Dr. Naval Mendiratta
Rheumatology
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
Hello doctor,
I have a question about a 71-year old female patient with no significant diseases in her medical history. Her height is 160 cm, and her weight is 75 kg. She does not have any history of smoking, diabetes, or hypertension. She is herself a doctor.
One night, she felt a sharp pain in her left lower leg. The pain was from the knee down to the ankle. After a few days of pain, she went to the doctor and did an MRI. The report shows osteoporosis, and she was told that she needs to take medications (Osteofos 70, NSAIDs, Avosoy, Calcium, and vitamin D) and was advised to lose some weight. The report also mentioned degenerative changes in her knee joint with effusion, osteoporosis, a cyst, and osteophytes. A few days later, she twisted her leg while trying to turn around. For that, she had an x-ray of the lower leg and was told that nothing new had happened and that she needed to go to ten sessions of physiotherapy and continue her medication. After the second physiotherapy session, the left lateral knee pain went away. But during the third physiotherapy session, they pressed her patella very hard in such w way that it resulted in intense pain on her knee, and she started to have terrible left knee pain, and she could not flex her knee. She can only walk with a walker. She feels that the joint is very loose, and the joint does not feel intact. After this, she could only walk with a walker and go to the toilet and back. She got a new MRI, and this new MRI is the one that is uploaded. My requests are the following:
1) Please provide a diagnosis based on the new MRI pictures. As we are all doctors and she is a doctor herself, please explain in medical language. If any additional tests or scans are needed, please let us know.
2) Please recommend possible medical and surgical treatments because the pharmacological treatment is not helping.
3) Please let us know what conservative treatments should be done.
Thanks.
Hello,
Welcome to icliniq.com.
I have gone through your query. To start with, she has been having osteoarthritis of the knees, which has been prevalent. As you mentioned, osteoporosis may have set in along with it considering post-menopausal status. Regarding her MRI (magnetic resonance imaging), I have gone through the images uploaded (attachments removed to protect the patient’s identity). There is definite effusion around the knee which may be reactionary considering the injury she sustained in the physiotherapy. It usually settles with time. But there is a definite ligament injury seen. Her x-ray report would have helped better as the radiologist will usually grade it so the management can be planned accordingly.
The management part for ligament injury and effusion at 71 years of age does become a little limited.
1) Medically, we need to give her some anti-inflammatory for effusion to subside.
2) For ligament regeneration, PRP (platelet-rich plasma) therapy is known to help, but only after the effusion subsides.
3) If the ligament damage is at grade 3 or 4, then an arthroscopy can be done, but with her age, it may only be viable to go for replacement as the joint is already affected by osteoarthritis.
I hope the information was helpful.
Regards.
Patient's Query
Hello doctor,
Thank you so much for the reply.
I have one more quick question:
Is it possible to see the level of injury in the MRI?
If not, what imaging or test is needed to determine that?
Thank you.
Hello,
Welcome back to icliniq.com.
Yes, an MRI can easily give you the grade of injury.
Regards.
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