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What do these following MRI findings indicate?

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Posted on Fri, 2 Dec 2016
Question: Hi. My wife XXXXXXX XXXX had fallen from stares in april 16 and her ligament had broken . She had gone for physiotherapy for two months got some relief but still not able to move straight and pain is still there while movement. The report is as below. Please suggest for the right treatment.
42Y / F
20-04-2016 / 01:39 PM
Patient
Referred By Dr XXXXXXX XXXXXXX
Registration Date
S-760
Mrs XXXXXXX XXXX Age/Gender
Reg. No.
Printed On 21/04/2016 / 04:39 PM
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MRI - RIGHT KNEE WITHOUT CONTRAST
MRI of right knee was done on 1.5 Tesla using extremity coil. PD, T2W, GRE and T2W fat-sat sagittal imaging was done. T1W coronal and T2W
fat-sat coronal and axial imaging was also done.(CD containing MRI images given along with the films).
There is non-visualisation of ACL, likely represent chronic complete tear. Buckling of
PCL is noted with anterior translation of tibia with respect to femur.
Mild ill-defined intrasubstance increased signal intensity is seen in proximal fibers of
PCL near femoral attachment, may represent early myxoid degeneration changes.
Edematous / fluid signal are seen on both sides of MCL, suggest grade I injury (sprain).
LCL is intact. Mild edematous signals are seen in relation to it, may represent low grade
injury.
Altered morphology with increased signal intensity is seen involving body ad posterior
horn of medial meniscus, suggesting tear.
Increased signal intensity is seen in body - posterior horn of lateral meniscus reaching
upto inferior articular surface, suggesting tear.
Mild to moderate joint effusion is seen with fluid in posterior recess.
An area of partial to full thickness cartilage erosion, measuring ~ 17 x 8mm is seen at
medial femoral condyle. Mild underlying subchondral sclerosis is seen. Subchondral marrow
edema is seen at medial femoral and tibial condyles, probably post traumatic. D/Dx:-
degenerative. Small focus of cartilage thinning is seen at medial facet of patella. Tiny focus of
subchondral marrow edema is seen at lateral trochlear surface of femur, suggesting
degeneration changes in overlying articular cartilage. No definite cartilage erosion is seen at
lateral tibiofemoral compartment. Small osteophyte are seen at medial tibiofemoral
compartment.
Trochlear groove is shallow in its cranial part, suggesting element of trochlear dysplasia.
Otherwise visualised bones reveal normal marrow signal intensity.
Patellar and quadriceps tendons are unremarkable.
There is thinning of medial patellar retinaculum with edematous signal in its posterior
aspect. Mild edematous signals are seen between adductor magnus tendon and vastus
medialis obliquus muscle.
Mild edematous / fluid signals are seen along myofascial planes of distal posterior fibers
of biceps femoris and proximal fibers of gastrocnemius muscles. Rest of the visualised muscles
reveal normal signal intensity.
Mild circumferential periarticular subcutaneous edema is seen.
IMPRESSION- Non visualisation of ACL, likely represent chronic complete tear.
- Grade I MCL injury (sprain).
- Tear of both menisci.
- Mild to moderate joint effusion.
- Early osteoarthritis of knee.
- Element of femoral trochlear dysplasia.
Clinical correlation is suggested.
Dr. XXXXXXX Lakhyani, MBBS, MD Dr. XXXXXXX XXXXXXX DMRD, DNB
XXXXXXX MRI Consultant MRI Consultant


Two days back she has again fallen while washing clothes. Again the swelling has come at knees and lot of pain is there in knees. Please suggest what to do in this case.
doctor
Answered by Dr. Gopal Goel (44 minutes later)
Brief Answer:
Primarily Re construction of ACL Tear is required as an immediate procedure

Detailed Answer:
Hi I am Dr Gopal Goel , Orthopedic Surgeon.
I have read the history and detailed report of MRI.Imp points are:
1.MRI report is significant for it reports complete tear of ACL( Anterior Cruciate Ligament)-- It is primarily this ligament which causes stability in the joint. At her age (42 yrs) she must undergo surgery for reconstruction of ACL to restore stability.
2.While the surgeon is doing arthroscopic examination he will be in a better position to evaluate both menisci and if required will do partial meniscectomy.
3. Cartilage defects are a sign of Osteoarthritis and can be treated at a later stage.
4.Grade 1 MCL injury will heal over time without surgical intervention.
5. Joint effusion will improve once healing of all tissues has undertaken.
Once again I suggest immediate treatment of Anterior Cruciate Ligament.
I hope to have answered all your queries. Pl don't hesitate to ask any question.
Above answer was peer-reviewed by : Dr. Veerisetty Shyamkumar
doctor
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Follow up: Dr. Gopal Goel (1 hour later)
Good evening Sir, Obliged for your prompt and kind reply. Kindly advise can ACL be cured without surgery and surgery is required then how is the success ratio and whether it will be minor surgery or major surgery. How much it will cost and what shall remain the precautionary post surgery factors.
doctor
Answered by Dr. Gopal Goel (22 minutes later)
Brief Answer:
only surgery is useful

Detailed Answer:
Hi I am Dr Gopal Goel Orthopedic Surgeon.
ACL tear can not be treated without surgery. Only surgical reconstruction(not Repair) is the answer. It will be done through arthroscopy and results are generally good. The cost will depend on the center and the endo buttons used . but roughly it should cost around 1.2 L. Post surgery walking can be started next day , with support , and most important is physiotherapy.
All the best for surgery and recovery.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Gopal Goel (16 hours later)
Thanks a lot Sir. Sir one more thing that my wife's knee is dislocating from many years and would set up after some hours. Shall this dislocating problem also be over after this surgery.
doctor
Answered by Dr. Gopal Goel (7 minutes later)
Brief Answer:
Knee dislocation

Detailed Answer:
Hi I am Dr Gopal Goel ,Orthpedic surgeon
Recurrent knee dislocation is very uncommon condition. If it is recurrent dislocation of patella(which is more likely as indicated by shallow groove in MRI) - It may require additional surgery. Too many operations at one time will lead to post operative adhesions and stiffness. But Ask your surgeon to look for any other finding. The treatment for recurrent dislocation of patella can be undertaken at a later stage.
Hope this answers your query.
Above answer was peer-reviewed by : Dr. Veerisetty Shyamkumar
doctor
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Dr. Gopal Goel

Orthopaedic Surgeon

Practicing since :1983

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What do these following MRI findings indicate?

Brief Answer: Primarily Re construction of ACL Tear is required as an immediate procedure Detailed Answer: Hi I am Dr Gopal Goel , Orthopedic Surgeon. I have read the history and detailed report of MRI.Imp points are: 1.MRI report is significant for it reports complete tear of ACL( Anterior Cruciate Ligament)-- It is primarily this ligament which causes stability in the joint. At her age (42 yrs) she must undergo surgery for reconstruction of ACL to restore stability. 2.While the surgeon is doing arthroscopic examination he will be in a better position to evaluate both menisci and if required will do partial meniscectomy. 3. Cartilage defects are a sign of Osteoarthritis and can be treated at a later stage. 4.Grade 1 MCL injury will heal over time without surgical intervention. 5. Joint effusion will improve once healing of all tissues has undertaken. Once again I suggest immediate treatment of Anterior Cruciate Ligament. I hope to have answered all your queries. Pl don't hesitate to ask any question.