As you note, For someone aged 55, grade 1 and 2 is to be expected, particularly in someone who is active. Therefore, I question whether the chondroplasty was necessary and whether that is why I am still having problems to this day? My primary care physician did not approve an MRI (I was limping for a while after the tear which I beleive I just received one day when I did a deep knee bend and later occurred in the day when just getting out of a chair), and later chastized me for agreeing to the surgery saying thet meniscus tears can heal and I jumped into surgery to quick. The orthopedic surgeon told me it would not have healed (depsite feeling better) as the tear was in an area that was not a red zone. Here is a summary of what occurred: In February 2009 I tore my medial meniscus in my right knee. 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."The surgeon did a meniscopy and too my surprise he also did a chondroplasty. The hospital report read:"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.As a result of the surgery, I had knee crepitus and grinding about the patellofemoral region immediately after surgery; my knee would pop/crack when I extended my leg. The doctor said that this is due to a "hole" resulting from the chondroplasty and that it takes time to build up fibrocartilage. The MRI's also noted postop changes that he attributed to the chondroplasty. He also stated that this is why my recovery time is taking so long. Is knee crepitus and grinding about the patellofemoral region normal after effect of a chondroplasty? I did not have knee crepitus or grinding about the patellofemoral region prior to the surgery. From what I have read usually this type of symptom is a reason for surgery not a result of surgery. I have complete records of X-rays and three MRI's if it would help with your diagnosis/analysis/recommendation. Very much appreciated!!
Hi there. Thanks for asking an additional question.
I guess I missed you and you are not online anymore but I will answer. I usually get online once a day so please bear with me if you respond and it takes me a day to get back to you. I certainly will I just am busy seeing patients during the day so I cannot get online.
Thanks for the information. Let me answer and explain.
If your meniscus tear was not in the red zone and if it was complex then it would probably not have healed on its own. A simple tear is a tear in a single direction. If a tear is in 2 or more directions it is considered complex. In people above probably age 45 most meniscus tears do not heal even if in the red zone.
The meniscus of a 20 or 30 year old is very thick and elastic like a rubber wedge. In a 50 or 60 year old it gets thin and the substance of it has degenerated. If you can imagine a tear in a young person has clean edges whereas in an older person it is kind of like very ratty frayed edges and the meniscus is not strong enough to hold a stitch.
Meniscus tears can be symptomatic or also not symptomatic and that is why sometimes people wait for surgery to see if the symptoms go away. The tear does not necessarily heal but just the symptoms go away. There are nerve endings into the meniscus and essentially you get desensitized to the tear and it does not cause problems anymore.
Chondroplasty is really a standard thing and not a big deal. When you look inside the knee with an arthroscope the cartilage usually has some wear and some fraying and some areas where there are cartilage fissures and flaps. If the surgeon sees this usually he will touch it up with a shaver and smooth it out. This is usually not on the consent form because it is a pretty standard thing. Some people even argue that if you look inside someone's knee and they have a lot of fraying and you don't chondroplasty it then that is malpractice.
However, others say that everything a surgeon does must be on the consent form. Being a surgeon I don't agree because in good faith you want to do what is right for your patient.
Crepitus after knee surgery or chondroplasty is variable. It happens sometimes and sometimes it doesn't. However crepitus and grinding has many causes and in the patellofemoral joint it is usually due to maltracking, a deconditioned knee, or from arthritis. If you only had grade 2 lesions then it is probably not from the arthritis. If you had grade 3 or 4 then you could say with more certainty that it is from the arthritis.
Your surgeon is correct in that it does take time for fibrocartilage to build.
So in summary, I think it is unfortunate that you continue to have symptoms after your surgery. However these seem to be from the patellofemoral region now. I think the best treatment for patellofemoral pain is quad strengthening and trying to get the patella to align and track better. This should be done under supervised physical therapy that your doctor can prescribe.
I hope I have answered your questions. I understand that you have xrays and MRIs but at this point your story is so common that I don't think it would help me assess the situation - you had a meniscus tear and some cartilage wear and had a meniscectomy with chondroplasty now with patellofemoral symptoms worse than before the surgery.
The only thing that I would probably have done differently is to tell you in advance that despite a report showing a meniscus tear, if there are signs of arthritis on your xray or MRI then the knee surgery and meniscectomy might not provide complete relief - essentially that in the setting of arthritis, you would get relief from the surgery but that pain may come back if it was due to the arthritis and not the meniscus tear.
I hope I have answered more questions than perhaps I have stirred up. As usual please let me know if the answers were satisfactory and you are free to follow up or post additional questions to me that I am happy to answer. Thanks.
Thanks for the detailed response. My post-surgery x-ray showed minimal arthritis. THe report stated:
Ignore above,.....my pres-surgery x-ray showed the following:
My pres-surgery x-ray apparently showed minimal arthritis, especailly for someone my age. The results were:
Hi there. Thanks for the additional information. The reports says early arthritis in PTF joint and medial compartment. So it doesn't really change my opinion in that your knee was already on the path of wear. The surgery cleaned things out but you seem to have crepitus and pain now, but it's not possible to say that it was caused by the surgery or by the progression of what you had pre-operatively in the PTF joint.
I honestly think that at this point it is best not to dwell on whether the surgery caused the damage because it is impossible to prove. You might have a claim that a chondroplasty was done without consent but that would be debatable and you might spend a lot of time and money for nothing. I think the best thing to do is try and improve what is going on with your knee. Namely PTF arthritis.
Lastly, you have to understand that the xray and imaging reports are generated by a radiologist who has never seen a patient in his life. He is not an Orthopedic Surgeon so the words that they use are not necessarily what we would use. All Orthopedic Surgeons look at and interpret their own films. The problem is that the patient gets a report that says certain things that we may not agree with.
If you want me to take a look at the actual images I could do that if you post in a separate question. However, in all likelihood you have some arthritis in the PTF joint and medial compartment and it is just a matter of if I think it is "mild" or "early" as stated in the report.
I hope I answered your question. Thanks.