Anthroscopic Surgery Done For Meniscus Tear In Knees. X-ray Showed Cyst Formation. Chances Of Osteo Arthritis?

Posted on Tue, 21 Aug 2012

Question: Hi I had an anthroscopic surgery on both knees 8 weeks ago, I had a mensicus tear in both knees. I have had physio on my knees do my exercises from my PT. After surgery I have found that I have no cushioning under the patella, and Specialist has stated that a partial knee replacement of the patella might be required if pain persists. A recent xray showed a subchondral cyst formation on the patellofemoral joint on the right knee. I find it very hard to sit with my leg straight down for very long, I get very distressed by tightness and grating in the front on the knee which goes down the leg & into the foot. I have tried to ask the specialist & the PT what could be wrong but they keep saying that it is too soon, and to keep exercising. I realise that I have a slight case of osteo arthritis, but I don't know what else to do as I have done all they have asked of me.

Answered by Dr. Deepak Goyal (49 minutes later)

Dear Ms XXXXXXX

Thanks for posting your query.

I would like to know more details from you, as I would be able to suggest you better then.

Please answer the following.

You have undergone Meniscus surgery, but was anything done for patellofermoral problem during meniscus surgery?

What were findings of Doctor's operative notes?

There are certain physios that you must not do in presence of patellar problems. But it can only be advised after seeing your x-rays, MRI scan pictures and your treating doctors’ reports.

Try icepacks on your knees, meanwhile.

Awaiting your response.

Regards

Dr Deepak Goyal
Consultant Knee Joint Surgeon

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Deepak Goyal (1 hour later)

As far as I know no patellofermoral problems were dignosed. PreOperative Diagnosis: bilaterial Knees: Meniscal tears chondral injury with pain swelling and disbility and failure of non operative treatment. Operativefinds: Right Knee Small Lateral Meniscal free edge tear with mild grade 5/5 chondral injury lateral half of patella & trochlea. Left knee:Larger tear posterior born of laterial meniscus with grade 5/5 chondral wear lateral half of patella and grade 4/5 chondral wear lateral half of trochlea
Operation: Antrhosopic menisectomy & chondroplasty. P/T me doing Heel slide, long XXXXXXX quad leg. Quad set pressing down knees, seated hip adduction ball squeeze/
standing hell riase, elastic band hip extension, elastic band hip abuction, standing hip flexion, squats, handstring stretch with towel. standing calf. I am using tens machine, left knee is the problem, patella is catching at times. Hope this helps,
Hi I also forgot to tell you that the left knee feels like it has never settled in properly it always tends to roll around since op and without pain killers it would be unbearable. Xrays recently show mild spurring of the tibial spines bilaterally more so on the right & there is calcification in the posterior recess of the right knee. There is degenerative change at the patellofermoral joint which is moderate on the right with subchondral cyst formation & asymmetrical joint space narrowing. As I tend to walk sometimes like a rubber band my back has also been a bit sore. She has also given me exercises for back cat & camel, double kee to chest stretch DKTC, lower trunk rotations LTR, QL stretch, Thoracic spine roll, lying big toe hamstring stretch. Can I have damaged left knee further? thank you for your help
Can I do hydrotherapy with simple exercises
XXXXXX

Answered by Dr. Deepak Goyal (4 hours later)

Dear Ms XXXXXXX
Thanks for the detailed description. As I can understand from whatever information you have put, you have got major arthritic changes in left patellofemoral joint with probably subluxating / Dislocating patella. You need to get it confirmed by your physician/ physiotherapist that it is indeed not subluxating/ dislocating or otherwise.

Normally we advise following sets of exercises to our patients with similar problems, before going for a definite surgery.
-Hamstrings Stretching Ex
-Calf Stretching Ex
-Gluteus XXXXXXX and Medius Strengthening Exercises
I am generally against heel slides, quads and load bearing exercised on patella.

Walking in a pool will put more load on your quadriceps. Ask your physio to modify her therapy as per above sets of exercises and omit all others for few days.

You might get better results, otherwise a revisit to your physician should help.
Let me know if I can address any more concerns.
Regards
Dr Deepak Goyal

Above answer was peer-reviewed by : Dr. Aparna Kohli

Follow up: Dr. Deepak Goyal (7 days later)

Hi I ask the PT and the GP if they thought it was subluxating. The left knee is still tending to be very tight through the knee and I have pressure built up thru to the foot. When exercises are done the knee it seems to loosen up. Unfortunately my foot seems to move around in my shoe even with tightening up shoe lases. Do you still think it is the above? XXXXXX