Banner - Hide this banner





Author Topic: Horizontal tear in posterior horn of medial meniscus. What do you think?  (Read 15525 times)

0 Members and 1 Guest are viewing this topic.

Offline ALRunner

  • Regular Poster
  • ***
  • Posts: 78
  • Liked: 1
I'm 28, M. I landed on my right knee about 12 years ago. It swole up nicely that day and I went to the ER. They xrayed and things were fine. I iced it/rested, all was good. Since then I've run on and off (maybe 8-10 miles/week) and consistently lifted weights, including fairly deep squats (I wish I hadn't!). Last April I started running again and in July started bumping mileage, peaking at about 35-40, where I kept it until 12 days ago when I stopped. I have had chronic runner's knee that entire time. I went to a sports physician last week and she did an xray (no problems) and an MRI, which showed my knee is perfect except for a horizontal tear in the posterior horn of the medial meniscus. Here is a badly taken pic of the MRI film: http://skoorbs.com/images/MRI.jpg

I've had runner's knee for years and I believe it's due to a pelvic imbalance/lack of ROM in muscles that I am now sorting out. I've never had any problem or symptoms associated with a meniscus tear. All pain has always been related to my patella (which is still healthy, so that's nice).

Based on other experiences here, what is the future likely to hold? The sports doc was pretty nonchalant about the tear. she referred me to a surgeon, who I've yet to see, but didn't seem too worried about it. I saw a PT guy today who's done 30 marathons and he was very, very nonchalant about the tear, saying that tons of runners have meniscus problems if they were to have an MRI and that if this is asymptomatic, then not to worry about it.

SO: Did this injury likely occur from that impact 12 years ago? Will it get worse with running? How long until I'm likely to feel pain? I know it can't be repaired and it seems ridiculous to get a menisectomy for something that is causing me zero problems, regardless of what I do (weights, sprinting, cycling, etc.). I've already decided to never do deep squats agin and since I'm planning on switching to triathlon, my running miles will go down to about 25 mpw, but I'll also incorporate cycling. Given that cycling develops quads, I'm going to stop all weight lifting related to quad strength.

I feel like if I had not gone in for the MRI for the patella, I'd continue on happily ignorant of this meniscus tear and possibly never be aware of it, but perhaps it's a blessing in disguise and now I know that I have it there so I can take early preventative measures? I really would hate to give up sport but I would hate to give up mobility at the age of 40 as well (and more).

Any input is appreciated!
« Last Edit: February 08, 2006, 02:37:45 AM by ALRunner »

Offline Nettan

  • SuperKNEEgeek
  • *****
  • Posts: 13862
  • Liked: 7
  • Stronger then yesterday...thanks Sis...
Re: Horizontal tear in posterior horn of medial meniscus. What do you think?
« Reply #1 on: February 08, 2006, 06:26:03 AM »
Hey !!

If I were you I would do exactly the same leave that knee as it is. Maybe surgery should give you more problems then help you right now and if doc or phys aren't concerned of it either why bother ? I think your plan in changing a bite around your activities sounds good. GOOD LUCK !!

HUGS NETTAN  8)
Surgery 6 times left knee torn meniscus, RSDS,chondromalacia, nervdamage cause constant nervpain,chronic inflamm.
Spinaldamage wheeler 100%.
Right knee damaged aug-06, use brace surgery 4/9-07.LCL tear.

Offline Audice

  • Global Moderator
  • SuperKNEEgeek
  • *****
  • Posts: 1061
  • Liked: 8
Re: Horizontal tear in posterior horn of medial meniscus. What do you think?
« Reply #2 on: February 08, 2006, 12:38:15 PM »
I'll second what Nettan told you - stick with what you've got so long as it's not causing you either pain or great alteration of lifestyle. My way of life allows me to get along just fine w/o an ACL & with a medial meniscal tear...Ellie
April, 2005 - ACL rupture, medial meniscus tear within posterior horn to articular surface, abnormal signal within lateral meniscus, partial tear MCL, bone contusions tibia/fibula, Baker's cyst.
No repairs.

Offline ALRunner

  • Regular Poster
  • ***
  • Posts: 78
  • Liked: 1
Re: Horizontal tear in posterior horn of medial meniscus. What do you think?
« Reply #3 on: February 08, 2006, 10:47:30 PM »
How is running likely to influence this particular tear? From what I can tell, longitudinal tears are worse and can easily deteriorate into a bucket tear. However, since the red zone of this one will not heal, since that's where it starts, the only way this tear can progress is into the white, closer to the center. If that happened, could it turn into a longitudinal? i.e. the tear would be all the way from outer to inner, in which case it would be a horizontal with a bucket tear, then rubbing against my femur or tibia?

I PRESUME that this occured 12 years ago. It would have been lovely to have an MRI from then. I guess it's possible that the tear happened then and has not progressed since. However, I don't remember recovery very bad. It swelled badly, as I mentioned, but after that night on my back with the knee elevated and not willing to bend without intense pain, I remember just wrapping it for several days and it seemed to get better relatively quickly. Would a tear of this severity, if it happened all at once, have such a short period of pain for me?

Offline sienna

  • SuperKNEEgeek
  • *****
  • Posts: 821
  • Liked: 0
  • Anyone seen the light at the end of the tunnel?
Re: Horizontal tear in posterior horn of medial meniscus. What do you think?
« Reply #4 on: February 08, 2006, 11:51:48 PM »
Hi,
Firstly, red tears are perfect for repairing as they have the most blood supply.  If your tear is in the red zone it is near the outer edges of your meniscus.  If it was to worsen, it sould go in a number of directions.  It could stay within the meniscal body and spread like a crack along the body of the meniscus.  It could tear towards the outer or inner edges of the meniscal body.  I'm not sure a horizontal tear would form a bucket handle unless you injured it further in a twisting fashion.  but don't quote me on that point.  Another thing that could happen if the tear broke the outer surface of your meniscus is that cyst could form.  Lots of things could happen but there's no guarantee that any of them might or might not. 

Tears of a horizontal kind happen after an injury to the knee.  The impact you had in your fall would have destabilised your knee and made you more susceptible to this type of tear.  Then following with years of deep squats (so glad you have seen the light regarding these) put too much pressure on your posterior horn which has now torn.  Since you have stopped squatting, you probably won't notice any pain as a small tear in the posterior usually gives you pain on deep bending. 

Running and cycling probably won't hurt your knee, neither will swimming.  I played netball with a tear for a few months and wasn't hindered at all except if I happened to accidently fully bend my knee.  The tear I had repaired happened after I had to start squatting and lifting heavy children as a part of my job. 

It is hard to know whether your tear will worsen over time.  They usually do.  But sometimes they don't.  I believe that mine did over the 6mths I had to wait will worker's comp got their act together.  But I was still working and trying not to lift squat etc but the damage was already done.

I think that waiting especially since that your tear isn't causing any probs at the moment is fine.  Some small tears have been known to heal on their own.  Not sure tha a horizontal tear would or not but you never know.  You are aware of it and are taking up activities that will help keep your knee strong and hopefully lessen the likelihood of further injury.  Keep an eye on it and be sensible when it comes to exercise.

There is more info on types of tears on the home page.  Follow the links.  There is great info there and its easy to understand.

Good luck
rk posterior meniscus tear. Successfully repaired 10 Sep,03. Now have nerve damage and cps which goes with it.  I want to slap the person who said 'It just takes time....'

Offline ALRunner

  • Regular Poster
  • ***
  • Posts: 78
  • Liked: 1
Re: Horizontal tear in posterior horn of medial meniscus. What do you think?
« Reply #5 on: February 10, 2006, 03:01:03 PM »
Thanks for the encouraging replies!

I read on the sheet yesterday by the radiologist (presumably, since he was the one who looked at the MRI first) and it did indeed say no problems except for the torn meniscus, but that it extends to the superior surface. that kind of sucks...so it would seem that my femur's condyle is rubbing against this thing on its fault line. I would guess that it's doing minimal, if any damage to that condyle, based on the plane of resistance, but I feel like I can just picture the entire meniscus splitting apart, like a filleted fish.

It's a bit late to witch hunt, but am I right to think that I maybe got substandard treatment those 12 years ago? I don't know when MRIs came on the scene, but it was an ER in Canada and I told them that it had been a nasty impact and they knew that I could not bend my knee properly and that walking on it hurt a lot. Surely they knew something amiss was going on in the knee...probably nothing could have been done, but I bet that if I came into an ER now and presented with the same problem, at least in the US (where MRIs can be ordered easily and quickly), I'd have had an instant and real diagnosis besides just "ice it and stay off it". Maybe it was for the best though as they may have just performed a menisectomy on the spot, which obviously would have been a bad idea now. Just pondering :)

Offline jb-knee-geek

  • SuperKNEEgeek
  • *****
  • *
  • *
  • *
  • Posts: 1527
  • Liked: 0
  • Nothing left to do but smile, smile, smile
Re: Horizontal tear in posterior horn of medial meniscus. What do you think?
« Reply #6 on: February 10, 2006, 05:21:22 PM »
Hi AL, sorry to hear of your injuries, I am in the camp of "less can be more" when it comes to surgery.

However, I have decided to decrease the activities which put my knee in joepardy (mensicus & ACL).

So far so good, after another knee sprain in Oct., I switched to moderate hikes, cycling, swimming, gym work. No pivots or bounce. My big test is this summer when I ramp up to more strenuous hikes and cycling.....

It may be a matter of time for the both us, in that our injuries may progress to a level of pain and/or inactivity which drives to surgery.

I'm willing to wait, having done so for a few years with my torn ACL I may have caused more damage to my meniscus, but, ACL allograft surgery has progresed in that time too.  Perhaps I'm just a big chicken, dunno..  :-[

good luck, keep posting
torn RK ACL March 2001, surgery Aug. 14 2006, after 4 knee sprains since Oct. '05.  Allograft, ~40% medial meniscus removed, some wear in the trochlear groove. Everything else looks good.

Post-op diary: http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=29749.

Offline ALRunner

  • Regular Poster
  • ***
  • Posts: 78
  • Liked: 1
Re: Horizontal tear in posterior horn of medial meniscus. What do you think?
« Reply #7 on: February 10, 2006, 07:04:17 PM »
Hi AL, sorry to hear of your injuries, I am in the camp of "less can be more" when it comes to surgery.

However, I have decided to decrease the activities which put my knee in joepardy (mensicus & ACL).

So far so good, after another knee sprain in Oct., I switched to moderate hikes, cycling, swimming, gym work. No pivots or bounce. My big test is this summer when I ramp up to more strenuous hikes and cycling.....

It may be a matter of time for the both us, in that our injuries may progress to a level of pain and/or inactivity which drives to surgery.

I'm willing to wait, having done so for a few years with my torn ACL I may have caused more damage to my meniscus, but, ACL allograft surgery has progresed in that time too.  Perhaps I'm just a big chicken, dunno..  :-[

good luck, keep posting
Do you currently experience any meniscus pain and what's the extent of the meniscal injury...?

I will surely update this thread on Wednesday after I see a surgeon over it. It sucks horribly waiting so long for these things! I can only imagine how terible it would be if it was a "real problem" like cancer or something  :o

Offline jb-knee-geek

  • SuperKNEEgeek
  • *****
  • *
  • *
  • *
  • Posts: 1527
  • Liked: 0
  • Nothing left to do but smile, smile, smile
Re: Horizontal tear in posterior horn of medial meniscus. What do you think?
« Reply #8 on: February 10, 2006, 09:33:05 PM »
I have NO pain, except some minor soreness after activity, slightly more than if I had a "normal" knee.

If this soreness were to keep me up at night or keeps me from my preferred activities, then I'm down with surgery....

In Nov. '05, my MRI showed a complex meniscus tear (oblique/radial form) in the medial meniscus, in the posterior horn extending to the body.  After 3 months of rehab, nutritional supplements, I am doing great, no limp, no pain, no locking, no instability, stairs no problem, up/down, 2 at a time. Perhaps it's healed some, MRI's are not 100% definitive for meniscus tears, perhaps I had a bone bruise, a combination of things, but I'm a lot better 3 months later.

Running is my threshold, not sure I'm confident to bounce on my knee in it's present form.

If I really wanted to run for distance and do pivot sports, I'd probably have more pain and I'd take my chance with surgery, as 99% of other athletes do.  I have a torn ACL to go along with my scratchy meniscus, but I've modified my activities, I believe it's made a difference.....

hope this helps.

torn RK ACL March 2001, surgery Aug. 14 2006, after 4 knee sprains since Oct. '05.  Allograft, ~40% medial meniscus removed, some wear in the trochlear groove. Everything else looks good.

Post-op diary: http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=29749.

Offline ALRunner

  • Regular Poster
  • ***
  • Posts: 78
  • Liked: 1
Re: Horizontal tear in posterior horn of medial meniscus. What do you think?
« Reply #9 on: February 11, 2006, 07:11:25 PM »
Thanks for the continued responses!

I did 30 min stationary followed immediately by a 3 mile run this morning. I felt no pain but upon looking at my right knee did notice a bit of swelling, in the same area as this dude http://www.skoorbs.com/images/swelling.jpg Is that where the medial meniscus would induce swelling? I thought at first it was surely because of that (still no pain or anything, including after trying a deep body weight squat...I know, I will stop those!) but the PT pressed the heck out of a tendon/muscle in that area two days ago and I can still mildly feel his press, but is this the area I should be looking at?

Upon further examination, it's my MCL that is hurting (barely) and presumably it is swollen. If so, that's no problem. Would the exercise encourage more swelling? Is it possible that it was pressed so hard that this happened? I've not had swelling in this area before and like I said, he pressed HARD.

It seems to me that if the posterior meniscus is swelling, there would likely be pain (there is none) and the swelling would be out the back of the leg, right (it's not)?
« Last Edit: February 14, 2006, 02:08:03 AM by ALRunner »

Offline ALRunner

  • Regular Poster
  • ***
  • Posts: 78
  • Liked: 1
Re: Horizontal tear in posterior horn of medial meniscus. What do you think?
« Reply #10 on: February 15, 2006, 11:56:52 PM »
I finally saw the sports physician today and got good news. He's a surgeon and a fellow physician was there, too. They were both of the opinion that I probably do not have a meniscus tear. Although there is a definite signal change in the MRI, they felt that a definite tear would be far more evident. Furthermore, the signal change was not inconsistent with people my age. They both performed, as my original doctor had, the mcmurray test and said that they saw no reason to think I had a meniscus tear. They felt that the physician who called it a tear based on the MRI probably jumped the gun, which is why some people feel MRIs should not say that a tear was found but rather a signal change was found, since a tear is a clinical diagnosis. The doctor said that he'd not worry about this if he was me and that I could continue to run and squat in the gym. I guess that in the end of this I have either no tear, but typical "signal differences" in my meniscus, or I have a patently asymptomatic tear but in any case there's nothing I can do for it from a medical point of view and it shouldn't impact what I do.

I hope that this advice is sound and that I can continue on for years on my knee without problems. I have found this recent worry (precipitated in part by a cautious sports doc, but I appreciate her concern) to be a bit enlightening. I am in need of grounding sometimes. All the docs have said to continue taking glucosamine and chondroitin.

Offline jb-knee-geek

  • SuperKNEEgeek
  • *****
  • *
  • *
  • *
  • Posts: 1527
  • Liked: 0
  • Nothing left to do but smile, smile, smile
Re: Horizontal tear in posterior horn of medial meniscus. What do you think?
« Reply #11 on: February 16, 2006, 04:50:02 AM »
happy to hear it AL, here's a good glucosamine product with Hyaluronic Acid, a nutrient which may help protect joints.

http://www.gnc.com/product/index.jsp?productId=2133465&cp&change_search=products&keywords=glucosamine+acid&y=0&searchId=10530656459&x=0&parentPage=search

continued good luck to you.

torn RK ACL March 2001, surgery Aug. 14 2006, after 4 knee sprains since Oct. '05.  Allograft, ~40% medial meniscus removed, some wear in the trochlear groove. Everything else looks good.

Post-op diary: http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=29749.