need help interpreting an MRI

[dreamer101]

I am almost 54, male, have sharp pain on right knee when I bend/fold knee (for 7 weeks), and folding seems quite tight, cant treadmill anymore. Fluid over kneecap was drained out and cortisone shot given 5 weeks back. Still new fluid has accumulated. MRI done is below, would like some interpretation. Arthritis is there definitely (from X-ray). Have I lost cartilage around kneecap, and can I regrow some cartilage somehow? I do not want to do knee replacement at this point, if somebody could tell me what to make of the below report:
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Osteochondral lesion involving the lateral aspect of the medial femoral condyle.

Patellofemoral compartment arthrosis and chondromalacia.

Moderate joint effusion.

Narrative
MRI RIGHT KNEE WITHOUT CONTRAST

** FINDINGS **:
TECHNIQUE: Multiplanar multisequence MR images of the right knee were obtained without intravenous or intra-articular gadolinium.

Menisci: The medial meniscus is intact. The lateral meniscus is intact.

Cruciate and Collateral Ligaments: The ACL is intact. The PCL is intact. The MCL is intact. The LCL complex is intact.

Extensor Mechanism: The visualized quadriceps tendon is intact. The patellar tendon is intact. The patellar retinaculum is within normal limits. Hoffa's fat pad is unremarkable.

Osseous Structures and Articular Cartilage: There is an osteochondral lesion involving the lateral aspect of the medial femoral condyle measures 11 mm medial to lateral by 14 mm anterior to posterior with underlying edema and overlying chondral fissuring. The lateral compartment cartilage is well preserved. There is fissuring of the lateral patellar facet and adjacent trochlear cartilage. No acute fracture or contusion.

Fluid: Moderate joint effusion. There are no osteochondral bodies.

There are no popliteal fossa cysts.

[vickster]

From the MRI, you have damage to the cartilage on the medial (inner) surface of the kneecap, to the trochlea (groove the kneecap sits in) but more you have a reasonable sized defect on the medial consuls ( the knobbly bit on the bottom of the thigh bone)

Unfortunately it's very hard to regenerate cartilage. You could try stem cells, PRP (but little evidence) or you might get relief from the inflammation from hyaluronic acid injections. Cortisone best avoided if possible as can further degrade articular cartilage

Have a read of the arthritis primer and other related resources in the learning portfolio. There are some cartilage repair options (depending on your country of residence) but they're a bit hit and miss especially in older patients (ie 35+)

Ice, physio, avoiding aggravating, pain meds, anti inflammatories, compression, elevation, weight control, usual treatments for arthritis

[dreamer101]

Thanks for the info. What did you mean by elevation? Also, I am in the South Bay area in USA, I saw cartilage repair stuff at https://www.ucsfhealth.org/treatments/cartilage_repair/ but seems like it can be problematic. Not an easy solution by any means.

[vickster]

Elevate your leg while sitting, so foot off floor, and when lying, keep it above your heart preferably which will help the fluid drain and also stop more accumulating

Here's the arthritis primer
https://www.kneeguru.co.uk/KNEEnotes/pr ... oarthritis
And another article
https://www.kneeguru.co.uk/KNEEnotes/ar ... eplacement

[dreamer101]

There was a missing part of the report that I see on printed copy, it's below:

Impression:
Osteochondrial lesion involving the lateral aspect of the medial femoral condyle.
Patellofemoral compartment arthrosis and chondromalacia.
Moderate joint effusion.

So far, the fluid has never completely subsided, although sometimes it has been less. Compression helps a bit, I think. When I bend the knee for a physiotherapy pose, I get pain so I stopped that pose. Also a bent knee brought back to straight position at a certain pain can trigger the pain point, I have noticed.

I am taking Osteobiflex, turmeric, ginger. Occasionally Magnesium.

One good thing, I have noticed, gas to brake, brake to gas, on driving, used to pain before, that has subsided. Maybe with more time, the pained internal bone will naturally heal. Just hoping.