Medial meniscus tear query

alisonkuan
alisonkuan Posts: 20 Member
in Fitness and Exercise
A radial tear is seen at the posterior root attachment of the medial meniscus with resultant medial extrusion of the posterior horn, body and anterior horn of the medial meniscus. Anyone can help explain ? Need surgery ?

Replies

  • surfbug808
    surfbug808 Posts: 251 Member
    I can't recall all the medical terms and so I don't understand everything you just wrote, but long story short, I've had my medial meniscus torn (along with partial ACL) and received surgery, to staple the tear. A couple years later I torn my anterior meniscus AND further tore the medial, and the rest of my ACL completely off, in which case the medial meniscus required a partial removal, i.e. another surgery. This is over 20 years ago and technology/options weren't as good as they are now.

    Fast forward, I just aggravated my medial meniscus again a month ago and am in physiotherapy to restrengthen my hams/quads/minute muscles in the knee. I do not have an ACL in that knee, the tears remain, but I am able to remain active, surfing (requires a lot of twisting), and soccer (running/twisting).

    Here's my two cents: The meniscus can spontaneously heal on it's own, with care. It did the first time for me, but the surgeon (over 20 years ago) could only see that after he had started the operation, and stapled it anyway to help it along. He told me after the fact, that the surgery turned out not to be necessary. The second surgery was the best option at the time to remove debris in my knee. Now that technology and research has improved, if I had my initial injuries today, I would have opted not to have surgery at all.

    So... I think it would be helpful to see a good physiotherapist to assess for stability and strength. You may not need surgery. As I understand it now, with more research being done, surgery is not as necessary as earlier deemed. Also, the trauma of surgery can lend to arthritic symptoms later. If you can maintain/regain stability, strengthen your knee and muscles around it to compensate for the tear, bring down the swelling, and help it to heal, you may be able to avoid surgery altogether. But in order to do that properly, I would STRONGLY suggest you get more than one opinion from sports medicine doctors, PTs, and possibly an orthopedic surgeon or several. Some surgeons are aggressive about surgery, so talk to a few specialists to get a better idea of what's best for you. Get a copy of your MRI and x-rays so you have them handy to show. If you show a lot of instability and are unable to compensate for that with strengthening exercises, then surgery would likely be the best option in that case. I hope this helps and good luck!
  • Azdak
    Azdak Posts: 8,281 Member
    The meniscus is a crescent-shaped cartilage “pad” that is located on the outer rim of the upper tibia. You have two—one on the side of the knee closest to the body midline (medial) and one on the outer part of the knee (lateral). They form the “junction” to fit the rounded condyles of the femur to the flat surface of the tibia. They also provide cushioning for the knee during movement.

    With certain types of stress, force, torque, etc, the pad can become torn. There are different types of tears: one resembles a “parrot beak” when the inner edge of the pad is torn and there is a flap of cartilage sticking out. In your case it sounds as though one of the edges of the meniscus has been torn where it attaches to the bone on the back part of the knee (posterior).

    The amount of pain or movement limitation depends on the size and location of the tear, among other things.

    There is no universal answer to the question of surgery or no surgery. The cartilage itself has no blood supply to speak of and cannot heal itself. However that doesn’t mean surgery is automatically necessary. You will get anecdotal evidence from plenty of people who have had this injury and did fine with conservative medical management (i.e. no surgery). You will have others say it was their only option.

    IMO, the questions to consider are: how bad is the pain? How much does it affect or limit your activity? What are the long-term implications?

    There are basically two surgical approaches: one to repair the cartilage and one to remove the damaged “flap” and smooth the edge.

    Surgery is mostly done on younger people. It maintains the structure and size of the cartilage. However, from what I understand, full recovery takes a little longer because you have to avoid re-tearing the repaired cartilage.
    Trimming the cartilage usually results in a shorter recovery, but some are concerned that removing the cartilage might put the person at higher long-term risk of osteoarthritis in the joint.

    My anecdote is as follows: I have had 3 meniscus surgeries. Because of my age and how long ago they occurred, surgical repair was not an option, so all were trimmed. I had the right knee done in 1994 and 2007, the left was done in 2004. I will be 66 on Saturday and I have never had any pain in my knees since the surgeries. I have no issues with arthritis. I have been able to do all of my activities. Because of a variety of other injuries, I have done very little outdoor running in the past 15 years or so. 98% of my running has been on a treadmill. So I don’t know if I would have any issues with the pounding of running on asphalt or concrete.

    Before my first surgery, I tried medical management. I “rehabbed” the knee for 6 weeks. I was pain-free for most exercise activities except for running—the pain with running never lessened. Since running was the main thing I wanted to do, I opted for surgery. For the second two, I knew instantly what had happened so I just went for the surgery right away.

    Hopefully this is helpful.
  • alisonkuan
    alisonkuan Posts: 20 Member
    Thks so much. How long u take to recover after the 1st surgery done ? Is this consider major or minor surgery ?
  • alisonkuan
    alisonkuan Posts: 20 Member
    This my xywyzhhh8181.jpeg
    this my partial MRI report anyone can help greatly appreciated.
  • Azdak
    Azdak Posts: 8,281 Member
    From what I can read, you appear to have more than one tear of the meniscus, sprains in the ligaments in the inside and outside ligaments of the knee and multiple areas of damage to the surface cartilage lining of the knee.

    The first part describes ligament thickening and edema that is consistent with a sprained ligament. The second indicates that there are 2 tears in your medial meniscus. It also suggests there is some degenerative changes in areas of the cartilage (“grade 2c signal”). This may or may not be significant.

    The third paragraph describes damage to the cartilage lining the end of the femur and the top of the tibia (Chondral defects and fibrillation with associated edema (swelling)). The fourth paragraph describes what they think might be a Baker’s cyst, which a number of people have in their knees.

    I am reluctant to put that into any kind of perspective (ie how serious is it?) because these types of reports describe every small little thing in a lot of detail and so it can often sound much more serious than it is.

    The good thing is that major ligaments (posterior and anterior cruciate) and tendons (patellar) appear to be undamaged.

    I do feel confident is saying that this appears to be a little more serious than a simple meniscus tear. Your long-term outlook may still be excellent, but this is probably going to take more time to fully rehab than a simple tear.

    I hope this helps you to understand the big picture and get an idea of what questions to ask your doctor. I am not trying in any way to diagnose your injury—just trying to explain the terms so that you have a more thorough understanding to hopefully make your conversations with your doctors more meaningful.
  • alisonkuan
    alisonkuan Posts: 20 Member
    Azdak wrote: »
    From what I can read, you appear to have more than one tear of the meniscus, sprains in the ligaments in the inside and outside ligaments of the knee and multiple areas of damage to the surface cartilage lining of the knee.

    The first part describes ligament thickening and edema that is consistent with a sprained ligament. The second indicates that there are 2 tears in your medial meniscus. It also suggests there is some degenerative changes in areas of the cartilage (“grade 2c signal”). This may or may not be significant.

    The third paragraph describes damage to the cartilage lining the end of the femur and the top of the tibia (Chondral defects and fibrillation with associated edema (swelling)). The fourth paragraph describes what they think might be a Baker’s cyst, which a number of people have in their knees.

    I am reluctant to put that into any kind of perspective (ie how serious is it?) because these types of reports describe every small little thing in a lot of detail and so it can often sound much more serious than it is.

    The good thing is that major ligaments (posterior and anterior cruciate) and tendons (patellar) appear to be undamaged.

    I do feel confident is saying that this appears to be a little more serious than a simple meniscus tear. Your long-term outlook may still be excellent, but this is probably going to take more time to fully rehab than a simple tear.

    I hope this helps you to understand the big picture and get an idea of what questions to ask your doctor. I am not trying in any way to diagnose your injury—just trying to explain the terms so that you have a more thorough understanding to hopefully make your conversations with your doctors more meaningful.

    Thks so much for explaining. Is surgery a better choice for recovery ? I worry therapy may take longer than expected. This happen when I change my running to a run stop run stop once n the next day my knee had the pain. But I believe already have the year much before.
  • alisonkuan
    alisonkuan Posts: 20 Member
    Should I request to extract water out from knee or let it naturally recover ?
  • Azdak
    Azdak Posts: 8,281 Member
    Your questions are asking me to give medical advice and I am totally unqualified to do that. My only goal is to give you information to allow you to have a more productive and knowledgeable conversation with your doctor.

    I will say one more thing: the recovery will take as long as it needs to take and will depend on the severity of the injury and the treatment plan. At this point there is no way to avoid that. Your choice of treatment will depend on a number of factors and that is up to you and your doctor to decide.
  • alisonkuan
    alisonkuan Posts: 20 Member
    My doctor recommend Synvisc injection can this last any side effect ? Or doctor just continue with physiotherapy. Can defects cartilage heal by itself ?
  • aokoye
    aokoye Posts: 3,495 Member
    alisonkuan wrote: »
    Should I request to extract water out from knee or let it naturally recover ?
    ...
    My doctor recommend Synvisc injection can this last any side effect ? Or doctor just continue with physiotherapy. Can defects cartilage heal by itself ?
    These are questions that you need to ask your doctor(s) and physical therapist not the internet. I say this as someone with a history of major knee issues (and yes I know what synvisc is - you still need to ask your doctor).
  • spiriteagle99
    spiriteagle99 Posts: 3,740 Member
    Synvisc won't repair the tears. It injects some liquid between the knee bones and is usually used when there is bone on bone arthritis to delay the need for a knee replacement. I've never heard of it being used on a torn meniscus, but I suppose the idea is that it would lubricate the joint so you wouldn't feel the tear.

    My husband had two meniscus tears, each requiring surgery about 10 years apart. In his case, he couldn't walk without extreme pain. After the surgery, he was able to walk normally within a week and was back hiking in about 6 weeks.

    He had synvisc injections in his other knee, which was bone on bone and would get very swollen when backpacking. The first treatment lasted about two years, the second injection helped for less than 6 months. He had a knee replacement after that.

  • Carlos_421
    Carlos_421 Posts: 5,132 Member
    These are great questions to have asked your doctor...
  • alisonkuan
    alisonkuan Posts: 20 Member
    spiriteagle99 wrote: »
    Synvisc won't repair the tears. It injects some liquid between the knee bones and is usually used when there is bone on bone arthritis to delay the need for a knee replacement. I've never heard of it being used on a torn meniscus, but I suppose the idea is that it would lubricate the joint so you wouldn't feel the tear.

    My husband had two meniscus tears, each requiring surgery about 10 years apart. In his case, he couldn't walk without extreme pain. After the surgery, he was able to walk normally within a week and was back hiking in about 6 weeks.

    He had synvisc injections in his other knee, which was bone on bone and would get very swollen when backpacking. The first treatment lasted about two years, the second injection helped for less than 6 months. He had a knee replacement after that.

    How old was your husband when he had the meniscus surgery ? Anyone in such condition do therapy can recover ?

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