The WAITING ROOM => GENERAL KNEE QUESTIONS and comments (good for new threads) => Topic started by: johnnyenglish811 on August 26, 2014, 01:55:43 PM

Title: Making sense of the jargon - what does it mean?
Post by: johnnyenglish811 on August 26, 2014, 01:55:43 PM

As you will see, I've just signed up and would appreciate being able to draw upon your understanding experience.  I've just had an arthroscopy and debridement on my left knee for the second time (first was around 20 years ago).  The surgeon has reported:

Left knee lateral meniscal tear.
Lateral tibial plateau articular defect Grade IV.
Lateral femoral condyle articular defect Grade IV.

I'm male, aged 40 and serving in HM Forces.  I've been suffering with swelling, stiffness and restricted movement in my knee for several years with physio getting me through.  The trigger for the surgery last week was loose cartilage catching in the joint.

What does the above diagnosis mean?  I was unable to speak to the surgeon before leaving hospital and have no sense as to how serious this is?  I wonder whether, given sufficient rehab, I'll be able to continue running and what the long term prognosis is.  Does anyone in the group have any experience of a similar injury? 

I'm hoping to pull together a few thoughts for my follow up in 6-8 weeks time.

Thanks in advance.

Title: Re: Making sense of the jargon - what does it mean?
Post by: Vickster on August 26, 2014, 02:40:12 PM
Unfortunately, depending on the size and location of the defects (weightbearing versus non weightbearing surface), these could be quite problematic going forwards.  Grade IV means that you have holes in the articular cartilage (shiny stuff covering the bones) through to the underlying bone (essentially arthritis), on both the outside part of the top of the shin bone and the bottom of the thigh bone - you would need to know whether these are opposite each other (known as kissing defects)

You also have a tear in the lateral meniscus (shock absorber between the two bones), which presumably has been trimmed away to remove the torn bit which was catching (you need to find out how much was removed and from which part)

Unfortunately, none of these bits will heal themselves as neither the meniscus nor the articular cartilage has a blood supply.  There are some techniques to try to cover the holes in the bone, but if the defects are opposite and the meniscus is missing the success is quite low.  Otherwise, if the bones are rubbing, they can be realigned to off load the rubbing bits.  Or there are replacements, if the rest of the knee is good, there are uni-compartment replacements (although less uncommon for the lateral side and you'd want to see a real specialist, like the group in Oxford)

There are non surgical measures that can help with the inflammation (injections of steroid or something called hyaluron acid which lubricates the joint, these help me, I have similar issues) or you could use an unloader brace to realign the bones without surgery.  Physio and good strong leg muscles are really important and trying to avoid high impact activities (running really is probably best kept to a minimum, swimming and cycling are good low impact activities as long as the surgeon is happy) and keeping weight in check

Have a read through of the meniscus and arthritis primers in the information hub for more background (linked above ^^^)

Good luck :)

Hope it all works out for you
Title: Re: Making sense of the jargon - what does it mean?
Post by: johnnyenglish811 on August 26, 2014, 07:34:32 PM

Firstly, many thanks indeed for taking the time to post a really informative reply.  As you'd expect, my marathon days are over and I've reduced my running to the bare minimum required to pass my annual physical tests - but even this is painful and requires ibuprofen pre and post-training followed by rest.  I've therefore fallen in to t cyclical pattern of physical training and physio over the past two years which hasn't really got to the bottom of the situation - I've also been rather stupidly stubborn and 'refused to give in'.

I may now regret that.  Are you able to bear weight an undertake any physical activity with your injuries (akin to mine)?  My quad strength is good and I'm sticking with my rehab exercises.  I've also switched to the low impact cross-trainer and cycling (I find breaststroke uncomfortable).  Your point about watching my weight is well made - and I'll need to match a reduction in exercise with a reduction in calorific intake.

I potentially have another 20 years Armed Forces service in me if I want it but I fear that my knee may for a re-think.

Thanks again for getting back to me.
Title: Re: Making sense of the jargon - what does it mean?
Post by: Vickster on August 27, 2014, 08:57:17 AM
I can't run, have been told not to, nor do I wish to so that's all good

Swimming, I have been told to avoid breast stroke, when I do swim, front crawl for me which is my preference anyhow

Cycling is my activity, mostly fine, I do get twinges in my knee but I did  fairly hilly 105km on Sunday and although my muscles are sore, my knee is fine.  My situation is complicated by a shin injury in February which needed surgery (large haematoma needed evacuation after it got infected), this affected my knee and back as I tried to cycle too much too soon

Currently I have a couple of small meniscus tears but they aren't affecting the ROM in my knee, plus various bits of articular cartilage damage and softening.  I have gained a bit of weight and are 10kgs off where I'd like to be, but that's pretty much normal for me! I'm 42 now (initial injury was 5 years ago now, my meniscus is degenerate to prone to tears, not getting any younger :( )

I have a desk job so no need to reach any levels of physical fitness.  Is there something you can do within the forces that is more sedentary?

Have a chat with your surgeon, there are options, some don't involve surgery but some involve big open operations with a number of months off work and 1-2 years of rehab.  The hyaluron acid injections work for me every 18 months or so.  I have private insurance, but have to pay for the stuff.  I don't know what your situation would be, they are used by the NHS though if indicated

Good luck :)
Title: Re: Making sense of the jargon - what does it mean?
Post by: johnnyenglish811 on August 27, 2014, 09:16:35 AM

Once again, many thanks.  That gives me a sense of what may be feasible in the future and has framed a couple of questions I can put to the consultant during my follow up.  Medical downgrading leading to limited deployment liability is possible in my role but, with the Army reducing in size, we need as many as possible to be fully deployable.  Ultimately, I think I need to take a long term view - with young children, I'd like to play an active part as the grow up and don't want to be limited by crippling pain in my knee.

In some respects, the damage is done so it's a matter of managing the current situation and reducing the rate of degradation in the knee - that's where a decision to remain in the Forces will come in to play.

I've never really taken to cycling but you clearly enjoy it - 105K 'ride' is quite an outing and I'm encouraged by your ability to do this without being laid up for days afterwards.  I'm also probably 10KGs off where I'm should be in terms of weight - the consultant advised me to aim for a 'Tour de France' physique!!  Not likely I'm afraid!

You've given me a few thoughts to explore - many thanks.  I'll keep you posted and may come back to you.  Thanks again.
Title: Re: Making sense of the jargon - what does it mean?
Post by: mmrocker13 on January 23, 2015, 05:40:18 PM
I realize this is an old post, but lateral defects are not quite as common, so I thought I'd chime case anyone else is looking :-)

I also have grade IV defects on the LFC and tib plateau. I no longer have any lateral meniscus, having had the last 5-10% or so removed last week. My cartilage defects are diffuse, and cover the entire lateral compartment.

You may want to look into an unloader brace, which will offload that lateral compartment. If you find that it helps, and you can run and be active... if your role in the service allows the time off, I'd look into an osteotomy. I came out of mine in 2010 feeling better than I had in decades. FWIW, I started life as a runner, but after a failed microfracture in my early/mid-20s, I moved to being a duathlete, and cut my running back to 3 dpw.