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Contributor – Mr. Dominic Spicer – Consultant Knee Specialist
You’ve finally had your MRI scan.
After weeks, or perhaps months, of knee pain, you’ve been hoping for some answers.
The report lands in your inbox or your GP tells you that it shows a meniscus tear, cartilage wear, or degenerative changes.
Suddenly you’re left with even more questions.
“Is my knee damaged?”
“Does this mean I need surgery?”
“Can I still exercise?”
“Is this just arthritis?”
If this sounds familiar, you’re certainly not alone.
At London Bridge Orthopaedics, one of the most common things we hear from patients is:
“My MRI sounds awful, but my knee doesn’t actually feel that bad.”
Or sometimes the opposite:
“My MRI only showed a small tear, so why is my knee so painful?”
The truth is that MRI scans are incredibly useful, but they only tell part of the story.
To understand what’s really causing your symptoms, your scan needs to be considered alongside your history, your examination and, most importantly, how your knee is affecting your everyday life.
The meniscus is a piece of cartilage that acts as a shock absorber in the knee. Each knee has two, and they play an important role in distributing load and maintaining joint stability.
Tears can occur suddenly with injury, or gradually over time as part of ageing.
One of the most important things to understand is that meniscus tears are extremely common – even in people without pain.
Research has shown that many adults, particularly over the age of 40, have meniscal changes visible on MRI despite having no symptoms at all.
This means that finding a tear doesn’t necessarily mean it’s the cause of your pain.
Pain is usually linked to how the knee is functioning rather than what the scan shows.
For example:
In some cases, particularly with certain types of tears, mechanical symptoms like locking or catching may be more directly related.
Modern MRI scanners are incredibly sensitive. They can detect tiny changes inside the knee that would have been impossible to see just a few decades ago.
While this is undoubtedly helpful, it also means they frequently identify changes that are simply part of normal ageing.
Think of it like finding a few grey hairs. They’re a change, but not necessarily a problem.
The same is true inside many knees.
Large research studies have shown that many people with no knee pain whatsoever have meniscus tears, cartilage thinning and other age-related changes on MRI. In fact, these findings become increasingly common from our 40s onwards.
This means that an abnormal MRI doesn’t automatically explain your pain.
Equally, someone with severe knee pain may have only relatively minor findings on their scan.
That’s why experienced clinicians never treat the MRI in isolation.
Reading an MRI report can feel like trying to understand another language. Let’s decode some of the phrases that commonly worry patients.
What many people think it means:
“My cartilage has ripped and needs repairing.”
What it often actually means:
The meniscus is a rubbery shock absorber that sits between the thigh bone and shin bone. It helps distribute load across the knee and provides stability.
Meniscus tears certainly can happen following a twisting injury, particularly in younger people or during sport.
However, many tears develop gradually over time as part of the normal ageing process, much like wrinkles appearing on the skin.
In fact, studies suggest that over a third of adults over the age of 50 have meniscal tears visible on MRI despite having no symptoms at all.
So the important question isn’t simply “Is there a tear?”
It’s “Is this tear actually responsible for your symptoms?”
This is probably one of the most misunderstood phrases in orthopaedics.
Many patients hear the word degenerative and immediately assume their knee is rapidly deteriorating.
In reality, degenerative simply means there are changes that have developed gradually over time.
It doesn’t necessarily mean your knee is severely damaged, nor does it predict that you’ll need surgery.
Many people remain active for years with mild degenerative changes.
Cartilage naturally changes throughout life.
Just as our skin loses elasticity and our hair changes colour, joint cartilage also undergoes gradual change.
Some cartilage wear is entirely expected with age and activity.
The important consideration is how much wear is present, where it is located, and whether it actually matches your symptoms.
Someone with significant cartilage changes may still enjoy walking, cycling and tennis, while another person with only mild wear may experience considerable discomfort due to inflammation, weakness or altered movement patterns.
This phrase understandably worries many people.
But early osteoarthritis doesn’t mean your knee is beyond repair.
In many cases, symptoms are driven more by inflammation, reduced muscle strength and changes in how the joint moves than by the arthritis itself.
Exercise, weight management, strength training and targeted physiotherapy can all have a significant positive impact.
Imagine two patients.
Both have exactly the same MRI findings: a small degenerative meniscus tear and mild cartilage wear.
One has completed a half marathon with only occasional stiffness afterwards.
The other struggles to walk downstairs and can’t kneel to play with their grandchildren.
The MRI is identical.
The treatment is not.
This is because clinicians don’t treat scans – they treat people.
A specialist assessment considers far more than imaging alone, including:
This information often provides far greater insight than the scan itself.
This is perhaps the question patients ask most frequently.
The answer is – not nearly as often as people think.
Twenty years ago, many patients with meniscus tears routinely underwent arthroscopic surgery.
However, over the past decade, high-quality research has shown that many degenerative meniscus tears improve just as well with structured rehabilitation as they do with surgery.
That doesn’t mean surgery no longer has a role.
It can still be an excellent option for certain patients, particularly those with:
The key is selecting the right treatment for the right patient – not simply operating because a tear appears on MRI.
One of the biggest misconceptions is that pain always comes from structural damage.
In reality, pain is much more complex.
Weak muscles around the hip and knee, reduced balance, joint stiffness, altered movement patterns and inflammation can all contribute to symptoms.
This is why two people with identical scans can experience completely different levels of pain.
Improving strength, confidence and movement often reduces symptoms far more effectively than focusing solely on what the MRI shows.
First of all – don’t panic!
An MRI report is written for healthcare professionals and often lists every structural change it can identify, whether or not that finding is clinically important.
The real question isn’t:
“What does my MRI say?”
It’s:
“Does my MRI explain why my knee hurts?”
Answering that requires a conversation with someone who can combine the scan with your symptoms, your examination and your goals.
Only then can the right treatment plan be developed.
The key is to interpret the scan in the context of your symptoms.
A good assessment will look at:
From there, a tailored treatment plan can be developed.
MRI scans have transformed how we diagnose knee problems, but they should never be viewed in isolation.
A meniscus tear doesn’t automatically mean surgery.
‘Wear and tear’ doesn’t necessarily mean your knee is wearing out.
And an MRI report should never define what you can, or can’t, do.
The best outcomes come from looking at the whole picture – your symptoms, your lifestyle, your examination findings and your scan together.
Because when it comes to knee pain, it’s not about treating the MRI – it’s about treating the person!
Englund, M. et al. (2008) ‘Meniscal tear in knees without surgery and the development of radiographic osteoarthritis among middle-aged and elderly persons’, New England Journal of Medicine, 359(11), pp. 1108–1115.
Katz, J.N. et al. (2013) ‘Surgery versus physical therapy for a meniscal tear and osteoarthritis’, New England Journal of Medicine, 368(18), pp. 1675–1684.
Beaufils, P. et al. (2017) ‘The knee meniscus: management of traumatic tears and degenerative lesions’, EFORT Open Reviews, 2(5), pp. 195–203.
Siemieniuk, R.A.C. et al. (2017) ‘Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline’, BMJ, 357, j1982.
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