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Lateral Meniscus tear


#1

I have a tear of the lateral meniscus in my right knee, today i saw an Ortho surgeon to discuss the treatment. He seemed keen to go for arthroscope surgery. He did however, say that it would lead to premature arthritis in my 40's or 50's - im 19 which i kind of knew already.

I asked him about how much damage there was, if there was any chance of repair, as i brought the MRI images and he said that he wouldn't know much until the day, and through looking through the scope. He said the blood supply is bad so it's likely it'll be a general procedure of shaving off what they need to but keeping as much as they can. Here's the report from the MRI;

Clinical indication; Ligament damage
Technique; sagittal T1 and gradient-echo. Coronal STIR. Axial PD fat-sat.
Findings; there is a large bucket handle tear of the lateral meniscus and the flipped fragment lies within the intercondylar notch. The medical meniscus, cruciates, collaterals and extensor mechanism are normal. No significant articular cartilage abnormality. No significant joint effusion.

I was kind of surprised there was damage of the lateral meniscus as i have had knee pain since i was about 15, walking up stairs, riding a bike, that sort of thing, and always felt the pain on the opposite side of both knees, however, i did remember a time where i was getting up from a push up position, the feeling where i couldn't straighten my knee at all, and it was really painful. This was about 5months or so ago.

It doesn't really bother me too much now, occasionally it hurts, and i notice it if i were to squat with my knees pointing forward, having said that, if i were to squat as with weight lifting, it seems a little unstable, so i may just need to have the surgery.

I asked what would happen if i didn't have the surgery, would that stop the earlier osteoarthritis, he said not really and that it could likely cause mechanical problems down the lie, so im guessing i will need to have the surgery as expected, but was wondering thoughts and opinions, perhaps trying PT first or just getting it done? Or even trying to push for some sort of repair, or get a second opinion?

All in all im guessing i will just need to have it done, but of course wanted an idea of how much they would need to shave off, doesn't sound good though, as usual.


#2

Increase your squat and deadlift. That's what I did. Common sense dictates that if it doesn't bother you much, deal with it.


#3

It did at first, a lot. Not as much now though, just mostly squatting and anything that requires a good degree of knee flexion.


#4

How big is the damage?


#5

Well from your report it would seem that the damage is pretty extensive. A bucket handle tear is a pretty sever type, especially since yours has flipped and is now stuck intercondylar notch. In layman's term the torn "flap" is stuck in the middle of your knee and could/does interfere with your extension mechanism. This can be problematic for various reasons. The obvious reason being that it physically impedes full extension of your knee the second that the chronic inflammation will lead to the inflammatory inhibition of your Vastus Medialis Obliques. The inside muscle of your knee responds very quickly to even very slight inflammation shutting it off. This causes problems since the vmo is vital in overall knee stability. You have two options, but in all likelihood you will need the surgery. One is that your physic can try and traction the knee and get the meniscus to flip back. If he succeeds there is a SLIGHT chance that it may heal itself. The second is surgery, the chance of this injury just healing itself is virtually nill. Whether it will be a meniscal repair or partial meniscectomy will depend on the degree and location of the tear. Should your tear be in the vascular region it could still be saved, if not they will shave it back to the healthy tissue. The good news is that the procedure will only keep you out of the game for a little while (upto 6 weeks in most cases to a almost full recovery). After that you will need to work hard on your knee and make sure you keep your joints as healthy as possible since you will be at severe risk of osteoarthritis. That means fish oils, glucosamine. If your the type, GHRP 6 and adequan. The future research on the artificial/stem cell generated joint tissues is promising at this point so there is yet hope.


#6

Thanks a lot for the reply rehan, very helpful, although a "severe risk of OA" doesn't sound, good, at 19. It's puzzling how it even happened, my guess was repeated trauma, but even then i can't remember how.

I guess all in all i'll know how much damage and stuff there is on the day when they look through the scope, but i guess then it's likely too late to pull out of the surgery. Doesn't sound good though. If i don't have the surgery, will the onset of OA be reduced?


#7

The other thing im worried and feel bad about is, where it happened a while ago, 5 months or so, i hear most people have surgery right away, where i still haven't, have i made a mistake and made things worse, long term? I mean, the pain is nothing like it was, and it only bothers me now and then, i can even run on it without much problem, but i haven't been. Squatting down is the problem.

I will likely go for surgery, but what im getting at is, is there a downside to putting surgery off for a while, i could of had it done next monday but wanted to think about things and get some opinions. If anything the pain is better than what it was, should i get a second opinion, id like to push for a repair if possible, but i guess id need them to look through a scope first, i don't mind a longer recovery, im patient if it'll mean a better outcome in the long term.


#8

I don't have a lot of time to type up a response right now but there will be zero to negative benefit from postponing the surgery. Since the torn part of the meniscus isn't doing any cushioning anyway it's essentially just hanging out waiting to get in the way and cause inflammation and mechanical problems.


#9

So just to clarify? No advantage to keeping the torn meniscus inside my knee? If so i will look into getting surgery shortly.


#10

Yes


#11

I was wondering is there an idea to determine how long, until OA sets in. As it sounds a large tear, doesn't sound good, but im sure they'll only remove as little as possible. When i saw the OS, he said arthritis would set in my 40-50's, im 19 at the moment, so by that estimate it gives me at least a good 20+ years, but does this seem reasonable? I guess i could believe it more if it was a minor tear? Plus i do plan to be active in the future, if possible.

Ive also heard from a couple of people that it hurts their knee to sleep on that side after the surgery, so that's putting me off a bit.


#12

there is no way to ACCURATELY predict when you will feel it. Your best bet is to just stay as healthy as possible, limit systemic inflammation, make sure the quality of your motor patterns are top notch, strengthen the muscles as much as possible and make sure you get your sups in (glucosamine, vit C, lysine, etc)


#13

Ok thanks. It's just that the guy being an OS, you would of thought he'd know his stuff, but someone active vs someone sedetary is going to have differences i guess, im just hoping 20 years isn't a "bad estimate"


#14

The thing with the doctor isn't necessarily that he doesn't know his stuff, but that they are trained to provide certain care based on a specific set of symptoms. So they have to deal with a vast variety of clients. They tend to give you the most general advice/prescription/estimate based on the very short amount of time they spend with you.

When you seek help from an educated population (physics etc) that have experience relating more to your lifestyle as well as the ability to understand your situation more in detail you get a far better diagnosis and course of treatment/advice.


#15

Hi, thought id update this as i went in for surgery yesterday.

My knee hadn't been given me much pain, so i had some words with the surgeon before hand, and explained that it wasn't giving me much pain and only feels unstabable at times if im in a squat position, like ATG. He said within the first minute of discussing whether surgery was right or not for me, that HIS opinion was, that i don't necessarily need it done.

He said where i was unsure, it ment i wasn't symptomatic enough to proceed with the surgery, but it was entirely up to me, and gave me time to decide what to do. The physio came round before hand and tested my ROM, both extension and flexion, which was fine without pain or discomfort. She advised on getting it done as she said, it'll only take another twisting injuy and the meniscus will get caught and potentially damage the ligaments aswell. At this point i was considering just getting the surgery done.

However, i feel the surgeon was being fairly vague in what he was saying, from about 3 surgeons i have seen, they all have a similar attiude, kind of an unwillingness to speak to you directly with specific answers, no matter how many times you ask the question.

I asked, judging from the MRI, how much % wise, roughly was damaged/would they need to cut away, and i said just as a random suggestion, 10%? and he said - less than that. He said he wasn't going to remove a lot anyway as it doesn't give me much pain at all, and if he looked inside my knee and felt that he needed to remove a lot, he wouldn't proceed with the surgery.

I was thinking to myself, if there's a tear in there, it's probably doing no good anyway, and incase i don't get it done, i guess there's a risk of the tear getting bigger and causing mechanical problems, but then again, maybe it won't. He said i didn't have to have surgery, and if my knee starts to give me pain within 3 months or so, you can always op for surgery again.

In the end, i said, im happy if you have to remove a small amount, but i wasn't too keen on a lot getting removed, as it wasn't giving me much pain, as some people there were having surgery as it caused them pain. The assist anesthestist said how a family member had, had a few scopes and their knee wasn't so great, so wasn't much reassuring to go through with the op.

So in the end, he didn't to look at my knee with arthroscope, which ment i was given a general anesthetic, which if i ever have to have again, i will strongly consider my options as i can't stand it, i don't think i tolerate it well, had it done few times in the past, and when i come round it's not too good. I didn't see the surgeon afterwards, but he did briefly speak to the family member accompanying me and told them;

That there wasn't no tear at my meniscus, and that mine was a different shape. Said my meniscus was flat and that i was probably born like it. I have the images so i can post them if anyone understands what they're looking at.

But, here's the thing, there is a lot of confusion. I will try and get another appointment to speak to a surgeon and show them the images, but this is what i didn't get;
The MRI revealed a large bucket handle tear of the lateral meniscus

When i saw the OS for the pre op assessment, he filed this in his notes, and then stated ;"MRI confirms a possible bucket handle tear of the medial meniscus" With this i thought, surely he's maybe made a mistake and ment lateral meniscus?

And then when i checked over the notes it said i was due to have medial meniscus arthoscope, which was crossed out as he didn't proceed with the op. However, on the photos, there are photos of both "LM" and "MM", so i guess he must of looked at both meniscus's and stated if there was any actual tear.

Guess i'll need a follow up, but at least i have the photos for now.


#16

The information seems very conflicting, post the pictures and let us have a gander anyway.

If the MRI said bucket handle tear then it would certainly be a surgery (considering how the report stated that it had become lodged in the interchondylar notch). Somewhere between all this something got mixed up


#17

you cancled your surgery due to doubt, yet the mri confirms a tear. in most cases the doc will say that
there could more or less damage in the knee and the only way to know is arthroscopy. Me i had
2 medial meniscus tears (one for each knee) could not have an mri due to a choclear implant. pain in the
knee got a little better but didnt go away and choose to have surgery and recently on my right knee. found
extensive scarring under knee cap that the doc said was remarkable and i did not have that pain, just the
tear of the meniscus medial tendon


#18

Yeah i even mentioned about the piece being stuck in the kneecap and the surgeon just shook his head. It's almost as though they didn't check the MRI, i dunno, something seems odd to me, but i hope they made the right decision - they did check the knee after all.

I'll try and get photos up tomorrow, i have 8 smallish photos on a sheet, so i'll try taking the photos seperately with a camera.


#19

Got the photos. My knee is hurting a bit today, if im honest, think i'll need some sort of surgery which does piss me off a bit seeing as i could of just had it done, but i dunno, i'll have to show an OS the photos and see what they say, it feels as though something is getting trapped in my knee at full extension (inter notch?), at times it's fine and i have good ROM. Could be related to having these stitches in and not being able to have much flexion, but even so, it feels like it did from time to time and feels as though it's coming from behind the knee, anyway, here's the images;

Left - PF, Right - MM

"MM, pof hom"?

"LM Diswid"

"LM Diswid tes"

"ACL"

"LM Diswid"

"LM"

EDIT; If anyone knows how i can post the images without you having to click a link, please do let us know.


#20

The last image shows some fraying of the lateral meniscus I am short on time but I can't tell what's going on based on that. It looks like fraying towards the posterior horn of the meniscus not very clear at all. What I don't get is how did the surgeon not have a decent look at it? and if there was they fraying he should have at least cleared that up.