T Nation

What Does This MRI Report Mean?


#1

I had ACL surgery done in Feb 2010. It was a cadaver graft on the right knee. Almost a year later and I still have pain in the Pes region of the knee and it's still weak as hell. The surgeon who did the surgery stopped taking my insurance and the last diagnosis he made was pes bursitis. In total, I had about 3 months of physical therapy but it was discontinued because it caused inflammation.

I got a new orthopedist and saw him a few weeks ago. He said ACL was intact, and by the looks of the X-rays everything looked OK. He said maybe the pain could be from the screw which hasn't fully mended into the bone. He said this can take up to 2 years.

He wrote a prescription for PT and sent me for an MRI and I got the results. Unfortunately, he won't tell me what it means over the phone and it'll be a week until I can see him. Fuckin' sucks. Till then, I'm very curious what exactly the MRI report means. If anyone can help decipher it, I'd really appreciate it:


FINDINGS;
Examination of the medial compartment demonstrates increased intrasubstance signal in the posterior horn compatible with degeneration. There is however a linear component contacting the inferior articular surface posteriorly compatible with a tear. The cartilage of the medial compartment is intact. There is no subchondral bone marrow edema. The posterior cruciate ligament is intact. The anterior cruciate ligament has been repaired with a graph. The femoral tunnel is intact.

There is a small amount of fluid within the anterior aspects of the tendon fibers, however, the fibers are largely intact, and there is no significant tear. The patient reports pain at the pes anserine region. The tibial interference screw does contact the cortex in this region and may protrude distal to the cortex. Correlation as to the syrnptomatology is suggested. The tunnel itself remains intact. The lateral meniscus is normal. The cartilage is nonnal in appearance in the lateral compartment.

The quadriceps tendon and patellar tendons are intact. The patellofemoral compartment is normal in appearance. There is no joint effusion. The medial collateral ligament and lateral collateral ligament complex arc norma1 in appearance. There is no acute fracture.

IMPRESSION

1) Status post ACL repair.

  1. The tibial interference screw does contact and probably protrudes through the anterior medial tibial cortex.. Correlation as to symptomatology is suggested. There is no loculated fluid collection in this region.

  2. There is a posterior hom medial meniscal tear.

  3. No evidence of arthrofibrosis.
  4. No joint effusion

#2

This means that the interference screw used to anchor your graft into your shin is sticking out of the bone surface on the inside of the lower leg. They suspect this might be why you are experiencing these problems

This is pretty self explanatory, in the report it suggested that this was not definitive but highly likely. It means that your medial (inside) meniscus has some damage posteriorly (back of your knee) where it attaches to the tibia (shin bone).

In this case I am not sure what will be done by the surgeon, as for the meniscal tear it would depend on the severity and if you are lucky enough it will heal itself.
If the protruding screw is giving you that much grief it will possibly require surgical intervention to mediate the situation but it would in all likelihood be a minor procedure relative to an acl reconstruction


#3

That makes sense. The new orthopedist suggested that may be the cause even before I did the MRI. He said it could take up to 2 years for that pain to go away.

The original MRI before surgery also said something about a menisus tear and cartilage damage. I'd like to think if it was major and needed repair, the surgeon would've done it when he did the ACL surgery. If it is the screw, it's definitely causing a ton of grief. Any activity will cause a shitload of inflammation and pain where the screw is. It was bad enough that my original surgeon took my off physical therapy for a while. I had some pretty big, strong legs before this shit happened and at this point the right leg has trouble getting my up a flight of stairs lengthwise.

I appreciate the help. I don't know why my doc couldn't just tell me this stuff over the phone.


#4

Update:

Saw the doc the other day and he went over the MRI with me. He believes there is no meniscus tear and that what the MRI tech saw was an aberration. The screw is not protruding so much that it requires surgery but might be just enough to cause the pain I'm feeling.

It's a self absorbing screw so he recommends I give it a few more months to "self absorb". Best part is that he said my knee looks great and I can push past the discomfort. My right leg has weakened to the point where I have to struggle going upstairs so this is great news.

Thanks again, rehanb_bl for the explanation while I was waiting for the doc to explain it.


#5

No problem man. Good to hear that all is well, I know what a tough process it can be to go through