Abnormal Knee MRI Findings in Basketball Players: Do They Explain the Pain?

Marc Darrow, MD, JD

An abnormal knee MRI can be unsettling, especially when the report lists several findings. For a basketball player, the immediate questions are practical: Is this why my knee hurts? Can I keep playing? Does the scan mean I need surgery?

Research in basketball players shows why those questions require more than a reading of the MRI report. Structural findings can be present in knees that do not hurt. An MRI can identify changes in tissue, but determining their importance requires the player’s symptoms, injury history, examination, and functional limitations.

The goal is to identify which findings matter to the individual player and use that information to guide care.

What did MRI scans show in pain-free college basketball players?

Pappas and colleagues studied 24 NCAA Division I basketball players, including 12 men and 12 women. Their asymptomatic knees underwent MRI before the season; three players did not return for postseason scanning. Every knee scanned had at least one structural abnormality at each assessment. The findings included changes in tendons, cartilage, bone marrow, the fat pad, and the meniscus. (1)

The reported preseason and postseason percentages were:

Postseason scanning involved fewer players; three of the original 24 did not return.

Cartilage injury scores also increased over the season. However, this small study did not establish that each finding would become painful or progress to arthritis. Its strongest clinical lesson is that an abnormal scan and a painful knee are different observations. (1)

A meniscal signal change is not necessarily a meniscus tear

One detail in the college study deserves particular attention: the researchers found intrameniscal signal changes, but no discrete meniscal tears. Describing those results simply as meniscus injuries can make them sound more definitive than they were. (1)

Patients should ask what the report actually describes. Does it identify a tear, or a change in signal within the meniscus? If there is a tear, what is its pattern and location? Does the examination support it as the explanation for the symptoms?

These distinctions matter when discussing treatment. A list of imaging findings does not, by itself, establish which structure should be treated or which procedure would help.

What newer research adds

A 2025 study evaluated 43 NBA Draft Combine participants, with 80 knees included. Cartilage pathology was identified in 48.3% of knees, most often at the patella and trochlea—the kneecap and the groove in which it moves. Overall, imaging findings had limited correlation with reported pain, function, and orthopaedic history. However, some associations were present, including an association between greater pain scores and an abnormal cartilage score. (2)

The appropriate interpretation is that MRI findings need clinical context. The study does not show that cartilage abnormalities never cause symptoms. It also cannot determine an individual player’s future course because it assessed participants at a particular point in time rather than following disease progression over many years. (2)

The Draft Combine and college studies involved different groups and assessment methods. Their percentages should not be treated as evidence that cartilage damage has increased or decreased over time.

Does the same issue occur outside elite basketball?

A systematic review of 63 studies, involving 4,751 asymptomatic adults and 5,397 knees, found that MRI features associated with osteoarthritis also occur in people without knee symptoms or a previous knee injury. Cartilage defects and meniscal tears were more common in older groups. The authors emphasized interpreting imaging alongside the clinical presentation. (3)

That broader evidence provides context for recreational players, but it should not be substituted for a basketball-specific prognosis. Age, injury history, activity level, and the nature of an imaging finding all affect how a clinician interprets the report.

How does a clinician decide whether a finding explains the pain?

The assessment starts with the story of the knee. Did symptoms begin after a specific landing or pivot, or develop gradually during a period of increased training? Where is the pain? Does it occur while jumping, landing, bending, or afterward? Has there been swelling, loss of motion, or a feeling that the knee gives way?

Examination then helps determine whether the suspected tissue and the symptoms fit together. Tenderness, movement, swelling, strength, and stability provide information that cannot be obtained from the wording of an MRI report alone.

For example, a report may describe several abnormalities while the player consistently points to one area of pain. Each finding should be considered in relation to that complaint. Conversely, a new injury with a substantial change in function should be reassessed even if an earlier MRI had been reassuring.

For a broader discussion, see Reliability of knee MRIs.

Are bone marrow edema and tendon findings harmless?

The presence of these findings in asymptomatic athletes should prevent automatic assumptions about pain. It should not lead to automatic reassurance about every abnormality in a symptomatic player.

Terms such as bone marrow edema describe an imaging appearance. Their significance depends on the pattern, location, associated findings, and clinical circumstances. Similarly, an MRI description of tendinopathy needs to be considered alongside the location of pain and the response to activity.

The important question is what a finding means in this particular knee. A player who has developed focal pain or a sudden loss of function needs an assessment directed at those symptoms, rather than reassurance based only on how often abnormalities appear in other athletes.

What does the research say about basketball performance after surgery?

The original version of this article also discussed a separate study of 348 NBA players who underwent orthopaedic procedures. These included ACL reconstruction, Achilles tendon repair, lumbar discectomy, microfracture, meniscus surgery, fracture fixation, and shoulder stabilization. Researchers compared return to play, games played, and player efficiency before and after surgery. (4)

Return-to-play rates varied by procedure. Players undergoing Achilles tendon repair or arthroscopic knee surgery had larger postoperative performance declines and shorter careers than players in some other surgical groups. (4)

These results are useful when discussing expectations, but they do not establish that surgery caused the decline. The study did not compare otherwise equivalent players with the same injury randomly assigned to surgery or nonsurgical treatment. The injury itself, age, rehabilitation, and other career factors can influence performance. Nor did it establish a connection between asymptomatic MRI findings in college players and surgical outcomes in NBA players. (4)

The practical lesson is to discuss the expected benefit and limitations of a proposed procedure for a specific diagnosis. Neither an abnormal scan nor a study of postoperative performance can make that decision on its own.

Related reading: When knee pain is worse after meniscus surgery.

Does an abnormal MRI mean you need an injection or surgery?

These imaging studies did not test PRP, prolotherapy, or stem cell treatment. They cannot establish that an asymptomatic MRI finding needs an injection, that an injection prevents arthritis, or that any treatment restores the tissues described on the scan.

Before considering an intervention, a patient should understand the working diagnosis, the treatment goal, the evidence relevant to that diagnosis, and the alternatives. For a player with symptoms, treatment planning should also address the activities that are limited and how improvement will be assessed.

Useful questions include: Which finding best explains my symptoms? What would treatment aim to improve? How would we measure progress? What would prompt us to reconsider the diagnosis or change the plan?

Can a player return to basketball with an abnormal MRI?

The asymptomatic athlete studies demonstrate that players can participate despite structural findings on MRI. They do not provide an individual return-to-play clearance or a universal recovery timetable.

Returning to basketball requires considering the demands of running, stopping, cutting, jumping, and landing. A treating clinician can assess symptoms, movement, strength, stability, and response to progressive activity in the context of the diagnosis. Any restrictions related to a specific injury or procedure must also be considered.

The purpose of reviewing an MRI is to help explain the knee problem and guide a useful plan. Patients should leave the discussion understanding which findings are clinically significant, what uncertainty remains, and what the next step is.

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