How to Read a Knee MRI Report

What the terms in a knee MRI report mean — meniscus, ligaments, cartilage, synovitis, bone marrow oedema — and which findings need a prompt orthopaedic consultation.

What a knee MRI shows

MRI shows soft tissues well: menisci, ligaments, cartilage, the synovial lining and bone marrow. Many findings are also seen in people without pain, especially after 40. A report is therefore only interpreted together with symptoms and examination.

Menisci

Changes are graded (Stoller). Grades I–II are changes inside the meniscus, not a tear; they become very common with age. Grade III is a tear that reaches the meniscus surface.

Horizontal — usually degenerative; without locking, treatment usually starts with exercise therapy.
Longitudinal — usually traumatic; in young people the meniscus can sometimes be repaired.
Bucket-handle — a displaced fragment that can lock the knee. A prompt surgical consultation is needed.
Radial and root tears impair meniscus function and may accelerate osteoarthritis — management is discussed with an orthopaedic surgeon.

Ligaments

For the anterior cruciate ligament (ACL) the report says “intact”, “partial injury” or “complete rupture”. With a complete rupture and instability, reconstruction is usually discussed for active people; some patients manage with rehabilitation. Collateral ligament injuries usually heal without surgery. More: cruciate ligament injury.

Cartilage (chondromalacia)

Grade I — softening, II — superficial fissures, III — deep fissures, IV — a defect down to bone. Treatment depends on symptoms: exercise therapy, weight loss, pain relief. Injections may reduce pain but do not restore cartilage. For limited defects in young patients, surgical techniques are discussed. More: chondromalacia.

Synovitis, effusion and Baker’s cyst

These are usually a consequence of another problem — osteoarthritis, a meniscus injury, an inflammatory disease. The cause is treated; a Baker’s cyst itself rarely needs separate treatment.

Bone

“Bone marrow oedema” is the bone’s reaction to overload or injury and is usually reversible. “Subchondral sclerosis”, “osteophytes” and “subchondral cysts” are signs of osteoarthritis. Osteonecrosis of the condyle and stress fractures need a physician’s assessment.

When you need a prompt consultation

The knee is locked and will not straighten.
Complete ACL rupture with a feeling of instability.
A fracture or marked bone marrow oedema with severe pain.
You cannot put weight on the leg after an injury.
Suspected tumour or infection.

What to do with your report

Show the orthopaedic surgeon both the report and the images. If surgery is recommended, a second opinion is sensible. We send your images to several clinics: each gives a preliminary opinion within 1–3 working days and quotes its own conditions and price. Send your images.

Who it is not suitable for and possible risks

Contraindications

Active infection — at the injection site or systemic, with fever.
Active cancer or ongoing chemotherapy.
Blood clotting disorders or a low platelet count. Anticoagulants are discussed with the physician.
Pregnancy and breastfeeding — the procedure is usually postponed.
A corticosteroid injection into the same area in recent weeks.
Severe stage IV osteoarthritis with axial deformity and joint destruction — joint replacement is usually discussed instead.

Possible risks

Pain and swelling at the injection site for 1–3 days.
Bruising where blood or fat tissue is taken.
Rarely, infection. The procedure is therefore performed under sterile conditions with ultrasound or X-ray guidance.
The effect may be absent or smaller than expected.

If any of these apply to you, mention it in your request. The coordinator will check with the clinic physician whether treatment is possible. Contact a coordinator.

Scientific evidence

Studies of regenerative methods show mixed results. Clinic physicians rely on research including the following:

Englund M et al. Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med, 2008.
Peterfy CG et al. Whole-Organ Magnetic Resonance Imaging Score (WORMS) of the knee in osteoarthritis. Osteoarthritis Cartilage, 2004.

Next steps: Treatment methods · Treatment cost · How treatment in Germany is organised

Frequently Asked Questions

What does knee MRI show?

MRI visualizes all soft tissues of the knee: menisci, cruciate and collateral ligaments, cartilage, synovial membrane, bone marrow. It is the gold standard for diagnosing knee joint injuries.

What does "chondromalacia" mean in a knee MRI report?

Chondromalacia is softening and breakdown of cartilage covering. There are 4 grades: from superficial softening (I) to bone exposure (IV). Early stages can regenerate with regenerative method.

Is surgery mandatory for meniscus tear on MRI?

No. Degenerative tears (horizontal, in patients over 40) often do not require surgery. Traumatic tears (vertical, displaced) more often need intervention. Regenerative treatment can be an alternative for partial tears.

How does RegenPAS help organise treatment?

RegenPAS is a patient service centre in Munich, not a clinic. We review your images and symptoms and send a request to several partner clinics at once. Clinics that can accept you send their own conditions and price; prices differ between clinics, and you choose the option that suits you. The coordinator replies within 24 hours, and a clinic physician’s preliminary opinion follows in 1–3 business days. We then arrange the appointment, visa invitation, interpreter, transfers and accommodation. Treatment decisions are made by the clinic physician. Contact a coordinator.

What is needed for a preliminary assessment?

Your MRI (or CT, X-ray) report and the images if you have them, plus a short description of your symptoms and previous treatment. Send them via the form on the website — the assessment is free and without obligation: the coordinator replies within 24 hours, and the clinic physician’s preliminary opinion follows in 1–3 business days.

How much does treatment cost and how long do I need to stay in Munich?

The cost depends on the method, the diagnostics needed and the clinic itself: prices differ between clinics. We request offers from several clinics and send you their conditions and quotes so you can compare. Price guidance is on the treatment cost page. For an outpatient procedure, 2–3 days in Munich are usually enough: examination, procedure and follow-up visit.

Clinic and method matching — free of charge

Describe your case and attach your MRI report. We will identify clinics that use the relevant methods and forward your request to them. No obligation; we reply within 24 hours.

Send a request