Surgery now or wait?

[LAS]

Hi, I'me kind of new on this site so I hope I am posting on the right page.   I was diagnosed with a posterior horn tear R knee.   I had throbbing pain in that knee for 2 months or so and it was waking me up at night.   OS gave me a shot of cortisone.   My knee feels alot better.   I am very afraid to have surgery because the left knee is not so great after surgery for another posterior horn tear.   Should I wait until the pain comes back, will I do more damage and make the tear larger or perhaps cause other problems in there?  By the time I had the last surgery I couldn't walk.   I felt like  I waited too long even  though the surgeon said I could wait.   It has been about a year after the surgery and I just stopped limping now and  he wants me to have another surgery on my so called good knee.   I would like to keep my meniscus for a long time.   I would appreciate any advice.   Thanks LAS

The OS said this tear was not as bad as the other.     

[kneepaincure]

I'm not too certain about the meniscus anatomy (you could check it up on the knee notes site here http://www.kneeguru.co.uk/KNEEnotes/node/2259) but the tear will not heal on its own if the region has no blood supply. It has to be fixed because it can cause damage to surrounding regions.

If your last surgery by this same doctor didn't go off well, then it would be good to seek a second opinion. Doesn't seem right (from my limited view of the situation) to go back to the same doctor who didn't do a good job the last time of a similar injury.

Did he say what grade of tear it was?

[LAS]

Thanks for the response:   No he didn't say what the grade of the tear was and it didn't say on the operative note either.  Just said there were gross abnormalities,  a good size tear down to the root, flap tearing and chrondromalacia.  It did not state a grade on any diagnosis.    At my first post-op visit he said my knee should be great in another 2 months.    So my expectations were high but that was not the outcome.   Now with this other tear I'me very reluctant because I don't want to be lame in both knees when right now it feels pretty good.   I have always suspected that he didn't do such a good job but I really don't know that for sure.   I waited to have the surgery because he told me that I wasn't being  reckless waiting to get it fixed so I did.  I do have a second opinion coming up at the MGH in Boston.   A friend of mine suggested this OS.   So you agree that it can do further damage by waiting?
 Thanks kneepaincure!

[lorilove]

I agree that you should consider changing doctors if you have concerns with the first one.  At the same time, note that some outcomes are not as positive and it may have nothing to do with the doctor.  You did not mention if you had physical therapy with the first knee scope?

Ultimately the knee scope is your only option since the tear will not heal on its own.  Whether you can do further damage is dependent on how long you wait and how active you are during that period.  You likely have more than enough time to seek a second opinion and consider your options.  I would limit your activity during that period with regards to exercise.

[kneepaincure]

Yes if they don't fix it, I suspect the tear can expand and damage more meniscus in the process. I think you are right to seek a second opinion. Don't just let anyone cut into your knee. He told you to wait the last time and I don't see the point in waiting to fix a serious meniscus tear.

[LAS]

Thanks guys for the replies:  Yes I had PT for six weeks, twice a week  and I did everything the Dr. and the PT suggested I do.  When I started to go for walks, that's when the limping started and went downhill from there.  Even with the tear, baker's cyst which I guess goes along with a meniscus tear and chrondromalacia I was not limping.   I know the outcome was worse than I expected but why didn't he explain what to expect, he must of known that I was not going to be up and running so to speak.    The level of trust has diminished a great deal with my OS even though I am walking better for now.   I know eventually the Synvisc One injection in the L knee and the cortisone injection in the R knee will be shortlived .  I am hoping this OS in Boston can give me a better picture of what is going on.     

I will take your advice and get the surgery done  sooner rather than later.   

[kneepaincure]

Only get it done sooner if you are confident that the OS who will do it is the right one. I know that we often rely on doctors to be all-knowing and trust them to do the surgery right, but I feel that in today's times of easy information access, the patient must make all efforts to be fully informed of what they are getting into.

[LAS]

Thanks kneepaincure:  Your right I just put all my faith into him thinking he was a great surgeon.   He did not give me good advice and when the outcome was not what I or even he expected he ignored it for the most part.  Now that I am seeking a second opinion he seems to be a little flustered and a little bit more interested.    I have been limping for almost a year now so  I want to make sure the next surgeon has better skill and communicates with me better.  That's what it's all about.   If they would just communicate better and let patients know what the hell is going on, they would have less complaints.   

Thanks again. 

[kneepaincure]

If they would just communicate better and let patients know what the hell is going on, they would have less complaints.   

I hear you loud and clear, having dealt with doctors like that (not just for my knees), and hoping not to encounter any more. Good luck in finding the right doctor soon!