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Knee MRI – What would yours show?

Prevalence of abnormal findings in 230 knees of asymptomatic adults using MRI

The idea that pain must be caused by a faulty structure is no longer true. However, it remains ingrained in our culture and many patients, and professionals struggle to cleave themselves away from the routine behavior of requesting a scan for the latest joint pain. While scans, including MRI, can be very helpful and occasionally lifesaving, what happens if you scan 230 healthy knees just for research purposes? How many do you think would have an abnormality?

A: 11%

B: 37%

C: 97%

Read on to find the answer…

A 2020 study in the BJSM (reference below) MRI scanned 115 people (230 knees) with an age range of 25-73 years. All with no knee problems.

Amazingly the MRI reports found structural abnormalities in 97% of knees. 48% of the group had meniscal tears or meniscal degeneration.

Again, this group did not have any knee problems, no symptoms, asymptomatic, hopefully that’s clear here.

The study also noted that bucket handle and complex meniscal tears were reported for first time in asymptomatic knees.

The high rate of asymptomatic adults with knee joint abnormalities on MRI may indicate why arthroscopy and other surgical interventions for these do not result in better outcomes than sham surgery. Furthermore, there continues to be no evidence to suggest that meniscectomy benefits patients presenting with meniscal tear symptoms more than sham surgery.

In fact, meniscectomy and other surgical interventions could lead to further complications or deterioration of the articular cartilage and increase the risk of osteoarthritis.

The research supports a diagnosis primarily based on patient’s medical history and physical examination by an experienced clinician, instead of solely focusing on the MRI results. Sadly, this is currently the wrong way around in most healthcare settings.

Exercise and advice remain the safest and most evidence-based treatment option for meniscus related knee dysfunction and pain. Naturally any adjuncts that support the patients exercise endeavors could be utilized in the clinic or in the form of self-management.

Knee Taping may help improve knee exercise experience: https://youtu.be/oAF10VsB6n4?si=mGsIiwvCBTXPFAUy

Meniscal Rehab Video from ThePhysioChannel: https://youtu.be/gf0vy_OZQcQ?si=czn-bQcHCvelEW1l

Reference: Sihvonen R, Paavola M, Malmivaara A for the FIDELITY (Finnish Degenerative Meniscus Lesion Study) Investigators, et al Arthroscopic partial meniscectomy for a degenerative meniscus tear: a 5 year follow-up of the placebo-surgery controlled FIDELITY (Finnish Degenerative Meniscus Lesion Study) trial British Journal of Sports Medicine 2020;54:1332-1339.