My MRI report says chondromalacia patella grade 2 or 3. What do the grades mean?

The grades in plain language

Radiologists and surgeons commonly use a four-level scale, based on the Outerbridge classification or a similar MRI system:

• Grade 1: the cartilage is softened or slightly swollen but the surface is intact
• Grade 2: partial-thickness fissures or fraying, less than about half the cartilage depth
• Grade 3: deeper fissures extending more than about half the depth, sometimes with flaps
• Grade 4: full-thickness loss with bone exposed in that area

Reports may also mention the location, for example the medial or lateral facet, and the size of the affected area.

Why the grade is only part of the picture

Low-grade cartilage changes are common on MRI in people with no knee pain at all, especially after the age of thirty. Equally, some people with significant pain have only grade 1 findings. So a report on its own does not decide treatment. What matters is how the findings fit your symptoms, whether the knee swells or catches, and how the kneecap moves and tracks on examination.

Other findings worth noting on the report

Look also for bone marrow oedema under the kneecap, which suggests the bone is under stress; a joint effusion, meaning extra fluid; a loose fragment or cartilage flap; kneecap tilt or a shallow groove (trochlear dysplasia); or a high-riding kneecap. These can change the plan more than the grade itself.

Going through your scan in Doha

Bring the MRI images, not just the report, to your consultation at Aman Hospital. Dr. Pablo Gelber reviews the images alongside a full knee examination, explains what the grade means for you, and discusses a plan that is usually built around rehabilitation, with other options considered only if a specific problem is found.