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Author Topic: Please advise: Complex tear of posterior horn medial meniscus  (Read 4061 times)

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Offline bubbly

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Please advise: Complex tear of posterior horn medial meniscus
« on: September 23, 2010, 07:27:26 PM »
I hurt my left knee last week, and I just received my MRI report indicating the foll :
"Complex tear of posterior horn medial meniscus with the vertical tear from the superior to inferior surfaces and oblique tear extending from vertical tear to the posterior surface. The vertical tear involves the body of the medial meniscus. There is a tear of proximal anterior cruciate ligament at its insertion site which is poorly defined and replacement by abnormal signal. Bone bruise of the posterior lateral tibial plateau. Chondromalacia patella with partial tears."

I was able to get an appointment with my Ortho only after 4 days. I have two little ones, and I am extremely anxious now, and very worried. Is surgery my only option ? will physical therapy alone not help ? Any inputs will be appreciated. Thanks folks!
« Last Edit: September 23, 2010, 08:29:16 PM by bubbly »

Offline arthriticknee

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Re: Please advise: Complex tear of posterior horn medial meniscus
« Reply #1 on: September 24, 2010, 12:11:23 PM »
Hi Bubbly,
Sounds like a bit of a mess you've got going on there.
There are a few things I would be asking if I were you. Remember that an MRI is essentially a series of still photos. It gives you an idea of the state of your knee but not how it behaves during movement and weight bearing. This is why your treatment will not be based on the MRI alone. It gives your surgeon some information but it is only a small part of the picture.
You have multiple issues:
1) Medial meniscal tear
2) ACL tear
3) Some damage to the posteolateral corner
4) Chondromalacia Patella

Some thoughts on these:
1) A complex tear such as this covering multiple areas of the meniscus will not heal or repair itself. It is unlikely to be suitable for a surgical meniscal repair. Your surgeon will assess your knee and question you to get an idea if it is  contributing to any mechanical symptoms you may have. For most people this will end up being treated with an arthroscopic partial menisectomy - removal of the torn sections via keyhole surgery.

2) The ACL tear is a concern. The MRI inconclusive but was rather suspicious. The top attachment of the ACL, where it joins the femur appears to have been torn. It does not say there has been a complete rupture but due to the poor quality of the view (this happens often for a variety of reasons) it seems like the Radiologist is hedging his bets. Your surgeon will do some special physical tests for your knee, pulling it around a bit to get an idea if the ligament is doing its job. This physical examination will have a big effect on your treatment. If it appears the ACL is ruptured, surgery is indicated if you plan to get back to a high level of activity such as skiing or playing most sports. If your surgeon has doubts or thinks that the ligament may be only mildly damaged, they would probably suggest key hole surgery. This would allow them to trim the meniscal tear, assess the ACL visually, as well as the other areas of the knee flagged by the MRI.
3) The posterolateral corner bruising is evidence a large amount of force went through the knee in your accident. This may settle down with rest but could be an indication of joint surface injury.
4) The Chondromalacia may well have been a pre-existing condition. It is more common in females (assuming you are) and is often something that happens over a period of time. Can be an issue but considering your other injuries is probably the least of your problems.

What I would do:
1) Clarify the status of your ACL. Does the surgeon suspect complete rupture or is a partial tear more likely.
2) Make sure your surgeon understands your situation. You have kids and responsibilities. Key hole surgery has a quick recovery time but an ACL repair has a major impact on your life. You may want to consider agreeing to arthroscopic surgery to trim the meniscus and assess other damage but hold off on more major intervention such as an ACL reconstruction.

The number one tip is good communication with your surgeon. Make a list of all your concerns before your next visit. Remember that your surgeon will make recommendations but the bottom line is that it is your knee. You make the decisions. Ask for time to think it over if necessary.
Don't forget the MRI is only part of the story. Experienced hands doing a thorough physical assessment fills in many of the blanks.
Remember that any advice on an online forum is of a general nature.
You are always advised to be assessed by a medical professional so your individual situation is addressed.