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Author Topic: Mild degeneration of the medial meniscus  (Read 17525 times)

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Offline SThoonen

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Mild degeneration of the medial meniscus
« on: April 14, 2011, 06:09:52 AM »
What is the best treatment for mild degeneration of the medial meniscus without a tear.?
Low greade inflammatory change in the pes anserunus bursa, mild chondral loss in the medial famoral condyle and mile lateral facet patella chondral pathology.
There is also grade two chondral loss at the apex of the lateral facet of the patella.  And there is no intra-patella fatpad oedema.
There comments have come from an MRI report.
In constant pain and doctor wont do anything.
Need help please
« Last Edit: April 14, 2011, 06:13:08 AM by SThoonen »

Offline Kimberly 77

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Re: Mild degeneration of the medial meniscus
« Reply #1 on: April 14, 2011, 03:57:00 PM »
Sounds like you actually have a fair amount of damage in there. I agree with Dr's when they don't want to rush right in and do surgery but to offer no treatment is just not right. You should be in physical therapy to strengthen and keep range of motion good. Weak muscles only lead to more damage. Also there are other conservative treatments that work well for some like, hylagan shots. They inject a fluid into your knee that can help lubricate things and give you more cushion. I personally don't get relief from these shots but lots of people do so it is always worth trying once to see if it works. Start taking a glucosamine/chondriton supplement, I use Osteo Bi flex, and take a anti inflamatory like ibprofen. The last option would be a scope, they can go in and tidy things up so the bone surfaces are smoother and that should reduce pain. During the scope they can see the knee and determine exactly what is going on and what needs to be done. If your Dr. isn't offering you anything then it is time to get a new one.
Right leg amputee.
Osteoarthritis in left knee.
Medial femoral condyle defect, arthoscopy 8-2-10
Grade 3 defects, patella, medial femoral condyle, tibia scoped1-12-2011
Physical theraphy and awaiting microfrature 2-1-12

Offline Vickster

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Re: Mild degeneration of the medial meniscus
« Reply #2 on: April 14, 2011, 04:08:16 PM »
Maybe I missed it, but I don't see mention of the meniscus in the report.  I am not sure if MRIs can pick up degenerative meniscus, only tears?

Do you mean the articular cartilage instead on the medial side which is mentioned.  There looks to be fairly widespread changes from the MRI but nothing that is too deep yet.  Grade 2 can be tidied up as Kimberley says, but more conservative measures (physio, getting those leg muscles as strong as possible to support the knee) and anti-inflammatories are preferable in the early stages.  Are you doing physio and also icing the knee?  Is the pain achy or sharp, burny, is there any locking of the knee or instability?  Swelling?

If the doctor won't do anything (which may be the best course of action here), you could always get a second opinion but I don't think most OS's like to go in too quickly unless there is something definitive to fix.

If you want to understand what the different gradings of cartilage change mean, there is a good page in the arthritis section in the information hub ^^^

Good luck :)
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline knee always hurts

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Re: Mild degeneration of the medial meniscus
« Reply #3 on: April 15, 2011, 06:32:51 AM »
You have to be careful with MRIs. MRIs will pick up mild degeneration that does not warrant and cannot benefit from surgery, including the mild meniscus degeneration you mention. Presumably, that is not the cause of your pain.

As far as the cartilage, Grade II lesions are not usually associated with pain. Is your pain behind the kneecap? It is possible to have irriated tissue behind the kneecap without any clearly visible damage. This is usually treated with physical therapy, but that doesn't always work. In some cases, the synovial capsule or lateral retinaculum can become irritated or inflamed. Surgery or injections can benefit this in select cases. Other than that, some surgeons will opt for a realignment surgery where the kneecap or large bones in the leg are realigned if they believe that is the cause of your problem. It works sometimes, but not always. Most people eventually overcome this sort of pain, but in some cases, there is no solution.

Good luck!

Offline SThoonen

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Re: Mild degeneration of the medial meniscus
« Reply #4 on: April 15, 2011, 01:25:34 PM »
Thanks for the advice.
The report says there is mild insubstance degeneraton of the posterior horn and medial meniscus withou a displaced medial meniscal tear.
My normal doctor comes back on the 4th May, will go and see him.
There was no mention of any physio or anything else other than don't stand for to long and wear a knee brace.
Thanks again for your help.

Offline Kimberly 77

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Re: Mild degeneration of the medial meniscus
« Reply #5 on: April 15, 2011, 04:14:08 PM »
I guess I should also say MRI's don't always show the full extent of damage to cartilage. I had 2 mri's and both showed only mild issues. After my first MRI my OS was very confused about my pain because all it showed was some edema and a little thinnig of both meniscus, nothing more. I actually had delamination and fracturing of my cartilage that is up to 2.5 cm in places and 3 different chondral flaps, none of that was on my report. My second MRI after first surgery came back showing just bone edema and again some thinning, after that surgery is when I was told about the grade 3 defects and needing a replacement in future. My Os is now talking about replacing now. So don't always be fooled by a mri report.
Right leg amputee.
Osteoarthritis in left knee.
Medial femoral condyle defect, arthoscopy 8-2-10
Grade 3 defects, patella, medial femoral condyle, tibia scoped1-12-2011
Physical theraphy and awaiting microfrature 2-1-12

Offline knee always hurts

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Re: Mild degeneration of the medial meniscus
« Reply #6 on: April 15, 2011, 09:40:53 PM »
That's a good point, the MRI can underestimate the level of damage, too. X-rays and CT scans are generally considered more useful for diagnosis of knee problems.

http://www.kneeguru.co.uk/KNEEnotes/node/1085

Offline Vickster

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Re: Mild degeneration of the medial meniscus
« Reply #7 on: April 15, 2011, 10:27:37 PM »
Indeed, MRI does miss things.  I had grade III wear and tear on lateral facet of patella found and tidied up during a scope (was pretty tatty from the scope images), not clear on MRI as far as I know.  Also grade I-II extensive softening on lateral tibia, chondroplasty during second scope.  The MRI did pick up a meniscus tear and a nice traumatic osteochondral defect (and confirmed by Xray) which didn't need attention during the scope in the end as it had filled with fibrocartilage in response to the trauma (the damage to the subchondral bone under the fibro is obvious on the latest MRI).

MRI can show false positive as well - a lot depends on the radiologist doing the report and also some MRI scanners are more advanced than others.  Still better for soft tissue issues than x-rays of course

Kneealwayshurts - did you have your MRI in the end?  What did it show?  Other imaging?
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline knee always hurts

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Re: Mild degeneration of the medial meniscus
« Reply #8 on: April 15, 2011, 11:00:05 PM »
Nope, I never had an MRI. Only X-rays. The crazy Harvard doctor that I went to didn't think that anything could be done, so why bother investigating further? Of course, if you don't investigate further, how do you know if anything can be done? That's why I'm considering going to Dr. Minas, who is an expert in cartilage problems. I don't imagine he would send me away prior to examination!

As far as the X-ray is concerned, it didn't show any problems at all. My joint space was perfectly fine as of last November, and there weren't any other problems identified.

Offline Vickster

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Re: Mild degeneration of the medial meniscus
« Reply #9 on: April 15, 2011, 11:10:13 PM »
Must be very frustrating! Bad enough having knee pain and knowing what the issue is without an easy fix (that doesn't involve saws, pins and plates  :o ) let alone not having a definitive diagnosis and a prognosis to go with!

Might it not be wise to get an MRI done at least (even if have to pay) so can develop a game plan?  Has your exercise program stopped helping?

Good luck :)
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline here2Stay

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Re: Mild degeneration of the posterior horn of the medial meniscus
« Reply #10 on: January 31, 2014, 12:44:19 AM »
Hi guys , I've had this degeneraton of the posterior horn and medial meniscus for a while now. I have tried my hands at arthroscopy AND PHYSIO , but it does not seem to help.















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