I’ve said before that I’ve got a tear in the lateral meniscus of my right knee, and that I’m supposed to get that patched up with arthroscopic surgery in less than two weeks. But my right knee is the good one, that until last summer never gave me any problems! It’s my left knee that has been a lifelong troublemaker: I dislocated it while shoveling rocks when I was 13 (child labor is bad, trust me on this) and again when I was in high school playing basketball against the Kent-Meridian High School varsity football team (they didn’t understand that tackling wasn’t part of the official rules.) Both were treated by wrenching my kneecap back into place, and putting me in a hip-to-ankle cast for 3 months. Kids, don’t injure yourself while living in the middle ages.
As long as I was going in for surgery on the right knee, the doctor figured we should check out the left. I had an MRI this week, and just got the text summary, which looks like it’s mostly normal, but with some minor funny business that I can’t tell if it’s in the normal range, or if I ought to get it repaired now, before I retire. I understand all the words, but lack the context to know what to do about it.
EXAM:
MRI KNEE LT WITHOUT CONTRASTINDICATION:
Meniscal injury, knee,r/o meniscus injury,Internal derangement of left kneeTECHNIQUE:
Multiplanar multisequence knee MRI without contrastCOMPARISON:
Prior radiographsFINDINGS:
Bones:Patella and trochlear subchondral reactive edema with small cysts.
Normal marrow. Minor patellofemoral osteophytes.Ligaments, tendons:
ACL, PCL: Normal
Extensor mechanism: Proximal patellar tendinosis. Distal quadriceps normal.
Attenuated anterior fibers of MPFL suspicious for old proximal tear. Also
medial retinaculum. Minor thickening lateral retinaculum.MCL and post/med corner: Distended bursa versus ganglion cyst along the
posterior/medial corner between pes anserinus and semimembranosus.Lateral and post/lateral: Normal
Gastrocnemius tendons: Normal
Joint spaces:Small effusion. Minor reactive synovitis suprapatellar recess.
Diffuse patellar and trochlear cartilage loss mostly grade 2 and grade 3 with
small surface area grade 4 both sides. Small subchondral cysts.Low-grade chondrosis medial, lateral compartments
Soft tissues:
No Baker’s cyst. Diffuse grade 1 muscle fatty infiltration
Tibial, common peroneal nerves: Normal
Menisci:
Lateral:Free edge surface fraying midbody. No definite tear
Medial: Normal morphology, signal
Comment: Abnormal MRI findings very common in asymptomatic volunteers,
frequently not a source of symptoms. Many studies demonstrate meniscal tears
in up to greater than 50% asymptomatic volunteers, cartilage defects >24%, bone
marrow lesions up to 50%, 21% tendon abnormalities, prevalence increasing w
age. Nearly all pain-free adult knees have at least 1 MRI abnormal finding, so
MRI findings must be interpreted under supervision of expert clinical
assessment.Culvenor et al, Br J Sports Med 2019
Parkar & Adriaensen, Eur Radiol 2024
IMPRESSION:
1. Small effusion, reactive synovitis, patellofemoral cartilage loss
2. Mild patellar tendinosis
3. Suspected old partial tear MPFL retinaculum complex
4. Posterior/medial corner bursal distension versus ganglion or synovial cysts
That’s entertaining, and I appreciated that comment that “Nearly all pain-free adult knees have at least 1 MRI abnormal finding,” so I don’t feel any need to freak out. But I would raise my hand and say that I’m not pain-free, it’s been a chronic source of low-level pain for 50 years, and I don’t know what part of that is relevant to my situation.
I’ll talk to my doctor in the next few days to find out.
“Internal derangement” sounds bad.
You never know with medical terminology. I’m not going to get hung up on a few words here and there.
Most of those findings could be caused by the strain of favoring the knee due to injuring the other knee. Inflammation should dissipate when you get back to walking while distributing your weight evenly.
I would ask about this finding in particular-
Fraying would suggest that something hard is impinging on the menisci, and causing damage and pain.
Internal derangement is a catch all phrase the Orthopods use when something is wrong, the specifics elude them, but they need a diagnosis to order the test. Reminds me of the word idiopathic.
“Idiopathic” is a medical term used to describe a disease, condition, or symptom that arises spontaneously or has no known, identifiable cause.
The MRI report tells me the knee has been beat up (old). Multiple issues throughout but nothing crucial. Balding tires, still have tread but eventually???
“Knees” are one of the obvious clues that “if humans were DESIGNED, the designer is an IDIOT”.
Along with that whole “routing sewer output near recreation area” thing.
I feel your left knee pain. And the early 80s weren’t much better. I dislocated my patella when I was 10, but it popped back on its own. So treatment was a brace for 4 weeks and on my way.
From then until I was 17, when I had surgery, if I ran more than 100 meters or so it would give out again and I would find myself lying on the ground. Surgery solved the dislocations, but the damage was done. In recent years when I’ve had problems and its been looked at I get a conversation that goes something like: “here’s a knee MRI/x-ray/CT, see this area in the joint where the cartilage is? Now this is yours, you don’t have any left.”