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Author Topic: Please explain MRI results - three areas of concern  (Read 525 times)

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Offline Monkeybunny

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Please explain MRI results - three areas of concern
« on: April 22, 2018, 02:53:53 PM »
Thank you in advance for your assistance!

Background:  51 yo female, eight time marathoner, active, struggles with weight.  Recently lost 25 lbs. to get to 28.5 BMI, intend to lose 25-30 more lbs.  Very good health.

MRI report, shortened to most important points:

Menisci:  An irregular incomplete radial tear partially transects the medial meniscus posterior root.  Associated peripheral extrusion and degeneration of the body of the meniscus.  Full-thickness hyaline cartilage loss at the posterior weightbearing portion of the medial femoral condyle, 19mm AP x 14mm transverse.  Mild associated subchondral edema.  9 x 11 mm area of full-thickness chondral loss at the medial portion of the medial tibial plateau with associated subchondral edema. 

Patellofemoral:  Moderate to marked chondral thinning at the upper portions of the medial patellar facet and median patellar ridge.

Osseous/bone marrow:  Slight cortical depression at the medial portion of the medial tibial plateau with associated subchondral edema.  Stress reaction edema in the inferomedial portion of the medial femoral condyle.

In addition to any insights you can provide, had a couple of questions:

Does the chondral thinning in the medial patellar facet disqualify me from a pkr?

I believe I have bone on bone cartilage loss.  Would the location and/or size of the lesions indicate a partial or total replacement operation or due to my age should we try cartilage regeneration (microfracture, oats, etc.)




Offline LisaWilliams38

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Re: Please explain MRI results - three areas of concern
« Reply #1 on: May 24, 2018, 07:10:10 PM »
Based on my past experiences and history of large and small condral defects, I'd say you're a wonderful candidate for the newer Microfracture procedure with Biocartilage (not the older microfracture)  or possible ACI if your defects get bigger, faster or an exploratory scope tshows they're much larger in reality.

Based on what I've been told and read, your defects are not really that large at the moment, thus there's no reason for a PKR or TKR. "Full-thickness" implies there's no articular cartilage left in the one spot---it doesn't mean the entire condyle is absent of articular cartilage. I've had a 2.5 INCH by 3/4 INCH full-thickness cartilage defect repaired with ACI (autologous condrocyte implantation) back in 2015/16. It worked wonderfully and I have brand new, hyaline cartilage in that area of my right knee now---full thickness, BEAUTIFUL cartilage---I'm just not allowed to run or jump on it because we want it to last a long time. :)  It bought me at least 7-10 yrs before we discuss PKR or TKR, even with other damage in that knee not severe enough for another ACI procedure.

I  just had MIcrofracture done on my left knee last week, with the addition of Biocartilage (look up Arthrex Biocartilage online) to fill in these smaller, full-thickness chondral defects. It's only on the lateral (outside) compartments of this left knee, and a PKR was never discussed because Biocartilage is a fantastic new way to preserve/repair joint surfaces longer without needing artificial parts---it adds about 75% improvement/success rates over the older microfracture procedures too.  The defects I just had filled are more along the size of what YOUR MRI is describing in your knee. Granted,the only way to know the true size is to cut the knee open, and look, but the scientific numbers/literature say to take the MRI size and add ~67 percent more---so if your defect is 10 mm by 10 mm, it's probably closer to 16 mm by 11 mm.

Lastly, I'm lucky to have researched and found a wonderful OS who focuses on the cutting edge of Articular Cartilage repair. He doesn't even do knee replacements because there's so much  one can do for younger people like us (I'm 46)  who need to NOT jump on the joint replacement bandwagon.He

I don't mean this next part rudely or to be pushy, but I don't know who/what you've spoken to or been told: My OS has told me a million times no surgeon should touch someone <50 yrs of age and offer a joint replacement without the person having tried MULTIPLE other approaches first or already being wheelchair-bound because of another traumatic episode in their life---car crash, building falling on you, etc.  If the Dr DOES push for a replacement, he just wants your money and isn't being honest about the limitations of artificial joints not lasting as long in younger patients (because, face it---we're more active than a 65 yr old, so our first replacements WILL wear out faster). They can't just keep revising old parts and swapping out new ones every 10-15 yrs as we age). I personally, don't want to risk my ability to walk on the future of medicine and how it plays out. He also said if I want to keep playing with my kid and go on vacation, and work out, I WILL NOT like the limitations that come with a TKR. There are definite things you're not supposed to do with a TKR or PKR, and if you break the rules, they wear out faster or break, and BAM---there's your first revision, YEARS before you had wanted it. :( I'm no major athlete, but I'm active and work-out 3-5 days a week,mostly walking, weights, gardening, hiking. He said my only benefit will be a complete lack of pain----but is that worth not being able to be as active as I was while IN pain. Many our age say No---I wish I would have waited and suffered a few more years. Now, If I had a dollar for every time someone asks me why I haven't had a TKR or PKR yet, I'd have been rich years ago. People just don't know all of the info (good and bad) out there, and I don't want you to fight that battle either. :) I'm in YOUR corner. :) 

Lastly, and I mean no offense at all, but I was shocked to read your post and even see a mention of a PKR. Did someone mention it to you?????? My first thought was maybe you have a couple (or 3) bad tires/rims, so why would you go out an buy a whole new car? :P ;D I would find a surgeon who specializes in articular cartilage repair---not just any random OS who works on anyone/everyone/any age, etc. I found Dr. Lehman in 2010 and he's done my last 5 surgeries---kept me walking, that's for sure.

Feel free to pick my brain for anything else. This was knee surgery #10 for me, and I've read so many MRI reports and researched so much my brain feels like it could explode.

Oh yeah---I do not know if chondral thinning in the patella makes it possible/impossible for a PKR. No idea there.

Also, I was told if you're having ANY articular damage defects Grade 2 or higher, EVERY meniscus tear should be repaired/cleaned out. Otherwise, floaties from the torn meniscus grind away the joint surfaces further and speed up your articular cartilage damage. He found 3 tears in my knee last Wednesday, and he swears this is why my knee went from pain-free in May 2017 to painful in August 2017, to "sheer misery" by April 2018. Apparently the floaties were getting stuck behind my kneecap, and that's why I occasionally couldn't get up/down the stairs---things were getting stuck mid-step both going up and down. The last week before this surgery, I had to give up steps all-together. :( He said we "should" have cleaned out the cartilage tears sooner to avoid more joint surface damage, but I told him I didn't have typical meniscus tear symptoms this time---I really thought there was a kneecap problem instead. Sometimes there's just no way to know, and I make too much scar tissue to go in randomly and do exploratory scopes. :(


Edited to add: This suggests you have more areas of cartilage thinning happening already (patellofemoral:  Moderate to marked chondral thinning at the upper portions of the medial patellar facet and median patellar ridge;  Osseous/bone marrow:  Slight cortical depression at the medial portion of the medial tibial pl[/i]ateau with associated subchondral edema.  Stress reaction edema in the inferomedial portion of the medial femoral condyle.[/i] Thinning and depressions are the first signs of where the articular cartilage is wearing away. :(

--Lisa 
« Last Edit: May 24, 2018, 07:30:28 PM by LisaWilliams38 »
'98 R plica
'99 L resect discoid meniscus
'01 L  meniscus tear
'02 R  meniscus tear
'10, R meniscus tears, Bursectomy
'13, R 3 meniscus tears, Grd 3 Biocartilage fil
'15 R Oct-ACI harvest,
'15 R Dec-ACI implant
'16 R Mar-lysis of adhesions
'16 R Mar-MUA
'18 L 3 menis tears, Grade 4 Biocartilage fill

Online Vickster

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Re: Please explain MRI results - three areas of concern
« Reply #2 on: May 24, 2018, 07:42:49 PM »
Lisa, what country are you in (terminology suggests North America?)
Access to these new treatments and techniques varies across the globe :). However much you might fight or push if itís not available or funded, it may simply not be accessible. Or you may not be a candidate due to factors other than age or depth of pockets :)

That said, the OP would appear to be across the pond too?

 In my case, I didnít have MACI back in 2010 due to valgus alignment. The surgeon wouldnít do it due to a max 20% chance of success and I wasnít prepared to have a DFO first.
« Last Edit: May 24, 2018, 07:48:58 PM by Vickster »
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
LK New MRI shows lat & medial meniscus tear & other stuff
RK MRI lat meniscus tear
8/1/15 RK Steroid jab,
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation

Offline LisaWilliams38

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Re: Please explain MRI results - three areas of concern
« Reply #3 on: May 24, 2018, 10:10:44 PM »
Vickster,
You make a great point. I am in The United States, and I know a few people in the UK who have greatly struggled to get access to cutting-edge (and even NOT so cutting-edge) technology. :) I definitely cannot tell if the original poster is in the US or UK though.

I feel blessed my husband has a good job with private insurance. If we lived in the UK or Canada, we wold be broke and our son would likely not have lived. I wish everyone had such choices.

--Lisa
'98 R plica
'99 L resect discoid meniscus
'01 L  meniscus tear
'02 R  meniscus tear
'10, R meniscus tears, Bursectomy
'13, R 3 meniscus tears, Grd 3 Biocartilage fil
'15 R Oct-ACI harvest,
'15 R Dec-ACI implant
'16 R Mar-lysis of adhesions
'16 R Mar-MUA
'18 L 3 menis tears, Grade 4 Biocartilage fill

Online Vickster

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  • Neelie knee!
Re: Please explain MRI results - three areas of concern
« Reply #4 on: May 24, 2018, 10:13:53 PM »
The OP talks of weight loss in lbs which tends to be how you guys measure weight, we go for stones or kgs.

You wouldn't be broke here, we have free healthcare for all, although waiting lists can be long for elective treatment. Acute care is usually beyond excellent
« Last Edit: May 24, 2018, 10:15:32 PM by Vickster »
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
LK New MRI shows lat & medial meniscus tear & other stuff
RK MRI lat meniscus tear
8/1/15 RK Steroid jab,
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation

Offline LisaWilliams38

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Re: Please explain MRI results - three areas of concern
« Reply #5 on: May 24, 2018, 11:03:34 PM »
That's good to know.  ;D
'98 R plica
'99 L resect discoid meniscus
'01 L  meniscus tear
'02 R  meniscus tear
'10, R meniscus tears, Bursectomy
'13, R 3 meniscus tears, Grd 3 Biocartilage fil
'15 R Oct-ACI harvest,
'15 R Dec-ACI implant
'16 R Mar-lysis of adhesions
'16 R Mar-MUA
'18 L 3 menis tears, Grade 4 Biocartilage fill















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