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Sports Medicine

Knee pain

06/30/2008

Question:

I had gone for an MRI to rule out a medial meniscal tear. I`ve been experiencing pain all around my entire knee and the swelling that I`ve had for the past couple of weeks would get so bad at certain times that I couldn`t even see my kneecap. It`s still slightly swollen and it never feels totally "normal". It also locks up on me occasionally where I have to actually manually straighten my leg out. Sometimes it feels like its going to give way when I`m standing and sometimes I can`t put all my weight on it (I only weigh 115 lbs and I`m 5`2" female). I always have a dull ache and when I turn my leg out laterally it hurts. 

I got the results for the MRI and there was no evidence of a tear. It says that there is mild degeneration of the posterior horn of the medial meniscus. Is it possible that the MRI did not pick up on a possible tear that may in fact be there and just not showing on the films? Please help. I don`t know what to do. I can`t really walk for too long or squat with out a flair up. What do you think can be the problem? Thank you.

Answer:

Although knee MRI scans are very good at detecting meniscal tears, they are not 100%. The physician who ordered your MRI scan is hopefully familiar with reading MRI scans, and would ideally review the MR images to not only determine if the scan was of high quality, but particularly, to determine if he or she agrees with the "official" MRI report.

If, indeed, there is agreement/concurrence with the official MRI report that there is no definite meniscal tear evident, again, although MRI won't detect all meniscal tears, your symptoms could be due to another cause, such as mild arthritic changes, or a problem involving your patella (kneecap).

A physical exam is certainly necessary to provide an appropriate context within which the MRI scan findings can then be interpreted.

Treatment options which could benefit your symptoms may include oral anti-inflammatory medications, ice application, trial use of a knee sleeve/brace, proper footwear with adequate arch support and cushioning, physical therapy/exercises to target any weak/tight muscles (particularly the hip and thigh muscles), possibly a knee steroid injection, and cross training to maintain/increase aerobic fitness via a low- or no-impact exercise which does not exacerbate your knee symptoms.

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Response by:

Brian L Bowyer, MD Brian L Bowyer, MD
Clinical Associate Professor
Physical Medicine & Rehabilitation
College of Medicine
The Ohio State University