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MRI Examination Of A Knee -- Possible Diagnosis

Jean Ross, as of May 28, 2003, had surgery for a complete knee replacement.  If you have any interest in the details of that action, current as of May 28th, CLICK HERE.

Lets say that you have sore or aching knees, and you eventually get an examination done by the MRI machine.  You then get a copy of the diagnostic report.  This report is intended for a specialist doctor who understands all the words on it, but you start reading it and find that you don't understand any of the words.  The MRI machine is fully described HERE.  For information about hip joint repair or replacement, click HERE.

This web section has many pages.  Look at the Table Of Contents for more.

How To Get What You Need From Health Insurance

Summary

The report refers to a tear of the meniscus, but those references must be evaluated in reference to the following.  It is probably better understood if you call this meniscus "cartilage" and consider it very similar to the "gristle" you find in tough meat.  Most likely in an older person there was not a sudden "tear" of this cartilage, but a gradual wearing and weakening.  There are a couple surgical possibilities described here.  There is also a non-surgical, non-drug treatment that undoubtedly cannot be the final answer, but can be a first response.

If you are considering getting an MRI?  Check this article out:

Left Knee

The report on the left knee includes this comment:  There is no definite evidence of meniscal tear identified. The patella appears to be unremarkable and shows normal relationship with the distal femur.  (source) At first glance this comment seems to conflict with other details about the left knee -- something the doctor's explanation certainly should clear up.

The left knee official summary is as follows:

• 1. moderate degenerative joint disease with joint space narrowing and thinning of the articular cartilage, more on the lateral compartment, with margin osteophyte formation.
• 2. There is mild joint effusion. No Baker's cyst.
  3. Degenerative maceration and tear involving the lateral meniscus.
  4. Grade II signal change seen in the posterior horn of the medial meniscus (source)

Right Knee

The major finding seems to be:  There is linear tear seen in the posterior horn of the lateral meniscus and macerated appearance involving the mid zone and anterior horn of the lateral meniscus.  (source)

• 1.  Moderate degenerative joint disease involving the lateral compartment of the right knee joint with joint space narrowing, marginal osteophyte formation and thinning of the articular cartilage.  There is no adjacent lateral femoral condyle and the lateral tibial plateau.
• 2.  There is degenerative tear seen in the posterior horn of the lateral meniscus and macerated appearance involving the mid zone and anterior horn of the lateral meniscus.
• 3. Mild joint effusion No Baker's cyst.
• 4. Remainder of the exam of the right knee otherwise appears unremarkable. Clinical correlation and follow-up recommended.  (source)

You want to have your own informed opinion on what the diagnosis means.  So, you come to this page and find that many of the words on YOUR MRI diagnosis are the same ones as shown here.  No patient should enter the meeting with the knee specialist without having read pages like the ones on this web.

The term "tear" of a meniscus is probably one of the most severe diagnoses for knee injury and pain.  There is material about this BELOW, and also on THIS PAGE.  Also there is a simple and brief explanation on THIS page.

The treatment for torn meniscus is to reduce the swelling, rest and ultimately, if necessary, surgery through use of an arthroscope device:

Initial treatment for a torn meniscus usually is directed towards reducing the pain and swelling in the knee.  Your physician may recommend crutches for resting the knee for several days and suggest ice to reduce the pain and swelling.  If the knee is locked and cannot be straightened out, surgery may be recommended as soon as reasonably possible to remove the torn portion that is caught in the knee joint.  Once a meniscus is torn, it will most likely not heal on its own.

If the symptoms continue, surgery will be required to either remove the torn portion of the meniscus or to repair the tear.  Most meniscus surgery today is done using the arthroscope.  Small incisions are made in the knee to allow the insertion of a small TV camera into the joint.  Through another small incision, special instruments are used to remove the torn portion of meniscus while the arthroscope is used to see what is happening. In some cases, the meniscus tear can be repaired.  The arthroscope is used to view the torn meniscus.  Sutures are then placed into the torn meniscus until the tear is repaired.   Repair of the meniscus is not possible in all cases.  Young people with relatively recent meniscal tears are the most likely candidates for repair.   Degenerative type tears in older people are not usually repairable.  (source)

When the damage to the meniscus is related to a state of degeneration, repair is usually not thought to be feasible.  Replacement was considered experimental in Denmark in 1998, but seems to be accepted by at least one surgeon currently.

In the case of older, degenerated (weakened and worn) menisci that typically split apart or break down under routine, day-to-day or minimal stress conditions, the meniscus itself has not been healthy for some time. A degenerative meniscal defect will almost never bleed, and in fact may often occur gradually, without the patient even being aware of it! When such gradual, degenerative meniscal cleavage or fissuring develops and is discovered by MRI scanning or arthroscopy, while it is still commonly said that the patient "tore" their meniscus, this is actually a mischaracterization. To most people, "tearing" something implies a sudden structural failure in response to a specific, applied force. While the terms "torn" and "tear" are convenient for surgeons to use because they are familiar to patients, it is misleading to use them in relation to a degenerated meniscus that is simply worn, frayed, fissured, fragmented or just plain broken down. When a patient hears a surgeon say "You have torn your meniscus", they naturally infer that their meniscus was healthy and functioning properly before it "tore", and that like freshly torn ligaments, their "torn" meniscus can simply be repaired back together again or "fixed", neither of which is the case with degenerated menisci. Within the confines of currently available medical technology, degenerative meniscal defects are almost never amenable to repair. Degenerate menisci break down either spontaneously or under minimal stress because their intrinsic strength and toughness have already been compromised by way of the aging process and/or joint surface erosion caused by arthritis. Attempts at surgical repair are, therefore, pointless and usually doomed to failure. There is little to be gained by trying to stitch mushy, permanently weakened and improperly functioning meniscal tissue back together again. For lack of a better available treatment, surgical removal of the painful, defective meniscal tissue is usually the most appropriate course of action.  (source)

. . . .

Aside from good surgical technique, the key to obtaining a high success rate with meniscal repair is often as simple as using selective judgment when making the decision to repair versus remove. All possible effort should be taken to repair otherwise healthy menisci that have excellent healing potential, whereas effort should not be wasted on thoroughly degenerated menisci that have no realistic chance of healing well and/or functioning normally. The decision whether or not to attempt repair in a "borderline" case (i.e., adequate healing is unlikely but not impossible) can involve some input from the patient, as well as consideration of the patient's specific circumstances. The younger the patient, the more consideration should be given toward meniscal repair, as loss of meniscal function sets in motion an accelerated aging process within the joint that leads to at least some degree of future osteoarthritis in the affected region of the knee. In an older individual (over 35 or 40) who is not overweight and who has no leg malalignment ("bowleg" or "knock-knee" deformity) a "borderline" meniscal tear with a sub-par chance for healing after meniscal repair is often best treated by primary meniscectomy.

Karl Note:  Complete removal of the meniscus is an extreme procedure  Do not miss THIS page to read about various forms of partial removal of a damaged meniscus.  This linked page disagrees with the minimal harm done by removal as indicated just below. 

"complete meniscectomy is a one-way ticket to arthritis!" (source)

If complete removal is indicated, then "knee replacement" is the next, serious, procedure to be understood.  On the "knee replacement page" are many links to separate pages with very detailed images of the text material -- don't miss those!

This is because the patient's knee has probably already been subjected to the majority of stresses that it will see during the course of its lifespan, and it has no specific risk factors (other than the meniscus injury) for premature osteoarthritis. This makes the loss of meniscal cushioning less objectionable. One must also consider the greater risk of surgical complications associated with meniscal repair procedures (vs. simpler and quicker removal procedures) and the extra surgical risks that the patient would be subjected to if a second procedure were to be required because the repair of a "borderline" tear ultimately failed. Even under ideal circumstances, a surgically "repaired" meniscus is not guaranteed to heal!

HERE is a list of the types of things looked for in an MRI of the knee, with the possible findings.  This list shows not only the type of things looked for, but the range of possible reports.  It is a good list to review to understand the MRI report as a whole.

Non-surgical and non-drug approaches to this diagnosis are slim, but include

As a nutritional consultant to the enlightened dental profession. In periodontal disease and surgery the soft connective tissue (meniscus) is exposed and involved. The natural healing protocols are:  (see source for remainder)

and,

Joint swelling scores improved in 47.2% in patients using cetyl myristoleate alone and 77.2% in patients using cetyl myristoleate plus Glucosamine. Patients experiencing worsening or no reaction totaled 1.0% both of the cetyl myristoleate groups, compared with improvement of 21.1% in placebo group.  (more at source)

There is a medical treatment, short of surgery, called Viscosupplementation with information here.  This is a procedure where an artificial fluid is injected into the knee area -- a fluid similar to the normal human fluid in the knee.  This is temporary, only, but can be useful particularly when a person is not a candidate for knee surgery.

One of the common symptoms of knee pain is also a terrible feeling of tiredness. That symptom may be caused by a problem of subnormal body temperature.  This is more widespread than thought and causes many other health problems. Click HERE to read more about that.

Here are linked pages:

Magnetic Resonance Imaging of the Knee

Patient's Guide To Meniscus Injuries

Meniscus Repair vs. Removal

Complete Removal Of Damaged Meniscus

Non-Surgical Treatment Of Meniscus DamageVitamin And Other Non-Drug and Non-Surgical Approaches

Joint Effusion  -- Part Of A Knee Diagnosis

Imaging Features of Pigmented Villonodular Synovitis with Emphasis on Sonographic Findings

Bakers Cyst

Osteophyte

Degenerative Joint Disease or Osteoarthritis of the Finger Joints

Arthroscopic Surgery

Arthroscopic Pictures of Normal and Torn Meniscus Cartilage

Artificial Knee Replacement
 

Here is a copy of an actual MRI report.

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Imaging Services
501 Soulb Mena
Burbank CA

DEPARTMENT OF IMAGING SERVICES
DATE OF PROCEDURZ:24-Jan-2003                  
EXAM#:35B-012403
REQUESTING PHYSICIAN: BENOWITZ, IRVIN S
Patient:  67 Year Old Female
DIAGNOSIS.  SEVERE BILATERAL KNEE PAIN
INDICATIONS: SEVERE KNEE PAIN
MRI TECHNIQUE. Using a GE 1.5 Tesla magnet, the following pulse sequences were obtained: Axial fat suppressed FSE T2, sagittal PSE proton density/T2 and caronal Ti/fat suppressed proton density sequences.

MRI LEFT KNEE:

The knee appears to be in normal alignment. There is mild joint effusion seen in the suprapatellar bursa.

There is no Baker's cyst.

The visualized distal quadriceps tendon, patellae tendon, ACL and PCL are well delineated and appear to be intact.

There is moderate degenerative joint disease with marginal osteophyte and joint space narrowing and articular cartilage thinning noted, seen more at the lateral compartment.

At the lateral compartment there is degenerative maceration of the mid zone and anterior horn of the lateral meniscus. There is truncation appearance of the posterior horn of the lateral meniscus, finding consistent with degenerative tear.

At the medial compartment there is Grade II signal change seen in the posterior horn of the medial meniscus.

There is no definite evidence of meniscal tear identified. The patella appears to be unremarkable and shows normal relationship with the distal femur.

On the coronal view projection the lateral and medial collateral ligaments appear to be intact.

The visualized bone marrow around the left knee appears to be unremarkable.

There are small subchondral bone marrow changes seen at the inferior aspect of the tibial eminence most likely representing degenerative changes.

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MRI:  The Right Knee:

The knee is in normal alignment. There is mild joint effusion, mainly seen at the suprapatellar bursa.

There is no Baker's cyst.

The visualized distal quadriceps tendon, patellar tendon, ACL and PCL are well delineated and appear to be intact.

The medial meniscus appears to be unremarkable.

There is linear tear seen in the posterior horn of the lateral meniscus and macerated appearance involving the mid zone and anterior horn of the lateral meniscus.

There is joint space narrowing seen at the lateral compartment with marginal osteophyte formation. This finding is consistent with moderate degenerative joint disease.

There is subchondral mild bone marrow edema seen at the lateral femoral condyle and lateral tibial plateau.

The lateral and medial collateral ligaments appear to be intact. The patella shows normal relationship to the distal femur.

IMPRESSION: LEFT KNEE: :

1. Moderate degenerative joint disease with joint space narrowing and thinning of the articular cartilage, more on the lateral compartment, with margin osteophyte formation.

2. There is mild joint effusion. No Baker's cyst.

3. Degenerative maceration and tear involving the lateral meniscus.

4. Grade II signal change seen in the posterior horn of the medial meniscus

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IMPRESSION: RIGHT KNEE:

1.  Moderate degenerative joint disease involving the lateral compartment of the right knee joint with joint space narrowing, marginal osteophyte formation and thinning of the articular cartilage.  There is no adjacent lateral femoral condyle and the lateral tibial plateau.

2.  There is degenerative tear seen in the posterior horn of the lateral meniscus and macerated appearance involving the mid zone and anterior horn of the lateral meniscus.

3 . Mild joint effusion No Baker's cyst.

4. Remainder of the exam of the right knee otherwise appears unremarkable. Clinical correlation and follow-up recommended.

Thank you for referring this patient to us.

Source

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Return To Top More detailed information on treatment of a torn meniscus Some of the following information and graphics were supplied courtesy of The Journal of Bone and Joint Surgery and Sulzer Medica. New Devices for Repairing Tears As you will have seen from the main torn meniscus page, at Alpha Klinik we go to great lengths to preserve as much healthy meniscal tissue as possible. In addition to the stitches and staples discussed on the main page, a number of new devices for joining the torn parts back together have been developed. One of these new devices is the so-called double arrow, which re-connects the torn section by means of a short suture or stitch (see figure A) and a special meniscal screw, the thread of which allows for "interfragmental compression" (see figure B).   Meniscal Transplants In younger patients, especially when there has been no arthritis-related wear and tear damage to date, meniscal transplants from a special tissue bank may also be an option. In the United States, the main supplier of such grafts is the Cryolife Company, in Europe a sub-agency of Eurotransplant in the Netherlands is the main supplier. The (human) graft tissues are known as "Allografts". They can be transplanted with a minimal-invasive arthroscopic technique, and the results achieved so far are very encouraging. The transplanted meniscus is fixed in place via cylinders of transplanted bone set into cylindrical "receptors" surgically drilled into the bone/cartilage surface of the upper surface of the lower leg bone and sutures hold the outer edge of the grafted meniscus in place (see figure C). The risk of disease transmission is minimal. As long as the grafted meniscus is not rejected by the patient's body during the first couple of years, the knee has a much-improved chance of not developing arthritis. Return To Top The Collagen Meniscus Implant (CMI): A new treatment for the regeneration of lost meniscal tissue According to a recent press release from Sulzer Medica, the Collagen Meniscus Implant (CMI) is the first product of its kind for the regeneration of sections of the menisci that have been lost as a result of degeneration or surgical removal following an injury. Definition of a Meniscus "The menisci are crescent-shaped cartilaginous structures located in the knee joint. They distribute and transmit the compressive loads between the thigh and the shinbone, provide shock absorption, lubricate the joint and help to stabilise the knee. Sometimes fast twisting or rotational movements of the loaded knee - which frequently occur during sport or daily activities - can lead to meniscus injuries. It is often not possible to repair the injured meniscal tissue, and in this case the damaged tissue has to be partially or completely removed. Such treatment may lead to arthritis later in life." What is the Collagen Meniscus Implant (CMI)? The CMI is a sponge-like structure that consists of highly purified collagen (see figure D). It is implanted arthroscopically in order to replace damaged or surgically removed meniscal tissue. The porous structure of the CMI serves as a "scaffold" that supports ingrowth of new cells, which in turn leads to the formation of new meniscal tissue. Patients are able to place full load on the knee within seven to eight weeks after the surgery. To date, the CMI has been implanted in about 200 patients world-wide. Thanks to good results in the European clinical trial, the CMI received official approval (the "CE mark") in February 2000. Design Criteria of the CMI The material used for the collagen meniscus implant has to conform to six criteria: 1) it is biocompatible and bioresorbable; 2) it has a physical shape similar to that of a normal human meniscus, or can be shaped intra-operatively to the defect geometry; 3) it has a porous structure to facilitate cellular ingrowth; 4) it has an initial mechanical strength suitable for surgical implantation; 5) it is permeable to macromolecules for nutrient supply; 6) it has an initial stability in order to function as a template. Return To Top Clinical Studies In an initial human feasibility study that began in 1993, the collagen scaffold was found to be implantable and safe over a three-year period. Histologically, it supported the regeneration of tissue for meniscal defects of various sizes. No adverse immunological reactions were noted during sequential serological testing. On a second look arthroscopy (performed either three or six months after implantation), gross and histological evaluation revealed newly formed tissue replacing the implant as it was resorbed. At thirty-six months the patients reported a decrease in symptoms and had returned to physical activity at a pre-injury level. Magnetic resonance imaging demonstrated progressive maturation of the signal within the newly developed meniscal tissue at three, six, twelve and thirty-six months. These findings suggested that the collagen scaffold supported regeneration of meniscus-like tissue. A second feasibility study was then conducted before multi-center trials were started in Europe and the US in 1997. To date, the CMI appears to be safe over at least 7 years (based on the available results) and no adverse effects attributable to the collagen scaffold material have been reported.   CMI images courtesy of Sulzer Medica. For more information on Sulzer Medica/the CMI, please click here to visit their web site.

Return To Top Source Knee Arthritis? How to avoid an artificial knee New hope for patients with arthritis of the knee thanks to biological cartilage replacement. by Dr. med. Juergen Toft Price: 22 Euro First Edition (Hardback) Publication Date: October 2000 Dimensions: 16 × 24 cm Publisher: Alpha Klinik, Germany ISBN: 3-00-006520-2 For the "man-on-the-street", there is virtually no literature on minimal invasive arthroscopic joint surgery. The treatment possibilities described in this book are especially interesting for patients who are too young for an artificial knee joint and wish to pursue an active lifestyle after treatment. Popular opinion says that the chances of healing a case of arthritis are very slim. This book opens new horizons for patients who do not wish to accept this diagnosis. In addition, readers will learn about healthy nutrition habits that can further speed the healing process in arthritis patients. The arthritis condition and treatment possibilities are described in lay man's terms, which helps patients decipher other medical reports that they may read or hear about. In addition, a huge array of images makes the "medical jargon" understandable even for patients who are informing themselves about this area for the first time.   Since it was published in English, French, German, Italian and Russian in 2001, Dr. Toft's book has sold over 20,000 copies worldwide and has been featured on well-known German and international television programs, as well as in many mainstream and medical magazines (e.g. N24 and "World of Wonders" on German TV, plus a number of TV programs in the U.S. and BBC News online). Return To Top   Topics dealt with in the book include:  What is arthritis?  How can I tell if I have arthritis?  How is it diagnosed?  Can damaged cartilage heal?  Can cartilage be replaced?  Can arthritis be healed after all?  What is a bioprosthesis?  What does an arthroscopic joint toilette with abrasion involve?  What happens after an operation?  How can I protect myself against arthritis?  Why is fitness important?

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