What can an exam and scan tell me?

What will happen during the visit?

The clinician will ask when the soreness began and what makes it better or worse. You'll likely be asked to bend the joint and show where it hurts.

The exam may check swelling, motion, strength, balance, and joint stability. Bring any old reports, your medicine list, and brief notes about recent flares.

You can ask, “What else could be sore besides the cartilage?” That question helps keep one MRI phrase from taking over the whole visit.

What do X-rays and MRI add?

A weight-bearing X-ray can show spacing, bone changes, and how the joint lines up. MRI shows cartilage, bone, the meniscus, ligaments, and joint fluid in more detail.

Neither test can tell how much soreness you feel. The useful answer joins your symptoms, the hands-on exam, and the images.

Ask whether the chondral defect is deep and whether bone is involved. Also ask if wider wear changes which choices are realistic.

Which warning signs can't wait?

Get medical help when an injured joint swells within hours or won't hold your weight. True locking, sudden weakness, or an inability to straighten it also needs attention.

If fever comes with heat and swelling in the joint, get urgent help. Don't wait for an office appointment if the change is severe or moving fast.

After any procedure, report new calf swelling, numbness, weakness, or quickly rising soreness. Your treating clinic can tell you whether urgent care is needed.

Sources

1. In a meta-analysis of 63 studies covering 5,397 knees of 4,751 adults with NO symptoms and no injury, the pooled prevalence of cartilage defects on MRI was 24% (95% CI 15% to 34%), rising from 11% in adults under 40 to 43% in adults aged 40 and over. Meniscal tears were present in 10%, bone marrow lesions in 18% and osteophytes in 25%.

   Culvenor AG, et al. — Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis.. Br J Sports Med, 2019. DOI: 10.1136/bjsports-2018-099257.

2. In 51 patients whose Outerbridge grade 3 or 4 chondral lesion (mean size 2.1 cm2) was found incidentally during ACL reconstruction and deliberately left untreated, outcomes at 10 and 15 years were not statistically different from matched ACL-only controls on Lysholm, Tegner or IKDC objective scores. At 10 years the subjective IKDC was modestly lower in the defect group (79.6 versus 83.7 points); by 15 years even that difference had gone.

   Widuchowski W, et al. — Untreated asymptomatic deep cartilage lesions associated with anterior cruciate ligament injury: results at 10- and 15-year follow-up.. Am J Sports Med, 2009. DOI: 10.1177/0363546508328104.

3. A JBJS evidence-based review of chondral lesions of the knee sets management by lesion size, location, limb alignment and rotation, and patient demand rather than by product: osteochondral autograft transfer is described as durable and predictable for smaller lesions (under 2 cm2) in young active patients, while lesions of 2 cm2 or more are typically treated with osteochondral allograft transplantation, particulated juvenile articular cartilage, or matrix-associated chondrocyte implantation, with favourable mid- and long-term results reported for allograft or MACI in large lesions of 3 cm2 or more.

   Dekker TJ, et al. — Chondral Lesions of the Knee: An Evidence-Based Approach.. J Bone Joint Surg Am, 2021. DOI: 10.2106/JBJS.20.01161.

4. Ten to 20 years after a diagnosed anterior cruciate ligament or meniscus tear, on average 50% of those patients have osteoarthritis with associated pain and functional impairment - the young patient with an old knee. The review found a lack of evidence that reconstructive or repair surgery protects against that outcome.

   Lohmander LS, et al. — The long-term consequence of anterior cruciate ligament and meniscus injuries: osteoarthritis.. Am J Sports Med, 2007. DOI: 10.1177/0363546507307396.

5. A systematic review of 32 studies found that osteoarthritis develops in the long term in knees operated on for meniscal tears, with the amount of meniscus removed, duration of pre-operative symptoms and lateral meniscectomy showing the strongest statistical association with later osteoarthritis.

   Papalia R, et al. — Meniscectomy as a risk factor for knee osteoarthritis: a systematic review.. Br Med Bull, 2011. DOI: 10.1093/bmb/ldq043.