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Author Topic: Meniscus tear? Mild arthritis? Something else? What to do?  (Read 1270 times)

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Offline poliakov

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Meniscus tear? Mild arthritis? Something else? What to do?
« on: June 25, 2015, 04:23:16 AM »
Hey everyone!

Thanks so much for all your effort to build a such a useful forum with actionable information. Learned a lot here.

I have somewhat of a difficult case. 30 year old male, generally healthy. Slightly overweight but I try to stay active and also lift weights. Used to run as much as 3 miles a day every other day. Never developed much in the way of of chronic symptoms, I’ve had occasional pain in the right knee cap here and there, but nothing too bothersome.

Past christmas, I was sitting down on the carpet, playing with some kids at a party. I was seated in a position such that my right leg was tucked under me, full knee flection. When I went to get up, with no warning at all, I found my knee was locked and I could not extend it. Instinctively, I forced the knee to extend, felt a very sharp pain and a weird sensation of what felt like my LCL sliding across the side of my femur. The pain was pretty bad, mostly in the lateral aspect. The knee swelled – I couldn’t fully flex it nor fully extend it. I could still somewhat hobble around. It was pretty bad but I decided to give it time to heal. It got better after about a month. I slowly started getting active again.

Then, in March I slipped on some ice and fell. As I was getting up – same kind of deal: locking, swelling, hobbling, pretty miserable. I got an MRI done which showed a healthy meniscus, but also a “full-thickness lateral patellar facet cartilage fissuring with underlying small focus of bone marrow edema”. So I got diagnosed with “chondromalacia” and sent to PT. I did the PT by the book for more than 6 weeks. My quads were already strong, but I did some work on the hips and started stretching diligently to improve flexibility and tracking. Then after 6 weeks, one morning, while getting down on the floor to do the very stretches the PT prescribed, it happened again! I went from active and happy to hobbling and miserable with zero warning. This was around May. The PT did some tests on me, noted tenderness in the lateral aspect, told me to go back to the doc.

MRI 2 found “local fraying in the periphery of the body of lateral meniscus, but without surfacing tear”. They also confirmed “deep fissuring of the lateral patellar facet cartilage with reactive subchondral marrow edema”. The pain from the May episode healed at about the time I saw my doc for a followup. She basically presented me with two options “we can go in with an arthroscope and see what we can find, or we can wait and see”. I decided to wait. Well, the day after that, I got a little brave and decided to 'test it'. I specifically sat down on the floor tucking my leg under me. Sure enough, it caught again and I was limping for another week!

So,.. if I take it easy and do normal everyday things, the knee is pretty much fine - maybe a little clicking, a little tenderness. But if I fall the wrong way, or if I get careless and sit on my leg, chances are high I become miserable quickly and the misery lasts longer than a week. Then it heals. Then it happens again! Every time the locking happens, it’s associated with either falling, sitting down with knee flexion or getting up from knee flexion. I go from no pain to lots of pain without warning. New episodes appear to be less painful than old episodes – though I’m not sure if it’s luck or me having learned to straighten the knee very carefully when it does happen.

Needless to say, I haven’t really done much running since christmas, instead scouring the web, obsessively looking for answers. Could it be that there’s dangling patellar cartilage that’s causing the locking? But then why does it always hurt in the side of the knee when it happens? Could it be that a piece of frayed patella cartilage lodged in the joint puts pressure on the meniscus, fraying it, causing pain? Could it be some sort of joint capsule or plica problem? Or am I going crazy? Should I go ahead and do the arthroscopy? Should I wait for another 3 months?

Really really appreciate your time and any thoughts you may offer.

Offline dal_knee

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Re: Meniscus tear? Mild arthritis? Something else? What to do?
« Reply #1 on: June 25, 2015, 06:01:00 PM »
If I were you...I would wait 6 months actually.     Try a couple of rounds of PRP and see how much cartilage healing you can get out of that.    You really need to work hard to avoid sitting on the floor in that specific position for the next few months at least.     

If you have patellar tracking issues...not totally clear, dry needling along with your PT exercises should help that.      Another thing I like to do for my patellar tracking issues ( only a temporary problem for me because i had recent surgery) is to use a TENS unit on modulation mode with the electrodes attached to my VMO a couple times a day.   That helps better than PT exercises, in my case.   Your issues are on the lateral side, so you may instead need to attach to the VL.   

For the joint locking, I don't have many comments here.   Just avoid the positions that trigger that for now. Bottom line, do what you can do to avoid surgery at all costs.
2007 - partial medial meniscectomy
2010 - full thickness chondral defect & adjacent subchondral edema MFC.   Direct result of stupid partial mensicectomy from 2007.
2014 - Subchondroplasty, chondroplasty, unauthorized 2nd partial medial meniscectomy.
2015 - partial failure of subchondroplasty.

Offline geococcyx

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Re: Meniscus tear? Mild arthritis? Something else? What to do?
« Reply #2 on: June 25, 2015, 10:57:34 PM »
Meniscus damage can cause locking, but yours is minor if I understand you correctly. Though I suppose it could still be the cause of your problem.
However your description reminds me a bit of my experience when I dislocated my kneecap. Has that been considered and ruled out? If the kneecap eventually goes back into place it won't show on MRIs or X-rays. Only any other damage that may have been done in the process, like torn cartilage. Oh and they won't see it if they go in and look either.
Don't provoke it, Regular dislocations are bad both for your ligaments and your cartilage. Damaged ligaments may lead to even more dislocations. Even if there's a completely different reason for your problem it's  probably not good for your knee.
What to do depends on what causes these issues, that may be hard to find out if the doctors can't help you. Try a second opinion maybe.
If these really are dislocations then there are several options, again depending on what's causing them - physio, taping, braces, surgery...
In the meantime maybe you could try one of those off the shelf patella stabilising knee supports. Even if your problem is a different one it shouldn't hurt you (only your wallet) though if it hurts to wear then don't.

Offline poliakov

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Re: Meniscus tear? Mild arthritis? Something else? What to do?
« Reply #3 on: June 26, 2015, 05:40:31 AM »
Thank you guys very much for your time! I really appreciate it.

A good friend of mine who's an MD (though not orthopedics) also said something along the same lines. "If there's a clear diagnosis and a clear surgical method to fix it, then surgery is a good idea; but just doing it 'to look around' doesn't seem justifiable."

I'm not sure about the dislocation part. Can't figure out what's causing the locking - either the patella can't "find its place" (doctor's words) or its a separate meniscus issue. When it happens it usually hurts on the lateral side. I can see the "fissure" on the MRI - it's right in the middle of the kneecap (both vertically and horizontally), and it's fairly small. If you navigate to it from the coronal point of view, it looks kind of like the little dip on the bottom of an orange - almost dead center with the same proportions.

I feel a bit overwhelmed browsing through here - many folks have much more severe problems, here I am complaining because I need to be more careful. And also - if I look over the last 6 months I've been experiencing the issue, I've had actual physical pain maybe 30% of the time - when the episodes happened. But I've had psychological anguish at least 80% of the time! Staring at the MRIs, searching the web, and so on... It's really quite something. I think I need to go just "live" a little, be careful about it but not have it occupy all of my life.

I also heard apparently biking is very good for knee rehab? Do folks have experience with that?