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Author Topic: Osteoarthritis on an mri?  (Read 3304 times)

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Offline kscope09

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Osteoarthritis on an mri?
« on: June 28, 2010, 05:52:23 PM »
Have been having moe problems with the good bad knee.

Does osteoarthritis always show up on mri?  I've got all the pain, stiffness and grining associated with the condition but a perfectly clear mri, so could there still be a popssibility that I don';t have OA.  I know its not a death sentance but I really am too young for it.  Im going to ask for an x-ray and if I'm diagnosed with it then I'm going to get on with things and explore the options; synvisc, cortisone, replacement, aci etc.

I'd also like to know who what surgeons practice ACi in the UK.  I'm going to get refered to a specialist on the NHs, tell them my problem and if they reccommend a scope then I'm going to see if they will send some cartliage to the lab if things are bad enough.  Will the NHs do that?  I'm sort of still hlding out that it's just a tracking problem and that the pain on the medial side is just a plica.  You can live with plicas and I really don't want another scope if I can possibly help it.
Feb 08 Inurred right knee
18 months of physio, knee tracking but knee still painful
Aug 09 Scope - Small tear in acl, fragment found in postereo-lateral compartment, suprapatella and lateral plica and small defect in mfc.
May 10 Right knee feeling better but left knee causing trouble as a result o

Offline Lottiefox

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Re: Osteoarthritis on an mri?
« Reply #1 on: June 29, 2010, 09:11:02 AM »
An X-ray will show any joint space narrowing or bone spurs. Stiffness, noises etc can be many other things than OA. Do you have symptoms associated with OA such as stiffness in the morning, restricted ROM, thickening of the joint, crepitus, etc etc. If you do have early OA you're years off needing to think of a replacement.

ACI isn't recommended for a generally arthritic knee. Its like darning a cloud. ACI isn't approved by NICE yet in the UK for general NHS use as it is going through trials. The ACTIVE trial will tell you who is enrolled on this but you need to meet many specific criteria and be prepared to be assigned to the group they choose. ACI can be used for focal Grade 3/4 lesions usually larger than 3cms - these would without doubt show on an MRI unless the radiologist was blind. The thing with a genuinely arthritic knee is that the cartilage across the joint surface is usually thinning - and stitching in new bits just doesn't have a great outcome. If however you have focal defects due to malalignment, injury or something then the technique can help. As can other repairs...

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 kscope09

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Re: Osteoarthritis on an mri?
« Reply #2 on: June 29, 2010, 10:16:55 AM »
I think I've got both.  The medial pain is so similar to that I had in the right knee and that needed a chrondoplasty.  BTW I had terrible medial pain in the right knee for 18 months and that only needd a chronplasty and that never showed up on mri.  There was never any stiffness in that knee and there is some in this knee, mainly in the morning and the noises a bit crunchy.

P.S. Can aci be used behind the patella.
Feb 08 Inurred right knee
18 months of physio, knee tracking but knee still painful
Aug 09 Scope - Small tear in acl, fragment found in postereo-lateral compartment, suprapatella and lateral plica and small defect in mfc.
May 10 Right knee feeling better but left knee causing trouble as a result o

Offline kscope09

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Re: Osteoarthritis on an mri?
« Reply #3 on: June 29, 2010, 10:26:59 AM »
pps Lottie, did your OA creep up on you gradually or flare up suddenly.  I know people with OA who just say they have stiffness in the mrning and a little pain descending stairs but they can still do everything more or less.  Then there are others who can hardly walk and stairs are a no no.  Their knees give way and they can't even get up on their own, somebody has to actually pick them up.  This is what happens if you let OA take over.
Feb 08 Inurred right knee
18 months of physio, knee tracking but knee still painful
Aug 09 Scope - Small tear in acl, fragment found in postereo-lateral compartment, suprapatella and lateral plica and small defect in mfc.
May 10 Right knee feeling better but left knee causing trouble as a result o

Offline Vickster

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Re: Osteoarthritis on an mri?
« Reply #4 on: June 29, 2010, 01:58:33 PM »
I don't think they do ACI for OA lesions, more focal traumatic ones where the rest of the knee is sound - certainly the case for MACI. 

My OC lesion showed up on the MRI but the Xray showed it more clearly.

If you are so concerned, it might be worth paying for a second opinion privately - have a look in the surgeon list on here for one locally.  Couple of hundred for peace of mind.  As Lottie says, pretty much all adults have some sort of changes in their knees, just how it is.  Could be years before you need a replacement even if you do ever,  You certainly don't want to go down that route if not necessary, not minor!

The best thing to do is keep the legs strong, don't do anything to aggravate the joints if you can help it and enjoy life!  There is too much info on the web, makes us worry about things that may not be there just because we read about it!
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline Dad3

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Re: Osteoarthritis on an mri?
« Reply #5 on: June 29, 2010, 02:30:32 PM »
P.S. Can aci be used behind the patella.

Yes it can, as I was discussing this with my consultant last week, however he puts the success factor at less than 50% - which is why they tend not to do it. Remember any pressure on the patella will cause the membrane and the regenerated cartlidge to be put under pressure thus possibly destroying what the OS has done.
Pressure on the patella would obviously be caused by any bending of the knee/leg, so you would have to be religious with your recovery.
 
RT Knee collapsed 08/2009
MRI 10/2009 - torn ACL
Arthroscopy and MFX - 10/2009
ACL and OATS 11/2009
RT knee lateral release, mosaicplasty and medial reefing - 22nd September 2010.
Still not 100% OK :(

Offline Lottiefox

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Re: Osteoarthritis on an mri?
« Reply #6 on: June 29, 2010, 03:04:29 PM »
kscope

You have a very black and white view of OA and knee conditions! In my case - I suspect I have had degnerative changes from about the age of 18 when my knee started making crunching noises. I saw a GP, had some PT but at that age things improve and you imagine you are invincible. I never had any MRI imaging done and I am glad I didn't - at that age it wouldn't have changed my outlook on my knees and life and I would have dismissed worries that things would all go wring at the age of 40 as being way off....

Here I am - at 41 - who knows how MUCH the actual degeneration has changed since those first symptoms; one thing I know is that cartilage wear and tear is extremely slow. It isn't like a focal ripping off of a chunk (like Vicks managed to do) which suddenly exposes bone. Those types of injury are more amenable to fixes as it is easier to integrate them into the surrounding cartilage. nevertheless it is a new science and fraught with problems. As Dad3 says, repairs to the patella are extremely hard because of the shearing nature of the forces around it, hence why many surgeons will opt to offload the worn areas using TTTs, LRs, combinations and associated measures. This only works if you have some undamaged areas to offload on to. Similarly new techniques like cartifill, and other MFX based texhnqiues with an add on may be better suited to the patella as they harden rapidly and allow a better chance of integration. Still, they are a risk and if you go into one of those before having what I would call life imposing restrictions on your function you may end up worse off - if a lesion or area of damage isn't that symptomatic and it is then drilled, filled and fails odds are you may more severe symptoms. So - did my OA creep up - yes, more than likely its been creeping up for the past 20 years. I guess its creeping up via other routes as well, in fact I know it is as my foot is about to be operated on for a severe case of hallux limitus (big toe arthritis).....in that case it probaly did get worse all of a sudden, but thinking back the initial symptoms have been there for many months maybe years.

When my knees got bad last year I was quite terrified that I had OA. I used to read the net for all sorts of diagnoses that might mean it wasn't OA. Unfortunately it kind of is, due to years of faulty alignment of my knecaps and pronated feet. One OS described it as early OA, another said its cartilage loss due to skewed trauma (or something) - either way I have lumps of the shiny stuff missing and it isn't ideal.

My view - I have a lot left. Finding out now means I can everything I can to keep the knees working. I will, most likely, need some form of surgery. But why rush - yes they niggle, yes the medial lesion hurts like **** if I hit it wrong and I can't run for sport but I could be far worse. I have all my limbs working, my brain works (usually), my family are alive and well, I'm fed, clothed, safe...OK, my knees are a bit crap, but hey, **** happens. I can't change things obsessing; I can change things by seeking out the right advice and being good to them.

I am going to post a clip shamelessly stolen from Snowy about Josh Dueck the paralympian. Watching this made me feel quite humbled and annoyed with myself for moaning about not being able to pivot properly or needing to avoid high heels. Be warned, it is quite harrowing and the language is colourful.

http://www.youtube.com/watch?v=CNippTHyNu8

Finally as Vicks says, a second opinion from someone to review ALL your scans and examine BOTH your knees might put your mind at rest.

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....