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Have swelling in knee. MRI showed small areas of patch T1 hypo and T2 hyperintensities of subchondral bone. Meaning?

DOCTOR OF THE MONTH - Jul 2013
Jul 2013
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Orthopaedic Surgeon, Joint Replacement
Practicing since : 1996
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I have had three MRI's to my right knee of the last 18 months due to swelling. The MRI says I have "small areas of patch T1 hypo and T2 hyperintensities of subchondral bone" This was explained as a "bone bruise" . I am a runner, and have stopped for the last 10 months but two subsequent MRI's show no improvement. I only ride an exercise bike, have a very small amount of swelling and no pain whatsoever. I have only had pain when I would run several days in a row, and the knee would swell, would need to stop. I don't think this is a bone bruise. What could it be?
Posted Sat, 24 Aug 2013 in Bones, Muscles and Joints
 
 
Answered by Dr. K. Naga Ravi Prasad 2 hours later
Hi, thanks for writing to XXXXXXX

Before I answer your query, I need to have a complete impression of the MRI findings. Please send a scanned copy of the REPORT (not the images) so that I can better judge your problem exactly.

Regards
Above answer was peer-reviewed by
 
Follow-up: Have swelling in knee. MRI showed small areas of patch T1 hypo and T2 hyperintensities of subchondral bone. Meaning? 21 hours later
I have attached the MRI report for your review. As you probably could have guessed, I did not include all of the report in my question, in an effort to be brief.
 
 
Answered by Dr. K. Naga Ravi Prasad 5 hours later
Hi, thanks for getting back.

It is very obvious from the MRI findings that you have got GRADE 4 CHONDROMALACIA PATELLA, which is your diagnosis. The term chondromalacia means "softening of the cartilage" of the patella (knee cap bone). This is usually the result of wear & tear due to running.

This condition is also called as RUNNER'S KNEE as it is commonly seen in runners and running causes worsening of symptoms.

The priliminary management of this condition involves -

* PHYSIOTHERAPY - to strengthen the Quadriceps muscle
* Avoiding "deep bending" movements of the knee
* Maintaining optimum body weight
* Simple analgesics like acetaminophen as needed
* At times steroid injection into the joint will help

If the above measures fail to provide you symptom relief, you may need some form of surgical intervention.

You need an orthopedic surgeon consultation for further management.

Hope this information is helpful . Good day

Above answer was peer-reviewed by
 
Follow-up: Have swelling in knee. MRI showed small areas of patch T1 hypo and T2 hyperintensities of subchondral bone. Meaning? 7 hours later
Thank you for your answer. I understand. What if I resume running? What are the implications? Is it manageable? You mentioned surgery. What corrective surgery?
 
 
Answered by Dr. K. Naga Ravi Prasad 1 hour later
Hi, Nice to hear from you.

* As already told by me, resuming running undoubtedly worsens your symptoms as well as cartilage damage inside the joint.
* Presence of Chondromalacia (in your case) implies that there is degeneration & loss of cartilage both on the patella & lateral femoral condyle and the issue needs to be addressed by some form or other. Or else it will lead to total damage to the knee joint over a period of time.
* Yeah, the condition is manageable now.
* If the present condition is not improving with conservative management, then surgery may be indicated. There are number of surgical techniques available to address this problem and the choice depends on the size of the lesion & experience of the operating surgeon. The following are the available surgical options -
- Arthroscopic chondroplasty
- Osteochondral autograft transplantation
- Autologous chondrocyte implantation
- Patellofemoral cartilage restoration
- Patellofemoral arthroplasty (last option)

Wishing you a faster recovery. Have a great day
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