MRI report on right knee reads " extensive intrasubstance tear of the posterior horn of the medial meniscus but not extend to articular surface. Very samll joint effusion noted" diagnosed June 2011, have tried physical theraphy and anti-imflammatory , didn't seem to work.MRI report on left knee reads "oblique tear of posterior third of the medial meniscus" diagnosed April 2012.My questions : without surgery, will the tears become worse? Will they heal on their own? Dr. recommended arthroscopy, will I be able to run after recovery? Could getting cortizone shots avoid the surgery or the shots merely postpone it? I am a 37 years old female, very active, and hope there is a treatment that could help me run again. Thank you.
Person's Gender: Female
Person's Age: 37
anti-inflammatory, physical therapy
Hi there. Thanks for your question. Let me answer.
I am an Orthopedic Surgeon and would like to help answer your questions. Please understand that the information that I provide is for educational and informational purposes and is not treatment or meant to substitute for being treated by a live physician. I get online once a day and therefore please bear with me if you post and I haven't responded yet. I will in due time. Please do not accept until you have had your question answered in a satisfactory fashion.
I'm sorry that you are having problems with both of your knees. Let me explain the MRI reports to you and then provide the information that you are looking for.
First of all, the right knee has a tear of the back portion of the meniscus. The meniscus is shaped like a "C" or a crescent. The back part or "horn" is torn in the substance of the meniscus meaning that it is not like a tear that has a torn piece flapping around but that the tear involves the thickness of the meniscus and does not exit the top or bottom of it.
The left knee has a tear that is oblique in orientation which means it is not vertical or horizontal but diagonal.
The key information regarding meniscus tears and whether or not to have surgery is age, location of the tear, and symptoms. If you are having what we call "mechanical symptoms" such as clicking, catching, locking, of the knee with restricted range of motion then that is a good surgical indication, meaning that those symptoms resolve with surgery.
If you are older like above 50, then having small tears of the meniscus is common and many people without symptoms have tears, so unless the mechanical symptoms are severe then surgery usually not offered. At that age, arthritis tends to set in and the wearing out of cartilage (arthritis) by definition compromises the meniscus because it is between the cartilage. Thus small tears in that age and above usually are not offered surgery.
The location of the tear is important because tears of the peripheral third have a greater chance of healing because the blood flow to the knee joint comes from the capsule and comes outside to inside. Thus the peripheral third has good blood flow. Central third is not as good flow. Inner third, very poor blood flow. Inner and central third tears are usually removed with a shaver. Peripheral third ones we try to repair.
If you have a repair then you need to be non weightbearing on that leg for 6 weeks.
Based on your reports it sounds like you would have removal of the tear and not repair.
The tears will probably not heal on their own. They could become worse over time. Depending on how much of the meniscus is removed you should be able to run.
Cortisone would likely just postpone the surgery.
I think the most important thing is that you should not have surgery based on an MRI report but more based on what your symptoms are.
Can you tell me what symptoms you are having? Are you able to walk without pain? Go up and down stairs? Play any sports? Bicycle?
Any mechanical symptoms?
I look forward to the additional information.
Hopefully I have already answered your question. If I haven't please let me know what other information I can provide. Thanks.
Thank you for your answer. I do
have clicking with both knees, right one is worse than the left one.
I am not exactly sure what knee catching or locking feel like. When I bend my leg and then straighten it , there is audible popping sound, feels like the bones are getting back to their position. Again, the noise from the right knee is louder than the left one. Neither is painful.
For most part, I do not feel pains, a little achy with the right knee from time to time.
There is not movement restriction with my left knee; the right knee feels pain if flexed to certain angle, say more than 120 degrees, and when crossed in a yoga sitting pose.
Going upstairs or downstairs normally doesn't bother me . However, after a few hour hiking, the right knee would have pains beneath the knee cap toward center, and the pains would persist for a few days after whether walking on level ground or stairs, then it will go away .
Otherwise, they don't seem to bother me. I work out daily following exercise disks ; the workout involves squats, lunges, kicking, lifting knees, moderate amount of hopping, yoga, pilate, stretch . I wear knee braces during workout. I do not lift heavy weight ( 2-3 pound dumb bells for arm exercises); I stopped running since that's when my right knee bothers me most. When I did, I ran once weekly, usually 5-6 miles an hour.
hi there. i would not worry about the risk of arthritis. if your meniscus is torn then it is not functioning properly and not protecting the knee from load like a normal meniscus would. if it is causing mechanical irritation then removal would be recommended.which is sounds like it is, then most surgeons would recommend removal. injections may help with the pain but it sounds like it is not that painful.
actually when i re-read your answer it sounds like the mechanical irritation is from the kneecap and not the meniscus. if you can that workout without meniscal pain then it is from the kneecap. first type of treatment would be physical therapy for kneecap alignment and better kneecap tracking with something called Mcconnel taping to see if that helps.
did your therapy involve thigh strengthening with focus on kneecap tracking? or was it general knee therapy?
given that the pain is not bad, then surgery is probably not the answer at least initially. i would exhaust all other measures outside of the injection because i am not a fan of injections because they do not address the underlying problem.
i hope i have answered your question. if not, please follow up and let me know what else i can address. thanks.
doc, thank u very much for the info and advice. I went to see my doc who suggested knee scope Thursday and this time he said unless I have a lot of pains, surgery shouldn't be in the picture. I asked him if I could run and he said I can do whatever I want as afr as I feel fine. I requested a MRI on the right knee since last one was taken last June. Also, I resumed Martial arts practice . I do feel a little pain but it is again beneath the knee cap . the doc' said I also have hip bursitis and iliotibialband syndrome. would it relate to my knee issues?
also, regarding the PT I had, I really was not sure what it really was about. It involed leg raise, squats, side stretch , bycling-- it didn't do much and I do that with my workout routines anyway.
Hi there. Thanks for accepting the answer. The hip bursitis and IT band syndrome unlikely to be related to the kneecap issue. Regarding PT for the kneecap, I think you should have specific PT geared toward kneecap tracking and strengthening of the quadriceps and VMO muscle. Also, they should teach you McConnell taping to see if that helps your kneecap pain. Good luck to you. You know where to find me. Thanks.