Medical Analysis Report

I. Imaging Findings

Based on the patient’s provided X-ray and MRI imaging data of the left knee, the following findings are observed:

• X-ray Plain Film: No significant fracture is detected, the joint space is basically symmetrical, and no obvious abnormality in bone density is noted. The shape of the joint surfaces appears acceptable, with no obvious osteophyte formation or subchondral sclerosis, suggesting that degenerative changes are not significant or only mildly present.
• MRI Images:
  • On the coronal and axial sequences, an abnormal increase in signal intensity is observed in the posterior horn and root region of the medial meniscus, with a discontinuous margin, suggesting a tear or degenerative change.
  • The medial meniscus shows a certain degree of extrusion toward the lateral side of the joint, with the extrusion measuring more than 3 mm, indicating that the abnormality of the posterior root structure prevents it from maintaining normal tension.
  • No obvious joint effusion is seen within the joint space, the soft tissue swelling is mild, and there is no significant periarticular edema.

II. Potential Diagnoses

1. Medial Meniscus Posterior Root Tear
   A tear at the posterior root of the meniscus can lead to an unstable attachment of the meniscus to the tibia, causing meniscal extrusion and joint instability. MRI may reveal a high-signal disruption at the posterior root with notable extrusion.
2. Other Types of Medial Meniscus Tears (e.g., Radial Tear)
   A radial tear also impairs the meniscus’s ability to distribute stress within the joint, showing high signal on T2-weighted images and potentially leading to sudden or progressive meniscal extrusion.
3. Degenerative Meniscal Changes
   Common in middle-aged and older patients, degenerative changes may appear as increased signal on T2WI. However, if there is no obvious tear, the extent of extrusion is typically mild.

III. Final Diagnosis

Considering the patient’s age (55-year-old, female), history of trauma (contusion of the left knee), clinical symptoms (posteromedial knee pain), and MRI findings (meniscal extrusion and a high-signal tear in the posterior horn of the medial meniscus), the most likely diagnosis is:

Posterior root tear of the medial meniscus in the left knee with meniscal extrusion.

Further correlation with clinical examination and arthroscopy (if indicated) is recommended to clarify the extent of the injury and stability, guiding the definitive surgical approach.

IV. Treatment Plan and Rehabilitation Program

1. Treatment Strategy

• Conservative Management: Suitable for patients with mild symptoms or those lacking indications for surgery. It primarily involves appropriate rest, oral nonsteroidal anti-inflammatory drugs (NSAIDs) to alleviate pain and intra-articular inflammation, and physical therapy (heat therapy, laser therapy, etc.).
• Surgical Management: For patients with significant posterior root tears or marked extrusion affecting quality of life, arthroscopic meniscal repair or suturing is recommended. If the meniscal tissue is significantly degenerated, partial meniscectomy combined with repair may be necessary, while preserving as much meniscal function as possible.

2. Rehabilitation/Exercise Prescription

The goal of rehabilitation is to promote tissue healing, maintain or restore joint range of motion, strengthen the muscles surrounding the knee, and prevent secondary injury. Based on the FITT-VP principle, the following is suggested:

• Early Stage (preoperative or first 2 weeks postoperative):
  • Frequency (F): Perform light activities 2-3 times daily.
  • Intensity (I): Very light, involving non-weight-bearing or partial weight-bearing exercises to maintain basic joint mobility.
  • Time (T): Approximately 10-15 minutes each session, focusing on passive joint movement or seated gentle knee flexion/extension exercises.
  • Type (T): Passive range-of-motion exercises, seated straight-leg raises (reduce angle if painful), and avoidance of deep squats or other high-load movements.
  • Progression (P): Gradually increase the range of flexion and extension as pain and swelling decrease.
• Intermediate Stage (2-6 weeks postoperatively or during conservative management):
  • Frequency: 3-4 times per week.
  • Intensity: Light to moderate, introducing small-range half squats and resistance band training for flexion/extension.
  • Time: 20-30 minutes each session, gradually increasing as tolerated.
  • Type: Continue joint range-of-motion exercises and progressively add strengthening exercises for the quadriceps and hamstrings, such as band-based flexion/extension and straight-leg raises.
  • Progression: Adjust the range of motion and resistance based on joint stability and pain levels.
• Late Stage (6 weeks to 3 months or longer postoperatively):
  • Frequency: 3-5 times per week.
  • Intensity: Moderate to moderately high, depending on recovery status, including functional training (e.g., light jogging or elliptical training).
  • Time: 30-45 minutes per session, incorporated into daily life activities.
  • Type: Emphasize improving knee flexibility and balance, with the addition of dynamic balance training and short bouts of slow jogging, if appropriate.
  • Progression: If knee stability is adequate, gradually return to normal daily activities or specific sports, but avoid high-impact or twisting movements.

During rehabilitation, avoid causing significant pain or swelling of the knee. If discomfort arises, promptly seek medical evaluation.

Disclaimer

This report is based on the provided clinical and imaging information and serves as a reference. It cannot replace a face-to-face medical consultation or professional medical diagnosis and treatment. Please consult a professional physician for any further examinations or treatment recommendations.