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454422 tn?1211419425

MRI CONFUSION

Hello all, I am a little confused over my most recent MRI.  I had arthroscopic surgery in 11/2007 after an MRI show a complete tear of the mid and anterior horn of the lateral meniscus, joint effusion with a rather large Baker's cyst and degenerative changes.  I have continued to have severe pain, swelling, limited mobility, unable to staighten my leg, feeling that my knee was going to lock up give way.  I demanded another MRI, which I had yesterday.  I received my report, this morning, being a nurse helped a lot, and this MRI showed 1) large joint effusion with large Baker's cyst, 2) complete absence of cartilage in lateral joint compartment, 3) subchondral edema and 4) chronic appearing complete tear of the mid anterior horn of the lateral meniscus.  My doc. has been blaming my pain on age, arthritis and weight.  Could it be possible that I have another tear to a different part of my knee.  I'm just confused!  I have a doc. appt. next week for a second opinion.  Any input just to put my mind at ease, would be appreciated.  Thanks :)
1 Responses
Avatar universal
Hello Dear,

I understand your problem and your concern.
How old are you?
Since how long have you been having the symptoms of arthritis?
Arthritides - osteoarthritis is the commonest condition associated with a Baker's cyst. Rheumatoid arthritis is another common association. In one study Baker's cysts were demonstrated in 48% of patients. Do you also suffer from rheumatoid arthritis.
(Refer: Andonopoulos AP, Yarmenitis S, Sfountouris H, et al; Baker's cyst in rheumatoid arthritis: an ultrasonographic study with a high resolution technique.; Clin Exp Rheumatol. 1995 Sep-Oct;13(5):633-6)
Arthritis is the most common condition associated with Baker cysts, with osteoarthritis probably being the most frequent cause among the arthritides. (See also the eMedicine article Osteoarthritis in the Physical Medicine and Rehabilitation section.) Although the prevalence of Baker cysts in patients with inflammatory arthritis is higher than in patients with osteoarthritis, osteoarthritis is much more common than inflammatory arthritis. Using ultrasonography, Fam and colleagues found that 21 of 50 patients (42%) with osteoarthritis had Baker cysts.5 Bilateral cysts were seen in 8 patients (16%). The occurrence of Baker cysts relates directly to the presence of knee effusion and the severity of the osteoarthritis.
In 99 consecutive patients with RA, Andonopoulos and coauthors demonstrated Baker cysts on ultrasonograms of 47 patients (48%).6 Twenty of the 99 patients (20%) had bilateral cysts. Of 198 knees, 67 (34%) had Baker cysts, yet only 29 cysts (43%) were diagnosed clinically.
(Refer: http://www.emedicine.com/radio/topic72.htm#section~Intervention)

Arthroscopic treatment of underlying knee arthropathy sometimes results in resolution of an associated Baker's cyst. Anterior synovectomy has been used to good effect in rheumatoid arthritis patients.
Arthroscopic treatment of the cyst per se has also been tried with some success.
Open surgical excision of the cyst is indicated if conservative measures or arthroscopic intervention fail. A stalk leading from the cyst down to the joint can often be located and sutured over or cauterised, after which the cyst can be removed. The recurrence rate can be quite high, particularly if an articular lesion remains uncorrected, but can be reduced by treating any underlying intra-articular lesions arthroscopically.

The treatment of Baker cysts is conservative and includes the use of nonsteroidal anti-inflammatory agents, ice, and assisted weight bearing, in addition to the correction of underlying intra-articular disorders. Internal derangements of the knee can be treated with therapeutic arthroscopy. Total knee arthroplasty is reserved for severe osteoarthritis.

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