Knee pain walking, sitting, driving, etc. - MRI results help needed

Posted by j12 @j12, Jul 3, 2022

Hello Everyone!

I've had pain in my right knee for a long time – I think for about 3 years now…
It might have started as a foot pain, but I don't remember, to be honest…

I went to a good doctor, he ordered an MRI, but he overcharged me for the initial consultation, and now I'm kind of thrown off by that…

Is there anybody knowledgeable here to help me interpret the MRI results?
Or, maybe somebody has had similar MRI results?
How can I make my pain go away? Preferably, non-surgical ways.

I'd appreciate any input (besides the obvious “go to (another) doctor”).

**Study Result**
***Impression***
Apical free edge radial parrot-beak tear, junction of mid body and anterior horn of the medial meniscus with apical fraying or continuation throughout the posterior horn with indistinctness of its margins back to the posterior root. Large undersurface oblique flap tear of the posterior horn of the medial meniscus, widest at the posteromedial corner extending out through the meniscocapsular junction. The tear attenuates in size, becoming much thinner as it progresses laterally throughout the posterior horn with intrasubstance degenerative signal extending into the posterior root. No evidence of displaced fragment. Intact anterior horn. Very mild subjacent stress related bone marrow edema at the peripheral medial tibial plateau.

Small synovial joint effusion with a collapsed Baker's cyst.

Intact cruciate and collateral ligaments.

No evidence of significant weightbearing chondromalacia.

Normal patellofemoral joint.

***Narrative***
MRI KNEE RIGHT WO CONTRAST

REASON FOR STUDY: Chronic intermittent anteromedial knee pain for the past several years

TECHNIQUE:

A variety of T1, T2, and proton density with fat saturation fast spin echo sequences of the right knee were obtained in the sagittal, coronal, and axial planes. The study was performed on a 1.5 Tesla GE Signa magnetic resonance scanner.

FINDINGS:

There is normal signal intensity throughout the osseous structures. There is preservation of height of the lateral and medial weightbearing compartments. There is no evidence of weightbearing chondromalacia. There is a small intra-articular joint effusion. The lateral meniscus is normal in size, shape, and signal intensity. There is an apical free edge radial parrot-beak tear (image 12, series 8) at the junction of the mid body and anterior horn of the medial meniscus with the free edge tear extending along the undersurface into a large oblique flap tear, widest at the posteromedial corner of the medial meniscus extending out through the posterior meniscocapsular junction. The tear becomes much thinner in size but persistent extending down to the inferior articular surface throughout the posterior horn of the medial meniscus with intrasubstance degenerative signal extending into its posterior root. There is indistinctness along the free edge margin of the posterior horn and root which may represent continuation of the free edge tear with fraying. There is no evidence of displaced bucket-handle fragment. There is mild reactive bone marrow edema within the subjacent peripheral medial tibial plateau. There is also very mild posterior parameniscal synovitis but no cyst formation. The anterior and posterior cruciate ligaments appear intact. Both the tibial and fibular collateral ligaments as well as the distal iliotibial band are normal. There is no evidence of popliteal fossa mass. There is a collapsed Baker's cyst present. The pes anserine tendons are unremarkable. The popliteus muscle and tendon as well as the popliteofibular ligament are also unremarkable. The tibiofibular joint is normal. The patellofemoral joint demonstrates central patellar positioning within the trochlear groove. The retropatellar and trochlear articular cartilage are normal. The medial patellofemoral ligament, medial and lateral retinacula appear intact. The distal quadriceps and patellar tendons are intact and unremarkable. There is physiologic fluid within the deep infrapatellar bursa.

Interested in more discussions like this? Go to the Bones, Joints & Muscles Support Group.

Welcome @j12. As I believe you know, Mayo Clinic Connect is a community of patients connecting with patients. While there may be a member here with the skills to read an MRI, the interpretation of the results are best done in consultation with a physician in person with you.

You said that the doctor who ordered the MRI is a good doctor, but you were overcharged. Are you planning to consult with this physician and point out the overcharge? It sounds like you would appreciate the physician's interpretation, but are skeptical of the business approach.

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Hi j12,
I'm not a doctor, so I use a medical dictionary to help me understand these scan results. Seems you have a torn meniscus, and an old Baker's cyst. I have an uncollapsed Baker's cyst, had it drained the second time just yesterday. The pain I have been feeling matches your description – most painful after driving for about 20 minutes.
Like strawboy12, I don't have a lot of confidence in doctors, in general. I have had a number over the years – and to me there are 2 groups – those that listen to me, and those that don't. The second group is a lot larger than the first. I do find that doctors at teaching hospitals are better (I'm in Oregon) and have had most doctor success at OHSU and UCSF. Unlike a lot of doctors, they are more interested in progress, not the "tried and true" methods that may relieve the pain, but leave you unable to do the things you like to do. It means travel and inconvenience, but this is my body and I'll do what I understand, and I am prepared to take the risks – reap the benefits or suffer the consequences – my choice. Finding a good doctor can take a lot of sleuthing – reviews from within their organization as well as without. BBB is also a place to look for reviews – at least to weed out the bad ones.
I understand that a torn meniscus is fairly serious – there are minimally invasive techniques out there, but if the damage is non-progressive, there may be alternatives, such as suggested by strawboy12. Finding a good naturopath is like finding a good doctor.
Enough of my rambling. Good luck!
gregv

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@j12, you may also be interested in this related discussion:
– I need a TKR: Do I do it, or go as long as I can? https://connect.mayoclinic.org/discussion/need-tkr/

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I had a complete meniscus tear back in 2006. Had surgery, surgeon said ripped meniscus floated out he shaved arthritis off knee. Went to therapy on crutches was like new in 6 weeks. Didn’t end up with TKR til 2021 and my new knee is awesome. Good surgeon would know what to do and remember you can always get a second opinion if you are unsure! Good luck

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Ouch. I am not a medical person, but it sounds like inquiring about a simple repair/trim of miniscus would be reasonable. You'll have some help if you can get to PT to help strengthen the muscles around your knee, back, etc so you have more support. I think you'll have to bite the bullet and find another Orthopedic since they are the best to analyze your best action. Here's a good site: https://www.mayoclinic.org/diseases-conditions/torn-meniscus/diagnosis-treatment/drc-20354823#:~:text=It's%20sometimes%20possible%20to%20repair,maintain%20knee%20strength%20and%20stability.

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Feeling frustrated as my Medicare Advantage plan will not authorize an MRI for pain in knee (MCL) without six weeks of PT which I began yesterday. I also have either a Baker’s cyst or blood clot behind the knee. Hoping the PT does not further exacerbate the condition / pain.

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I’m not a doctor but if your doctor is suspecting a blood clot or a bakers cyst, that’s a huge difference. If your doctor is suspecting a blood clot you could get an ultrasound or a CTA depending on where they suspect the blood clot. They would be approved before an MRI. MRI would be best for Bakers cyst. Have they done another test to rule out a blood clot?
https://www.health.harvard.edu/diseases-and-conditions/how-do-you-treat-a-bakers-cyst

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Epat and Emtt machine. One of them is made by Cureaex(spelling)
Not covered by insurance

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