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Author Topic: mri misses, meniscus, arthroscopy, pain.  (Read 9645 times)

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Offline xhui

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mri misses, meniscus, arthroscopy, pain.
« on: March 05, 2010, 04:55:25 AM »
Hi everyone,

Found this forum while doing some reading up on my knee pain. I'm not local, but desperately need some advices from fellow gurus here.

To cut the long story short, i've injured my left knee while picking up some heavy equipments from the floor with my left knee down/bent. I vaguely remembered twisting my knee and hearing a pop sound. That was like about 4months ago.

Now, with every step, more so with weight bearing, sharp pain runs across from my inner knee across the joint line. My knee rotates and seems to have a full range of motion though pain worsens when i try to straighten my knee. No visible swelling but I feel tight around the injured area (swelling kind of feeling) and pain when pressed upon.  :-\

Have been seeing a Ortho doc who initially suspected a meniscus tear but did an MRI but came back normal with just traces of fluid in there. Was kindof lost as again, nothing conclusive!

Was given the option of doing an arthroscopy or follow up with physiotherapy to strengthen muscles around the knee in attempt to alleviate pain. Have actually started physiotherapy sessions but the pain seems more persistent now and my knee feels consistently tired and painful!

Help! should i go with the scope or try out few more weeks of PT first? Cost isn't a concern here but I guess the bigger disappointment would be to go for the scope and for the doctor to report a normal diagnosis again while the pain is real and really hampering my daily routines.

Thanks in advance for your advices and sharings!  :)
« Last Edit: May 02, 2010, 03:30:53 PM by xhui »
Nov 09 - injury: twisted left knee
Jan 10  - first appointment with Ortho doc
Feb 10  - MRI showed normal, nothing conclusive
Mar 10  - started PT for a month
15 Apr 10 - Arthroscopy, medial meniscus trim (frayings)

Offline tez27

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Hi xhui
Your case sounds similar to mine I also had an m.r.i that showed pockets of fluid but nothing else, I decided to have a scope because of constant pain and the fact like you it was affecting my daily life.
I came round from the anasthetic to be told I have a complete rupture to the a.c.l and a tear to the m.c.l at the moment the o.s is not sure what extent the m.c.l is torn because there was a lot of scar tissue.
My injury occured 19 months ago and I now wish I had had the scope a long time ago as the scar tissue is possibly where a lot of my pain is coming from and that would have been less extensive had somthing been done just after initial injury.
So please go for the scope its the only way to be sure what is going on in your knee I also tried physio thinking this would help with the pain but it did nothing to help at all so again please have the scope even if it's just to put your mind at rest that all is well with your knee
Take care Tez
















i
L K injured 25th June 2008
scope Jan 5th 10
diagnosis ACL rupture
fiberous band excised from acl
ACLr July 19th 2010  scope on 24th Sept 2011
ACL has failed incorrect tunnel placement
23rd July 2012 1st stage of a 2 stage ACL revision
10th May 2013 2nd stage ACL revision

Offline dm

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It's fairly common for an mri to be inconclusive, given several factors. One, the quality of the films, two, the experience of the radiologist reading them, and three, the mechanism of injury. So, you end up having to take the results you've got, combine it with the ortho's clinical opinion, your pain factors, and decide if it's worth the risks of an exploratory scope, or to just leave things be and wait and see. After 8 months of being told that my pain was in my head, I got another opinion, because the mri was inconclusive, and I was in pain, and my 1st doc didnt belive me, so I got another opinion, and he gave me the same options yours did... live with it or go see what's going on. You choose.
multiple arthroscopies 2/00,3/01,6/01,1/03, 12/07,10/10. chondromalacia, severe medial joint space narrowing following 3 partial menisectomies, chronic pain problems, kneecap problems, OCD lesion, failed mfx.

Offline xhui

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Thanks so much tez and dm for the replies! Your sharing of experiences really just tip me towards the decision of doing the procedure. I guess after much procrastination, I realised I didn't really have much valid fears not to do it. Probably only the disappointment and frustrations if the scope would come back with NIL returns.

Thanks guys, the disabliting effects are getting to me hence shall make an appointment with my doc again to get this done. Will post back again on progress.

Any other replies are very much welcome still! (it sure is exasperating to be scourging the Internet for similiar experiences and what to do).
Nov 09 - injury: twisted left knee
Jan 10  - first appointment with Ortho doc
Feb 10  - MRI showed normal, nothing conclusive
Mar 10  - started PT for a month
15 Apr 10 - Arthroscopy, medial meniscus trim (frayings)

Offline Clarkey

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  • Neil TheElephant knee packed up carrying his trunk
Hi xhui,

I too had a normal MRI scan on my right knee with some fluid inside the knee but was told physio might solve the problem but it ddi not help. I fell hard onto the pavment onto my right knee in October 2007 and took over 2 years until they decided to scope my knee. I felt sharp pain and catching inside the knee and could no longer run since my fall.

When my OS looked inside my knee he had to remove the medial plica and fat pad as they where so large and inflammed that they were rubbing against my bone. I am now nearly 16 weeks post op and knee still not improved and knee worse off now then before the surgery.

Do not be put off having surgery just because mine is not working so far as surgery for most people helps or reduces knee pain and in your situation would have your knee scoped as I am sure your OS will find a problem and will be able to fix it.

Nick :) {2010} :)
RK: PFPS, Arthrofibrosis, Tendinopathy, Five cortisone injections
16/01/18 Anterior interval release, distal patella excision, lateral meniscal repair
18/07/14 Anterior interval release  
16/11/09 Medial plica excision, fat pad trimming

Offline xhui

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Hi xhui,

I too had a normal MRI scan on my right knee with some fluid inside the knee but was told physio might solve the problem but it ddi not help. I fell hard onto the pavment onto my right knee in October 2007 and took over 2 years until they decided to scope my knee. I felt sharp pain and catching inside the knee and could no longer run since my fall.

When my OS looked inside my knee he had to remove the medial plica and fat pad as they where so large and inflammed that they were rubbing against my bone. I am now nearly 16 weeks post op and knee still not improved and knee worse off now then before the surgery.

Do not be put off having surgery just because mine is not working so far as surgery for most people helps or reduces knee pain and in your situation would have your knee scoped as I am sure your OS will find a problem and will be able to fix it.

Nick :) {2010} :)

Thanks Clarkey for sharing your experience! Woah. that whole procedure sounds rather painful and complicated.. It must be pretty frustrating to have your knee feeling worse then before! But thanks for sharing, at least I can have balanced views of what a surgery can do and can't do.

Sincerely hope your knee will turn out better after some time of recovery and thanks for the encouragements! Don't give up on your knee too!
Nov 09 - injury: twisted left knee
Jan 10  - first appointment with Ortho doc
Feb 10  - MRI showed normal, nothing conclusive
Mar 10  - started PT for a month
15 Apr 10 - Arthroscopy, medial meniscus trim (frayings)

Offline Clarkey

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  • Neil TheElephant knee packed up carrying his trunk
Hi again,

As you have found out from members on this board MRI scans are not always accurate and the only person that knows there a problem in the individual that feeling pain inside the knee. The knee hurts for a reason and MRI scans do not always show up a knee problem and the best way to diagnose and fix a problem is to scope the knee.

Thanks for your concerns about my knee it not really improving at the moment and due to see my OS at the end of this month and hope he can sort out my knee problem finally.

Nick :) {2010} :)
RK: PFPS, Arthrofibrosis, Tendinopathy, Five cortisone injections
16/01/18 Anterior interval release, distal patella excision, lateral meniscal repair
18/07/14 Anterior interval release  
16/11/09 Medial plica excision, fat pad trimming

Offline xhui

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Thanks for all the kind help and replies so far.

Just some progress updates.

Have been undergoing physiotherapy to about a month now (since injury it has been 4months). I can feel my leg muscles are much stronger and seems to be supporting my weight better as I go about doing my daily routines. The pain seems to have subsided quite a bit from daily walking, but once any additional weight, twisting and up down stairs, the pain still comes on. Oh the reduced pain is more significant with some anti-inflammatory meds.

It was in this midst of waiting for my doctor appointment (1 month wait) that i underwent these physio exercises. I'm going to meet my ortho doc next week and I have to decide if I should consent to undergo the scope.

Now I'm starting to wonder if PT will really "fix" my problem and get me back to full exercise routine again?

Maybe I'm being procrastinating here, but the reduced pain seems to be wavering my initial decision to go ahead for the scope (that's the result for waiting too long!). Does PT actually solves say, a suspected meniscus issue? Or maybe my doc and therapist have been wrong all these while on the meniscus? A possible >4 months old knee sprain?

I've minimal or no swelling pretty much since injury, just some nasty sharp pain across jointline and medial side of my knee (tender to touch!) whenever i walk, put load on my knee.

My concerns for scope now is whether I'll be doing more damage to my knee then my current situation. Please advise and help!  :-\
Nov 09 - injury: twisted left knee
Jan 10  - first appointment with Ortho doc
Feb 10  - MRI showed normal, nothing conclusive
Mar 10  - started PT for a month
15 Apr 10 - Arthroscopy, medial meniscus trim (frayings)

Offline dm

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  • I hate my knee!! :(
"just some nasty sharp pain across jointline and medial side of my knee (tender to touch!) whenever i walk, put load on my knee" is indicative of meniscal issues IMHO, so keep the appointment and tell the doc exactly that. at this point, low swelling is good, I don't swell up much with meniscal tears either, have had 3 of them. Follow up with the knee, is my advice.
multiple arthroscopies 2/00,3/01,6/01,1/03, 12/07,10/10. chondromalacia, severe medial joint space narrowing following 3 partial menisectomies, chronic pain problems, kneecap problems, OCD lesion, failed mfx.

Offline tez27

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Hi xhui
I realy wish I had had a scope when I first injured my knee because I now have a lot of scar tissue as well as the other injurys and I think that is where some of my pain is coming from. I also had a load of physio and it did help strenghthen the muscles round my knee which in turn helped the pain a bit but it has always been there and at least now that I have had the scope I know what is wrong with it and can start the process of getting it fixed. Dont wimp out now lol as far as I can tell you will not get a proper diagnosis without the scope.
I'm no expert but thats my experience.
Take care Tez 
L K injured 25th June 2008
scope Jan 5th 10
diagnosis ACL rupture
fiberous band excised from acl
ACLr July 19th 2010  scope on 24th Sept 2011
ACL has failed incorrect tunnel placement
23rd July 2012 1st stage of a 2 stage ACL revision
10th May 2013 2nd stage ACL revision

Offline Lou123

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Re: [Not local, need advices] New here, normal knee mri but persistent pain
« Reply #10 on: March 19, 2010, 08:27:38 PM »
Thats one thing that I'm finding annoying. When the dr and 2 different physios have done a physical exam of my knee, they have all been certain that there is cartilage damage, but as the MRI showed no tears, just fluid in the knee the os wants to keep on with conservative treatments.
Its been nearly 10 months since the injury, and they are not working. As much as i would like to avoid surgery, I think a scope is probably the best option now. I am worried that there will be scar tissue building up, which may be getting in the way.

Offline tez27

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Re: [Not local, need advices] New here, normal knee mri but persistent pain
« Reply #11 on: March 19, 2010, 10:14:41 PM »
Hi Lou
My advice would be to push and keep pushing your o.s to do a scope I really wish I had but because I am a total wimp I took what I was told and went on my merry way doing more damage as I went lol.
L K injured 25th June 2008
scope Jan 5th 10
diagnosis ACL rupture
fiberous band excised from acl
ACLr July 19th 2010  scope on 24th Sept 2011
ACL has failed incorrect tunnel placement
23rd July 2012 1st stage of a 2 stage ACL revision
10th May 2013 2nd stage ACL revision

Offline xhui

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Re: [Not local, need advices] New here, normal knee mri but persistent pain
« Reply #12 on: March 20, 2010, 02:05:08 AM »
Hi dm & tez,

thanks so much for your replies!

@dm
and I thought I was the 'weird' one by not having any swellings when doc kept saying meniscus issue. Was also ploughing the net for any other possible explainations to my pain and weakening knees. Thanks for sharing :)

@tez
oh my, can understand your regret for not doing that scope earlier! Scar tissues, this is something I've missed to consider! Thanks for the advices too, I'll try not to wimp out now till my doc visit. Lol. Am not even sure if I'm hoping for the os to find some 'problems' with my precious knee or to pray it is all well (huh again?!) oh well, this can get pretty frustrating!

@Lou
thanks for shaing your experience too. Seems like we are pretty much in the same boat. Everyone here have been really helpful so maybe you'll find their advices on follow up here. Take care :)
Nov 09 - injury: twisted left knee
Jan 10  - first appointment with Ortho doc
Feb 10  - MRI showed normal, nothing conclusive
Mar 10  - started PT for a month
15 Apr 10 - Arthroscopy, medial meniscus trim (frayings)

Offline Clarkey

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  • Neil TheElephant knee packed up carrying his trunk
Re: [Not local, need advices] New here, normal knee mri but persistent pain
« Reply #13 on: March 20, 2010, 10:24:39 AM »
I was in a similar situation you are in at the moment was told to keep on top of my PT and knee should be ok but after months of PT knee was still not improving. I went to the gym 3 times a week to build up on my quads and when I finally saw an OS he said my quads are very strong and gave me a cortisone injection which did not really help so had no option but to scope my knee.

I would go ahead and have your knee scoped as its not too bad as long as you keep on top of your PT after your surgery. I am over 4 months post op and knee not improving, but do not be put of by my situation as there are many succesful scopes done worldwide everyday. You only read up about the failed scopes on KG bulletin board because the members that surgery was successful no longer post on KG. Even the general anesthetic is not too bad as they have improved a lot over the years and the after affects are minimal. There are risks having a scope DVT and scar tissue but it does not happen all the time to patients so there always going to be risks with any type of surgery.

Nick :) {2010} :)

RK: PFPS, Arthrofibrosis, Tendinopathy, Five cortisone injections
16/01/18 Anterior interval release, distal patella excision, lateral meniscal repair
18/07/14 Anterior interval release  
16/11/09 Medial plica excision, fat pad trimming

Offline xhui

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Re: [Not local, need advices] New here, normal knee mri but persistent pain
« Reply #14 on: March 27, 2010, 05:00:59 AM »
Thanks Clarkey for your sharing again!

Just some updates, I've seen my OS and had scheduled for a diagnostic scope for the 15 Apr. They took some blood to test for any arthritis issues (hmm but I'm just 28yrs old!) I'll be going under general anesthesia(doc didn't give any other choice). Kindof scary, first time going under and sleeping..

What should I expect pre, during and post procedure? I've been informed to fast the night before and if nothing much has been found in my knee I'll probably be on 2weeks medical leave, while any other repair work might warrant a longer leave.

In the meantime, should I continue my PT sessions? I'll assume I'll continue PT after the scope too.

Saw on my checksheet doc wrote, surgery for diagnostic purposes, 'debridement/meniscectomy'. Does it mean she'll remove parts of meniscus if they are torn? Kind of worried about early oestheo or  arthritis problems!

After the surgery do I need crutches or can I literally limp off home (they mandate I have someone to fetch me). Hope my knee won't be too wrapped up or sorts, hate the feeling of being in need..

Thanks everyone for your advices!   
Nov 09 - injury: twisted left knee
Jan 10  - first appointment with Ortho doc
Feb 10  - MRI showed normal, nothing conclusive
Mar 10  - started PT for a month
15 Apr 10 - Arthroscopy, medial meniscus trim (frayings)