Knee pain bilateral for past 4 months.

At your age, MRI is absolutely justified and necessary. We can not label this as “arthritis” without ruling out meniscal root tear or osteochondral pathology, as early intervention can prevent long-term joint degeneration.

1)If Meniscal Tear is found on MRI then Physiotherapy if stable & small tear and Arthroscopic repair or partial meniscectomy if symptomatic/root tear 2)If Osteochondral Defect then Activity modification Offloading brace (medial unloader) Surgical options if unstable lesion (microfracture / fixation depending on size)

Delaying MRI or continuing high-impact activity (running, squatting, jumping, heavy gym work) may convert a potentially repairable condition into permanent cartilage loss and early-onset arthritis.

Knee meniscal issue Confirm with mri

Based on the X-ray and your symptoms, bilateral knee pain with activity-related worsening and reported medial compartment joint-space narrowing at 22 years suggests an early biomechanical overload problem rather than true age-related arthritis common possibilities include varus alignment related medial overload, early cartilage wear chondral injury meniscal pathology, or patellofemoral maltracking which may not be fully visible on X-ray at this age, X-ray changes alone are not enough for a final diagnosis so an MRI is appropriate to assess cartilage meniscus ligaments and subchondral bone. until MRI reduce high-impact activities running, jumping, deep squats avoid prolonged standing, use supportive footwear, and manage activity levels long-term outcome is usually good if the underlying cause is identified early and load on the medial compartment is corrected