Suggest Treatment For Severe Knee Pain And Difficulty In Walking

Question: This is a question for an orthopedist only please:
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

Thanks Dr XXXXXXX for your input, your time is greatly appreciated. Please see my attached MRI report. Sorry for for the pages being out of order. My symptoms began last November, and have decreased remarkably without any pain meds or NSAIDS. Although I am not symptom free, I am improving. As I said before, just 2 weeks ago, my internist encouraged me to have the arthroscopy because of the condition of my meniscus, saying it may cause problems if I do nothing. My next questions to you are.

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

Not sure if I deleted my reply to you. My X-ray was done at the drs office, so I do not have access to it.
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

I sure wish there was a clear cut answer. Based on your first impression though it sounds like you suggest avoiding arthroscopy. Is the likelihood of meniscal fragmentation low?

Thank you very much for your help. Your last response was of great value to me in making my decision. You have answered many questions. Thanks for taking the time.
XXXX

Will do. I am thinking this will be an easy recovery. My leg is strong and non traumatized going in. Keeping my fingers crossed. I even have my anesthesiologist picked out, we have spoken and he will certainly take good care of me.