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Author Topic: Macerated Lateral Meniscus After Repair  (Read 3900 times)

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Offline kneesmustbe

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Macerated Lateral Meniscus After Repair
« on: September 06, 2015, 10:31:43 PM »
I had a lateral meniscus that was clunking in and out and the initial mri's showed an unstable tear of the posterior horn.  I didn't want any of the meniscus removed for the obvious reasons.  So I went for a meniscal repair.  I expected to see the meniscus in very poor shape at surgery as I was awake during the procedure and watched everything on the projector.  Instead it was totally intact but had come away from the capsule and was jamming the joint when the knee was flexed.  It was stitched back using an inside out procedure and as, it was a peripheral detachment in a highly vasculated zone, I was very optimistic of a full recovery.  I deliberately avoided all weightbearing for 6 weeks just gently tried to flex the knee after straight leg raises.  The locking stopped but flexion beyond 90 degrees was very slow to regain.  After about 3 months it was flexing to about 110 degrees but a pouch of fluid was being
expelled from the side of the knee every time I went through this passive range.  An mri taken showed tears of the posterior and anterior horn of the meniscus which was astonishing to me, but the surgeon said it was hard to interpret mri after meniscal repair and I was advised to carry on as normal.  The knee was painful on stairs, but I continued as advised.  A year after the surgery the meniscus started locking again after fairly benign activities such as weeding the garden while bending from the waist with the knee only slightly flexed. The locking will disappear after slight hyperextension of the knee or rest for 15 - 20 minutes.  A new mri has been done and the report says the lateral meniscus is macerated.
The surgeon tells me there is an osteophyte beneath the repair site which has caused this and the only option is to put up with the locking or have a total menisectomy; I don't want to do either. 
Another surgeon has told me the meniscus looks very abnormal on the mri and it is in the wrong position in the knee.

I'm very unhappy at the situation and am at a loss to understand why my perfectly good meniscus should now be shredded to bits as I followed the rehab protocol to the letter and treated the knee very delicately after surgery. I am, of course, assuming there is now really major damage to that meniscus.  But when it clunks out now it feels as solid as it was originally, before the surgery, so I can't see that it can all have reduced to glass wool or pulp! Perhaps the mri is misleading?

Has anyone had a similar experience please and managed to find a surgeon to salvage a meniscus like mine is now said to be?

I've read that horizontal cleavage tears, effectively the same as maceration, are successfully treatable with fibrin clots.  Who does this in the UK?  Is it available on the NHS?

I absolutely don't want to lose that meniscus and all advice and referrals will be gratefully read and replied to.

Thanks

Offline Vickster

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Re: Macerated Lateral Meniscus After Repair
« Reply #1 on: September 06, 2015, 11:05:34 PM »
How old are you? Meniscus naturally starts to dry out and degenerate from the age of 30 on. Much of it also has a poor blood supply as I'm sure you know

Ian McDermott in London is probably the go to man for meniscus in the UK but he's now private only. Might be worth paying for a consultation to see what he says or if he can suggest whom to see on the NHS. The NHS isn't terribly good with anything experimental unless you can get on a trial.

Why didn't the surgeon deal with the osteophyte when you had the repair or has it formed subsequently? Or can it still be shaved away and the meniscus tidied?

There's good a good meniscus primer and course in the Learning part of the website

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 kneesmustbe

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Re: Macerated Lateral Meniscus After Repair
« Reply #2 on: September 07, 2015, 08:39:47 AM »
Thanks Vickster.  Very good question as the osteophyte was there before surgery.  I don't think the os was expecting to find a tear initially and thought the original locking was coming from loose bodies, but there weren't any in the joint.  I'm 42 and yes, you're right the quality of the meniscus does decline with age, but when it was scoped mine looked in very good shape apart from the fact that it had come adrift from the capsule.  The os hasn't suggested removing the osteophyte now just a total menisectomy.

Offline Vickster

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Re: Macerated Lateral Meniscus After Repair
« Reply #3 on: September 07, 2015, 10:09:16 AM »
Where in the UK are you? I assume you are seeing a knee specialist rather than a more general orthopod? The osteophyte is a sign of arthritis typically (unless it's congenital, I have bone spurs on both fibulas and nothing else going on around there as far as I know), is there other cartilage damage. I expect you'd be best to get the osteophyte excised ASAP and the meniscus sorted, both will end up in a worse state. I can't see why the surgeon wouldn't take out the osteophyte, it's not a difficult job I believe (unless they are mind where there's a high risk of nerve damage)

There are cadaver and synthetic meniscus transplant options in the UK, but surgeons are few and far between. Ian McDermott does them privately and Tim Spalding up in the midlands also on the NHS. There are probably others too. But your age may unfortunately be a barrier, especially if there is bony damage too
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 kneesmustbe

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Re: Macerated Lateral Meniscus After Repair
« Reply #4 on: September 07, 2015, 02:44:59 PM »
Thanks for the info.  I'm in Oxford but I don't mind how far I travel for the right treatment.  Clearly I need a specialist to sort this out.
And I just don't know why the osteophyte wasn't taken out before the repair; to ask a silly question as to would I try and lay a carpet over a nail?!
I've been scanning the web and apparently a chewed up meniscus is for all practical purposes similar to what is known as a complex degenerative tear and there are reports that these can be treated and improved with fibrin clots when previously the position was hopeless, so I won't give up on another repair of some sort yet.

Offline Vickster

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Re: Macerated Lateral Meniscus After Repair
« Reply #5 on: September 07, 2015, 02:56:57 PM »
The Oxford knee group (private but also some with NHS practice at the JR) have a good reputation, they are pioneers in unilateral replacements so will see lots of patients with meniscus histories I should think. I had a complex degenerative lateral meniscus tear, caused by an accident,  trimmed back in 2010, around 15% removed, the knee had been locked for 5 months, no choice as it was being mashed up more while caught in the joint. I have hyaluronic injections in that knee, there's other stuff going on, but it doesn't give me much grief

In your shoes, I'd make a private appointment to see Ian McDermott in London. 

Googling fibrin clot for meniscus brings up very little recent and even less from the UK.
« Last Edit: September 07, 2015, 03:09:38 PM by Vickster »
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 kneesmustbe

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Re: Macerated Lateral Meniscus After Repair
« Reply #6 on: September 07, 2015, 08:51:02 PM »
Yes, I'm minded to go and see him.  Are the hyaluronic shots beneficial? I think the fibrin clot treatment was reported by knee surgeons in the far east.  I  came across a video showing a discoid meniscus in a 51 year old woman that exhibited a macerated tear being very meticulously and successfully repaired with suturing; makes me wonder if some specialists really want to take the trouble, or perhaps the 'production line' mentality has led to a protocol being adopted whereby complex degenerative/macerated tears are just written off and excised out of hand, obviously if the meniscal tissue has no strength then it wouldn't be viable, but I wonder if that is always the case.  I've read that anatomical structure and appearance in physiological terms is not necessarily infallible proof of function.

Offline Vickster

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Re: Macerated Lateral Meniscus After Repair
« Reply #7 on: September 07, 2015, 09:44:17 PM »
They work for me but I have arthritic changes, a cartilage defect and tatty meniscii on MRI but no osteophytes chewing up the tissue
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















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