Need Help Interpreting MRI Report

[Hitchhiker]

I had a torn meniscus on the right knee that was repaired back in '06 which subsequently got staph infection in it. The infection was cleaned out and after a 30 day regime of antibiotics through a pic line I went through several weeks of physical therapy. Final followup with surgeon was about two years ago and the knee has been hurting ever since.

In the past 6 months the knee pain is getting almost unbearable at times, keeps me awake at night, and hurts like heck when I drive the car. I finally went back to the surgeon last week and he ordered an MRI. This morning he reviewed the MRI results with me and basically said my problem is arthritis and I'll just have to live with it. He said there wasn't anything surgically he could do for me. Since a cortisone injection last week didn't help he'll not continue that regime.

So after he left the room I snagged a copy of the report that he was reading from and brought it home to study... but I can't make much out of it.. it's all in doctor talk with big words that I've never heard of.

I attached a scan of the report below, maybe someone can interpret it for me and educate me on what's wrong with my knee and why it hurts all the time.

Thanks,
'Hitchhiker'

[dede23]

i wld help u but its not clear enuf to read!! Its blurry, can u try and scan it again??

[Hitchhiker]

dede23,

Thank you.

I tried rescanning to a pdf file but problem is that the forum's software downsizes my file to about 15K from it's original size of 437K rendering it illegible. I sent the file to you as an email attachment.


Thanks,
'Hitchhiker'

[kjwilkin]

Hi there,

I also tried reading it and see if I could increase the size, but not possible.

Personally I wouldn't accept the phrase, "just live with it". I am tired of hearing that. You need to find someone that can help you. It depends on the stage of arthritis as to what options you have.

My advice would be to see a good sports physician that could refer to a top knee surgeon. I know of some great ones in Melbourne and Canberra.

Whereabouts do you live ?

[dede23]

Hitchhiker, i got the email. Its not in order of the scan but its east to follow:
Ultimately i cld get that u have 1) progressed cartiledge loss/chondral loss in the end part of femur which is refered to as CHondralmalacia- loss of chondral material. Its full and partial so uneven wear and tear. If u actually walk a different gait with walking u can alter the weight dispersment within the joint so. Its progressed from previous scans from about 2.5yrs ago, its prob a fast deteriation but it also depends on ur walking gait, how u disperse ur weight and stuff like that. 2) U cld also have a tear of ur posteria horn lateral meniscus. It says retear so maybe u had a small one before ur menicus trimming in the scope. 3) U also have a joint effusion which is prob the result of the surgery and hasnt dislolved yet. It can cause issues with locking and giving way. Effusion is a collection of fluid so it sld be synovial fluid or it cld be blood. 4) General lateral and medial chondral loss within the joint. 5) MCL sprain(medial cruciate ligament)- chronic meaning it hasnt resolved and is continuing.6) ANd u have a synovial cyst or ganglion whihc is pretty big- 2.3cm in size. Im not sure of the exact location of the adductor magnus insertion site so. U might like to look this up but, i think its attatched to the femur from the hip and inserts at just above the knee joint. Depending on where the location is will depend on how much of a true issue it is or will be. 7) Osteocytes are little bone fragments. Its not from actual fractures from the scan result suggests but they can cause locking, pain and can increase chances of the chondral loss to get worse.

With all this, its alot to understand and if ur not happy with ur surgeons views, maybe its time to seek another surgeon for a second or even 3rd opinion. U need sm1 u feel comfy with and can get a LAYS person explanation. I have done a fair explanation of the terms but its best to actually get them to explain each issue and the reality of how serious or not serious they are on individual basis or as a whole. There are a few there that are a bit concerning but sm are results of post surgery recovery so. U wld be best to get sm1 of true dr experience to give u this info. I am a nurse so i can read results to a certain degree but its BEST for u to get the accurate reporting from ur dr!!!!

Gd luck and let me know how u get on ok!!!!

Cheers. Dee

[Hitchhiker]

Thank you Dee, I really appreciate your help on this. Based on your response I'll be seeking out a 2nd opinion and hopefully can get some Dr help with this. The clinic I went to has a few other Dr who specialize in Orthopedics, perhaps I can get one t look at the MRI report and give me a another interpretation.
Do you think any type of injections would help? They tried the Cortisone to no avail but I think there's another called Hylan that is available.

[Hitchhiker]

I figured out how to scan the document and use MS Office Document Imaging to save as a text file and have copied and pasted the MRI Report below:

PATIENT: XXXXXXXXXXXXXX

DOB: 11/21/1945 REFERRED BY: XXXX XXXXX, M.D.

EXAM DATE: 02/24/2009 PATIENT #: XXXXXXXX

MRI RIGHT KNEE

HISTORY: Right knee pain. Meniscal surgery in November 2006.

COMPARISON STUDIES: I 0/18/2006
.
TECHNIQUE: Multiplanar sequences with TI , intermediate, T2, and/or T2* weighted image contrast.

FINDINGS:

Ligaments: Chronic MCL sprain. Cruciate and lateral collateral ligaments are intact.

Menisci and femoral-tibial hyatine cartilage: Truncation of the posterior horn body and anterior horn lateral meniscus with intermediate signal intensity that extends to the truncated edge. Under surface irregularity of the posterior horn with horizontal signal intensity that extends to the tibial articular surface suggestive of lateral meniscal tear/retear. Chondral thinning within the lateral compartment. Decreased size of the posterior horn body and anterior junction medial meniscus with intermediate signal intensity that extends to the free edge and both articular surfaces, likely postsurgical. ChondraL thinning throughout the medial compartment. Partial-thickness chondral loss within the medial and lateral compartments.

Patellofemoral joint and extensor mechanism: Full and partial-thickness chondral loss, progressed when compared with the prior study. Alignment is within normal limits. Quadriceps and patellar tendons are intact.

Osseous/bone marrow: Small knee joint osteophytes. No fracture, avascular necrosis, or worrisome osseous lesion.

General: Small joint effusion. 2.8 cm ganglion/synovial cyst along the adductor magnus insertion. Small amount of fluid extending along the musculotendinous junction of the popliteus.

IMPRESSION:
1 . Truncation of the posterior horn body and anterior horn lateral meniscus which may relate to prior partial lateral meniscectomy. Irregularity ofthe posterior horn and intermediate signal intensity that extends to the tibial articular surface of the posterior horn lateral meniscus suggestive of lateral meniscal retear.
2. Postsurgical changes of partial medial meniscectomy without evidence of retear.
3. Patellofemoral chondromalacia with partial and full-thickness chondral loss, progressed when compared with the prior study.
4. Chondral thinning within the medial and lateral compartments with foci of partial-thickness chondral loss.
5. Chronic MCL sprain.
6. Small joint effusion.
7. 2.8 cm synovial/ganglion cyst along the adductor magnus insertion.

Subspecialty interpretation by
RAD SOURCE
Signed electronically by: xxxxxXXXXXXXXXX, M.D.
D: 02/24/2009 T: 20:15

[ginny]

New to this so not sure if I'm putting this in the right place sorry if I'm wrong.

I also have a report that I would like someone to clarify. I am a midwife in a busy clinic and have the following report.


Old injury from beign hit by car 30 yrs ago.

Now has been getting progressivley worse ie giving way repeatedly.

Chronic high grade partial tear of th ACL with only a few intact fibres- this maybe functionaly complete. Associated ganglion cyst(6x8mm) adjacent to the ACL femoral insertion site.
The PCL is intact.
There is no significant joint effusion. No popliteal fossa cyst.
Scar is noted within hoffa fat pad consistent with previous arthroscopy.
The medial collateral, lateral, biceps tendon, iliotibial band and extensor mechanisms are intact.
There is a normal pattellar femoral joint.
The medial meniscus and hyaline cartilage of the medial compartment are intact.
The lateral compartment is abnormal. There is an area made up of subchondral cysts measuring app 1.5x1.5cm in size within the medial and central aspect of the tibial plateau with oedema extending into the lateral tibial eminence. This may represent the site of a previous osteochondral injury with an area measuring app 5mm in width and greater in length of severe chondrosis overlying the cystic change. There is a 4x5x15mm long intermediate to low signal (?chondroid) body lateral to the lateral tibial eminince and adjacent to the subchondral cyst.

The dirrectly opposing cartilage of the lateral femoral condyle demonstrates focal fissuring and thinning in keeping with mild to moderate chondrosis. There is no subchondral oedema. Small marginal osteophytes pointing into the intercondylar notches are noted within each compartment consistent with early osteoarthritis..
The lateral meniscus demonstrates a complex tear of small calibre with predonimamtly vertical component within the anterior horm. The body and posterior horn of the lateral meniscus are intact.
The popliteal tendon and remaining posterolateral corner structures are intact.
A 5mm subchondral cyst or defect is noted within the anterior aspect of the medial femoral condyle.
5mm low signal intensity joint body is noted within the posterior joint recess adjacent to the PCL tibial attachment.
Comment:

1. Focal area of subchondral cyst within the medial aspect of the lateral tibial plateau with overlying focal severe chondrosis? sequelae of previous injury or trauma with an adjacent joint body (possibly chondroid) between this area and the lateral tibial spine. Associated fissuring of th e femoral hyaline cartilage directly opposite the tibial subchondral cysts. Further 5mm joint body within the posterior joint recess adjacent to the PCL tibial attachment.

2. Small complex tear of anterior horn of lateral miniscus.

3. Chronic high grade partial tear of ACL with ganglion cyst formation.




GOD I HAVE A NEW FOUND RESPECT FOR MEDICAL TYPISTS!!


Am on the wait lists for recon. Would like any info you can give me. such as clarifying above and aslo and idea of off work time!

Thanks in advance guys ,

Ginny

[dede23]

Ur def in line for a recon and wil prob get some clean up during this operation. Ur a midwife yeah? U will need to be off work for 4-6mths and re introduce lighter duties then get back to full activities in the 8-9 mth. But thats a ruff idea depending on ur recovery and the extent of diagnosis. It looks lik u have sm major injuries so its going to require patience. U have some wear and tear on ur bone surfaces and cartiledge. U have tears in cartiledge. U have sm cysts in there too which can represent true cartiledge tears. Basically there is a large amound of stuff going on and need the recon done! Im awaiting ACL recon too but now need the PCL done too so. I also have the cysts and cartiledge and meniscus tears so kinda in same boat. Gd luck.

[ginny]

Thanks for the reply. Was looking in the wrong place all the time and just found this. Thought I was stupid asking anyone for advice. Am sue to have op June 18. At least now know roughly what to expect. Cheers