In February 2009 I tore my medial meniscus in my right knee. Despite being 53, I still had good speed being a college sprinter (400 meters) and was doing interval work (sprinting followed by slow jog and then repeat), and in retrospect sometimes pushing myself on long, slow runs (not that long - 2.5 miles) by altering my stride. I first noticed a problem just getting up from an office chair at work.
An MRI showed "an indistinct, small complex tear of the posterior inferior corner of the posterior horn of the medial meniscus, and Grade I/II chondromalacia of the posterior weight-bearing portion of the medial compartment, which is greater on the condylar side laterally over the posterior horn of the medial meniscus."
After the tear I was limping for some time, but then I started to get better to the point I was walking normally and the only pain I felt was if doing a complete squat, and very minor pain when declining stairs. However, the surgeon stated that the tear was present and that the "improvement" was due to the "flap falling back into place" and that delaying surgery could make the injury worse.
I had the surgery on May 23, 2009, and went to physical therapy
one week later and continued therapy for almost three months. I couldn't bend my knee fully for several weeks. In early September my knee still did not feel recovered, and my orthopedic surgeon ordered a new MRI. The surgeon stated that my recovery was taking so long because besides doing a meniscopy, he also did a chondroplasty.
I obtained the hospital report and it stated, ""Through an inferolateral portal the knee had a grade II chondromalacia, which was debrided. Medially there was a complex tear of the posterior horn of the medial meniscus, which was resected using upbiting shaver to a stable rim. Chondroplasty of the medial femoral condyle was carried out. It had a Grade II lesion which had significant delamination of the weightbearing dome."
A new MRI was taken on September 20, 2010, which stated: "Postop change of the posterior horn medial meniscus. The signal in the posterior horn extends to the fibial articular surface maybe slightly more prominent, but is probably due to postop status; Findings suggestive of a small new tear at the apex of the body segment medial meniscus. A new tear in the posterior horn lateral meniscus also; Chondromalacia of the posterior articular surface of the medial femoral condyle may be slightly more prominent. Chondromalacia of the patella stable." My surgeon dismissed the tears as MRI artifacts as he said he did not see them when he did the surgery, and I had no pain on the outside of my knee.
1. Did the small, complex tear of the medial meniscus definitely require surgery, or could it have healed with physical therapy? Can delaying surgery cause a tear of the medial meniscus to worsen?
2. Was a chondroplasty warranted? Is it standard procedure to perform a chondroplasty when doing a meniscopy when Grade II chondroplasty is seen? I raise the question because usually the recommended treatment (from what I have read) for Grade II chondromalacia is physical therapy. Should the doctor have asked permission before performing a chondroplasty?
3. The new MRI indicates postop changes. Is this normal, or indicative of a worsening of the condition due to the surgery?
4. Is the clicking upon extending my knee normal? The doctor said that this is due to a "hole" resulting from surgery and that it takes time to build up fibrocartilage. Your opinion?
It has know been 16 months from the surgery and I still feel the knee is stiff at times, slight pain when descending stairs, some pain after cycling on recumbent bike for thirty minutes, and when I extend me knee a slight clicking sound is heard (less clicking than four months after surgery; however, I had no clicking upon extending leg prior to the surgery. I am concerned that the clicking may result in arthritis). I have yet to try running on the leg, or playing basketball or tennis, but want to resume the activity I had prior to the surgery. The doctor told me it was alright to start running in February 2011 with the caveat that is would be wise to run on a soft surface. Is this possible without reinjuring my knee? I see where many if not most patients come back from meniscus surgery in a matter of weeks, but, again, I was told my lengthy recovery was due to the chondroplasty.
Answers to these questions and any observations much appreciated. I have an upcoming appointment with the surgeon so welcome questions to ask the doctor and whether a new MRI is warranted.
Positive feedback and maximum bonus upon detailed answering of questions. Thank you!!