Knee MRI

[ABN307]

I was wondering if I could an opinion on a recent MRI I had done after I twisted my knee. The following was straight from the MRI report:

FINDINGS: MRI of the knee was performed without intravenous contrast using standard axial, sagittal and coronal sequences.

There is a moderate to severe bone contusion involving the lateral plateau. There is some suggestion of cortical discontinuty, particularly laterl at the tibial plateau, raising the possibility of a nondisplaced tibial plateau fracture. The lateral meniscus is intact. There is a focal high signal involving the free edge of the anterior horn of the medial meniscus, which could represent a tiny radial tear. The remainder of the medial meniscus is intact. The lateral and medial collateral ligaments are intact. The anterior and posterior cruciate ligaments are well visualized and intact. Extensor mechanism is intact. The articular surfaces are intact. A small suprapatellar knee joint effusion is present. The soft tissues are otherwise unremarkable.

IMPRESSION:

1. Moderate to severe contusion, lateral tibial plateau. The possibility of a nondisplaced tibial plateau fracture is raised.
2. Possible tiny radial tear, medial meniscus.
3. Small suprapatellar knee effusion.

I trust the opinion of those who are members on here and have no ulterior motive.

Most of what is written above is foreign to me and wasn;t explained.

My Doc told me: If it starts hurting again, come see me!

Well, it's hurting but, it's hurting behind my knee when I excercise.

Thank you for your time.

[medicerik]

I'll try and explain. Hopefully one of the DOCS or PAs will chime in on this one too.

Knee injuries suck. I dislocated my patella in high school and ended up with six months of rehab. :lifter

Findings
1) You have a big bruise over the outer part of the top of the tibia. A big bruise of the periosteum that cover the bone can hurt almost as bad as a fracture.
2) There is a partial sun shaped tear in the medial meniscus. If it continues to give you trouble, surgery for removal will be the next step. Meniscuses that get torn tend to have the torn portion removed. Most of the meniscus has a poor blood supply and doesn't heal well:boohoo , hence the attempt not to stitch it shut.
3) There is a small colleciton of fluid sitting above your patella. could be joint fluid, could be blood from the trauma.
Rest of the MRI
The ligaments that run along the sides of the knee, the medial and lateral colligaments are in one piece. This prevents the knee from moving side to side without your director control. One less injury to worry about rehabing. The meniscus is a piece of tissue that has a lateral and medial componenet, ie a right one and a left one. It helps to distribute body weight through your lower extremities.

Hope this helps,
Erik

[ABN307]

Erik,
Thanks for the response. Any guess on healing timeline? I am 42 and never injured my knee before. Some days it doesnt bother me while others it hurts on about a 3-4 level.

[Kyobanim]

ABN307,

I'm not a doc but have had similar knee problems, specifically, the meniscus tear. If in fact you have a tear it will not heal. It will only get worse, at least that's what my surgeon told me. All you can do is try to control the pain or have it repaired. Depending on your physical shape, recovery from the surgery is 3 to 4 weeks. I was moderately active in one week and 100% in 3 when I had it done.

The hurting behind the knee is an indicator of the torn meniscus. Look at it this way, get the tear fixed and use the rehab time for the rest of the knee to heal. My repaired knee is the best joint on my body.

My .02

[medicerik]

Assuming you don't have a fracture, three to four weeks is reasonable. On crutches for one. Crutches with you the next two just in case. Get ready to PT hard and make your quadraceps real strong.

[ABN307]

I assume that stronger quads will help stabilize the knee?
Also, would a neoprene wrap or brace be something to consider?

Once again, thanks for help Erik.

[Kyobanim]

I assume that stronger quads will help stabilize the knee?
Also, would a neoprene wrap or brace be something to consider?

Once again, thanks for help Erik.

I wore an elastic knee brace for 6 months doing martial arts. Didn't help the pain but did keep me aware of my problem so I didn't make it much worse.

[ABN307]

I wore an elastic knee brace for 6 months doing martial arts. Didn't help the pain but did keep me aware of my problem so I didn't make it much worse.


Kyobanim,
Thanks for the feedback. Although I feel like it has come a long way since I injured it, I am still concerned. It feels a little stiff most of the time and a little bit of pain. I guess time will tell.

[medicerik]

Sorry for the delay in answering. I've been out of town for a continuing education course. A neoprene support brace for your knee is a great idea. Whether it will help with pain seems to vary from person to person, but it will definintely keep you aware of what you are doing to avoid excessive "bad" motion of the joint. My one caution with them, when I had the one for my knee, it had to be specially made after all kinds of measurements were taken and was real expensive.

Quad strength counters nicely for a weak or injured knee to a certain extent. Damage to cartillage, ligaments, tendons is still there. Your orthopod should be able to either point you in the direction of how best to strengthen your quads or get you referred to a good physical therapist who can do the same. One thing to consider for overall pt though is to cut down on running and look more towards biking. Much less stress on the joint that way.

Erik

[x SF med]

be careful in the future - I followed all the Dr's advice while I was still on AD - and my knee seemed to heal. But 15 years after getting out of SF, all of the stress on my knees came back to haunt me. I was at the gym working out and my knee locked up -no problem - ex 18D - ice, wrap, elevate, heat, ice, wrap, elevate (ad infinitum) until it seemed ok - then it happened again 6 weeks later - went to an orthopod - xrays - effusion and 'blips' ; mri - looked like the 18Cs had had a field day in my knee - chips, cartilege frayed, worn through, bone wear, stretched meniscus(old), stretched and scarred cruciates(also old).
Needless to say, the doc got a funny gleam in his eye, and said - arthroscopy!! I want this knee (the guy is a pretty good surgeon, uses knee arthros to practice for hands and wrists) - it took him 3 1/2 hours to clean and 'fix' my knee - and took me 8 mos of PT to recover fully - and I still am not supposed to run long distances - but I can forecast the weather changes...

Listen to your Doc, Listen to your Team Medic(s), follow their recommendations to the letter - but keep an eye on old injuries, the might cfome back to haunt you - and document everything - I didn't, and I'm paying for it.

[ABN307]

Thanks for the replies everyone. I went to the Hospital today (civilian) (TRICARE) and picked up the MRI's. I am going to have someone else take a look at them. Something just doesn't feel right.

[Goggles Pizano]

- it took him 3 1/2 hours to clean and 'fix' my knee - and took me 8 mos of PT to recover fully - and I still am not supposed to run long distances - but I can forecast the weather changes...

Listen to your Doc, Listen to your Team Medic(s), follow their recommendations to the letter - but keep an eye on old injuries, the might cfome back to haunt you - and document everything - I didn't, and I'm paying for it.


Whoooo Boy do I know THAT one! ABN307 I had knee surgery last June and made the mistake of trying to do too much after the Doc gave me a green light to run and ruck again. By that I mean I jumped into my workout hard and fast-too fast and now I am going through another rehab (Doctor's orders and yes he yelled...a lot!) this time to build up the knee so I can run and ruck distances at all! It's going to be slow and it's going to suck. Kyo is on the mark; you will have pain (albeit limited) but that is part and parcel of the job you do. Work through the small stuff and tell your Doc everything. Only YOU know your body so speak up or undergo the knife a second time!

[ABN307]

I finally got in to see a Occupational Therapist. He said I also managed to stretch my hamstring and I have a touch of tendonitis in the large tendon in the rear on the knee. This was actually welcoming news, I didn't want to be cut on. A little more time and taking it easy should heal it up.

[frostfire]

While on the same subject, would anyone mind giving me an input based on their expertise or experience from a same/similar condition. Thank you in advance.

Does MRI diagnosis always contain "may be" and "possible" and is arthroscopy the only way to have the final and best diagnosis?


HISTORY: Bilateral knee pain, possible medial meniscal tear
MRI of the left knee
TECHNIQUE: Sagittal, axial, and coronal T1-T2 noncontrast
FINDINGS: There is a large knee joint effusion
There is thickening of the medial patellar plica measuring up to 3mm which may cause problems. PLease clinically correlate.
Patellofemoral articular cartiladge appears to be within normal limits
Extensor mechanism including the quadriceps and patellar tendon is within normal limits
There is no evidence of Baker's cyst and the remainder of the popliteal fossa is unremarkable
There is no significant lateral patellar tilt
Bone marrow signal is within normal limits
The ACL, PCL, MCL, and LCL complex are intact
Popliteus is intact
There is abnormal signal identified within the posterior horn of both the medial and lateral meniscus without definite extension to the articular surface. There may be a radial tear involving the periphery of the posterior horn medial meniscus. This is best seen on sagittal T1 images 6, 7, and 8

IMPRESSION:
Large knee joint effusion
Medial patellar plica thickening
Possible peripheral tear involving the posterior horn of the medial meniscus as described

HISTORY: Evaluate for medial mediscal tear
MRI right knee
TECHNIQUE: sagittal, axial, coronal T1, T2, and STIR imaging was performed
FINDINGS: There is no meniscal tear identified
There is small area of marrow edema in the medial femoral condyle. This could be reactive perhaps from unseen meniscal tear or potentially related to altered biomechanics or direct trauma
The anterior and posterior cruciate ligaments appear intact
The medial collateral and lateral collateral ligament complexes also appear normal
The extensor mechanism appears normal

There is joint effusion. Fluid distends the tibiofibular joint
There is popliteal cyst
There is no focal articular cartilage abnormality
There is some high signal in the marrow of the proximal tibia particularly laterally, though this is probably related to incomplete fat saturation. This could potentially account for the marrow change also described in the medial femoral condyle

IMPRESSION:
There is no meniscal tear identified
There may be subtle marrow edema in the medial femoral condyle versus artifact of incomplete fat signal saturation or inversion as discussed above



The orthopaedist said the result is inconclusive, but he offered arthroscopy to drain the liquid and shave any cartiladge found jagged. He also mentioned the pain on the upper knee is tendonitis and that the grinding is not related to the pain. I just felt uneasy about his diagnosis and that I should find a 2nd, 3rd, usw. opinions. Also since my insurance coverage for preexisting condition already ran out, I have to postpone any further treatment until I switch provider.

Nevertheless, as if there's placebo effect to it, since my self-diagnosis of chondromalacia was not confirmed, suddenly all the pain dissappeared, the grinding does not bother me anymore, and I've hit the gym again and will go rucking.