The WAITING ROOM => GENERAL KNEE QUESTIONS and comments (good for new threads) => Topic started by: AGORA on May 16, 2012, 01:26:51 PM

Title: Help Understanding MRI report: options?
Post by: AGORA on May 16, 2012, 01:26:51 PM
I have been having pain in my right knee (following extensive cycling and running) for over a year now and have just received my MRI report. The doctor wasn't very helpful, she just read me the report and told me to see a physiotherapist. Does anyone know how to make sense of this? Are there any other treatment options in addition to physio?

Thank you!

MRI RIGHT KNEE: Without contrast

TECHNIQUE: 3T - Sagittal isotropic 3D SPACE PD-FS, PD, Axial and Coronal PD-FS sequences. Off axis MPR's acquired from 3D volumetric sequence for optimal assessment of menisci and ligaments.

Subtle blunting of the inner margin of the medial meniscus is seen. The meniscus s otherwise intact. Lateral meniscus intact.

ACL and PCL intact.

MCL thickened proximally implying a healed sprain.
LCL complex intact.

Extensor mechanism intact.

Patella is well aligned. Patellar cartilage is thickened and heterogenous through the central portion predominate affecting the lateral facet. A focal fissure is noted on the medial facet.

Subtle heterogeneity of the cartilage is noted over the lateral tibial plateau. Elsewhere the cartilage is within normal limits.

There is no important join effusion or Baker's cyst. Muscle and marrow signal is otherwise preserved.

1. No sign of important meniscal or ligament injury. Healed MCL sprain.
2. Grade II and small focal area of Grade III chondromalacia patella.
Title: Re: Help Understanding MRI report: options?
Post by: aaa on May 16, 2012, 02:44:56 PM
Did you have an injury?  How did it happen?
Title: Re: Help Understanding MRI report: options?
Post by: AGORA on May 16, 2012, 03:41:26 PM
I'm not sure when the injury would have happened exactly, it feels like it was a gradual thing (although apparently it was sprained at one point, which I assume was during the most intense period of pain).

Last summer I started to run for the first time. I may have jumped into it too quickly, starting with about 5km 3 or 4 times a week and moving to about 8 km by the end of the summer. It tingled sometimes but nothing I really paid attention to. In late August/early September I did an approx. 100 km backpacking hike, with an approx. 30 lb pack. A few days into the hike my knee started to get noticeably sore on the descents especially (they weren't huge mountains, the highest peek was 1782 ft, but there were quite a few sections that were pretty steep, it was basically all up and down with very few flat areas).

When I got back from the hike I registered for an endurance spin class (indoor cycling) and continued running regularly.  Around one month in I was literally crying during the spin class and the instructor suggested I stop attending. The pain got so bad that I couldn't use the stairs, even for a single floor, I was limping and the pain would wake me up at night (I imagine this is probably when it was sprained?). I saw a doctor who said I should just stay off my knee and stop doing any of the activities that have been hurting it. She didn't do any x-rays, or even touch it to see if it was sprained etc.  I quit  spin, stopped running, was basically morbidly lazy all fall/winter. The agonizing piercing pain eventually went away but the knee continued to feel sore.

It has now been 6 months since I have done any physical activity and my knee still hurts.  It is no longer constant or piercing, but still starts to throb sometimes when I take stairs (esp. going down), hurts a lot after prolonged sitting at a desk (I'm a PhD student so I do a LOT of sitting, reading an writing). I did some hiking last weekend for the first time since last summer, just 2 days in the adirondacks. The first day was ok, just some tingling but on the second day it was sore. I recently attempted jogging and it's still painful. So essentially staying off the knee has not helped.

A week ago I started just going easy on the elliptical (lowest impact activity I can think of aside from swimming). It's generally ok but knee feels mildly tender afterwards. Tried a higher resistance 2 days ago and that was a bad idea.

Another thing I guess I could mention, I'm not sure how relevant it is, but I spend last summer/fall commuting by bike, but my gear shift was broken so I spend a few months of that stuck on one of the harder gears (making hills with groceries especially difficult!). My knee still bothers me when I bike (gear shift has since been repaired) so I'm not sure if that might also have been related to my knee pains.

I hope this clears things up, since it has been so long and the pain accumulated gradually, i have a hard time pinpointing exactly what made my knee give way.

I have a referral for and x-ray now (in addition to the MRI) but haven't gotten around to it yet. Is there any chance there is still bone damage from last fall/summer?
Title: Re: Help Understanding MRI report: options?
Post by: aaa on May 16, 2012, 03:53:31 PM
Where would you say the pain is?  Is it one area of the knee?  Does it feel like it is behind the kneecap?
Title: Re: Help Understanding MRI report: options?
Post by: AGORA on May 16, 2012, 04:05:03 PM
It's hard to pinpoint exactly since it's inside and not near the edge anywhere but I think the best way to describe it is immediately below and behind the knee cap....also  some more minor pain on the right side of the knee cap if you were too look straight at me (side of knee closer to my other leg)

(i'm speaking about the right knee by the way)

Title: Re: Help Understanding MRI report: options?
Post by: Snowy on May 16, 2012, 04:07:06 PM
That's basically a pretty reassuring MRI report - the MCL sprain has healed, no major ligament or meniscal injuries, but you do have a bit of chondromalacia (softening) of the cartilage on the kneecap. Your symptoms support this - they're a good match for what's often generally described as "patellofemoral syndrome" (a catch all for anterior knee pain), especially the discomfort on descents/going down stairs.

Physio would be the appropriate first step given that you don't have anything obvious that would need surgical intervention (and it's always good to avoid surgery if you can). You'll most likely be given exercises to build up specific muscles, which will help the kneecap tracking. I had chronic PFS for many years, and for me the answer was getting a physiotherapist who knew how to deal with it, being religious about the exercises (it took a bit of time for them to start having an effect), and getting orthotics to correct an overpronation in my gait. Get a bike shop to take a look at your bike fit - incorrect fit can contribute to knee pain, particularly if you're prone to knee issues.

Good luck! I hope physio helps.