdeial trochlea.
4. Small joint effusion with moderate arthrofibrosis at the Hoffa's fat pad.

I really do not want to have to wait for two weeks for my DR appt to figure out what all this means. I know you guys are pretty much experts. Question on the right knee.... How much of what ever damage listed above do you think has occurred after the surgery I had 12/10? The doctor was very confident in December that my knee was in excellent shape. He fixed two tendons and sent me on my way.


Offline Lottiefox

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Re: two MRIs. Do I need artho or total knee replacement.
« Reply #3 on: October 20, 2011, 09:37:50 PM »
OK.....firstly none of us are doctors on here (well, with the exception of the real doctor on here!) and we're only really "experts" in our very own knee issues but hopefully we try and help others going through it. I don't think we can answer the question of whether you need a TKR though; that has to be the discussion between your doctor and you about the pros, cons and other options if they exist. Your knees do seem to be showing signs of damage to the articular cartilage, to varying degrees and in various places. I'll try and interpret as I see it:

left knee. (less injured).  As there is prominent undersurface tear defect at the posterior horn and body of the medial meniscus. A 12mm x 15 mm parameniscal cyst note at the posterior meniscocapsular junction extending to the inter- condylar notch. There is moderate chondral wear at the central weight-bearing surface of the medial femoral condyle with partial thickness chondral delamination and fibrillarion; A 6 mm x 8 mm chandral flap noted. Superficial fibrillation noted at the medial tibial plateau. You've got a tear in the medial meniscus - the shock absorber bit between the bones and medial refers to the inner side of the knee, there is also a cyst of some type but I don't know enough to say what this is due to, and you've got some partial thickness loss of the articular cartilage (the slippery stuff on the end of our bones that is important for protection, sliding, cushioning etc) on the end of the femur (thighbone) and top of the tibia (shin bone for want of better word) in the same medial area
  There is a 14mm x 10mm region of moderate chondral wear at the posterior weight bearing surface of the lateral femoral condyle with fibrillation of the remaining cartilage. There is similar near full thickness chondral wear  ar the posterior half of the lateral tibial plateau. Fraying and shallow tearing is also noted a the free edge of the posterior horn and body of the lateral meniscus. You've got similar articular cartilage wear on the lateral (outer) part of the knee, with it being deeper on the tibia this side and a bit of damage to the meniscus in this area too
  There is full thickness chondral denudation at the superior aspect of the medial patellar facet with subchondral denudation at the superior aspect of the medial patellar facet with sub chondral edema. Shallow 3 mm chondral flap formation seen at the inner aspect of the lateral patellar facet.  there is 3 mm by 7 mm region of full thickness chondral fibrillation at the medial trochlea. On your kneecap, on the inner side you've got a full thickness area of cartilage loss and swelling underneath this, there is a bit of cartilage flapping off the outer part of the kneecap, and there is also full thickness loss on the groove that the kneecap runs in (trochlear groove)
  There is a small joint effusion. There is a partially ruptured Baker's cyst. You've got some swelling, and a Bakers cyst that sits behind the knee has ruptured

Impression:
Prominent undersurface tear defect at the medial meniscal body and posterior horn with parameniscal cysts.  there is associated grade II chondromalacia at the medial femoral condyle.

Grade III chondromalacia of the posterior labrum surfaces of the lateral femorotibial compartment with shallow tear at the free edge of the lateral meniscal body and posterior horn.

Grade IV chondromalcia at the meial patellar facet with focal grade III chondromalcia at the medial trochlea.

Small joint effusion.
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline Lottiefox

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Re: two MRIs. Do I need artho or total knee replacement.
« Reply #4 on: October 20, 2011, 09:51:00 PM »
There is increased signal at the posterior horn of the medial meniscus center on the undersurface which may reflect undersurface tear defect. There is a discrete radial truncation defect at medial meniscal body free edge spanning aprox.. 3 mm in maximal transverse dimension and is seen in the axial sequences, image #21; this finding may reflect a tear versus focal meniscal debridgement. There is near full thickness chondral loss at the inner third of the weight bearing surface of the medial femoral condyle with superfifial fibrillation note is peripherally. Chondral wear and superficial fibrillation noted at the articular surfaces of the medial tibial plateau. Not sure about the technical stuff in this but basically it is saying there is an issue with your meniscus again in the medial part of your knee, and you've got significant articular cartilage damage on the medial femur and a bit on the tibia that isn't as deep
  Truncation defect noted at the posterior horn and body free edge of the lateral meniscus. Fraying noted at the anterior horn free edge. There is full thickness fibrillation a the ccental weight bearing surface of the lateral femoral condyle spanning a 12mm x 6 mm region. Near full thickness chondral wear noted at the posterior third of the lateral tibial plateau. Again you've got damage to the lateral meniscus, and deep cartilage loss on both the lateral femur and tibia - sounds like they may be opposite each other - what is termed kissing lesions and can be VERY painful...
   There is full thickness chondral loss at the medial patella facet . Mild chondral wear noted in the lateral patella facet with subchondral proud bone formation. There is focal 6mm x 6mm region of full thickness chondral loss at the inferior aspect of the medial trochlear with cental ostephyte formation. The extensor mechanism is maintained. Full loss of cartilage on the medial surface of the kneecap, some mild loss on the outer kneecap and full thickness damage on the trochlear groove again with some bone osteophytes - these are formed when the joint gets damaged and the bone tries to heal itself but throws up little spurs
  There is small joint effusion. EXtensive arthrofibrosis scarring noted within Hoffa's fat pad, most pronounced mediallly and centally spanning 2 cm x 5 mm distribution. A Baker's cyst is not identified. There is no stress fracture of osteonecrosis. A bit of swelling. They have commented on scar tissue in your fat pad (the soft bit under the  kneecap) 

IMPRESION:
1. Post surgical changes medial meniscal debridement with undersurface fraying/shallow tear at the posterior horn meniscal undersurface. Radial truncation defect at the medial menicsal body may also represent sequela of previous surgical intervention. There is grade III chondromalacia at the medial femoral condyle, most pronounced at the inner lateral margins.
2. Truncation tear defects at the posterior horn and body of the lateral meniscus with fraying of the anterior horn free edge. Grade III chondromalacia noted at the central weight bearing surface of the lateral femoral condyle.
3. GRADE 4 chondromalacia at the medial patellar facet with more focal great 4 chondromalacia at the mdeial trochlea.
4. Small joint effusion with moderate arthrofibrosis at the Hoffa's fat pad.

I really do not want to have to wait for two weeks for my DR appt to figure out what all this means. I know you guys are pretty much experts. Question on the right knee.... How much of what ever damage listed above do you think has occurred after the surgery I had 12/10? The doctor was very confident in December that my knee was in excellent shape. He fixed two tendons and sent me on my way.

I don't feel I can make any comment on whether the damage is linked to your surgery or your accident or just life. How old are you if you don't mind me asking? How much pain have you got? How much function? It certainly sounds like you have had a nasty accident and the knees have suffered but it is always hard to know how much is just normal wear and tear that only becomes a problem after we injure something else. People often walk around with cartilage issues and never know about them until they do something else e.g. my knees have been creaky and crackly for years, odd pains, but one only got really bad after a summer of hill sprints and pivots tore a chunk off my medial femur.

I think you need to get a list of questions to ask your doctor. TKR is a big operation and will take some time to get over but if you read through the TKR stories and diaries on here you'll get a good overview. People who have done very well and people who have had problems. No one can give you any guarantee with any surgery. Are you able to do any sort of exercises to get your legs as strong as possible? Decent muscle strength will go a long way to helping knee pain with or without surgery and might stave off anything more dramatic. I also have Euflexxa injections but my damage is probably a bit more localised than yours, and they have helped me a lot. They are like an oil change for your knees.

Good luck with your decisions, HTH

Lottie
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline blackgrapes

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translation
« Reply #5 on: October 21, 2011, 04:05:43 AM »
Lottie,

wow.
Thank you so much for all of that. You have no idea how greek this is to me. I am an active 50 year old. I used to run a lot but I can't now due to the pain. The car accident in July really messed me up. I was sitting in traffic on the highway and someone slammed into me at 65 MPH. Both cars were totaled. The driver broke his arm and his wife went through the windshield. I tore my hip labral (labrum?) smashed my knees, got a concussion and cervical issues in my neck. I have to get injections in my neck under anesthesia. I have been going to PT since July. My knees are not getting better. They gave me steroid shots which help for awhile but they really mess with my blood sugar. I am a type 1 diabetic.
   I only weighed 110 before the accident and I am now down to 99 pounds. The nausea from the concussion started it but it is hard to eat when your sugars are off the charts. At any rate, I really appreciate your help. I will read about TKR on this site. I just want ALL the pain to go away. I had 2 tendons repaired (arthro) in December. I was building a KOI pond and fell in without the water in yet. The Doc was really pleased with his surgery, but I think I messed up his work with this car accident.

Thank you again and take care,
Heidi

Offline Lottiefox

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Re: two MRIs. Do I need artho or total knee replacement.
« Reply #6 on: October 21, 2011, 08:00:23 AM »
Heidi

Ouch, that sounds like a horrible accident. No wonder your knees got smashed up; I am guessing they were shoved into the dashboard pretty forcefully? Dealing with all this along with Type 1 diabetes cannot be fun at all, managing your sugar levels is a trial enough with Type 1 let alone throwing in pain killers and ortho injuries. You must feel wiped out from it all. I guess at 50 and being active with running you'll probably have had some wear and tear anyway in the knees. Its a fact of life - I am 42 and active and my knees look way older than they should do on scans! It sounds like perhaps the horrible accident has possibly set off a chain of inflammation and stuff that now means a little wear and tear has become problematic.

Are you able to take any painkillers at all? Steroid shots can be good for inflammation but long term they can mess with your cartilage even more hence why they'll only give you 2-3 a year. The visco type shots don't mess with anything but not everyone gets relief. Have a look through here on Euflexxa, Hylauron, Synvisc. I think in the USA you can get Euflexxa and I prefer that one as it doesn't have rooster combs in it like the others - yes, weird but visco supplements have bits of chicken in them and I didn't fancy that shoved into my knee joint. Hence Euflexxa! Has your PT looked at any form of brace or support at all? That might take some of the load off of the knee joint and help with the pain. None of these are long term fixes but are more conservative than a TKR. At 50 you'll also probably get comments from doctors that you're too young for a TKR. If you look on here there are many people who have had them at a young age, from 35ish upwards so if you're in constant pain with no quality of life push to find a doctor who will try and give you function back whilst you're young enough to enjoy it. No point spending another 15 years in pain then getting a TKR - in my opinion anyway.
You might want to post a thread down in the TKR section and see if people down there can help. Not everyone reads the new posts so you might get more advice/replies.

Good luck and I am glad it helped,

Lottie x
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....