The WAITING ROOM => GENERAL KNEE QUESTIONS and comments (good for new threads) => Topic started by: Gishy on December 26, 2015, 01:50:59 PM

Title: Non-diagnostic MRI (ganglion cyst?)
Post by: Gishy on December 26, 2015, 01:50:59 PM

I'm a 32yo female with knee pain which began 8 years ago. Docs always told me it was patella tracking and told me to do exercises (which I did - no improvement). I finally had an MRI and what I see in the MRI doesn't seem consistent with radiology report. I see a ganglion cyst (possibly on my PCL) and all my symptoms match this. The radiology report doesn't even mention the big blob that I see on the scan. My doctor can't read MRI's so couldn't comment but insisted that Radiologists know what they're doing and have seen thousands of knee scans. She reluctantly gave me a referral to an OS - I think so that he could convince me that the radiology report was correct.

The imaging company has told me that the only way to get a second opinion would be to have the scans re-done which will cost me another $400.

My OS appointment is in January and I'd like to know if I'm wasting time and money on the basis of Dr. Google, or if there really is something wrong with my knee and the OS can fix it.


Radiology report:

Clinical Notes: ?Chondromalacia and medial meniscal tear

Technique: Coronal and sagittal proton density and proon density SPAIR, and axial T2 spair and GRE sequences

Findings: The medial and lateral menisci, ACL and PCL and collateral ligaments are intact. The articular cartilage surfaces are normal. No osteochondral defect, loose body or large effusion is detected. There is no chondromalacia detected.

The quadriceps tendon and patellar tendon appear normal. There is a small focus of oedema in the superolateral quadrant of the anterior fat pad but there are no further ancillary features of underlying patellofemoral tracking disorder detected. The posterior soft tissues are normal.

Conclusion: Normal examination. No medial meniscus tear detected. No chondromalacia detected.
Title: Re: Non-diagnostic MRI (ganglion cyst?)
Post by: Vickster on December 26, 2015, 02:03:59 PM
Have you tried prp? The fat pad inflammation could be the culprit, but after 8 years?  Have you been fully assessed for biomechanics by a physio?

See the specialist (ensuring he is a knee OS not a general one), get him to read the MRI, I assume it's your GP who can't. If the knee specialist cannot, find another who can
Title: Re: Non-diagnostic MRI (ganglion cyst?)
Post by: Gishy on December 27, 2015, 10:12:15 PM
The only treatment that my GP will consider on the basis of the MRI report is PT which, if it's a cyst will do nothing other than trigger the pain further - it's generally worse after exercise.

Its not really an option to shop around for specialists here. I just need to go in with a concrete argument to get him to look at scans. His receptionist already slammed me for using Dr. Google and a family member (psychiatrist) politely told me to trust the report and that ganglion cysts don't cause any pain anyway.

The fat pad inflammation is barely noticeable and most likely the result of limping for three weeks according to GP. I understand that radiology is a complex field but he never once mentioned a 4cm clearly outlined area of fluid inside the joint.
Title: Re: Non-diagnostic MRI (ganglion cyst?)
Post by: walkingdaily on December 28, 2015, 08:52:38 PM
Gishy, don't take the following of any kind of diagnosis or suggestion, but, to me, the white patch in your MRI doesn't seem to be of enough "regular" shape to be a ganglion cyst. I have finished a medical faculty and have researched a little bit about ganglion cysts, but far away of being capable of diagnosing online MRIs...
One nice MRI of a knee ganglion cyst is here:

Ganglion cyst at the back of the knee (Baker's cyst) would cause pain (if) and a palpable swelling at the back of the knee.

If worried, you may contact someone who knows someone...a radiologist or a surgeon who can interpret knee shuld take few minutes for him/her to know...
Title: Re: Non-diagnostic MRI (ganglion cyst?)
Post by: Gishy on December 28, 2015, 11:58:19 PM
Thanks for the response walkingdaily

From all my reading on this subject I'm pretty sure that a bakers cyst is quite different to a ganglion cyst. The bakers cyst forms in the tissue behind the knee and is visible outside.

I'm convinved I'm looking at is an intra-articular ganglion on my PCL. Ganglion cysts are often multiloculated and do not necessarily need to conform to the typical "drumstick" shape.

I found a few links but unfortunately the paste function on my iPad isnt working properly on this site so I can't add them.

There is a general belief among many doctors that cysts don't cause pain which may be the reason the radiologist who made my report didn't mention it.

Title: Re: Non-diagnostic MRI (ganglion cyst?)
Post by: walkingdaily on December 29, 2015, 10:59:00 AM
Some authors consider Baker's cyst as a type of ganglion cyst and some take them as two different things. Anyway, by saying that it does not look regular enough to me, I was thinking more of the outline rather than the pedicle. Can you edit your MRI image and put a small arrow to the area you think it may be a ganglion cyst? Or if you just say in which of the four images do you see it and exactly where? The upper right one?
Title: Re: Non-diagnostic MRI (ganglion cyst?)
Post by: Clarkey on December 29, 2015, 05:00:04 PM
Hi There,

I could say that my present on-going right knee problems sounds very similar to what you are experiencing right now. I am only 5 years older than you are aged 37, my knee problems have been on and off since childhood onwards that has gradually got worse over the last 12 years.

I have had a total of 5 MRI scans since 2003 to present, only 1 out of the 5 came back positive that was last year Spring 2014. It mentioned bone bruising or oedema. I had AIR surgery to remove excessive scaring that was from scope #1 when I had my fat pad trimmed and medial plica removed in 2009.

My fat pad did show small effusion that my OS at the time did not seemed to be too concerned about despite feeling catching and sharp pain. In the end I was allowed to have a diagnostic arthroscopy when my OS could see this was the only sensible option left.

PFS I have always had since birth that gradually caught up with me that is a common knee problem. The problem I am facing now is I not able to run for 3 years in January that now slowing down my walking pace.

Chondromalacia is linked with PFS on the severe side of cartilage defect that cannot be reversed that's more common in females than males. My OS is reluctant to scope my knee again even though there are signs on the MRI that the fat pad is not happy as he is concerned that it could make my right knee problem worse rather than better.

I cannot advise you on what to do about a ganglion cyst as I never had to deal with it yet, I would think that none surgical treatments would be considered first. I am having on-going problems with my patella tendon that showed effusion on my last US guided cortisone injection of patella tendonitis.

Another option to consider is CT scan of your knee to see how well or bad your kneecap is tracking that is often done if you have been diagnosed with PFS. Your OS will then have an idea how your kneecap is aligned and if it badly tilting to one side to warrant a 'osteotomy'. It would be a big open surgery to be going through. It is only done if it is really necessary if you would benefit from the surgery that's performed on many young patients with a high success rate. 

Good luck in January when you see your OS, only leave the consultation once you are completely satisfied with what he/she suggest to do next to try and sort out your knee. What Vicky has suggested is sensible advice to have a full gait analysis with a trustworthy PT or sports physician.

[email protected]
Title: Re: Non-diagnostic MRI (ganglion cyst?)
Post by: Gishy on December 30, 2015, 11:01:52 AM
Thanks everyone for all your comments.

Walkingdaily- the cyst is the white area in the fat sat images and the matching grey shape in the PD image (top right).

Yesterday I managed to find a knee expert who has confirmed that it is a cyst and is likely to be the cause of my problems. Hopefully this should carry enough weight to convince my OS to question the original report.

Title: Re: Non-diagnostic MRI (ganglion cyst?)
Post by: Vickster on December 30, 2015, 11:26:29 AM
Hopefully the cyst is easy to remove with no nerve involvement. It's always
good to identify a clear and resolvable cause of knee pain

Good luck :)
Title: Re: Non-diagnostic MRI (ganglion cyst?)
Post by: Clarkey on December 30, 2015, 01:26:19 PM
Good luck with the removal of your cyst, Happy New Year in 2016.

[email protected]
Title: Re: Non-diagnostic MRI (ganglion cyst?)
Post by: ttinok on December 31, 2015, 09:14:04 AM
Hi Gishy, Ganglions in the knee are not common & often mis-understood.  The white blob on your MRI scan looks very much like mine did, but my ganglion made its way to the surface just above the MCL and was a very noticeable lump.  This made it easier to be ultra sounded & the fluid could be drawn out to confirm.

Mine was removed via an open incision in April along with an arthoscopy that showed some very cool pictures of my knee cap that was put on tilt due to the size of the ganglion.  When Ganglions get big, like ours, they very much cause pain & discomfort due to the pressure they are putting on everything around them as well as catching/clicking.  In my case it was the MCL & for you the PCL.  I delt with the discomfort for about a year before finally deciding on surgery.  Heat and rest made it feel better & excision/wrapping made it feel pretty good for about a month.  My OS was convinced there was an underlying meniscus tear, but it turned out to be a tear in the joint capsule that grew to be a "golf ball sized" mass.

I hope you and your OS can get on the same page.  I know that I feel as if I have a whole new knee after making thru the post-op recovery/PT period.

Keep us posted.