Can you help with my dad's MRI results!!!

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Specializes in OB/PP/Nsy.

Hi guys. My dad who is 56, has been having knee pain, with being unable to bear weight on it from time to time for about 2 months now. He does not have insurance, so he has to drive 3 hours to get his medical care from VA clinic. He had an MRI last week and they called him today and told him they saw a mass which they need to biopsy, but will have to "wait" for his appointment. - the wait for the MRI was 2 months. I am going to post what the report said, and would appreciate anyone's input, or guidance to a website where I could find out what we are dealing with. I am a first semester student, so am not familiar with this yet.

IMPRESSION:

1) Large unstable osteochondral defect of the lateral femoral condyle measuring 17x13x5mm.

2) 4 x 17 mm intra-articular cartilage containing loose body within the posterior aspect of the lateral compartment.

Here is the rest of the report:

Findings: There is a 5 mm deep divot involving the weight-bearing portion of the lateral femoral condyle involving both the articular cartilage, cortex and underlying bone marrow. the defect measures 17 mm transversely x 13mm sagittal and is consistent with a severe osteochondral defect. There is a cartilage containing intra-articular loose body within the posterior aspect of the lateral compartment measuring 4 x 17 mm. There is a 6 mm degenerative cyst within the marrow deep to the osteochondral defect

There is a focal area of full thickness cartilage loss involving the weight-bearing portion of the medial femoral condyle without subcortical edema. This is consistent with grade three chondromalacia. The patellofemoral compartment is unremarkable.

Both menisci, cruiate ligaments, the medial and lateral and stabilizing complexes, and the extensor mechanism are intact. There is a small joint effusion, but no soft tissue mass.

The end........................

I have tried looking up the unstable osteochondral defect thinking that is what they are going to biopsy, but it doesn't make sense, but that is what they had underlined in the impression when I picked up the report.

I don't know whether to be scared or not, the words mass & biopsy always alarms me, but I just couldn't make sense of the MRI results.

I would appreciate anyone's input/advice. I am the only one my dad told, he hasn't even discussed it with my mom because she is dealing with her mother who has alzheimers, and is very stressed out, and her health is not good, and dad doesn't want her to worry about something else. I pray this is not anything serious.

Thank You

Paula

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Specializes in Vents, Telemetry, Home Care, Home infusion.

what is osteochondral defect?

the word osteochondral refers to anything relating to cartilage and bone. your thighbone (femur), shinbone (tibia), and kneecap (patella) fit tightly together and move smoothly because the bone surface is covered with a thick coating of articular (hyaline) cartilage.

an osteochondral defect is any type of damage to articular cartilage and underlying (subchondral) bone. usually, osteochondral defects appear on specific weight-bearing spots at the ends of the thighbone and shinbone and the back of the kneecap.

osteochondral defects can range from:

  • roughened cartilage that causes slight pain
  • small bone and cartilage fragments that hinder movement
  • complete cartilage loss that leaves your bones grinding against each other.

http://www.proteamphysicians.com/patient/treat/treatment.asp?id=123

what is chondromalacia?

chondromalacia (pronounced kon-dro-mah-lay-she-ah), also called chondromalacia patellae, refers to softening of the articular cartilage of the kneecap. the disorder occurs most often in young adults and may be caused by trauma, overuse, parts out of alignment, or muscle weakness. instead of gliding smoothly across the lower end of the thigh bone, the kneecap rubs against it, thereby roughening the cartilage underneath the kneecap. the damage may range from a slight abnormality of the surface of the cartilage to a surface that has been worn away completely to the bone. traumatic chondromalacia occurs when a blow to the knee cap tears off either a small piece of articular cartilage or a large fragment containing a piece of bone (osteochondral fracture).

http://healthlink.mcw.edu/article/926052680.html

great pics here: http://www.arthroscopy.com/sp05032.htm

exercise/treatment: http://www.orthoseek.com/articles/chondromp.html

grading:

the outerbridge grading system (14) is the most widely used method of classifying chondromalacia patella:

grade 1 = softening or swelling,

grade 2 = fragmentation and fissuring in an area one-half inch or less in diameter,

grade 3 = fragmentation and fissuring in an area more than one-half inch in diameter,

grade 4 = cartilage erosion down to the bone

http://www.findarticles.com/p/articles/mi_m0918/is_2_32/ai_n6170859

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laymens terms:

dad has osteoarthritis ( chondromalacia) of the knee, loose cartilige tissue (osteochondral defects) and possible bone fragments restricting movement, rubbing causing edema and swelling (cyst).

next move since grade three would be arthroscopy to really visualize inside knee with any loose tissue being removed by orthopedic surgeon if indicated.

conservative treatment till can get ortho appointment:

1. call va ask for np who is manageing medical care and ask for orthopedic appointment asap based on mri reults.

2. rest and ice knee periodically throught the day.

3. antiinflamatory meds usually prescribed---see articles above.

3. mild exercise 30 min after pain meds per above article to strengthen muscles around knee cap.

husband has had bilateral similar knee problems occuring 2x over 10 years due to work injuries and arthroscopic repair significantly improved function and quality of life.

wishing your dad a speedy appointment and full recovery.

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Specializes in OB/PP/Nsy.

Thank You NRSKarenRN for you quick and thorough reply.:) That helps so much.

From his MRI report what could be the mass they are going to biopsy? That's what they told him over the phone.

Thank You.

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Specializes in Vents, Telemetry, Home Care, Home infusion.

"There is a 6 mm degenerative cyst within the marrow" that would be what they biopsy along with pieces of loose tissue removed arthroscopiclly---all part of standard surgery to biopsy any tissue removed.

"There is a small joint effusion, but no soft tissue mass".

Effusion is fluid formed after prolonged inflamation due to arthritis wear and tear on the knee joint.

Soft tissue masses in the knee/bone area are often indication of cancer; "No soft tissue mass" is good news as cancer not suspected.

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Specializes in OB/PP/Nsy.

THANK YOU so very much for your help NRSKarenRN!!!!!!!:balloons:

"There is a 6 mm degenerative cyst within the marrow" that would be what they biopsy along with pieces of loose tissue removed arthroscopiclly---all part of standard surgery to biopsy any tissue removed.

"There is a small joint effusion, but no soft tissue mass".

Effusion is fluid formed after prolonged inflamation due to arthritis wear and tear on the knee joint.

Soft tissue masses in the knee/bone area are often indication of cancer; "No soft tissue mass" is good news as cancer not suspected.

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Also, if his doc didn't explain things thoroughly, he should call them back and ask questions. It sounds like they had both of you worrying about cancer, when the report sounds more arthritis-related.

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Specializes in OB/PP/Nsy.

Well that's the deal, the Local VA's office is the one who called him and the doctor is 3 hours away in Little Rock. The girl that called him specifically told him that he had a mass that needed to be biopsied, and that he had to get a diagnosis before seeing the ortho guy. So.... he had me stop and pick up a copy of his MRI, and that's what I posted, and I just couldn't see where it said he had a mass. I don't know if there has been a mistake or what. He was supposed to call today and ask more questions - I doubt he will get to talk to the doctor. But I'll let ya'll know what I find out.

Thanks !!!!!

Also, if his doc didn't explain things thoroughly, he should call them back and ask questions. It sounds like they had both of you worrying about cancer, when the report sounds more arthritis-related.
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Man, that sucks. They shouldn't be having someone who doesn't know what they're talking about calling people with results. :angryfire

Hope you get better care and better answers from them in the future.

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