Magnetic resonance imaging of the knee joint. It is the gold standard method for diagnosing meniscal tears, anterior/posterior cruciate ligament, and collateral ligament injuries.
Indication
- Pain, swelling, and locking after knee trauma
- Suspicion of meniscal tear (medial or lateral meniscus)
- Assessment of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) injuries
- Evaluation of medial collateral ligament (MCL) and lateral collateral ligament (LCL) damage
- Cartilage damage (chondromalacia, osteochondritis dissecans)
- Patellar (kneecap) problems — chondromalacia patellae, patellar tendinitis
- Unexplained chronic knee pain; activity-related swelling
- Pre-surgical planning (ACL reconstruction, meniscal repair)
Preparation
- Fasting is not required (for non-contrast imaging)
- All metal items are removed
- Previous knee surgery (screws, anchors, prosthesis) should be reported
- The physician should be informed in advance in case of claustrophobia
- If intra-articular contrast (MR arthrography) is required, an additional 30-40 minutes should be allocated
How it's performed
- The patient is positioned supine; the knee is in slight flexion, with a surface coil placed over the joint
- Imaging takes approximately 20-30 minutes; immobility of the knee is important
- T2 fat-suppressed sequences are the most sensitive for meniscal tears, cartilage damage, and joint effusion
- PD (proton density) sequences are used for detailed evaluation of menisci and ligaments
- Axial, sagittal, and coronal sections are evaluated together for three-dimensional analysis
- MR arthrography with intra-articular contrast injection may be performed in cases of suspected cartilage damage
Post-procedure
- No special restriction is required after imaging
- The result is reported by the radiologist and interpreted by the orthopedic specialist
- The decision for surgery is not made by MRI alone; it is taken together with clinical examination and patient expectations
- If MR arthrography was performed, intra-articular fluid is absorbed within 24-48 hours
Risks
- Inability to complete imaging due to claustrophobia
- Risk of heating or displacement in MR-incompatible metallic implants
- Rare infection or pain due to intra-articular injection in MR arthrography
- Rare allergic reaction to gadolinium contrast agent
FAQ
Does knee MRI always show meniscal tears?
Knee MRI shows the vast majority of meniscal tears with high accuracy. Very small tears and degenerative changes can sometimes be confused with true tears; therefore MRI findings are evaluated together with the clinical examination.
My MRI showed an ACL tear; do I have to undergo surgery?
No. Surgical or conservative treatment is selected based on age, activity level, joint stability, and other injuries. In low-activity patients, daily life can be continued with physiotherapy; ACL reconstruction is recommended for patients seeking high activity.
Is ultrasound sufficient instead of knee MRI?
Ultrasound is useful for tendons, soft tissue, and superficial structures. However, MRI is much more sensitive for intra-meniscal tears, cartilage damage, and cruciate ligaments.
I have a knee prosthesis; can MRI be performed?
Modern knee prostheses are mostly MR-compatible, but image quality around the prosthesis is affected due to the metal. You should share information about the prosthesis and the surgical report before imaging.
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