MRI Right Knee - Clinical Analysis

Patient: Sunil Prajapat, 19-year-old male | Date: 26/05/2026 Scan: 1.5 Tesla MRI, no gadolinium, sequences T1W, T2W, PDW/FS PDW, STIR, GRE

MRI Findings Summary

Structure	Finding
Posterior horn medial meniscus	Contusional (intrasubstance) signal - Grade 1-2 signal change
ACL	Moderate sprain (Grade 2 - partial tear)
Bones	Normal cortical outline, normal marrow; no osteophytes
Tibiofemoral joint space	Preserved
Lateral meniscus	Normal morphology and signal
PCL	Normal morphology, signal, alignment, fibre continuity
MCL	Normal
LCL	Normal
Patellar retinaculum	Intact, normal signal
Popliteus/posterolateral corner	Within normal limits
Patella (Wiberg Type 2)	Articular cartilage normal
Joint effusion	Mild/no significant effusion

Clinical Findings to Expect

1. Medial Meniscus Posterior Horn Contusion (Grade 1-2 Intrasubstance Signal)

A "contusional signal" in the meniscus represents an intrasubstance injury - the signal change (increased on MRI) does not extend to the articular surface, meaning this is not a full tear. The meniscal architecture is preserved.

Expected clinical signs and symptoms:

Medial joint line tenderness (posteromedial aspect)
Pain worsened by full flexion or rotation
McMurray's test may be mildly positive (pain without a definite click/clunk)
Thessaly test may provoke pain at the medial joint line
No locking (no displaced fragment)
Possible mild swelling from synovial irritation

2. Moderate ACL Sprain (Grade 2 - Second-Degree Sprain)

A "moderate sprain" corresponds to a Grade 2 / second-degree sprain - partial disruption of ACL fibres with intact gross continuity. The ACL is not completely torn.

As per the sprain classification from Campbell's Operative Orthopaedics:

Disruption of ligamentous fibres (partial, not complete)
Joint reaction (pain, tenderness, swelling)
Some loss of function / mild-to-moderate instability

Expected clinical signs and symptoms:

Anterior knee pain and swelling
Lachman test: Positive but with a firm endpoint (ligament partially intact)
Anterior drawer test: Mildly positive
Pivot shift test: May be mildly positive
Difficulty with cutting, pivoting, or sudden deceleration
Joint line tenderness anteriorly
Mild haemarthrosis may be present

Treatment Plan

Immediate / Acute Phase (Week 1-2): PRICE Protocol

Component	Detail
Protection	Functional knee brace (hinged) to protect the partially injured ACL; activity restriction
Rest	Avoid pivoting, running, jumping, contact sport
Ice	15-20 min application, 3-4x daily to reduce swelling
Compression	Compression bandage or sleeve
Elevation	Limb elevation when resting

Analgesics/Anti-inflammatories:

NSAIDs (e.g., ibuprofen 400-600 mg TDS or diclofenac 50 mg BD) for 1-2 weeks
Paracetamol for background pain relief

Conservative Rehabilitation Phase (Week 2-12)

This is the primary treatment for this patient, given:

Grade 2 (moderate) ACL sprain (not a complete rupture)
Meniscal contusion (intrasubstance, not a tear requiring surgery)
19-year-old - young patient who must be carefully monitored for instability

Phase 1 (Weeks 1-3) - Inflammation control:

Crutches for offloading if pain is significant
Isometric quadriceps and hamstring exercises
Straight leg raises
Range-of-motion exercises to regain full extension

Phase 2 (Weeks 3-8) - Strength recovery:

Closed-chain exercises: mini squats, leg press, stationary cycling
Proprioception and balance training (wobble board)
Swimming and pool running
Progressive weight-bearing

Phase 3 (Weeks 8-16) - Functional return:

Jogging on flat surfaces
Sport-specific agility drills
Neuromuscular control training
Plyometric exercises when quadriceps strength reaches 80% of contralateral limb

Surgical Considerations

Surgery is NOT indicated immediately for this presentation. However, surgical intervention should be reconsidered if:

Persistent instability despite 3-6 months of rehabilitation
Meniscal contusion progresses to a symptomatic tear (locking, catching, giving way)
Return to high-demand sport fails due to recurrent giving way episodes

If surgery is needed in future:

ACL reconstruction (autograft - patellar tendon or hamstring) - best performed when the knee has recovered full range of motion and muscle strength
Arthroscopic meniscal debridement or repair if contusion evolves into a tear

Sprain Classification Reference

ACL Sprain Treatment Algorithm - Campbell's Operative Orthopaedics

This patient falls into the second-degree (moderate) sprain category: conservative treatment with functional bracing, rehabilitation, and delayed return to vigorous activity until the inflammatory response has settled and rehabilitation is complete.

Follow-Up Recommendations

Orthopaedic review in 2-4 weeks - assess Lachman/pivot shift clinically, monitor effusion
Physiotherapy - structured programme as above
Repeat MRI at 3 months if symptoms worsen or instability persists
Return to sport only after full strength recovery and negative instability tests
Avoid high-risk activities (pivoting sports, contact sports) until cleared

Note: This analysis is based on the radiological report. Clinical correlation with history, mechanism of injury, and physical examination findings is essential before finalizing the management plan, as stated in the report itself.

Bailey and Love's Short Practice of Surgery 28th Edition, Meniscal tears section
Campbell's Operative Orthopaedics 15th Ed 2026, Classification and Treatment of Sprains

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