About six weeks after surgery, when my knee was not healing as fast as expected, I asked the doctor about the recovery time, and he showed me a model of a knee and pointed to some cartilage on the knee that would take time to heal. I didn't really understand what he was talking about until I saw the bill and saw that I had two charges from the doctor: one for a meniscopy and another for a chondroplasty. So I looked the term up on the internet and was dismayed by the number of people who talked about long recovery times fro chondroplasty, and by medical web sites that said it was even common in high school kids (usually girls), but that in most instances physical therapy is tried before surgery, and that type 1 is usually not even distinguishable (surgeon cited type II in hospital report).
So I tactfully bring up the subject of the need for the chondroplasty, and he showed me a page full of circular slides taken during surgery that showed fragments rather than clear edges. The doctor said that the chondroplasty would help put off arthritic advancement by ten to fifteen years. In a later appointment, I asked him if the chondroplasty was purely preventative or whether it was needed for the tear, and he said it was not just preventative, although I got the impression he was just trying to appease me. Thoughts on this?
So after the appointment, I thought that although it may not be standard procedure to do a chondroplasty with stage 2, that in the instance of performing a meniscopy, and the knee already being "opened", that surgeons may routinely debride and shave rough cartilage. I still don't know if this is standard procedure. Your opinion?
I have notes from an appointment I had with the surgeon on 8/23/10, where I noted that dull pain is present when I walk, with the degree of pain varying. I also noted that my knee was popping right above the patella when I extended my right leg. I told him I also had pain when squatting, and he told me to avoid this.
The doctor stated that if I would continue riding my exercise bike that the fibrocartilage should fill in. He also recommended gludosamine/chondroitin supplements which I take daily.
As noted earlier, I have concerns over the results of a 9/20/10 MRI ordered due to my concern for knee pain, with stiffness and popping. The doctor wanted to rule out a new tear. The results of the MRI had the following impressions:
IMPRESSION: Postop change of the posterior horn medial meniscus. The signal in the posterior horn extends to the tibial articular surface maybe slightly more prominent, but is probably related 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. Continued on page 2.'85 Probable mild tendinosis of the distal quadriceps tendon and proximal patellar tendon. Possible chronic strain of the ACL.
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. However, he did not specifically bring up the radiologist's impression of findings of a small new tear at the apex of the body segment medial meniscus, which gave me concern in that the absence of pain on the outside of the knee would not rule out a new medial tear.
The findings on the MRI are, with areas I find of concern bolded:
There is a slight amount of fluid within the knee joint felt to be within physiologic range, and it is also smaller when compared to prior study. Minimal signal intensity to the articular cartilage patella is noted with a tiny surface irregularity to the lateral patellar articular cartilage near the junction of the facets, stable. Area of cartilaginous hyperintensity and irregularity to the posterior articular surface in the medial femoral condyle appears to be slightly more prominent than before with possible slight subchondral edema, series 3, image 9. There is interval blunting of the apex of the posterior horn medial meniscus most likely postsurgical in nature. A small hyperintense signal oblique in manner extending to the tibial articular surface of posterior horn medial meniscus is seen such as on image 7, series 2 appear to be slightly more prominent than before. This is probably due to postop change. There is a new horizontal to slightly oblique hyperintense signal to the apex of the body segment of the medial meniscus seen best on series 2, image 6. This may be due to a new tear. The rest of the medial meniscus is normal. The lateral meniscus reveals a hyperintense signal at the tibial articular surface of the posterior horn, image 22, series 2, which is more prominent than before and also seen as an oblique line on image 7, series 4. This is concern for a new tear. There is no definite tear of the retinacula patella, medial and lateral collateral ligament complexes, distal quadriceps tendon, patellar tendon or popliteus tendon. There is minimal signal to the distal quadriceps tendon and proximal patellar tendon on fat sat images maybe due to focal tendinosis. No popliteus tear. No definite ACL or PCL tear. There is slight increased signal to the distal portion of the ACL not significantly changed maybe due to some chronic strain.
Question: Should I be concerned over the above MRI? Even if no new tear is present, I am concerned with the many references to postop changes, and areas noted a more prominent than before. Is this normal? Should I be concerned?
At my 9/19/11 appointment I brought this up and he stated that it was the result of the surgery and that at this time he had hoped the fibrocartiage would have filled in this area. In your opinion, with stepping up my bike riding (prior doctor on "Just Answers" recommended two hours a day in 15-minute intervals, although he or she just cut and pasted the recommendation from a web article as I cited earlier), could this area still fill in, or is it as good as it gets by now? What aggravates me about this is that the clicking is often cited as a reason for surgery; yet for me it was the result of surgery! I take it that this is not normal? Is the clicking on leg extension permanent or could it still go away with increase exercise and fibro cartilage fill in?
I had a follow-up MRI on 11/30/10 with the following results (different radiologist):
FINDINGS: There is stable mild generalized deficiency of the medial meniscus compatible with post surgical change of prior partial meniscectomy. At least 75% of the medial meniscus is remaining. There is a stable tiny intermediate linear hyperintensity involving the undersurface of the mid to medial posterior horn of the medial meniscus compatible with residual postoperative meniscal signal. No new medial meniscal tear is seen. A stable tiny horizontal linear intrasubstance hyperintensity is seen in the posterior horn of the lateral meniscus that closely approximates the undersurface of the meniscus and might represent Grade III signal of a meniscal tear. The cruciate and collateral ligaments are intact. The extensor mechanism is intact. The visualized bones are intact. There is minimal lateral subluxation of the patella. There is slight heterogeneous signal alteration and surface fibrillation of the lateral patellar facet compatible with Grade I chondromalacia, which appears relatively stable. There is stable focal mild cartilage thinning of the posteroinferior lateral medial femoral condyle at the level of the posterior horn of the medial meniscus compatible with stable chondroplasty of previously seen Grade II chondral lesion. Articular cartilage of other portions of the medial compartment and lateral compartment are normally maintained. A minimal knee effusion is present. No popliteal cyst is seen. Visualized muscles about the knee are unremarkable.
IMPRESSION: Status post partial medial meniscectomy. No evidence of recurrent meniscal tear. Stable appearance of possible horizontal undersurface tear of the posterior horn of the lateral meniscus. Intact ligaments. Stable Grade I chondromalacia of the lateral patellar facet and focal mild cartilage thinning of the posteroinferior lateral medial femoral condyle at site of prior chondroplasty. Minimal knee effusion.
Again I see reference to postoperative changes. Is this normal? I am concerned with the statement that, "There is stable focal mild cartilage thinning of the posteroinferior lateral medial femoral condyle at the level of the posterior horn of the medial meniscus compatible with stable chondroplasty of previously seen Grade II chondral lesion.",
because in my last appointment with the doctor on 9/19/11, he was more cautious about me running than before. In prior appointments he advised me to run on a soft surface, but at this appointment he specifically mentioned the thinning of my cartilage and that I may run but that I should limit my running due to this,although he approved tennis and light basketball. Is this thinning a part of aging wear and tear, or was it due to the chondroplasty? Since my tear occurred with very little stress on the knee (just from getting off a chair), maybe the tissue had just worn out over time? The doctor told me to come back in the spring, and stated that if I was still experiencing problems he would order another MRI.
I know this us a lot to cover, but I would appreciate it if you could go back and read my question(s) from the beginning and give me your opinion about the surgery, the MRI results, and recommendations for further action; e.g., new MRI; hydrolauic acid injections; physical therapy; exercise limitations; second opinion from another orthopedic surgeon in different medical group (I am in a PPO); etcetera. I used to really enjoy running if even for three days a week and took pride in that I still had very good speed for any age, and would, for example, often sprint out to my mailbox just for the joy of it, or run back and forth at good speed on the basketball court for fun and exercise. And I took pleasure in the interval training because I often found the long,slow jogs boring.
At this point I am wondering whether I even should have had the surgery because I felt OK a couple weeks prior to the surgery (about three months between injury and surgery). However, for several weeks I was limping, and I would still feel mild pain when descending stairs and if attempted to due a full squat, so I went ahead with the surgery because I figured it was pretty minor, having heard that recovery usually takes only a few weeks. Further, my surgeon stated that waiting could make the condition worse, and that since the tear was in a white area, it wouldn't heal because it wasn't in an area with blood supply. The surgeon also stated that although I felt my knee was better it was only because the (torn?) flap had fallen back in place temporarily. Does this make sense?
The doctor said he would try to repair rather than remove part of the meniscus (which I now wonder if even a possibility since the tear was in a white area). I believe I still have a very slight limp now (at slow walking speed my right foot is in contact with the ground slightly longer than my left foot; surgery was to the right knee).
So I've thrown a lot at you, and I really appreciate your time, and will give positive feedback and maximum bonus if you can address the above! Thank you so much, and feel free to take your time in responding.