What's new
Fantasy Football - Footballguys Forums

Welcome to Our Forums. Once you've registered and logged in, you're primed to talk football, among other topics, with the sharpest and most experienced fantasy players on the internet.

Help me diagnose my wife's knee MRI results (2 Viewers)

cosjobs

cosjobs

Footballguy
Wife has had a lot of knee trouble the last few years. She finally got na MRI, here' what it says?

MENESCI - degeneration and tearing of posterior horn and body of the medial meniscus, with associated peripheral extrusion. Lateral is inteact

ACL - Severe attenuation and amorphous appearance of the ACL, without well-defined, intact fibers. This is favored to represent chronic over deficient high grade partial tear.

PCL, MCL, LCL - intact

ARTICULAR CARTILAGE - Diffuse variable high grade partial and full-thickness cartilage loss throughout the medial compartment.Low grade partial thickness loss within the lateral compartment.Moderate grade partial thickness loss within the the lateral compartment. Moderate grade partial thickness cartilsgre thickness loss within the patellofemoral compartment.

OSSEOUS STRUCTURES -Tricompartmental osteophytosis. Moderate subchondral marrow edema within medial femoral condyle and subjacent tibial plateau.

JOINT - a small joint effusion is noted

SOFT TISSUES - moderate sized politeal  seen in the semimembranosus-gastrocnemius bursa

IMPRESSION - 1) Sever medial compartmental arthrosis with associateddegeneration and tearing of the posterior horn and bosy of the medial meniscus and subsequent reactive marrow edema. No fracture.

2) Chronic ruptured ACLfavored over very high grade partial tear.

3) Moderate patellofemoral compartmental catilage loss

======================================

wat?

 
kevzilla said:
I  suspect the pain is more a result of the cartilage loss than the ligament damage. She may be a candidate for replacement when the pain becomes intolerable. GL Mrs cos
Click to expand...
Its periodically intolerable. Wondering prolo therapy might help, or surgery or replacement? No docs available until late next week.

 
Lack of ball...cancer.  Doesn’t sound great no matter what the diagnosis, but hoping for a speedy recovery.

 
cosjobs said:
Wife has had a lot of knee trouble the last few years. She finally got na MRI, here' what it says?

MENESCI - degeneration and tearing of posterior horn and body of the medial meniscus, with associated peripheral extrusion. Lateral is inteact

ACL - Severe attenuation and amorphous appearance of the ACL, without well-defined, intact fibers. This is favored to represent chronic over deficient high grade partial tear.

PCL, MCL, LCL - intact

ARTICULAR CARTILAGE - Diffuse variable high grade partial and full-thickness cartilage loss throughout the medial compartment.Low grade partial thickness loss within the lateral compartment.Moderate grade partial thickness loss within the the lateral compartment. Moderate grade partial thickness cartilsgre thickness loss within the patellofemoral compartment.

OSSEOUS STRUCTURES -Tricompartmental osteophytosis. Moderate subchondral marrow edema within medial femoral condyle and subjacent tibial plateau.

JOINT - a small joint effusion is noted

SOFT TISSUES - moderate sized politeal  seen in the semimembranosus-gastrocnemius bursa

IMPRESSION - 1) Sever medial compartmental arthrosis with associateddegeneration and tearing of the posterior horn and bosy of the medial meniscus and subsequent reactive marrow edema. No fracture.

2) Chronic ruptured ACLfavored over very high grade partial tear.

3) Moderate patellofemoral compartmental catilage loss

======================================

wat?
Click to expand...
What's the specific question?  It sounds like she has a chronically beat up knee with changes in her meniscus, cartilage and associated joint inflammation.  Probably experiencing pain (guessing that's what brought her in) and maybe some clicking/locking of her knee?  Will need to follow up with an orthopedic physician but it's unlikely much can be done surgically without a replacement and it's going to be mostly trying to rehab as best she can.  It also depends on what kind of activity level she wants to keep up.  If she's looking to be active with things that will put strain on it, there may be more invasive options to try and improve symptoms. 

 
Last edited by a moderator:
How old is she and what is her activity level like now? The older way of thinking was to put off knee replacement until the pain was getting unbearable. Thats changed, from waht i can tell. The MRI suggests she has just worn down her cartilage and, in places might be close to bone on bone. A replacement is likely in her future, just a question of how long she wants to wait, and what kind she wants to get.

From what i hear, she’ll be glad she did it once she gets it done. People get immense relief from knee pain after replacement, and can maintain activity levels pretty well. Recovery is usually not too bad, either. 

 
gianmarco said:
What's the specific question?  It sounds like she has a chronically beat up knee with changes in her meniscus, cartilage and associated joint inflammation.  Probably experiencing pain (guessing that's what brought her in) and maybe some clicking/locking of her knee?  Will need to follow up with an orthopedic physician but it's unlikely much can be done surgically and it's going to be mostly trying to rehab as best she can.  It also depends on what kind of activity level she wants to keep up.  If she's looking to be active with things that will put strain on it, there may be more invasive options to try and improve symptoms. 
Click to expand...


ProstheticRGK said:
How old is she and what is her activity level like now? The older way of thinking was to put off knee replacement until the pain was getting unbearable. Thats changed, from waht i can tell. The MRI suggests she has just worn down her cartilage and, in places might be close to bone on bone. A replacement is likely in her future, just a question of how long she wants to wait, and what kind she wants to get.

From what i hear, she’ll be glad she did it once she gets it done. People get immense relief from knee pain after replacement, and can maintain activity levels pretty well. Recovery is usually not too bad, either. 
Click to expand...
She is 62. She is a nurse and wants to continue another 5-8 years, because she enjoys it. But it is beginng to be very hard on her. She's an L&D nurse and has to much hoisting of 300# mothers and lots and lots of walking.

 
She's got good med coverage and ST disability benefits. I'd prefer her to do what it takes to get it as well as possible and enjoy the end of her career.

 
I am a few years behind her but on the same path. She needs a new knee. 

If if it were me (and it likely will be in a few years), I would get the knee replaced as soon as feasible. They will give her other options to try to delay surgery but that’s pointless. GL mrs Cosjobs.

 
Yep, sounds about right. As noted above, knee replacement probably the only option to make much difference. Can try conservative rehab but unlikely to make a huge difference given those findings.

 
cosjobs said:
She is 62. She is a nurse and wants to continue another 5-8 years, because she enjoys it. But it is beginng to be very hard on her. She's an L&D nurse and has to much hoisting of 300# mothers and lots and lots of walking.
Click to expand...
I get that- im an RN, too. It’s become the exception to the rule now to have a pt with a BMI under 38. And being a fairly large dude, i almost feel onligated to take the real heavyweights when they come to the unit, just out of chivalry and sheer logistics.

consult with an orthopod and see what they have to say. At 62, and still wanting to work, id do a replacement in a heartbeat (probably will end up doing the same). In the meantime, if you havent already, try ice and NSAIDS to keep swelling down, she can try a compression sleeve, but it probably won’t help much. And it was all the rage to down supplements like SAM-E and glucosamine not too long ago, but i think that’s gone out of favor as being effective. GL

 
shuke said:
Looks like she may be a candidate for unicondykar knee replacement. 
Click to expand...
I could see that with the MRI results, but whats the outcomes of needing to go the total knee within 5-7 years? Is it just stalling, or is there real benefit to the unicondylar? 

 
ProstheticRGK said:
consult with an orthopod and see what they have to say. At 62, and still wanting to work, id do a replacement in a heartbeat 
Click to expand...
this. sounds bone-on-bone-ish to me w arthritis on the way. dont know anyone who's had a knee replacement and didnt wonder why they waited so long...

 
Her body will tell her what to do.  When the pain is bad enough she will get surgery.  If at this time it is not having a drain on her life or impact of movement I would wait for surgery.    Although I have had many people tell me that if they knew their knee would feel this good after surgery they would have done it years ago. 

 
ProstheticRGK said:
I get that- im an RN, too. It’s become the exception to the rule now to have a pt with a BMI under 38. And being a fairly large dude, i almost feel onligated to take the real heavyweights when they come to the unit, just out of chivalry and sheer logistics.

consult with an orthopod and see what they have to say. At 62, and still wanting to work, id do a replacement in a heartbeat (probably will end up doing the same). In the meantime, if you havent already, try ice and NSAIDS to keep swelling down, she can try a compression sleeve, but it probably won’t help much. And it was all the rage to down supplements like SAM-E and glucosamine not too long ago, but i think that’s gone out of favor as being effective. GL
Click to expand...
This is why peds is where it's at.  :bowtie:

 
Tecumseh said:
Oh, I love it. Plus, adults are just gross.
Click to expand...
I started doing hospice after almost 20 years in surgery.   I have had surgery after surgery where the pt's easily push over 300 lbs.     People are just getting bigger and bigger.  We had to order special O.R. tables for 500 plus people.   Use it about once a month.   

 
SHIZNITTTT said:
I started doing hospice after almost 20 years in surgery.   I have had surgery after surgery where the pt's easily push over 300 lbs.     People are just getting bigger and bigger.  We had to order special O.R. tables for 500 plus people.   Use it about once a month.   
Click to expand...
Yeah, no thanks.

 
I'm going to take the argument against TKR. I'm happy to discuss.

cosjobs said:
IMPRESSION - 1) Sever medial compartmental arthrosis with associated degeneration and tearing of the posterior horn and bosy of the medial meniscus and subsequent reactive marrow edema. No fracture.

2) Chronic ruptured ACLfavored over very high grade partial tear.

3) Moderate patellofemoral compartmental catilage loss
Click to expand...
This is really the whole thing. 

When did all this happen? Also has she ever had any prior procedures?

 
cosjobs said:
Wife has had a lot of knee trouble the last few years. She finally got na MRI, here' what it says?

MENESCI - degeneration and tearing of posterior horn and body of the medial meniscus, with associated peripheral extrusion. Lateral is inteact

ACL - Severe attenuation and amorphous appearance of the ACL, without well-defined, intact fibers. This is favored to represent chronic over deficient high grade partial tear.

PCL, MCL, LCL - intact

ARTICULAR CARTILAGE - Diffuse variable high grade partial and full-thickness cartilage loss throughout the medial compartment.Low grade partial thickness loss within the lateral compartment.Moderate grade partial thickness loss within the the lateral compartment. Moderate grade partial thickness cartilsgre thickness loss within the patellofemoral compartment.

OSSEOUS STRUCTURES -Tricompartmental osteophytosis. Moderate subchondral marrow edema within medial femoral condyle and subjacent tibial plateau.

JOINT - a small joint effusion is noted

SOFT TISSUES - moderate sized politeal  seen in the semimembranosus-gastrocnemius bursa

IMPRESSION - 1) Sever medial compartmental arthrosis with associateddegeneration and tearing of the posterior horn and bosy of the medial meniscus and subsequent reactive marrow edema. No fracture.

2) Chronic ruptured ACLfavored over very high grade partial tear.

3) Moderate patellofemoral compartmental catilage loss

======================================

wat?
Click to expand...
@Dr. Dan might be able to help

 
SHIZNITTTT said:
I started doing hospice after almost 20 years in surgery.   I have had surgery after surgery where the pt's easily push over 300 lbs.     People are just getting bigger and bigger.  We had to order special O.R. tables for 500 plus people.   Use it about once a month.   
Click to expand...
Yeah, i torqued the hell outta my back a few years ago moving a 480 lb’er off an OR table. Was leaning across a bariatric gurney, and bad mechanics, i guess. I remember we had to turn away a 550 lb person from doing a cysto, because our table was only rated for 450-500. So glad i didnt have to do the prep on that case. 

 
kevzilla said:
I  suspect the pain is more a result of the cartilage loss than the ligament damage. She may be a candidate for replacement when the pain becomes intolerable. GL Mrs cos
Click to expand...
This. My father in law had many of the same problems/symptoms your wife had. He had first had the meniscus and ACL repaired and after a couple of months of rehab it was fine for about a year. Then everything started happening again and he opted for the knee replacement and hasn't had an issue in the 4ish years since then.

If she wants to keep working knee replacement is the only way to go IMO.

 
Last edited by a moderator:
Cjw_55106 said:
Did the Dr not give a diagnosis? 
Click to expand...
Not yet. He ordered the MRI, but has not yet been scheduled for going over the results. We got the report off the MRI patient portal.

I've been seeing a prolo/stem cell/ alternative guy for my back and she was supposed to get a round of prolo this week. We might just have a consultation since the MRI have been received since last visit. Also plan on a consult with the Orthopedist

 
Sounds like the acl is torn. Meniscus is shot and there's a bunch of #### floating around in her knee. 

At her age, acl replacement might not be needed/necessary/wanted. Rehab is a #####. 

Meniscus, cartilage and the floating debris it what is probably causing most of the pain. 

My acl replacement involved a lot of the same verbiage and the parts that took the longest to become pain free were the the meniscus and the groove behind my knee cap which needed to be cleaned out. 

Glgb

 
I'm a therapist and usually recommend giving therapy a chance before considering anything surgically.  Doctors don't always do that. Big shock.  She's most likely looking at a knee replacement in the not too distant future. 

 
ProstheticRGK said:
I could see that with the MRI results, but whats the outcomes of needing to go the total knee within 5-7 years? Is it just stalling, or is there real benefit to the unicondylar? 
Click to expand...
Unicondylar is less invasive. Smaller incision, shorter OR time, quicker recovery.  Yes, a good chance a total will be needed eventually, but I'm keeping as much of my own native tissues as long as possible.  

 
cosjobs said:
Wife has had a lot of knee trouble the last few years. She finally got na MRI, here' what it says?

MENESCI - degeneration and tearing of posterior horn and body of the medial meniscus, with associated peripheral extrusion. Lateral is inteact

ACL - Severe attenuation and amorphous appearance of the ACL, without well-defined, intact fibers. This is favored to represent chronic over deficient high grade partial tear.

PCL, MCL, LCL - intact

ARTICULAR CARTILAGE - Diffuse variable high grade partial and full-thickness cartilage loss throughout the medial compartment.Low grade partial thickness loss within the lateral compartment.Moderate grade partial thickness loss within the the lateral compartment. Moderate grade partial thickness cartilsgre thickness loss within the patellofemoral compartment.

OSSEOUS STRUCTURES -Tricompartmental osteophytosis. Moderate subchondral marrow edema within medial femoral condyle and subjacent tibial plateau.

JOINT - a small joint effusion is noted

SOFT TISSUES - moderate sized politeal  seen in the semimembranosus-gastrocnemius bursa

IMPRESSION - 1) Sever medial compartmental arthrosis with associateddegeneration and tearing of the posterior horn and bosy of the medial meniscus and subsequent reactive marrow edema. No fracture.

2) Chronic ruptured ACLfavored over very high grade partial tear.

3) Moderate patellofemoral compartmental catilage loss

======================================

wat?
Click to expand...
Don't concern yourself with the top portion. Just look at the Impression. That's the meat and potatoes. 

1. She has severe inside knee arthritic changes. Likely age and prior ACL tear related. Meniscus: Inside-back portion of the mensiscus is torn, that is not fixable. Needs to be cut out. Meniscus is a flexible cartilage that sits on the tibia between that and the femur. Only a small portion has a decent enough blood supply to be fixed, the rest has to be cut out when it tears. When cut out, it exposes the underlying cartilage (or in this case bone- the cartilage is gone/nearly gone)
2. ACL: It's torn. They think it happened over time. She likely partially tore it at one point and then tore it again or did so slowly over time. 
3. This is very normal. The "track" that the knee cap slides in has some moderate arthritic changes / cartilage loss. Very normal over time change. Don't concern yourself with this, many people have this. 

How old is she?

If she's older, just replace the knee. If not, you would need to get the ACL reconstructed to prevent even more severe arthritis later in life, however I would bet top dollar that she would have inside knee pain following due to the need to remove that medial meniscus and the underlying arthritis that would be exposed once that tear is removed. What to do is all age dependent and unfortunately there is not great answer. She may very well never be 100% again but it could be realistic to be in the 90%s 

This is a classic example of an ACL tear not being fixed and resulting in early onset arthritis. Research is pretty conclusive on this, which is why we want to fix ACLs for younger folks when they are torn. They will still get arthritis earlier in life, but it will be far less than if they don't have the ACL fixed. 

She will eventually need a knee replacement IMO. I can only imagine the amount of quadricep atrophy and poor recruitment of those muscles if it's been a problem for years... she needs to do a lot of rehab and strengthening regardless

 

 
Last edited by a moderator:
Thanks for all the feedback, you've given us lots to talk and think about.

Is anyone familiar with Prolo therapy? Think is might be worth the $1200 to do a series of injections (3) in the hope that it will reduce the pain and put off replacement?

 
cosjobs said:
Thanks for all the feedback, you've given us lots to talk and think about.

Is anyone familiar with Prolo therapy? Think is might be worth the $1200 to do a series of injections (3) in the hope that it will reduce the pain and put off replacement?
Click to expand...
Prolotherapy is considered experimental by some insurances and may not be covered.

Here's an older study but it shows promise for helping with OA in the knee. Here's a March 2017 review showing Moderate evidence to support it for knee OA 

Personally, I would do whatever it takes to avoid a replacement unless I was >55 years old, and even then I'd want to try and make it to 60.

Has she tried cortisone? Or Euflexxa? Both would be covered by insurance. I would try those before going with prolotherapy, but I think that is a good option too if the other two have not worked. It has favorable evidence. Surgery should be a last resort, always. 

 
Last edited by a moderator:
Dr. Dan said:
prolotherapy is interesting. Basically creates scar tissue to stabilize a joint. 

Here's an older study but it shows promise for helping with OA in the knee. Here's a March 2017 review showing Moderate evidence to support it for knee OA 

Personally, I would do whatever it takes to avoid a replacement unless I was >55 years old, and even then I'd want to try and make it to 60.

Has she tried cortisone? Or Euflexxa? Both would be covered by insurance. Prolotherapy is considered experimental by some insurances and may not be covered. I would try the other two before going with prolotherapy, but I think that is a good option if the other two have not worked. Surgery should be a last resort, always. 
Click to expand...
Thanks for the input. She's 62. Prolo did wonders for my bad knee (or coincidentally the passage of time). The cortisone did not help her, she has not tried the Euflexxa (did not help me). But you are correct, those are covered 80% by insurance. 

 
cosjobs said:
Dr. Dan said:
prolotherapy is interesting. Basically creates scar tissue to stabilize a joint. 

Here's an older study but it shows promise for helping with OA in the knee. Here's a March 2017 review showing Moderate evidence to support it for knee OA 

Personally, I would do whatever it takes to avoid a replacement unless I was >55 years old, and even then I'd want to try and make it to 60.

Has she tried cortisone? Or Euflexxa? Both would be covered by insurance. Prolotherapy is considered experimental by some insurances and may not be covered. I would try the other two before going with prolotherapy, but I think that is a good option if the other two have not worked. Surgery should be a last resort, always. 
Click to expand...
Thanks for the input. She's 62. Prolo did wonders for my bad knee (or coincidentally the passage of time). The cortisone did not help her, she has not tried the Euflexxa (did not help me). But you are correct, those are covered 80% by insurance. 
Click to expand...
Personally, I'd go for it. Sure beats a 60 grand bill with 6-8 weeks of missed work at a minimum. 

 
You must log in or register to reply here.

Similar threads

Mark Wimer
  • Locked
2012 Preseason Injury Report: 8/29 Final update and revision
Replies
43
Views
10K
Mark Wimer
Mark Wimer

Users who are viewing this thread

Total: 2 (members: 0, guests: 2)
Top