Brief Answer:
Were you diagnosed with an actual tear of the meniscus

Detailed Answer:
The degree to which conservative treatment should be carried out or encouraged beyond the ACUTE phase of injury (usually first few days to weeks) is dependent upon the presence of a tear or not and how severe. Most meniscal tears will NOT heal on their own no matter how great the physical therapy is or much the patient baby's the joint or follows doctors orders. Sounds like you've worked the PT thing for as far as you can but just in case have you been prescribed simple rest with activity modification, ice, and nonsteroidal anti-inflammatory drugs (NSAIDs)? I just have to ask to be sure you've actually done all those things. If the decision is that you've reached your limit of conservative treatment then, I believe surgery is a good option at this time.

The procedure chosen will be dependent upon the amount of damage to the meniscus itself. I can tell you that I've seen many a patient be sent for surgery and most tears are not repairable. Resection therefore, must be restricted to only the the portion of the disc that is not functioning. As much of the normal meniscus should be preserved. Make sense?

If there is meniscal damage then, a thorough search of the ligaments and tendons must also be undertaken since often these 2 things go hand in hand and if you diagnose one but miss the other then, you might as well not diagnose either since the outcome will be the same....POOR. The idea here is that the surgeon is going to be as diligent as possible to make sure that the knee is just as STABLE AS it can be before doing anything aggressive.

There are several different surgical approaches to this sort of problem which are best explained to you by an experienced orthopod but in general repair of tears (if possible) can restore near normal function therefore, this should be looked for at the time the injury can be surveyed.

There is also the relatively newer procedure of meniscal transplantation. Although this technique of treatment is possible to offer patients there are a number of other approaches that could be just as successful and less risky which still have good potential to retard progression of chronic pain so as not to become something more sinister down the road such as debilitating arthritis or degenerative forms of arthroses such as what you're describing seems to be afoot.

I believe you need to have a discussion with your orthopod sooner rather than later.

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The query has required a total of 35 minutes of physician specific time to read, research, and compile a return envoy to the patient.

Replied by Dr. Dariush Saghafi , 1 day ago

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Brief Answer:
Doesn't seem as if the meniscus is actual torn from report

Detailed Answer:
Thank you for the file. There is only the IMPRESSION of an MRI. Your message stated attachment(S)

Please keep in mind that your orthopedist is the one who should know the best whether you are a candidate for ongoing physical therapy vs. arthroscopic evaluations/surgery. 2 months of healing for an injury like this is not that long a time if you are being good about your physical therapy, following restrictions, and using the heat the way I am indicating at least a couple of times daily. I've had personal injury myself of the knee in blunt force situations which have taken up to 6 months to heal.

From the radiology report describes it does not appear that there has been tear to the meniscus. This is very good news. What it does detect are changes (likely from the trauma) which are typical of what happens to soft tissue when it has been placed under force. So that's what the MYXOID DEGENERATIVE changes are telling us. It is not the same as arthritis but it can lead to arthritis in the future. The posterior horn of the medial meniscus is the location most often affected by these sorts of injuries. If on the other hand the tissue is suffering from swelling because there is a piece of the meniscus which is being trapped in the joint and if that's what's causing the pain and ongoing symptoms then, arthroscopy may be necessary to fix it...again, your orthopedist will be better able to make this call upon examining the knee.

However, if we simply accept the MRI read stating NO tear then, I don't see where surgery would be helpful. The best way to take care of the soft tissue changes is to use warm compresses regularly, use knee elastic braces sold in pharmacies to add support and stability to the joint and watch your activities as I've suggested below. This may very well lessen pain. If you are not at your ideal body weight then, going on a weight loss program can also reduce load and tension on the knee which can relieve some more pain and additional forces to slow the degenerative processes down.

Restriction of activities that place excessive stretching on the knee such as FULL SQUATTING, heavy lifting, repetitive knee flexion (even if not squatting), a lot of stair climbing should be limited or eliminated if possible until additional healing occurs.

You can also talk it over with your orthopod but I have many patients who feel better taking dietary supplements which are believed to aid in joint injuries such as glucosamine chondroitin sulfate. There's been a bit of a push-back more recently from reports that believe its use is over-drummed...and perhaps, that's true, but I see little down side to taking it if there's a chance it can aid in collagen repair. It's a nutritional supplement and therefore, pretty benign in terms of side effects or drug interactions if taken according to directions.

I hope this answer satisfactorily addresses your question. If so, may I ask your favor of a HIGH STAR RATING with some written feedback?

Also, if there are no other questions or comments, may I ask you CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary?

Please direct more comments or inquiries to me in the future at:

bit.ly/drdariushsaghafi

I would be honored to answer you quickly and comprehensively.

Please keep me informed as to the outcome of your situation.

The query has required a total of 75 minutes of physician specific time to read, research, and compile a return envoy to the patient.

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