How to Read a Knee MRI: An OT's Perspective

Knee injuries can affect any age group.

Knee injuries encompass a wide spectrum of trauma and conditions affecting one of the body's most intricate joints. Ranging from mild strains to severe ligament tears and cartilage damage, knee injuries often result from sudden impacts, repetitive stress, or degenerative changes over time. Knee injuries can affect any age group, which is why it’s critical for occupational therapy professionals to understand how to read a knee MRI.

Recommended course: Anatomy and How to Read an MRI of the Knee

Common knee injuries

Common knee injuries include:

• Anterior cruciate ligament (ACL) injuries
• Posterior cruciate ligament (PCL) injuries
• Collateral ligament injuries
• Meniscal tears
• Tendon tears
• Fractures
• Dislocation

Evaluating knee injuries

Knee magnetic resonance imaging (MRI) is a common diagnostic examination for identifying knee injuries. Although many patients consider MRI machines uncomfortable because of the enclosed space, it provides better soft tissue contrast than a CT scan. MRIs can be used to evaluate:

• Swelling, or bleeding in the tissues in and around the joint
• Knee injuries, such as sprains and torn ligaments, cartilage, or tendons
• Arthritic damage
• Build-up of fluid in the knee joint
• Knee infections
• Trauma following knee surgery

Occupational therapy for knee injuries

Occupational therapists (OTs) work with clients to improve their functional abilities and overall quality of life. OTs are trained to understand how changes to the musculoskeletal system can impact a person's ability to perform daily activities and engage in meaningful occupations. Therefore, OT's understanding of how to read a knee MRI extends beyond pathology to encompass functional implications, thus providing a more holistic understanding of the patient's condition.

Reading a knee MRI: Understanding knee anatomy

OTs receive training in musculoskeletal anatomy and biomechanics, including a detailed understanding of the structures and functions of the knee joint. This knowledge forms the foundation for understanding the language involved when reading MRI image reports and visualizing the location of abnormalities such as ligament tears, meniscal injuries, and cartilage degeneration.

Comparing current MRI results to previous MRI results can provide additional information regarding changes in the patient’s knee. When reviewing a knee MRI, the OT must first orient the image to determine if they are looking at the femur or the tibia. The femur has a rounded head, while the tibia is flatter. This orientation assists with identifying the location of the fibula and the triangle-shaped lateral and medial meniscus.

Determining functional implications of results

OTs assess the functional implications of MRI findings on a patient's occupational performance. This involves factors such as pain, range of motion, strength deficits, and proprioceptive impairments, all of which influence a person's ability to engage in meaningful activities.

OTs understand that a significant reading on an MRI can mean an impairment in the following occupations:

• Activities of daily living (ADLs) such as lower body dressing, toilet transfers, and cooking while standing.
• Instrumental activities of daily living (IADLs) such as taking care of a pet and washing laundry.
• Work activities such as lifting boxes and carrying items from one location to another.
• School activities such as participating in physical education activities and transitioning from one classroom to another.
• Leisure activities such as playing sports and gardening.
• Community mobility such as driving and navigating the grocery store.

The results of a significant MRI can also inform an OT's course of treatment. An OT can use an MRI to identify an acute condition and monitor progress once they’ve determined a course of intervention. The OT will have to consider contraindications to prevent additional damage and promote healing. For example, a patient who is recovering from surgical intervention after a meniscal tear may need to adhere to the following precautions:

• Less than full weight bearing
• Restrictions on the range of motion of the knee

These precautions will determine the limitations of how a functional activity can be performed. As a result, OTs may provide patient and caregiver education that encompasses the following:

• Activity modification strategies
• Pain management strategies
• Assistive device provision
• Environmental modifications
• Joint protection
• Energy conservation techniques

Knee rehabilitation: Collaborating with an interdisciplinary team

By collaborating with an interdisciplinary team, including doctors, radiologists, and physical therapists, OTs ensure that interventions address both structural pathology and functional goals, facilitating optimal recovery and restoration of occupational performance. Through this collaborative approach, individuals with knee injuries can receive tailored care that addresses their unique needs, enhances functional abilities, and promotes overall well-being.

An interdisciplinary team can include:

• The doctor who orders the MRI
• The radiologist who reads the results
• The physical therapist provides a mobility device.
• The OT provides environmental adaptations and assistive devices to maximize functional performance in ADL areas.

Conclusion

Diagnosis through knee magnetic resonance imaging (MRI) offers valuable insights into the extent of damage, guiding treatment decisions and rehabilitation efforts. Occupational therapists (OTs) play a vital role in this process, leveraging their understanding of knee anatomy and the functional implications of MRI findings to develop comprehensive treatment plans.