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MRI of The Knee Medical Transcription Sample Report

MRI OF THE LEFT KNEE

Left knee MRI is performed in the usual fashion. The patient had significant trauma. There is a nondisplaced fracture, which is vertical in orientation, primarily between the condyles of the distal femur. Much edema is noted around it. The axial planes show a well-demarcated line extending directly between the medial and lateral femoral condyles and extending anterior to a location directly behind the patella. However, there is not a definite cortical break to the most anterior component to indicate that this is a complete fracture. No fragmentation is noted. Edema on either side of the fracture line is apparent. There is no meniscus in portions of the medial meniscus. This is either iatrogenic or is due to a complete tear and possible buckling. There is loss of the normal condyle surface involving the medial tibial plateau and medial femoral condyle. The lateral meniscus anteriorly is intact. Posterior component suggests some mucoid degeneration and possible partial and peripheral horizontal tear. The PCL is thickened and on fat saturated images shows some edema within it, which may indicate a strain. It is grossly intact. The ACL is not completely visualized on this examination and suggests that it is completely torn. Age of that tear is uncertain. There is some chondral injury to the posterior patella and the anterior femoral condyle. No Baker's cyst is present on this examination. Minimal joint effusion is present.

IMPRESSION:
1.  Nondisplaced fracture placed directly central between the lateral and medial femoral condyles, extending both in anteroposterior and vertical component. Edema and contusion is noted around it. It is questionable  as to whether it is complete. No dislocation or fragmentation is associated with it.
2.  Either iatrogenic removal of part of the lateral meniscus or a complete tear with possible flap has occurred over time. There is chondral erosion noted at the lateral femoral condyle and lateral tibial plateau as well.
3.  Posterior cruciate ligament appears grossly intact but does have edema and some thickening indicating a possible strain.
4.  Anterior cruciate ligament is not visualized indicating that it is not intact. Age is uncertain, however, as there is not much edema in that area to indicate an acute injury directly at that time.

MRI OF THE RIGHT KNEE

Multiplanar images were obtained.  The PCL is intact.  The ACL appears to be grossly intact but slightly increased signal.  Some partial injury to the ACL is not excluded.  Overall, the menisci appear to be grossly intact.  There is some slight globular increased signal in the posterior horn of the lateral meniscus for which a degenerative-type change is not excluded.  The menisci are otherwise within normal limits.  The collateral ligaments are grossly intact.  There is soft tissue edema laterally, lateral to the lateral collateral ligament.  There is no significant suprapatellar joint fluid.  There is no significant popliteal cyst.

IMPRESSION:
1.  There is edema in the lateral soft tissues.  Collateral ligaments are intact.
2.  Anterior cruciate ligament is grossly intact but increased signal for which a partial injury is not excluded.
3.  Menisci are intact.  There is some globular increased signal in the posterior horn of the lateral meniscus for which degenerative change is not excluded.
4.  The underlying bony structures appear intact.

MRI OF THE LEFT KNEE

Multiplanar images of the left knee were obtained without contrast.  The ACL and PCL are both intact.  The collateral ligaments are intact.  There is some mild anterior lateral fluid.  There is some very minimal posterior medial fluid.  The menisci are intact.  The marrow signal within the bony structures is within normal limits.  On the coronal images only, there is a mild defect involving the medial aspect of the lateral femoral condyle suggestive of a nondisplaced fracture.

IMPRESSION:
1.  Menisci, collateral ligaments, and cruciate ligaments are all intact.
2.  There is some very minimal fluid posteromedially suggestive of a minimal popliteal cyst.
3.  There is no significant suprapatellar joint fluid.
4.  There is some lateral fluid collection that is more posteriorly located.
5.  There is a nondisplaced osteochondral defect involving the mid aspect of the lateral femoral condyle medially.  The cartilage appears intact.  This is suggestive of a nondisplaced fracture such as an osteochondritis dissecans.

LEFT KNEE MRI

Routine MRI of the left knee is performed.  There is a horizontal peripheral tear suggested of the most peripheral and posterior aspect of the medial meniscus.  No vertical tear component is definitely seen. There is an unusual presentation of the anterolateral meniscus.  It is separated from the superior tibia.  This would suggest the possibility of a partial detachment.  Much fluid is noted in that area.  No injury to the underlying tibial surface is noted however.  Please correlate to any sign of discomfort in that region.  The lateral meniscus itself is grossly intact without vertical or degenerative tear suggested. No osteochondral defects are noted. The ACL and PCL are intact. There is some chondral irregularity of the posterior patellar surface indicating some contusion or chronic inflammation/irritation to that region.  A small-to-moderate joint effusion is present. The medial and lateral retinaculum and collateral ligaments are intact. No significant Baker's cyst is present.

IMPRESSION:
1.  Small horizontal and peripheral posterior tear of the medial meniscus is suggested.  No vertical tear component is definitely seen.
2.  Possible, at least partial detachment of the inferior aspect of the anterolateral meniscus relating to the underlying tibial surface.  The tibial surface, however, is without contusion or trauma indicated.  Please correlate to clinical exam.

LEFT KNEE MRI

INDICATION FOR STUDY:  The patient has a possible posterior medial meniscal tear.  The patient has a known osteochondral defect.  History of skeletal dysplasia and prior meniscal repair on the right knee.

Today's examination is compared to the report of the left knee MRI of MM/DD/YYYY.  Those films are not present for a direct comparison. We once again see, as was indicated on the prior report, a large osteochondral defect seen in the posterior medial femoral condyle.  This is a large broad-based defect.  It is filled with a substance having a similar intensity to the fluid in the joint space, and therefore, it is believed simply to be a fluid space occupying.  This defect does involve both a small portion of the osteoid and the chondral area involved.  The largest diameter in its horizontal plane is approximately 1.5 cm in width.

The underlying posterior medial meniscus is not normally seen on this examination.  There is much edema within that area of the joint space, which could obscure some smaller fragments but most of the posterior medial meniscus is not present or not identified due to a possible very thin nature.  This includes both the sagittal and coronal imaging using several different planes.  This would suggest at least a degenerative tear if not a component, which may involve a bucket handle type tear. The lateral meniscus appears intact.  The lateral femoral condyle is intact. There is again extreme thinning of the ACL and the orientation of the lower half of the ACL, which lies horizontal to the tibial plateau, indicates a tear.  Please correlate to clinical examination. The chondral surface of the lateral femoral condyle and the posterior patella is within normal limits.  There is a moderately significant joint effusion present.  There is a very minor, approximately 5 mm x 1 cm Baker's cyst suggested.

IMPRESSION:
1.  There is no normally visualized posterior medial meniscus present.  It does appear in one image to have a degenerative-type tear with a very minimal amount of meniscus still remaining, which indeed on one of the images suggests even a large bucket-handle type tear.  This area is obscured with a large amount of fluid due to the overlying large osteochondral defect.  This osteochondral defect does present as a broad-based cavity, which is filled with probable effusion.
2.  There is questionable tear of the anterior cruciate ligament.