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Author Topic: MRI negative for suspected Medial Meniscus Tear, now what?  (Read 7268 times)

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Offline dorme

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MRI negative for suspected Medial Meniscus Tear, now what?
« on: October 06, 2011, 02:44:37 PM »
Hi all,

When I was 13 (6 years ago) I started to get awful knee pain (right knee), mostly behind the knee cap, was eventually diagnosed with Patellofemoral Syndrome when I was 14, and later had hyper-mobility added to the list. At this stage I saw my first (and a few months later second) orthopedic surgeons, they refused to do anything until I was at least 21, even though it did not respond to vigorous physio. Last December/Early January this year I was Diagnosed with Inflammatory Spondyloarthritis, at that stage only effecting my lower back/sacroilliac joints and hips.

About 7 weeks ago at dancing (hip hop) I landed heavily on my right knee, I was practically squatting on the ground, with my foot twisted towards the right (I was supposed to be doing some kind of floor crawling thing, it looks better than it sounds!), there was a lovely audible pop and I had almost instant pain. My MCL swelled a little that night, but the real swelling didn't really hit until the next day, the whole inside of my knee was swollen, not so much my knee cap vanished, but it was noticeable larger than the day before. It was incredibly painful to walk on and I saw my physio a few days later, he said I'd 'irritated' my MCL, gave me some dry needling, kinesio strapping and sent me on my way, I have seen him almost weekly up until last week. My MCL has settled down, and doesn't hurt too much anymore, but I have pretty intense joint line pain, positive McMurrays, can't squat very far at all. I experience a 'popping' sensation regularly, can be while I am walking, going up stairs, or doing anything where I bend and straighten my knee. I also get incredibly sharp pains through the inside of my joint line, sometimes I can keep walking with it, other times I have to stop dead and wait until the pain dies down.  Physio suspected torn Medical Meniscus, sent to a 'back door entry' GP at his preferred ortho surgeons rooms, after 6 weeks of physio, knee didn't respond to any of it. Saw the GP and she sent me for an MRI, had the MRI today and it came back all clear. "No clear reason for this girl's symptoms".

Does anybody have any ideas? Could it be worth asking for the lateral release now (I'm 19 and a half now)? I am still experiencing significant patellofemoral syndrome symptoms (on top of this fun stuff!)

Thanks in advance for any help!
Courtenay.
« Last Edit: October 06, 2011, 04:20:49 PM by dorme »

Offline Clarkey

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Re: MRI negative for suspected Medial Meniscus Tear, now what?
« Reply #1 on: October 06, 2011, 05:32:46 PM »
Hi Courtenay,

I have been a KG member for nearly 8 years and would be very cautious before you consider a lateral release as they often fail and do not work for the patient. I know you want to get your knee sorted out as you are still young and should discuss what options you should take with your OS.

Nick :) {2011} :)
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 Brambledog

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Re: MRI negative for suspected Medial Meniscus Tear, now what?
« Reply #2 on: October 07, 2011, 06:09:46 PM »
Hi Courtenay,

As well as echoing Nick (lateral releases are sometimes a 'snip it and see' op, steer clear unless you have proof it is going to do good), I'd add that MRIs are NOT the most infallible of techniques. Both my xrays and MRI came back clear and they then found my advanced patellar arthritis during an arthroscopy. It is not uncommon for an MRI to get it wrong. Sounds as though with your long history of patella issues that they should be pursuing this more than they are.

You don't mention an orthopaedic surgeon - have you not seen one? If not I would see your GP asap and tell them you really want a referral to an OS as it is still very painful and it is not resolving. If she quotes the MRI, then mention that you've been reading up and that MRIs can miss stuff! If you HAVE seen an OS then I would consider a second opinion.

Don't let them stonewall you on this. It needs sorting.

Good luck!

Brams  ;)
2009 - diagnosed coeliac
Aug 2011 - L knee arthroscopy
Aug 2011 - diagnosed PF arthritis L knee
Nov 2011 - diagnosed CRPS L knee
Dec 2011 - MRI R knee, PFOA is worse than L!
June 2012 - no surgery 'til TKR's
Nov 2012 - CRPS spread to L foot/thigh, increasing pain
- Worsening pain/symptoms R knee
;-)

Offline dm

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Re: MRI negative for suspected Medial Meniscus Tear, now what?
« Reply #3 on: October 07, 2011, 06:43:19 PM »
A partial thickness meniscus tear in the middle of the meniscus may not show on the MRI, nor may something like I experienced - having my meniscus detach itself from the bone anchor on the tibia.

An MRI is not a certain diagnostic tool - there are variational factors - the skill of the tech doing the scan, the type of scanner, your body mass, etc. Newer scanners may be better than older machines at picking up fine details. Surgeons who rely solely on the radiologist report can find themselves sadly mistaken. My OS reads the films himself, and has seen things in my films when the report said nothing wrong! I'd then be booked for surgery, and sure enough- my OS was right- and had the before/after photos from the surgery to show me at my postop appt.

My last MRI - only showed a POSSIBLE acl tear. REALITY - tear to the remainder of my medial meniscus, tear in my previously intact lateral meniscus, partial acl tear, and a full thickness articular cartilage defect in the weight bearing surface of my medial femoral condyle where I'd basically knocked a hole in the articular cartilage, clear to the raw bone.  How could an MRI miss all THAT??? Doc ended up having me on the table nearly an hour and a half AFTER I'd been knocked out, trying to fix it all.

SO- keep pursuing the problem. Take your films and get a second opinion if you must. Pursue a diagnostic arthroscopy if it comes to that. DO NOT have a Lateral Release, or let them "just do it". You'll regret it later.
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 Clarkey

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Re: MRI negative for suspected Medial Meniscus Tear, now what?
« Reply #4 on: October 08, 2011, 12:16:20 PM »
Hi Courtenay,

The reason why I mentioned being a KG member for 8 years is because the majority of members that have posted over the years that have had LR surgery has failed or made their knee problems worse rather then better. Maybe your OS may decide to do a exploratory scope if the MRI scan shows up no problems as mine did. Once he was inside my knee he shaved my fat pad and removed my medial plica that failed to show up on my MRI scan!

Nick :) {2011} :)
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 dorme

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Re: MRI negative for suspected Medial Meniscus Tear, now what?
« Reply #5 on: October 09, 2011, 06:31:43 AM »
Thanks for your input! I am basically seeing a GP who works as my Ortho Surgeon's assistant, hopefully she will recommend I have an appointment with the surgeon, if not I think I will ask for one. This particular surgeon will be my third opinion. The first one said he wont touch me until I am 21, the second wanted me to continue with physio (have been having physio monthly since I was 13, am 19 now, not a cheap process). I think I'd like to have an exploratory scope, but have a feeling they will tell me it is just my arthritis and send me on my merry way. I don't think it is, it feels different to my other arthritic joints, and only part of my joint line is painful, I would have thought the whole lot would hurt if it was arthritis.

My knee cap has been mal-tracking since I was in my early teens, we have addressed the muscular imbalance and still no improvement in any way shape or form.

It's all good Nick, I understand, you would have seen many people coming here wondering why the 'fix it' surgery didn't do anything.

Thanks for your input again,
My appointment has come up quick, I will keep you updated after it tomorrow.
Courtenay.

Offline Brambledog

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Re: MRI negative for suspected Medial Meniscus Tear, now what?
« Reply #6 on: October 09, 2011, 09:50:47 AM »
Good luck Courtenay - hope you get a better response this time! If they decide to do an exploratory, an arthroscopy isn't fun, but it's better to know exactly what the problems are in there than have them guessing from the outside...especially if they're guessing wrong.

Brams  ;)
2009 - diagnosed coeliac
Aug 2011 - L knee arthroscopy
Aug 2011 - diagnosed PF arthritis L knee
Nov 2011 - diagnosed CRPS L knee
Dec 2011 - MRI R knee, PFOA is worse than L!
June 2012 - no surgery 'til TKR's
Nov 2012 - CRPS spread to L foot/thigh, increasing pain
- Worsening pain/symptoms R knee
;-)

Offline Clarkey

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  • Neil TheElephant knee packed up carrying his trunk
Re: MRI negative for suspected Medial Meniscus Tear, now what?
« Reply #7 on: October 09, 2011, 01:18:36 PM »
Hi Courtenay,

Also wish you luck and success with your appointment and think the only option left now is a exploratory scope as physio is not doing anything to improve the condition of your knee and have had the problem for a while and are running out of all conservative options. You will also read on KG that you should avoid surgery if possible as once you have knee surgery your knee never be right again.

It took me 18 months post op to recover from my scope and can now run 6 minutes a mile and do not feel too much knee pain and surgery did help get rid of the catching on the lateral side of my right knee. Surgery was a success for my knee condition and may be the same for you and is worth the risk having a exploratory scope done.

My quads however are smaller in size and took a while to get them nice and firm again as surgery weakens the quads and have to keep on top of your PT after your scope to get them strong again. Do not give up you will get there in the end!

Nick :) {2011} :)
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 dorme

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Re: MRI negative for suspected Medial Meniscus Tear, now what?
« Reply #8 on: October 10, 2011, 10:06:44 AM »
Thanks again guys,

My appointment was awful, the Dr. basically just told me it was my arthritis and to go have more physio. So back to the physio I go, here's hoping it actually does something, I have also booked in for a massage, hoping that might do something too, nothing ventured nothing gained. They want to wait to see if my arthritis meds get changed and see if that does anything, that will happen in about 9 days. I told her my knee seriously didn't feel right, getting absolute killer random sharp pains doesn't seem normal to me, she just said 'wait and see'. I think I will give another 8 or so weeks of physio a shot, and if I get no improvement I will try the only ortho surgeon I haven't actually seen here yet and see what they think. She also seems to think the problem is my tibia, but the MRI didn't go that far down, so who knows now.

Courtenay.

Offline Nettan

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Re: MRI negative for suspected Medial Meniscus Tear, now what?
« Reply #9 on: October 10, 2011, 10:48:14 AM »
I have a history like you from younger age. At some point physio never helped here either. I was one of the hopeless cases. But in all if you have had an injury and still feel a certain pain all is not revealed on Mri. I had a cartilage damage in just one of those spots that was discovered during a scope and I needed microfracture. To start doing lateral release in your case is just probably a bad idea.
I think you should go for more opinions and not be happy with this answer.
Also if you are in PT you should aim for aquatherapy instead, PT in a warm pool. Much better for you in long run and effective.
If you need any feedback at all, just contact me.
All best/Nettan
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 dorme

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Re: MRI negative for suspected Medial Meniscus Tear, now what?
« Reply #10 on: October 10, 2011, 11:26:42 AM »
Hi Nettan,

I used to have hydrotherapy, but the council changed the pool laws and the pool at Physio got closed down because it was no longer financially viable. I don't have any alternatives. I've been a hopeless case for years now, constant physio, the original physio I saw managed to miss my hyper-mobility so was exercising me the wrong was, which made everything worse and since then nothing has helped. I managed to regain enough strength to stop my knee from giving way, but now I have fallen it has suddenly started giving way again, which is incredibly annoying.

Thanks Nettan,
Courtenay.