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Author Topic: Surgery or no?  (Read 1270 times)

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Offline ALMASH

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Surgery or no?
« on: August 02, 2012, 12:54:51 AM »
I recently had an MRI of my left knee.  I had twisted it about 6-7 weeks ago, though I've had no pain for about 3 weeks.  The results of the MRI read
1) Horizontal tear of the posterior horn of the medial meniscus.
2) Medial subluxation of the patella.
3) 3 x 2 mm cartilage defect of the medial femoral condyle with associated subchondral edema.
4) Small joint effusion

The orthopedic surgeon recommended arthroscopic surgery to correct it, saying that not doing so I run the risk of getting early arthritis (I'm 52 and fairly active).  I'm not eager to have surgery (not surprising!) and I'd like to know if anyone can answer the following questions:
a) Do tears like that described in my meniscus heal over time?
b) How serious is a "3 x 2 mm" cartilage defect, as described here, and would such a defect heal over time?
c) If I "wait and see," what risks are there?
d) And, while I'm "waiting and seeing," what exercise or activities should I avoid or take part in? Should I work to strengthen the muscles around the knee?

Any advice or explanations anyone can give would be most appreciated!

Thank you,

Offline kneepaincure

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Re: Surgery or no?
« Reply #1 on: August 02, 2012, 05:16:24 PM »
If that part of the meniscus has no blood supply, it will not heal. It needs to be fixed so that the meniscus does not tear further and cause damage to surrounding areas.

I'm not sure about the other findings of the report. As to the type of activities that you can do, it would be best to ask the doctor but there will probably be only a few things that will not cause more meniscus damage.
Have had tilted kneecaps for many years, and occasional patellar tendinitis.

Offline Kwal57

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Re: Surgery or no?
« Reply #2 on: August 02, 2012, 06:11:01 PM »
I am no doc, but I would suggest swimming. It takes the weight off the knees, so less strain on them. I have meniscus tearing and cartilage missing. But I'm a but younger, so I am going for the surgery. I have found swimming left my legs stronger and a bit easier to function for a short time after. This temporary relief was worth every second. :)
'Runners' knee > Lateral Release 3/11
Minor Meniscus tear > clip 3/11
Fall on bad knee 1/12
PT 3/12-6/12
MRI > Cartilage missing = Cortisone + PT 5/12
Arthroscopy > cartilage missing, meniscus tear, & misalignment 8/12
TTO/ACI 10/13
Healing....for now :)
instability :/

Offline Vickster

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Re: Surgery or no?
« Reply #3 on: August 02, 2012, 06:49:45 PM »
To your point b) How serious is a "3 x 2 mm" cartilage defect, as described here, and would such a defect heal over time - this is pretty small, but could be painful if it's on a weight bearing surface and if there is damage to the bone underneath.  Articular cartilage on the bones has no nerves (so shouldn't hurt unless the bone is damaged) but also no blood supply and hyaline cartilage (the normal stuff) does not heal / grow back - it may fill with fibrocartilage (scar tissue) but this is not as good as the hyaline stuff but can be perfectly liveable

If you've no pain, I wouldn't rush into surgery - what is the surgeon planning on correcting and how?  I would avoid any sort of running, twisting, pivoting, jumping - swimming, cycling are good low impact sports

If you wait and see, the meniscus tear could get worse and be harder to fix in the future, but it could also get better on its own.  Surgery could make things better, but also a whole lot worse - should really be a last reort if possible

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 LAS

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Re: Surgery or no?
« Reply #4 on: August 03, 2012, 03:18:12 AM »
In my situation I had a medial meniscus tear and was in pain for over a year.  I waited to see and arthritis did set in after the surgery.  I also needed to get synvisc to help with the limping.  I wished I had gone to the surgeon much sooner and planned the surgery sooner.    No it won't heal on it's own.   Maybe if you stay off your feet completely for 2 months but we all know that's not reasonable.   You don't have to rush into surgery if you have no pain but I would definitely consider it at some point.   You can probably do some quad strengthening but check with your surgeon first or physical therapist.  Definitely avoid doing anything that aggravates it.   Hope this helps you.    LAS

Offline marco4432

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Re: Surgery or no?
« Reply #5 on: August 03, 2012, 08:13:47 PM »
I guess were all diferent, I went to the Dr when I felt a little pain 2 and a half years ago, biggest mistake of my life, four surgerys later and I'm nearly crippled, as for the Doctors you will find that if the surgey is not successful they will dump you so you go to another and another, they get there money so they don't care.

My input anyways wish you all the best I hope you have a better outcome then I did
R Knee Arthospic  06/01/2010, partial lateral menisectomy synvisc injections
Start of dibilitating pain after operation
Ri knee Arthosopic Meniscus tear 03/13/11
partial lateral menisectomy synvisc
 Nerve Surgery09/15/2011Right knee
12/23/11 CT scan nerve block
02/29/12 2nd failed nerve surgery

Offline LAS

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Re: Surgery or no?
« Reply #6 on: August 04, 2012, 03:03:57 AM »
I hear you Marco.  I recently had a tear in my other knee and I was told by the same surgeon that I needed surgery on that knee.  Since my left knee was not so great and recommendations  from other knee geeks on this site. I decided to get a second opinion.  Low and behold this renown trauma knee surgeon said no way I don't need surgery in this knee at this point.   It's makes me angry to think this other surgeon would do surgery just for monetary gain.    Even though I know I did need the surgery before who knows if he did a good job or not.  Like I said I had a limp after the surgery but he said arthritis set in so I blame myself for that.  Needless to say I won't be going back to the first surgeon.   I geuss it's true you live and learn as you go.   So ALMASH get at least one more opinion before you get surgery.  It's the best thing to do and I'me glad I took the advice from this forum.  Hope this helps and best of luck.  LAS