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Old 07-19-2012, 09:36 PM   #1
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Synvisc injections and my MRI report

I had my third Synvisc injection 2 weeks ago. So far I am still having alot of pain and swelling of the knee and around the knee. I am placing ice on my knee 2 to 3 times a day and taking pain meds. They said it could be 3 weeks
after my third injection before it kicks in. I am worried that the injections may not help. The following is my MRI report that I am still trying to wrap my head around of what all it means.
There is some mucoid degenerative signal in the anterior horn of the medial meniscus with mild meniscal extrusion without a tear. The body of the medial meniscus has some mild truncation and extrusion without a tear. The posterior horn of the medial mniscus is unremarkable.

The latral meniscus shows no abnormal signal to suggest a tear. Th lateral meniscus shows no extrusion. No parameniscal cysts are around the lateral mniscus. The posterior root of the lateral meniscus is intact.

The anterior cruciate ligament shows no abnormal signal to suggest a tear. The posterior cruciate ligament is unremarkable. The extensor mechanism shows no edema to suggest a tear. The mdial collateral ligament is intact without a tear. The fibular collateral ligament is unremarkable. The biceps femoris tendon shows no tear. The iliotibial band reveals no inflammation.

There is no significant joint effusion. There is a small Bakers cyst. There may be some mild synovial thickening within the knee joint. There is grade IV chondromalacia of the medial patellar facet with mild subchondral bone marrow edema and cystic change. The medial trochlea also has a small area of grade IV chondromalacia with small osteophytes. The weight bearong medial compartment has grade IV chrondromalacia with small osteophytes. The lateral compartment has some mild diffuse articular cartilage thinning. No definite intra-articular bodies are identified.

The bone marrow shows no contusions or fractures.

The muscles have some mild chronic fatty atrophy. The fat around the knee has mild edema. No soft tissue masses or hematomas are present.

Impression: There is articular cartilage loss in the medial compartment greater than the patellofemoral compartment.

There is some mild medial meniscal degenration without a meniscal tear.

Ok, thats my MRI report the part that worries me the most is the grade IV.
So I am concern that the injections may not help. If you have gone thru some knee problems also please share.

 
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Old 07-20-2012, 07:31 AM   #2
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Re: Synvisc injections and my MRI report

Chondromalacia is a softening of the cartilage under the kneecap. I had that in both knees. Mine was not diagnosed through an MRI. My doctor diagnosed it during a physical exam of my knees. My kneecaps were also subluxing (popping out of their groove. That was diagnosed with a special x-ray view. I went to physical therapy several times during three years, but that didn't help me. Because my kneecaps were not tracking correctly, my orthopedic surgeon said that I needed surgery to correct the tracking issues. I had surgery on my left knee in 2008, and the surgery for my right knee was a year later. During my surgeries, the surgeon cleaned out all of the frayed/torn cartilage under my kneecap. I am glad that I had the surgeries done. I am more active now than I was before my knee problems started.

I hope this helped.

 
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Old 07-20-2012, 09:24 AM   #3
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Re: Synvisc injections and my MRI report

Synvisc is a good option for chondromalacia, even in Stage IV. Give it a few more weeks and see what happens. Keep in mind, chondromalacia is pre-arthritis, so Stage IV doesn't mean your knee is dead, just that it's beginning to have real osteoarthritis.

 
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Old 07-20-2012, 02:04 PM   #4
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Re: Synvisc injections and my MRI report

Yes your replies help. I had read some where that if your knee is at a stage IV that the injections would not help so I was really hoping that this was not true. I know I will need a total knee replacement at some time but my doctor is hoping the injection would help. I am 50 so he said to try to hold off 4 to 6 years if the injection work. I work at a school so I am off right now for the summer but in 20 days I start back to work and I will be on my feet so I am hopeing not to come home in pain everyday.

 
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Old 07-22-2012, 05:46 PM   #5
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Re: Synvisc injections and my MRI report

Hi Janewhite1,

I'm not sure where you got your information, but I just looked up chondromalacia and whether it was the same as early osteoarthritis. IT IS NOT THE SAME!!!

According to the article I just printed out from an online site about Degenerative Chondromalacia, the condition is not the same as osteoarthritis, and one does not necessarily lead to the other! Here is the difference according to this article: "Osteoarthritis results from long-term wear and tear that causes the lining of the joints to become rough and painful. Chondromalacia results from an INJURY to otherwise healthy cartilage, or a response to abnormal pressure on the cartilage." The article goes on to say that Chondromalacia can actually be prevented in many cases, such as using proper bending and lifting techniques to prevent excessive stress on the knee. Another article I read on the topic says this condition usually only affects people engaged in high impact sports that put a lot of stress on the knees repeatedly.

The condition can be treated several ways both non-surgically and surgically, but from what I read, IT DOES NOT MEAN THAT west2222 WILL DEVELOP OSTEOARTHRITIS in her knee OR need a TKR for Chondromalacia (IF that's really what she has!) And besides, osteoarthritis is not only a degenerative wear and tear disease, but it is USUALLY somewhat hereditary. I know I got MY osteoarthritis partly from my late father who had it in his knees, though he never tore his meniscus in either one through all the years that he played racquetball! I was a "couch potato" while he was alive, and I'M THE ONE WHO DEVELOPED "END-STAGE" OSTEOARTHRITIS IN BOTH KNEES, necessitating TKR's in the past year for both. (I could not take the Synvisc as I found out that I would have been allergic to one of its chemical components.) My ONLY OPTION was the TKR surgery on both knees, and now, I AM REALLY GLAD I HAD THEM DONE!!

As for west2222, I suspect that maybe her Ortho surgeon might have goofed on the diagnosis (or whoever looked at and interpreted the results of her MRI). It's entirely POSSIBLE that what she really does have IS the beginning of osteoarthritis, particularly because, as she notes in her last post, she is 50 and that is the average age at which MOST patients start developing osteoarthritis. Plus, as she notes, she works at a school and is on her feet all day five days a week! That can certainly contribute to the wear and tear of her knee cartilage. If the Synvisc DOES start to kick in soon, since she just finished the round of 3 injections, and she does find relief from the pain, then I would agree with her surgeon to try and hold off on asking for a TKR for a few more years. (He can always do another round of Synvisc injections, every six months if need be.) However, if she finds the pain coming back in less than six months every time she has the injections, THEN, she would probably have to consider the more reliable and proven track record option of knee replacement. Synvisc, for those who CAN take it (unlike me as noted above), has only been out there a few years and does not yet have a long-term reliable success rate in MOST patients. Total knee replacement surgery, which has been around for almost 40 YEARS, now has a proven success rate of 90+ PERCENT in most patients! Plus, the models of prosthetic knees being used today, as opposed to the original metal on metal TKRs, are designed to last much longer - usually 20 to 25 years or more in someone who is not a uber athlete. And, since the majority of TKRs are being done on people from their mid-fifties (like me), upward, the likelihood of the prosthetics lasting the rest of the patient's life are pretty close to 100%! Plus, the newer ones being used are now GENDER SPECIFIC, so the fit during the surgery is usually more successful.

Just wanted you and west2222 to understand the difference between chondromalacia and osteoarthritis. Chondromalacia, as noted above, is a CONDITION that results from injury to otherwise healthy cartilage, whereas Osteoarthritis is a DISEASE OF THE JOINTS!!

west2222, I hope this explanation clears things up for you and helps you decide how you want to have your Ortho surgeon proceed down the line with long-term treatment of your knees. You MIGHT want to get a second opinion from another Ortho surgeon as to what you ACTUALLY HAVE GOING ON IN YOUR KNEES!

Regards,
Carol

Last edited by ldy12; 07-22-2012 at 05:54 PM. Reason: grammar corrections; more info

 
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Old 07-22-2012, 07:19 PM   #6
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Re: Synvisc injections and my MRI report

I still think chondromalacia may be the correct diagnosis. I did not have an injury prior to my diagnosis, but my surgeon did see that my cartilage under my kneecap was softened and frayed. At my first post op appointment after I had my surgery, the surgeon told me that I will develop osteoarthritis in my knees because of the cartilage that he had removed or had already worn away.

 
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Old 07-23-2012, 10:12 AM   #7
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Re: Synvisc injections and my MRI report

Hi ozfan,

As long as you have confidence in your surgeon, that is probably the MOST IMPORTANT aspect of getting proper treatment and relief of your symptoms.

Note that the article I quoted to Jane merely distinguished between chondromalacia and osteoarthritis as being TWO DIFFERENT DIAGNOSES, and that one (the chondromalacia) did NOT NECESSARILY mean that you would develop the osteoarthritis.

If you DO end up needing a total knee replacement because of the condition of your knee, please feel free to post with ANY pre-op questions you might have, so you know what to expect during and after surgery. Since I've been there, done that twice in the last year and had excellent surgical experiences and outcomes on both knees, I feel well equipped to be able to help others who are now going through what I did.

Good luck and keep me posted.

Best regards,
Carol

Last edited by ldy12; 07-23-2012 at 10:14 AM. Reason: more info

 
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Old 07-23-2012, 02:29 PM   #8
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Re: Synvisc injections and my MRI report

Thanks for posting what you have been thru everyone. It helps so much to know others understand what I am going thru with my knee and the pain that I have been in.
As far as the osteoarthritis I had test 5 years ago and I have been dealing with arthritis so I know a good part of my problem with my knee (maybe knees) is osteoarthritis but I had also read that I probably had an injury to my knee first. I played alot of sports growing up and was pretty rough on my knees.
As far as my knee and the injections I am just this week beginning to notice an improvement I think. I still have some pain off an on but not like it was, and I was waking up thru the night in pain and also having swelling first thing in the morning but the last 4 days that has improved the most. I have been walking a mile in the mornings and handling it pretty good. I feel I am heading in the right direction. I am think about asking to have an MRI on my right knee, I am not sure if the pain I am starting to have in the other knee is do to damage to it also or because I have put more pressure on it due to the other knee. I think it makes since that since my left knee is so bad that my right knee most likely has problems also.
Do most of you have problems with one knee or both knees?

 
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Old 07-23-2012, 02:55 PM   #9
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Re: Synvisc injections and my MRI report

Hi west2222,

You should DEFINITELY ASK for an MRI on your right knee if it's starting to be painful. You are ABSOLUTELY CORRECT about possible meniscal tears in your right knee because you ARE FAVORING IT while you are being treated with the Synvisc in the left one. If you put too much stress on the "supposedly good knee", it eventually will develop osteoarthritic problems.

That's what happened to me last year two months before my right total knee replacement surgery. I started feeling pain in my left knee because it was the "good" knee at the time. Turns out I HAD DEVELOPED a meniscal tear AND A TORN ACL (anterior cruciate ligament) in the left knee. My surgeon agreed to do an arthroscopy at the tail end of my right TKR surgery, on the left knee. Unfortunately, as good a repair job as he did, 8 months later, I was back in his office, telling him that the left knee was going bad again. He took an x-ray and said it was probably about time for a left replacement this spring. He tried two cortisone shots six weeks apart first, but that didn't help. So by the end of January, I was begging him to do the left TKR the first available date in March, which was actually four months ago today (3/23/12)! When he opened the left knee to start the TKR surgery, he told me later, that he found it was worse than he expected in there! I had NO CARTILAGE LEFT AND THE ACL WAS ALSO TOTALLY GONE! He had to clean all that out first, before he could start cutting to fit the prosthetic knee! He said he had to do a lot more cutting than he originally anticipated. But the good news was that, since I now had the right stable TKR to work with this time, my left TKR recovery went MUCH FASTER THAN LAST YEAR'S SURGERY!!

When I got the surgical reports for both TKRs, he noted that the diagnosis was "end-stage" osteoarthritis in BOTH KNEES!

But he did a fantastic job and I did the rest in rehab and now I'm a VERY HAPPY CAMPER, WITHOUT PAIN IN MY KNEES FOR THE FIRST TIME IN SEVEN YEARS!

Glad to hear you're starting to have a good response to the Synvisc. (As I noted in my previous post, I could NOT have had Synvisc last year because I am allergic to one of its components. TKR surgery for the degree of osteoarthritis I had, was the ONLY option for me.)

Keep me posted on your progress, and let me know what you find out about your right knee.

Regards,
Carol

 
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