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Author Topic: Knee Arthroscopy  (Read 610 times)

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Offline Tisme

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Knee Arthroscopy
« on: December 15, 2021, 04:32:24 PM »
Hi,
I've ongoing issues. I've been offered an arthroscopy.  My MRI did not show anything except mild meniscal degeneration.  However the pain is unbearable. I'm just wondering would arthroscopy fix this. I'm dubious that is the issue with my knee as its debilitating pain limiting me so much.

Offline silver_maple

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Re: Knee Arthroscopy
« Reply #1 on: December 15, 2021, 05:21:18 PM »
This is a very peculiar situation given the benign MRI. However, an MRI might miss things or the radiologist's interpretation could be sub-par (unlikely but possible). To have *debilitating pain* with such an MRI is incredible.

By way of comparison, I have a complex degenerate meniscus tear confirmed by two MRIs 18 months apart, two different radiologists, two different hospitals. I have no pain and apart from mild crepitus (which I think is patella-driven, not meniscus-driven) I am asymptomatic. Walk, hike, bike, swim with no issues (but have given up running).

An arthroscopy can allow for a detailed look to complement the MRI. Be very cautious about partial meniscectomy and agree rules of engagement with the surgeon in advance. Once inside the knee the surgeon might be tempted to "tidy up" the meniscus (i.e. partial menisectomy) even it is debatable whether the meniscus is the source of your debilitating pain. After a partial meniscectomy your journey on the road to arthritis is accelerated.

Back to my comparison, I have consulted three docs for my degenerate meniscus tear. None recommended any surgery, with the prevailing view being that my situation is "age appropriate" (51 y.o.) - exact words used by a Detroit-area top surgeon I consulted this past summer. He even refused to inject stem cells in saying it would be a waste of money (and I had my wallet practically open).

Back to your case, an offer of arthroscopy seems logical if the MRI is relatively benign and you are in major pain. Arthroscopy is an advance from open surgery but is still surgery and somewhat invasive. There is a recent advance - nano arthroscopy. If you can get nano to just look, the disruption to tissues would be minimal. If something is found then you could do regular arthroscopy to correct, if called for.
2019 - Chondromalacia patella gr 1-2, both knees; early bilateral tibio-femoral arthritis; 5mm focal chondral lesion (LK); degenerate meniscus tear (RK)
2020 - PRP x3 in RK
2021/22 - PRP x4 in RK, PRP x2 in LK

Online vickster

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Re: Knee Arthroscopy
« Reply #2 on: December 15, 2021, 06:14:52 PM »
What does the surgeon suggesting the arthroscopy consider to be the likely cause of your pain?
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffaís fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline Tisme

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Re: Knee Arthroscopy
« Reply #3 on: December 15, 2021, 09:02:46 PM »
I'm baffled too. The pain is baffling the doctor. I've had serious illnesses before and have a good pain threshold so when I'm in pain it's bad. I think the arthroscopy is to look inside see what's going on and clean out. I know to see my MRI everything looks pretty good and technically I should not be in the amount of pain that I am. The doctor isn't trying to fleece me. However to cause that much pain there is something wrong. I'm just wondering what can an arthroscopy do or see ?

Online vickster

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Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffaís fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline Tisme

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Re: Knee Arthroscopy
« Reply #5 on: January 12, 2022, 09:29:55 PM »
Hi,
Interesting reading however I've had x ray plus MRI and have no arthritis at all in my knee. I also had Mri on back and hip to rule out any referred pain they were clear too.

Online vickster

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Re: Knee Arthroscopy
« Reply #6 on: January 12, 2022, 09:41:39 PM »
If thereís no arthritis, ie wear to the cartilage, what is the surgeon going to clean out with the arthroscope? Is he hoping to find a meniscus tear or something thatís not obvious on MRI or bits of meniscus floating around (or indeed some mild arthritis?)

Iíd be very wary of surgery when imaging has shown nothing specific to fix, as the knee could be worse after or no better after recovery.

Perhaps get a second opinion and a thorough assessment by an experienced physio and confirm that it is the knee and not referred pain from elsewhere?
Has anyone suggested nerve conduction tests to check itís not neurological?
« Last Edit: January 12, 2022, 09:49:22 PM by vickster »
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffaís fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline Dave33

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Re: Knee Arthroscopy
« Reply #7 on: January 12, 2022, 09:47:14 PM »
Maybe a bit more info for us armchair crackerjack "doctors".

Age?
Is the pain constant?
How long has this been going on?
Did it come on suddenly, or gradually keep getting worse? If former, what were you doing?
Do you get swelling?
Do certain physical activities make it worse? ie- walking/cycling?

Offline JerHyman

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Re: Knee Arthroscopy
« Reply #8 on: January 14, 2022, 06:52:47 PM »
I would beg you to think very carefully before you get any invasive surgery. The success rate of arthroscopic procedure is very low especially when the scans are clear.
I had several MRI scans which were clear even though I have debilitating medial knee pain and over a period of 5 years Iím still looking for the answer.
I took the chance of bi lateral arthroscopy and have regretted it ever since. I also had an arthroscopy 3 years earlier in one knee and quite frankly it made it far worse.
Iíve found out that the arthroscopic tools can cause many other problems ie Hoffmans Pad issues. They never explain this clearly other than to say there is no guarantee of success.
My surgeon told me that he could not foresee an outcome where he could t find and fix me considering my level of pain and inability to walk, yet here I am 1yr later in much worse condition.
If possible you should make this an absolute last option.