More Data that Knee MRI Findings don’t always explain Knee Pain
MRI knee pain? If you have a hole in the cartilage, a meniscus tear, or arthritis on your knee MRI that means that these things are causing your knee pain, right? Not so fast. Much research over the past few years has shown that structure as seen on an MRI scan doesn’t equal pain. This means that some patients without much in the way of MRI findings have loads of pain and some patients with severe problems on their MRI have little if any pain. For example, recent research has shown that knee meniscus tears detected in middle aged and elderly patients generally aren’t the cause of pain. Despite this, we have a medical care system that often assumes that a structural abnormality seen on MRI of the knee is always the cause of the patient’s pain. Now a new study adds more fuel to this fire by showing that alignment of the knee in patients who underwent High Tibial Osteotomy (HTO) surgery has nothing to do with pain. HTO surgery is performned to straighten a side bent knee (knock kneed or bow legged). The assumption is that the alignment problem is causing one side of the knee to wear down faster leading to more pain and that by fixing the alignment surgically, the pain will be improved. Indeed MRI studies of the knee have shown that cartilage swelling on the overloaded side decreases after HTO surgery. However, this new study showed that alignment and pain are separate entities. Meaning the patients who got the best alignment on MRI of the knee after surgery weren’t the patients who had most pain relief from the surgery. This all fits with the Orthopedics 2.0 approach we use, where the cause of knee pain in a patient with arthritis is as likely to be the knee joint as it is a pinched nerve in the back. Pain is a complex phenomenon and diagnosing why a body part hurts is rarely as simple as looking at an MRI image. The upshot? Structure doesn’t equal pain, so make sure that if you have chronic pain in a joint like the knee, that your MRI helps make or exclude a diagnosis rather than leading to an automatic surgery that may not help.