
Suggest Treatment For Severe Knee Pain And Difficulty In Walking

I am a 62 y/o male, still working as a CVICU RN. In Nov, 2016 I started with severe back of the Rt knee pain when I walked, and it migrated to the medial side. It was severe and made my life miserable. I had difficulty walking (this is my "good" knee). There was not a specific activity or injury that caused this, absolutely no pain in this joint prior to the sudden onset. I saw an Ortho. He injected it and sent me for MRI, showing a complicated meniscus tear along with (Surprise) arthritis. He suggested arthroscopy. I have scheduled it in 2 weeks. My question is: although my knee does not feel "right" and I am guarding it, no twisting, and when I walk on uneven ground, I am symptomatic. But generally IT IS IMPROVING every day, I feel. I have reluctancy to have this arthroscopy done. I do go to the gym and am focusing on my legs more to get ready for this procedure. But I still question if I need it. I have already postponed it once. My internist said I really should have it done or I risk having more issues down the road especially with my MRI findings. My ortho said I should get it done but my symptoms have steadily improved even after my last visit with him. MY FMLA is in place, time off approved and this ball is rolling. I need more professional input. For reference, I have had an open arthrotomy and meniscectomy in 1968 on my other (bad) knee and 8 yrs ago arthroscopy on it as well as a result of 8 bad injuries to it. This situation I face makes no sense, because I did nothing to bring it on. I know what a true knee injury is. This is one blowing my mind. Any input is appreciated, thanks. XXXX
Arthroscopy vs Arthroplasty
Detailed Answer:
Hi XXXX,
Thanks for the query
The meniscus tear can be a degenerative tear which occurs in the setting of knee Osteoarthritis.
Usually Osteoarthritis is common past 60 years age especially if your other knee is injured so more weight is being preferentially borne on the normal knee leading to earlier degeneration.
Avoid squatting, cross leg sitting, climbing stairs and kneeling. Avoid Arthroscopy if you can bear the pain. Wear knee brace. Perform quadriceps strengthening exercises.
If these measures do not help you for 2 months, then you can consider surgical intervention.
Take an Xray of the knee because medial knee joint pain is suggestive of knee Osteoarthritis. If you have significant arthritis then Arthroscopy won't help. Only knee replacement may be a solution in severe knee arthritis with/without meniscus tear.
I hope I have answered your query.
I will be available to answer your follow up queries.
Regards,
Dr. Aashish Raghu


1. Can the deteriorated meniscus complicate mobility in the future, fragment and become loose in the joint? I have no loss of ROM, nor do I have swelling. ( I am 200 lbs and about 6 ft and go to the gym 2-3 x week)
2. Would I benefit from making the meniscus smooth with arthroscopy?
3. My ortho says he can also "smooth" the arthritic surface thus making me more comfortable.
Does any of this this sound reasonable?? This is month # 4 since the onset of symptoms.
Your answers should complete my questions regarding this problem. My pre op work up is on 4/1, and my procedure is scheduled for March 24, so I need to make my final decision very soon.
Thanks.
XXXX
Xray
Detailed Answer:
Yes, the meniscus can become further degraded and form possible loose body.
Meniscus shaving can reduce the chance of degeneration to some extent but prior knee condition is important to note.
Please upload the knee Xray then only I can comment on the effectivness of the Arthroscopy procedure.


I have had a torn meniscus that was fragmented in my other knee and thAt was traumatic for me as a teen. I would not want that to happen again. That fact alone might sway my decision.
I understand you have difficulty guiding me because of the lack of information, but it sounds like smoothing the articulating surface could help preserve the joint? I just don't want to make things worse.
Thanks again
XXXX
Cartilage loss
Detailed Answer:
You have significant cartilage loss. There will be only possibly mild reduction in pain after Arthroscopy. Arthritis has set in


Joint pathology vs Meniscus
Detailed Answer:
The fact that you already have knee joint cartilage loss, the meniscus treatment will not alleviate your pain completely.
Your joint degeneration is another cause of the pain and that needs to be treated.
Meniscus fragmentation will be accelerated in arthritic knee.


XXXX
Get well soon
Detailed Answer:
Thank you. Get well soon. Do follow up with me on your progress.


Good Luck
Detailed Answer:
That's great! Hoping for the best for you

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