What should a standard MRI knee report include for patients of all ages with various knee conditions?

Standard MRI Knee Report Format

A structured knee MRI report should use a compartment-based format with anatomic headers that allows narrative grouping of related pathology, rather than either unstructured free text or rigid itemization of every structure. 1

Essential Report Components

Technical Parameters

• Document field strength (1.5T or 3.0T are both acceptable for standard clinical evaluation) 2
• Include imaging planes: three orthogonal planes (sagittal, coronal, and axial) are mandatory 3
• Specify sequences obtained: must include T2-weighted fluid-sensitive and T1-weighted images as the basic protocol 3

Anatomic Structures to Systematically Evaluate

Menisci

• Report tears using clinician-friendly terminology (location, pattern, size) 3
• Document meniscal extrusion, particularly in degenerative disease 4
• Critical caveat: In patients over 45-55 years, explicitly note that meniscal tears may be asymptomatic findings, as the majority of people over 70 have asymptomatic tears 5
• Prioritize reporting of associated bone marrow edema-like lesions, which correlate better with symptoms than meniscal tears in elderly patients 2, 5

Ligamentous Structures

• Evaluate all major ligaments (ACL, PCL, MCL, LCL) 3
• In acute ACL injuries, specifically identify associated injuries that influence early management 6
• Report changes in signal, shape, and integrity 4

Cartilage

• Assess articular cartilage in all compartments 3
• Document location, depth, and extent of defects using standardized grading 3

Bone Marrow and Osseous Structures

• Prioritize bone marrow edema-like lesions in elderly patients with chronic pain, as these correlate better with symptoms than meniscal pathology 2, 5
• Report subchondral cysts and bone contusions 7
• In acute trauma, bone marrow contusions predict concomitant soft-tissue injuries 7

Joint Effusion and Synovitis

• Document presence and size of effusion 7, 5
• Report synovitis, as both effusions and synovitis correlate with symptomatic disease in osteoarthritis patients 2, 5
• In acute trauma with effusion >10 mm on lateral view, this finding has 91% positive predictive value for internal derangement 7

Soft Tissues and Bursae

• Evaluate periarticular soft tissues and bursal collections 3

Alignment

• Document any malalignment or patellar tracking abnormalities 3

Incidental Findings

• Report any unexpected pathology 3

Report Structure Format

Use compartment-based headers (medial compartment, lateral compartment, patellofemoral compartment, cruciate ligaments, etc.) rather than rigid itemization of every anatomic structure 1

• This format received statistically significant higher scores for readability, usefulness, and quality compared to unstructured free text or highly itemized templates (p<0.001) 1
• 83% of orthopedic clinicians found structured headers most coherent 1
• Allows logical grouping of related pathology while maintaining narrative freedom 1

Age-Specific Reporting Considerations

For patients ≥45 years with chronic knee pain:

• Explicitly state that meniscal tears may represent incidental findings 5
• Emphasize bone marrow lesions and synovitis/effusion findings, as these better predict symptomatic disease 2, 5
• Recommend correlation with weight-bearing radiographs to assess for osteoarthritis 5

For acute trauma patients <40 years:

• Prioritize identification of associated injuries beyond the primary pathology 6
• Note that MRI performed within 6 weeks of acute trauma better visualizes certain injuries 7