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Ein 73-jahriger Patient stellte sich wegen Beschwerden im linken Kniegelenk ohne vorausgegangenes Trauma vor. Bei der klinischen Untersuchung zeigte sich eine Schwellung des Gelenkes ohne wesentliche Bewegungseinschrankung. Im Routinelabor fand sich lediglich eine leichte makrozytare Anamie. Anamnestisch wurde als einzige relevante Vorerkrankung eine Mycosis fungoides angegeben. Zur bildgebenden Diagnostik wurde eine MRT des linken Kniegelenks durchgefuhrt.

Diagnosis of inflammatory rheumatic diseases is besides clinical parameters mainly based on the potential for differential diagnosis of radiographic symptoms obtained by systematic analysis. The initial analysis should emphasize which part of the joint is involved referring to synovial disease, cartilage disease or disease of the enthesis. Synovial arthropathies are assessed regarding soft tissue swelling, soft tissue opacification and the presence of erosions. Cartilaginous pathology is reflected by reduced or increased joint space, calcifications and subchondral bone changes. Enthesopathy is typically located at tendon-ligament and joint capsule attachment, where osteoproliferative but also erosive changes might occur. Lastly, differential diagnosis of arthropathies is mainly based on distribution and allocation of affected joints.

Due to the increasing number of surgical procedures performed on the knee, MR imaging of the postoperative knee has gained more and more importance. For the evaluation of anterior cruciate ligament grafts and postoperative menisci, basic knowledge of surgical techniques is essential in order to differentiate normal postoperative findings from transplant failure, retears, and complications. This article reviews technical aspects of MR imaging following knee surgery, basic principles of operative techniques for anterior cruciate ligament reconstruction and therapy of meniscal tears, normal postoperative findings, MR imaging criteria for recurrent lesions, and findings with typical complications.