Meniscus and osteoarthritis - best decision?

[Veth25]

Hi,

back in April, when bicycle season started, I probably started too hard and during one of the the early rides, my knees suddenly started to hurt. Next few days it got worse - some swelling, inflammation, pain on joint line, no mechanical symptoms though. I visited orthopedic specialist - after some tests and x-ray, I was diagnosed with leison of medial meniscus posterior horn and very early osteoarthritic changes (little bit of space narrowing, nothing critical for now though).

I was shocked, especially with the early osteoarthritic changes - I am 32 years old. Conservative therapy was chosen, after rehab, drugs, rest and other measures, it did not improve much. It is now over 4 months after the injury.

The thing is my doc wants to do arthroscopy for the meniscus and nothing else. My dilemma is: what is better in long term for the knee detoriation? Undergone surgery, get meniscus probably trimmed and hope for best in long term, or rather do not go (I have some pain, yes, but not locking or other mechanical symptoms), treat it with some conservative measures and hope the knee will hold longer?

Simply - The slowest knee detoriation is a key for me. It is more important for me than some reasonable pain and discomfort. I am just afraid that if the doc remove even the smallest part of meniscus, things will go over the top way too fast, especially when there are present early degenerative changes even now.

Cant make up my mind. It would be easier if my knees would stuck or it hurt like hell. But It just...hurts.

Would be glad for any answers, tips and ideas for contemplating.

Sorry for my English.

Thank you!

[Brandon123]

Hi Veth25,

If you want the slowest possible knee deterioration, you should try to avoid surgery as long as possible. There are many studies showing that meniscus trim is not better than placebo. These are just two:

https://ard.bmj.com/content/77/2/188?intcmp=ard&type=0-A

https://www.nejm.org/doi/full/10.1056/NEJMoa1305189

4 months is a short period of time when it comes to knees. Try out all sorts of conservative/non-surgery options for a year or so, and see if the situation improves. For some ideas:

https://www.dougkelsey.com/meniscus-tear/

https://www.dougkelsey.com/meniscus-tear-surgery/

I hope this can help you!

[vickster]

As above, avoid menisectomy surgery if at all possible,

You may also find some of the discussion in the recent meniscus substitution webinar interesting, downloadable here
https://www.kneeguru.co.uk/KNEEnotes/live-events-0?action

[Veth25]

Thanks a lot for information. I was told in past that untreated meniscal tears leads to arthritis and my current doc said that as well. Is this general consesus? And recently I discovered that menisectomy leads to it too. That was the reason I started this thread - get to know what is better - if anything.

It is definitely my goal to stay out of surgery if possible, however I dont want, few years later, to learn that some part of teared/detoriated meniscus grinded articular cartilage that much that it has caused full blown arthritis. Choices, choices...


 

[vickster]

On the forum through this link, you can find good information on arthritis, its treatment and also the meniscus

https://www.kneeguru.co.uk/KNEEnotes/learning-portfolio#Primers

If you have arthritic changes, it is probably that the meniscus is degenerate so it’s possible it will continue to fray even if you have the surgery.

Perhaps consider a hyaluronic acid (not steroid as that can lead to further cartilage breakdown and should be avoided) injection to help settle and lubricate the joint. You could also look into newer options like PRP and stem cell injections

Good luck