I got the MRI findings for my left knee which has been terrible since racing the 5 mile last month. I’ll be seeing my ortho on Monday to go over this and figure out what is next. I’ve been running and so far it hasn’t gotten worse and maybe even a little better after the Medrol dose pack and the topical anti-inflammatory drugs. It feels okay while biking and maybe even a bit better post-ride (blood flow with no impact may be the reason for that). Findings in RED and then results from Google on what it means.
FINDINGS:
Medial compartment diffuse high-grade (predominantly) chondromalacia.
Medial compartment: The inner side of your knee where your thigh bone meets your shin bone.
Diffuse: The damage covers a wide area rather than a single isolated spot.
High-grade: Advanced damage (typically Grade 3 or 4), meaning deep fissuring or near-complete loss of cartilage down to the underlying bone.
Chondromalacia: The softening, breakdown, or deterioration of joint cartilage
Medial tibial rim microfracture with rim edema.
Medial Tibial Rim: The inner edge of the top of the shinbone (tibia) where the knee bears much of your body's weight.
Microfracture (or Subchondral Insufficiency Fracture): A tiny, stress-type fracture just beneath the smooth joint cartilage, often caused by repetitive pressure, minor trauma, or underlying joint wear.
Rim Edema: Swelling and fluid buildup in the bone tissue right around the fracture line, indicating a recent or actively healing injury.
Thin medial meniscal tear primarily affecting the outer margin, along the capsular attachment, sparing the free edge. May require probing at arthroscopy to appreciate.
Outer Margin / Capsular Attachment: The meniscus is a C-shaped piece of cartilage that acts as a shock absorber in the knee. The outer margin is the part anchored directly to the knee joint capsule. This area has an excellent blood supply compared to the rest of the meniscus, giving it a high potential to heal if properly stabilized.
Sparing the Free Edge: The "free edge" is the thin, inner rim of the meniscus that extends into the center of the joint. Because this inner edge is perfectly intact (spared), the main body of the meniscus still looks normal from the inside of the joint.
May require probing to appreciate: Because the tear is hidden far back along the outer wall and the inner edge looks normal, it can easily hide from view during a standard visual inspection. An orthopedic surgeon must use a physical instrument (a small metal probe) to lift, pull, or press on the tissue. Only by manipulating the tissue will the hidden separation along the capsule reveal itself.
About 1 cm. Interval grade 2 (intermediate grade) MCL sprain. No focal retracted component. No lateral meniscal tear. No high-grade chondromalacia lateral compartment.
About 1 cm. Interval grade 2 (intermediate grade) MCL sprain: The MCL is the ligament that runs along the inner side of your knee to keep it from buckling inward. A grade 2 "sprain" means the ligament is partially torn. The "1 cm" and "interval" descriptions outline the specific span or zone of the ligament that has been stretched and damaged.
No focal retracted component: This is excellent news. When a ligament tears completely, the two ends can snap backward like a broken rubber band (retraction). Because there is no retraction, it confirms the ligament is still connected and in continuity, which means it has a high capacity to heal on its own without surgery.
No lateral meniscal tear: The meniscus is the shock-absorbing cartilage wedge in the joint. Your outer (lateral) meniscus is perfectly fine.
No high-grade chondromalacia lateral compartment: Chondromalacia refers to the softening or thinning of the protective cartilage that caps your bones. "No high-grade" means the cartilage on the outer side of your knee joint is healthy and has no severe wear-and-tear.
Patellofemoral high-grade chondromalacia, most notably 4A, trochlear groove. Mild lateral subluxation and tilt. Prepatellar and prepatellar tendon swelling with periostitis at the prepatellar plate. Periretinacular edema. Effusion. Capsulitis.
Patellofemoral high-grade chondromalacia, most notably 4A, trochlear groove: Chondromalacia refers to the softening and breakdown of the cartilage protecting your joint. Grade 4A is the most advanced stage, meaning the protective cartilage has completely worn away in a focal area, leaving the underlying bone exposed ("exposed bone"). This is located in the trochlear groove, which is the bony V-shaped track on your thigh bone where your kneecap sits.
Mild lateral subluxation and tilt: Your kneecap (patella) is not gliding down the center of its track. Instead, it is shifting slightly outward (subluxation) and tilting. This "maltracking" is likely the main cause of the heavy wear on your cartilage, as it unevenly concentrates pressure on one side.
Prepatellar and prepatellar tendon swelling with periostitis at the prepatellar plate: There is significant swelling in the soft tissues and tendon directly in front of your kneecap. Periostitis means the highly sensitive outer lining of the bone (the periosteum) is inflamed, which is a common source of sharp or deep aching pain.
Periretinacular edema: The retinaculum is the band of tissue on either side of your kneecap that helps hold it in place. "Edema" means there is fluid buildup and irritation here, likely because it is being stretched or strained by the kneecap tilting outward.
Effusion: This means you have an excess accumulation of joint fluid inside the knee capsule, usually produced by the body in response to cartilage irritation and friction.
Capsulitis: Inflammation of the fluid-producing capsule that surrounds and seals your entire knee joint.
Quadriceps tendon is intact. Patellar tendon is intact. ACL, PCL, remaining posterolateral corner (fibular collateral ligament, popliteus tendon, conjoined tendon and lateral capsule) and IT band are intact. Remaining muscles are unremarkable. Remaining tendons are unremarkable. No AVN. No large loose body. Neurovascular bundles are unremarkable.
CONCLUSION:
1. Region of fat behind the PCL near the posterior medial meniscal root attachment to the tibia, suspected small lipoma. Less likely an ossified body. Consider x-ray. About 1 cm.
2. Medial compartment diffuse high-grade (predominantly) chondromalacia. Medial tibial rim microfracture with rim edema.
3. Similar very thin medial meniscal tear primarily affecting the outer margin, along the capsular attachment, sparing the free edge. May require probing at arthroscopy to appreciate.
4. Interval grade 2 (intermediate grade) MCL sprain. No focal retracted component.
5. Patellofemoral high-grade chondromalacia, most notably 4A, trochlear groove.
