If I Have a Hole in My Knee Cartilage, Surely it’s causing My Knee Pain?
I have a hole in my knee cartilage on my MRI…am I doomed? A new study would suggest you may want to ignore the hole, as your other knee that doesn’t hurt likely has one too. MRI is a wonderful tool, but regrettably it’s a two edged sword. What do I mean? Study after study continues to show that doctors place too much weight on knee MRI findings. For many patients this is heresy, as they focus on their MRI results as if they were critical. It’s not their fault, as most physicians look at knee MRI reports as if they came from the Oracle at Delphi. Why do I conclude this? In the last few years we’ve learned that meniscus tears on knee MRI are mostly unimportant. Just as many middle aged and elderly patients without knee pain have meniscus tears as those with knee pain. Other studies have shown that the general severity of knee arthritis either on MRI or knee x-ray also doesn’t predict pain. Now a new study just released again shakes up the world of the knee MRI believers. Almost all practicing physicians who read knee MRIs would be convinced that a patient with an isolated hole in the cartilage would have knee pain. After all, the cartilage protects the bone and there’s a hole in it, so that’s got to hurt! In fact, we have created an entire surgical industry based on fixing these holes-micro fracture, OATS procedures, ACI, MACI, etc… So these knee cartilage lesions must be critical, right? Nope, not according to this new study.
The new research looked at groups of patients enrolled in the Osteoarthritis Initiative Study who had reported that they either had knee pain or didn’t have any knee pain. They then looked at research grade 3.0T MRIs and tried to match those images with focal cartilage lesions to those patients who reported knee pain and those pictures without knee lesions to those who didn’t report knee pain. They couldn’t, meaning that those patients with a knee cartilage hole didn’t have any greater chance of having knee pain as those without a cartilage hole. They also noted that the patients with only one sided knee pain had just as many bilateral knee cartilage lesions as those with bilateral knee pain. The upshot? Outside of a few knee MRI findings like BMLs, knee MRIs are a very inaccurate predictor of knee pain. So what’s causing your knee pain? Read our Orthopedics 2.0 book to find out.