It is common for people to have an “abnormality” which is completely asymptomatic (pain-free). The mere presence of an abnormality does not signify that there is a problem which must be treated, and it is the doctor who must decide whether the so-called abnormality is truly the source of the problem.

Some unscrupulous orthopedists routinely dictate ‘MRI-confirmed meniscal tear’ in their operative reports when describing the cartilage they have just ‘operated’ on. This way, presumably, if the patient still has pain after surgery,the surgeon can blame the MRI. “It’s not my fault, Mrs. Jones, that we chose the wrong operation. That MRI report did report torn cartilage, did it not?”

The MRI reports often emphasise the wrong condition.

An MRI report commonly reads something like this:

• tear of the meniscus
• water in the knee
• partial tear of such and such ligament
• Baker’s cyst
• arthritis

While this report may technically be correct, the order of the conditions listed implies that the torn meniscus is the main problem. In most patients, however, the presence of arthritis supercedes all other afflictions. The patient will not improve until the arthritis is addressed, whereas little tears of the meniscus, water in the knee, and partial tears of ligaments are not likely to be the source of the patient’s pain. The bit about the “tear of the meniscus” does succeed in catching the eye of the patient and the unsuspecting family doctor, and it paves the way for an offer from the orthopedist to fix that nasty little problem with a surgical procedure.

All MRIs are not equivalent

You would be appalled by the variations in image quality from one MRI to another and by the differences in accuracy from one report to another. This is a reflection of the diversity among the four elements that make up an MRI and its accompanying report (the machine, the software, the Radiologist and the Orthopedist).

What is wrong with simply getting an MRI?

It is expensive and often does not even give you all the requisite information. Add the cost of all the unnecessary MRIs and you get a hefty figure. This affects your premiums as well as the insurance companies’ ability to pay for other tests and treatments. A good set of x-rays will usually suffice.

Is there ever a good reason for obtaining an MRI?

Of course. The MRI is an extraordinary test. When the doctor is truly stumped, an MRI can reveal subtle and rare conditions such as tumors. If there has been a major injury to the knee, and surgery is being contemplated, the MRI can help assess the status of “soft tissues” such as the cruciate ligaments. If a patient suffers from kneecap malalignment and even the Merchant view and true lateral are normal an MRI can sometimes detect this malalignment. If an older patient has the early stages of osteonecrosis (a bone “stroke”), this may only be detectable on an MRI.

In a large majority of patients with knee pain, high quality x-rays obviate the need for MRI imaging.