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Author Topic: Meniscectomy or Not?  (Read 70 times)

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Offline Bella Gamba

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Meniscectomy or Not?
« on: February 17, 2021, 04:44:27 AM »

Nearly a year ago (presumably last April) my 62-year-old husband suffered a tear in his right knee’s medial meniscus (I paste below the MRI findings and the OS interpretation).  It presumably occurred while running up a hill from bending the knee too tight during a rare slip on a steep trail (no strange knee bend, just tighter than normal).  His normal runs were 4-5 miles in hills.  He didn’t think much about it until about three months later when a small, intermittent pain began on the inner knee.  A few months later an MRI in October confirmed a tear. 

His knee specialist suggested surgery to clean up the tear.  However, he was told the data are unclear if it would help with potential future osteoarthritis.  Since he suffered only occasional mild pain and he wasn’t keen on surgery, the doctor said he could continue running, hiking, etc. as long as no weird twists.  When asked when would he know it required surgery, the doctor answered when it became painful in the future.

My husband stopped running for a bit as a precaution, replacing the runs with daily 3-4 mile walks on the same hilly routes.  During these walks/hikes his knee doesn’t not hurt significantly (a slight pressure) but feels out of normal after about a mile or so.  Lately his knee has been swelling slightly, but noticeable.  His knee is getting stiff and bothersome because of this.  Again, the swelling is slight.

He is starting to wonder if surgery would be wise.  He’s met a few people in our area that have had meniscectomies without issues.  His goal has been to continue running at least to the age of 70.  The real issue is whether it will lead to osteoarthritis or whether that will occur regardless of the surgery?   The knee surgeon is very good and has a good reputation not only in our area...

I am looking for feedback on what might be the recovery time if he decided to have surgery (waiting for vaccine!!).

MRI report:
“IMPRESSION: Linear obliquely oriented signal posterior horn medial meniscus compatible with a tear. Linear obliquely oriented signal intensity posterior horn lateral meniscus suspicious for small tear Moderate effusion. Cruciate and collateral ligaments appear intact”

OS Interpretation:
“Complex tear of medial meniscus of right knee as current injury”

Thanks!!

Offline vickster

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Re: Meniscectomy or Not?
« Reply #1 on: February 17, 2021, 04:58:34 PM »
This is quite an interesting article around posterior horn meniscus tears which are more likely age related than caused by a trauma and if they do not cause biomechanical issues (locking, bucking) and ‘only’ pain they can be left alone

https://www.howardluksmd.com/posterior-horn-medial-meniscus-tears/

If he has degenerate meniscus it’s quite likely there’s also arthritis (given his age)...was anything seen on the MRI in terms of articular cartilage damage.joint space loss? Inflammation and  Arthritis also often causes stiffness and swelling.  Does he use ice when it’s swollen?

Maybe some sort of brace or support would be a far less invasive way of managing?  Has he had his gait assessed by a podiatrist?  Is he seeing a physio?

Recovery wise from menisectomy, 3-6 months assuming all goes well would be expected.

Ultimately it’s up to him, if left the tear could get worse and if it gets caught in the joint, he may get biomechanical symptoms that need surgery to resolve.

There’s a good meniscus primer in the learning portfolio :)

Even if vaccinated, there’s still a risk he could catch Covid in hospital (although at least here in the UK, testing and isolation are required before admission) (as he could in the community of course)
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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