Cartilage damage due to partial menisectomy - how to live with it?

[k24043]

Hi,

does anybody have similar experience or advise?

I'm 34 years old and my both knees have ~1.5x1.5cm full thickness femoral condyle cartilage damage. This is probably due to lateral meniscus flap tears that were fixed with partial menisectomy in 1995 (right) and 2000 (left). Both meniscus tears came in quite innocent everyday situations - I have survived much worse sports mishaps with no injuries at all.

My right knee started acting up in 2003 but I was able to run, ski, play tennis, make long mountain hikes etc., just had to be careful not to overdo it. Pain came and went. Year ago, in Dec 2009, while skiing I accidentally overbended my left knee. I guess I tore my left lateral meniscus again. There was very little pain after the first days but could not squat past 90 degrees.

X-rays showed narrowing lateral hiatus (sounds logical if 1/3 of the lateral menisci is partially missing...) and After MRI that showed tears in my lateral menisci so I had an atroscopy. it showed that the posterior horn of the lateral meniscus was ground into atoms - no rim left and hiatus practically partially open. there was also cartilage damage in the femoral condyle - in the areas corresponding to meniscus damage. Damaged areas were microfractured and knee was "cleaned up".

Now ~1 year post-op I have very little pain. I avoid squatting - can do it but there is some "snap-crackle-pop". Basically it only stings a bit if I bend the knee and twist it inwards or in very quick movements like in badminton. I quit running (did not like it anyway) and substituted it with road cycling. I cross country ski and can play light tennis. Did even couple of 8hr high mountain hikes in the summer. As an office worker I don't really even notice that there is something wrong. I have been also eating Glucosamine pills.

I have consulted several recognized orthopedic surgeons and it seems to me that further surgical procedures like mosaicplasty/oats or ACI are an unnecessary risk since my knees are in quite good shape and the microfracture has helped the situation. I still have estimated 50% or even 60% lateral menisci left in my both knees.

All ligaments and medial meniscus + cartilage surfaces are fine. So I guess I have mild OA that has resulted from partially missing menisci. Does it necessarily worsen over time? Wondering how I could keep it mild... Do medium-impact activities such as recreational downhill skiing / hiking / tennis make it worse over time or should I stick barely to low-impact sports?

All advise is appreciated!

[martialartist]

This is similar to what I have currently. My defect is 1.4 x .9 and pains me sometimes.  At times, its quite painful, but not really often.  3 well known orthopedic surgeons have varying degrees of advice. One said outright dont do anything, ramp up my game and if it still hurts fix it or adjust my life. He gave me this song and dance I am getitng older, time to slow down. Basically the old joke... "Doc it hurts when I do this." "Well.. dont do that then." ....

 The next said similar. If I had no symptoms, he would recommend not doing anything, but since I do have some syptoms, fix it or it will get worse over time. The third, told me fix it.  I worry that in some years, the defect will grow so I am leaning on getting it fixed.  Each one had varying idea about the future, but the theme was the same. More damage would come down the road. I am still fairly young and wish to avoid total knee replacement. I think fixing now is a pre-emptive strike and will stop more wear from coming. I hope I am right..

Good luck.

[HurleyG]

I have similar situation: partial meniscus tear 20 years ago and now I have OA , limited motion, "trick knee" etc. I got the same advice you did: slow down, change activity, etc.
I am doing PT, ice, Ibuprofen, but that is not enough.
I just got a cortisone shot 2 days ago. So far the only benefit is that there is less pain when my knee catches.

What can you tell us about the stem cell solutions I am hearing about ? I heard on NPR that in Australia they are reporting 90% success ( whatever that means) on dogs. WHat can a stem cell injection do ? Will it insert a cushion between my bone on bone wear ?

When they inject the stem cells is it done in conjunction with arthroscopic "cleaning"  ?

[mmrocker13]

Your best plan for keeping it mild is to do what you're doiing: Eat right, keep your weight down, exercise regularly (maybe add in some strength training), consult with your doctor if things get worse. :-)