Dr. Santosh Kumar Bashyal
Orthopedician and Traumatology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I am a 52-year-old female with mild OA in my knees. I injured and twisted my knee while walking with a heavy box. I have mentioned the written results of my MRI knee.
MRI right knee:
Indication: Knee instability, pain, and limited range of motion.
Comparison: None.
Technique: Multiplanar and multisequence imaging was performed without intravenous contrast.
Findings:
Osseous alignment: Normal tricompartmental osteophytic changes worst in the patellofemoral joint.
Bone marrow signal: Subchondral edema in the medial tibial plateau.
Abnormal fluid collections: Small knee effusion.
Medial meniscus: There is a tear in the meniscal body, extending to the inferior articular surface.
Lateral meniscus: Intact and normal in signal intensity.
Cruciate ligaments: Intact and normal in signal intensity.
Collateral ligaments: Intact and normal in signal intensity.
Patellar retinacula and extensor mechanism: Normal.
Articular cartilage:
Patellofemoral joint: Severe thinning of cartilage along the inferior aspect of the lateral patellar facet. Cartilage edema along the medial patellar facet.
Medial compartment: Severe thinning along the weight-bearing portion of the condyle.
Lateral compartment: Preserved.
Impression:
DJD with patellofemoral and medial compartment predominance.
Medial meniscal tear involving the periphery of the meniscal body.
Small knee effusion.
Kindly help me.
Hello,
Welcome to icliniq.com.
I went through your complaint and MRI (magnetic resonance imaging) findings. I want to make you understand simply. Due to a twisted injury over your knee, you got an injury over the cushion part of the knee, which contains the medial and lateral meniscus. The commonest structure to get damage or tear is the medial meniscus. If you attached the film, I could even know how deep the tear is. But we can also see some dirty water collected inside the joint, which is causing you pain. As you are 52 years old, I would also like to know whether you are a post-menopausal woman or not. Other factors include hormonal changes and erosion of the cartilage, which supports the knee joint. So during friction movement, you get pain; this finding should be from before the injury. Also, the report says you have an injury over the peripheral part of the medial meniscus, so the blood supply area should be preserved.
Patient's Query
Hi doctor,
May I know what dirty water is? And what is bone marrow signal: subchondral edema in the medial plateau? I am almost at menopause but still have periods. Unfortunately, I cannot seem to upload the image, but I saw the doctor today.
Hello,
Welcome back to icliniq.com.
I used the phrase dirty water to explain the mechanism of twisting injury and tear in the medial meniscus that causes micro hemorrhage (small amount of blood collected in the joint space of the knee) and results in pain. The medial plateau means the prominent head structure of the tibia, like Mount Everest, where the medial meniscus and anterior cruciate ligament (ACL) are inserted. But other structures, such as the anterior cruciate ligament and posterior cruciate ligament (PCL), are fine, according to the reports. This edema means the presence of swelling and some dirty fluid present over that structure which causes pain during movement (flexion). I hope you understand. As you are near menopausal, I suggest you take care of your bone cartilage and hormonal status. In addition, I would suggest you take a bone mineral density test (BMD) to know the density of bone and to know whether you are at risk of osteoporosis or not. May I know what did your doctor suggest to you today?
Patient's Query
Hi doctor,
Thank you. How do I get rid of dirty water, or does it resolve on its own in time? I saw the doctor later today, and asked me to get a BMD test.
Hello,
Welcome back to icliniq.com.
Yes, sometimes it gets healed with a natural blood system. But I suggest you wear a knee hinge brace. Then, according to your capacity and pain, you can increase the movement in flexion. I also suggest you take the following medications:
1. Tablet Serratiopeptidase three times a day for one week (it reduces the inflammatory reaction in your knee due to medial meniscus injury, edema, and dirty fluid).
2. Collagen, Hyaluronic acid, Zinc supplement, and Vitamin D3 supplement for at least one month; we can extend it up to three months depending upon your condition (it will reduce your edema and inflammatory response in your knee).
I also suggest you do quads and calf muscle gentle strengthening exercises. So gradually, it will get healed.
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