How to Read Knee MRI in Simple Way| Easy Notes and Video

How to Read Knee MRI? is a need for the orthopedic doctor and a special need for the knee surgeon. Some points that are to be known while reading Knee MRI are discussed

Reading MRI is challenging for the orthopedic surgeon. The complex film has to be made simple . Only reading MRI report by the radiologist is not sufficient so to increase the specificity of MRI, the orthopedic surgeons or Knee surgeons must read MRI by themselves

It has to be made a practice that reading MRI report only is not to be done. It will be better to read MRIs by every surgeon.

How to Read Knee MRI ?

To go for how to read MRI, some simple things are to be known basically. The view is important. There are certain things you should go one by one while reading MRI by yourself. Following things are to consider while practicing to see an MRI of the Knee.

Here is the basics of MRI Reding notes by Dr. Saroj K. Suwal, He is a orthopedic Surgeon in Madhyapur Hospital

When we see the Types of MRI Knee Films, there are Two Images types. They are  T1 and  T2 Weightage Images consisting of three cuts of MRI

• Sagittal Film
• Coronal Film
• Axial Film

Now lets go one by one to  Read Knee MRI with reference to the above types of images.

Sagittal images of Knee MRI

Following structures are to be seen in the sagittal images of MRI of Particular MRI

#1. Extensor Mechanism

• need to see Patella, quadriceps, , patellar tendon, quadricep tendon

#2. Meniscus

Cuts are From Lateral to medial or Medial to Lateral

• Lateral meniscus finding:
  1. by tibial pleatue surface:  Convex surface of tibial pleatue due to lateral femoral condyle
  2. Fibula head presence
• Medial Meniscus finding
  1. By tibial pleatue surface: Concave surface of tibial pleatue due to Medial femoral condyle
• Anterior Horn and posterior horn
• In the notch area there is no meniscus, only find ACL and PCL

#3. Meniscus Tear -Grading

Grade 0, –> No Tear

Grade I–> Intrasubstance tear, Degenerative changes only

Grade II–> Intrasubsance , degenerative changes only

Grade III–>going to intraarticular ( horizontal, radial, Bucket Handle Tear)

Note: Meniscal tear is only tear, when the tear go to the articular region either superiorly or inferiorly

Signs in Meniscal Tear

Double PCL Sign in sagittal view–> bucket handle tear

Ghost sign in coronal view in Meniscus tear

#4. ACL & PCL

IF Film coming from lateral to medial condyle àACL comes first then PCL Comes then

• PCL is homogenous and darker than ACL
• Wavy PCL denotes ACL Tear, Notch sign
• ACL attach to medial Femoral condyle to tibial spineà so comes first in lateral to medial MRI Film
• Tibial translation ( Anterior in PCL tear, Posterior in ACL Tear)
• Buckling of PCL à due to lax of ACL
• Blumensat line and ACL blumensat Line (blumensat angle)
  • Angle of blumensat goes to femoral convexity
  • Decrease in angle and apex of angle direct to tibia indicates the ACl tear

#5. Patella

1. See cartilage
   1. For reading cartilage –> FAT stat MRI is needed
2. Defect of patella
3. Patella alta, patella baja

Coronal View of Knee MRI

We confirm what we see in Sagittal view. Mostly we see other viees . We need to see following structures

• MCL, LCL, Cartilage
• Medial epicondyle–>MCL will be seen
• MCL–> has deep and superficial part
• Deep MC–> end to superficial tibial pleatue
• Superficial MCL –> about 8 cm surface to tibial pleatue(medial)
• LCL–>Starts from Human face end to the head of Fibula
• Cartilage –> femoral and Tibial Cartilage.

Meniscus

• Seen both medial and Lateral meniscus at the same time
• The root is important to see ( root coming down to notch)
• Intermeniscals fibers

Axial cuts of MRI

Basically in axial cuts of MRI following structures are to be identified.

• Patellar cartilage, Femoral Cartilage
• Patella femoral alignment

How to Read MRI | Video Guide

By dr. Amit Joshi