MRI- Finding the Cause of Knee Pain

Several months ago, I was in the gym doing some back squats and felt a twinge in my right knee. I figured it was my form (which is horrible). I racked the bar, readjusted, and plowed through the rest of my workout (always a bad idea).

The next day, my knee was swollen and painful to walk on. I gave it a couple of days, and it felt a little better but I still wanted to get checked out. I asked around and found a reputable, local orthopedic doctor. He performed a clinical exam and stated that I probably have a medial meniscal tear. 

Each knee has a medial and lateral meniscus. The medial meniscus is on the inside of your knee and the lateral meniscus is on the outside. You can think of them as cushions, or shocks absorbers, between your upper and lower legs. 

My doctor gave me a script for an MRI and said we would find the best path forward from there. 

As an MRI technologist at The Radiology Clinic, I already knew where the best practice to schedule my exam was! I scheduled my appointment time to coincide with the end of my shift. When it came time for my exam, one of my MRI coworkers asked me to lie down on the scanner table and placed a coil around my knee (think of an MRI coil as a camera that takes the pictures). After I was comfortable, they gave me ear plugs to reduce the noise and headphones to listen to my favorite tunes during the exam (classic rock of course). The study took about 20 minutes.

It was different being on the other end of radiology. Usually, I’m the one performing MRI studies on patients, not the other way around. The experience was pleasant but also taught me what might be the most important aspects of an MRI experience to a patient, apart from quality. Things like comfort during the exam, noise reduction, and communication throughout the study stuck out as cornerstones of a good MRI experience. It was a good reminder of the responsibility that I/we have, as technologists, to the patient’s experience. 

Unfortunately, as my doctor predicted, the scan revealed that I do, in fact, have a medial meniscal tear. 

When I went back to the orthopedic doctor, he said I have a few options: physical therapy/strength training, surgery, or take it easy and wait and see. I have two young children and a busy schedule so I opted for the “take it easy” approach. Luckily, in my situation, it worked out. After a couple of months, my knee was close to 100%, and I was back at the gym. 

Unfortunately, for many patients, knee injuries require more than a “wait and see approach.” This is especially true to individuals whose career depends on their physical abilities such as athletes. A knee injury for these patients can be a life changing event.

Take the example of Robert Griffin III; former pro football player for the Washington Football Team. When RGIII was drafted in 2012, he was the most exciting thing to happen to football since the ball! He was one of the most aggressive, running quarterbacks in modern history. Unfortunately, running quarterbacks make themselves a prime target for defensive lineman.

Towards the end of the 2012 season, RGIII sustained an Anterior Cruciate Ligament (ACL) tear during a game. The ACL connects the femur to the tibia and provides stability to the knee. Many believe that he was poorly diagnosed and managed. In his case, it ended his career as he knew it.

Figure 1A is an MRI example of a normal, intact ACL. A yellow arrow is pointing to the dark structure stretching from the femur to the tibia. This is what the ACL looks like on MRI.

Figure 1B shows a fully torn ACL. Notice that the black line is missing, and there is a large amount of fluid in the knee, which shows up as a bright white color in MRI.

Ligaments attach bone to bone, and a ligament tear can create substantial pain and instability. A partially torn or stretched ACL may heal with time, physical therapy, and TLC. Full tears will almost always require surgical intervention for a full recovery. 

Meniscal tears, like I had, are by far the most common knee injury we see. Multiple studies have confirmed that an estimated 60% of adults over 50 have a meniscal tear. Many are unaware and have no symptoms or pain. Very often these tears are small and only require intervention when they become a problem for the patient.

Unlike ACL tears, which almost always require surgery, patients can usually find relief through a variety of treatment options for meniscal tears, including physical therapy, steroid injections, braces, or simply light duty for a while. An orthopedic doctor can guide a patient through options while considering the patient’s age, activity level, and chances of increasing the severity of the tear. 

Unfortunately in some cases, especially with moderate to severe tears, surgery is the only realistic option to relieve pain. With this being said, surgical intervention consistently produces excellent results. After a period of recovery, many patients are pain free. 

Figure 2A is an MRI study that depicts a normal meniscus. In an MRI exam, the meniscus appears as a dark wedge shaped structure. The yellow arrow is pointing to the meniscus.

Figure 2B is an example of an MRI that reveals a torn meniscus. The yellow arrow is pointing to a thick white line cutting through the black meniscus; this is the tear.

Although meniscal and ACL tears are very common knee injuries, there are others that can cause some grief including medial collateral and lateral collateral ligament injuries, cartilage injuries, posterior cruciate ligament tears, and various tendon injuries. 

At The Radiology Clinic, we only use high field MRI scanners and high resolution protocols on all of our patients. All of our studies are read by fellowship trained radiologists who can easily visualize damage to the knee. 

If your physician feels that an MRI would provide more light to your knee injury, you can trust that you’ll receive the best experience, with the highest quality imaging at The Radiology Clinic. 

If you have a doctor’s order and would like to schedule your exam, or if you have questions about the study, please call us at 301-217-0500 or email us at info@theradclinic.com. We would be happy to help you on your journey to recovery.

•  Mike Mager. An MRI Technologist at The Radiology Clinic