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Author Topic: MRI Conflicting opinions! Help  (Read 866 times)

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Offline willrunagain

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MRI Conflicting opinions! Help
« on: February 04, 2015, 07:51:41 PM »
The interpretation on the MRI of my right knee concluded with the diagnosis "Patellar maltracking" and "No evidence of chondromalacia in the patellofemoral articulation or knee joint."  I have been to two different OS for this problem.  The first OS simply diagnosed me with runner's knee and sent me to PT for 2 months (which failed).  My most recent OS is very concerned that I have cartilage damage behind my patella and possibly in the femoral condyle.  He wants to schedule an arthroscopy to find the extent of the damage and do a biopsy!  I am beyond confused right now because if the MRI shows no chondromalacia, then how could I have this serious of a problem? I realize MRI's are not 100% accurate and the radiologist's experience can play a role as well, but I figured a big cartilage lesion should and would show up on an MRI!  Who should I believe??

Offline MDAL

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Re: MRI Conflicting opinions! Help
« Reply #1 on: February 04, 2015, 10:06:28 PM »
Don't know... but here's some observations:

- Yes, MRIs are not too precise, it's a cloudy image which is interpreted based on a lot of guessing.

- You don't actually need a big defect to have bad symptoms (there are no nerves there), all you need is a small active condition in the cartilage. This emits inflammatory signals which get picked by the synovium and broadcast the inflammation around. So no, you don't need to be bone on bone to have nasty symptoms.

- Surgery for it (cleaning up /shaving around) is a gamble.  Works for a few by healing the superficial zone that is sending out signals, but for many it just continues the same since there is also damage caused by the shaving which can cause another inflammatory process. Even if it works in the end you will have less cartilage than before which will continue to progress from there.

I would recommend if you have it available in your area and affordable, a series of PRP injects. The purpose of this is that the platelets once injected connect to these damaged areas (by protein signals), pack there like a pit mosh, healing it and resolving the inflammatory process, both in the cartilage itself as well as the synovium and all the propagated inflammation. In this case you heal without surgery (just injections) and you get to keep the cartilage since no one has been shaving it...

It worked for me, but of course can't guarantee it would work for you. But still believe it's a better gamble than surgery. You don't really need expensive PRP. I took the cheapest option and it worked great.

Offline WeenietheWarriorPrinces

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Re: MRI Conflicting opinions! Help
« Reply #2 on: February 05, 2015, 07:24:11 PM »
I have had MRI's not pick up my cartilage defect that went all the way to the bone. It was only once the surgeon got inside my knee was he able to see the damage. If it is bothering you, you have tried other options and you trust hour surgeon I would do the arthroscope.
Weenie the Warrior Princess
Left knee:
6/2012 Arthroscope w/ debridment, and plica removal
3/2013 Microfracture of MFC & patella and lateral release
6/2014 Microfracture MFC (same spot as last time, was damaged in a car accident)(infection week after & ultimately a failed surgery)
11/2014 OATS(autograft) MFC

Offline willrunagain

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Re: MRI Conflicting opinions! Help
« Reply #3 on: February 05, 2015, 07:51:04 PM »
Thanks for the replies.  I went ahead and scheduled my arthroscopy for February 18th with a very reputable surgeon.  I am praying the damage is minimal and I will be able to run again someday.  Just not knowing is the hardest part.