Does my knee need this?

October 28, 2006 8:00 PM

Orthofilter: So, I've got a damaged medial meniscus and MCL in my right knee. The pain since this began (July) has really subsided to the point of mild inconvenience. Arthroscopy and debridement seem to be fairly common procedures, and I'm wondering whether I can achieve relief without surgery?

The surgery orders are for partial medial meniscectomy, arthroscopy and debridement. Physical therapy has been fairly useful so far, though at times I'm really unstable on my knee. I'm planning on seeking a second opinion, just to be sure.

posted by moonbird to health (7 comments total)

Trying going to an osteopathic physician (under physicians in phone book: D.O.)--i'm in that type of medical school, and although I've not gotten too far in some of the manipulations performed, this type of physician may be able to work on your knee and prevent having to have surgery--again, I'm not quite sure if it's possible or not yet as I just started 2 months ago in an osteopathic school--but what i've learned so far has suprised me at what DO's can do! give a try--can't hurt, plus it's your second opinion (as we are fully licensed physicians)
posted by uncballzer at 9:34 PM on October 28, 2006

A college roommate of mine injured her knee in junior high school, and thought she had made a full recovery. Five years later, the tear in her meniscus had gotten bad enough that a piece of it would occasionally flop out of place and lock out her knee joint. After the third time she woke up in the middle of the night screaming, she didn't think twice about having the offending bit of meniscus cut out (as well as having a piece of her hamstring used to repair the torn MCL that allowed the continued abuse on her meniscus).

That being said (and bearing in mind that at best my clinical knowledge is anecdotal at best...), the cartilage in your knee probably isn't going to repair itself, but having it cut out isn't going to repair it either, it's just going to prevent it from impinging your joint and causing pain. So if it's not causing pain, and it's not in a position that is likely to get in the way, then I'm not sure what the hurry would be to get it repaired (but I am not an orthopedic surgeon).

I think the most important thing is following through on therapy to repair/strengthen the support structures in your knee (MCL, and the other CLs) so that you don't do further damage to your cartilage (also, I am not a physical therapist).
posted by cosmonaught at 9:46 PM on October 28, 2006

The problem with leaving it alone isn't the pain: it's the instability. If you choose not to fix it, your bones will slide around when you move. This can ultimately cause quite a bit of damage that might require more dramatic fixes down the road.

Having said that, surgery sucks. I had a complete ACL and meniscus repair surgery. It wasn't fun. It took a lot of physical therapy and a second surgery to get it right. And, it's never going to be the same but it is back to ~95%. I can be active on the knee again without the risk of really screwing it up (i.e., the instability you mention) which is why I wanted to fix it. If you are sedentary and don't plan on doing much for the rest of your life, leave it be. But if you want to be active it's probably best to bite the bullet now.
posted by SciGuy at 10:53 PM on October 28, 2006

I always thought of the menisci as more of shock abosrobers then stabilizers. I know they give a little stability because they cup the ends of the bones, but I don't know how removing damaged portions would help with that. Then again, I was pretty clear on how well uninformed I am on the subject...

Looking around on the internet, it seems like everyone recommends corrective surgery, and there isn't really any reason that the pain should go away entirely on its own (plus the stability stuff SciGuy posted about, and joint impingement isn't fun), so... surgery?
posted by cosmonaught at 11:15 PM on October 28, 2006

One of the things you need to consider as well, is if you are walking around on a damaged/torn ACL/MCL, you can be doing further damage to the meniscus, and the bone.

I fully tore my ACL, with no other noticeable damage, back in November/December 2004. Like you, I wanted to explore the non-surgical options, strengthening my leg muscles in physio to allow for more stability. In the end, the pain was minimal, but it would lock up on me, and give out in random intervals, occasionally so bad that I would be on crutches for several days. I decided on surgery, and by the time the arthroscopic surgeon went in(June 2006), my meniscus was torn, and the bone was damaged and ragged, from all the extra 'work' it had to do to to compensate for the missing ACL.

That said, I second SciGuy in saying that the surgery sucks, too. I'm almost 5 months post op now, and while there is still a fair bit of rehabilitation to do to the leg muscles yet, the knee is more stable than I would have ever expected. I have no regrets about getting the surgery, except maybe that I didn't get it sooner.

Definitely go for the second opinion if it makes you feel more comfortable. If you decide on the surgery, keep working at the PT beforehand as it will help significantly with recovery afterwards. Oh, and check out this link for more information than you'll ever need about different knee surgeries, as well as an extensive forum. This was a godsend when I was bedridden for a week postop.

Good luck! Email is in profile if you have any other questions.
posted by irishkitten at 1:22 AM on October 29, 2006

My story is similar to others. I gradually over the years damaged my ACL and meniscus. I opted for strength conditioning rather than surgery after one event resulted in a trip to the hospital. That was fine for a couple of years, though like others, my knee would act up on me occasionally. Then in 1997, when I pushed myself off a low wall, I injured my knee again, bad. This time I opted for surgery. It sucks recuperating, but once it healed up I was about 95% or so of pre-injury. I stayed that way until I started a martial arts class a few months ago that required kneeling that really stretched the knee. I was worried, but I took it slow, and after a couple months of stretching the knee that way, I'm at 100% mobility and strength for that knee.
posted by forforf at 9:14 AM on October 29, 2006

Really, I could mark all of these as best answers. I wasn't sure what kind of response I'd get (meta for asking a medical ?, etc) but all of you have given good advice on all the points. While the second op is essential, I am leaning towards biting the proverbial bullet and getting this fixed. While I know unpleasantness is ahead, I also know that in the long run I've got to do what is needed to keep this machine running.

Thanks again all for all the stimulating and thoughtful responses.
posted by moonbird at 8:03 PM on October 29, 2006