Question: Hi there,

Good Morning,

I am Dr. XXXXXXX Nadeem, working in Insurance Company. I have one Orthopedic case. I Need to have your expert opinion on this case.

This is 50 years old female member complaining of recurrent pain and swelling in the left knee. she is having this pain for the last 3 months during housekeeping. She is also complaining of pain on extension and walking. She was treated with NSAIDs but no improvement.

Examination:

•     Left knee patellofemoral crepitus.
•     Synovial swelling.
•     Tender medial aspect of the knee.
•     Extension lag.

MRI Findings:

•     Medial Meniscus: No tears. The posterior horn of the medial meniscus shows Internal bright signals on gradient echo and proton density WIs not dissecting articular surface denoting degenerative derangement This also shows postero-medial subluxation beyond the tibial confines
•     Lateral Meniscus : No tears. No abnormal signal.
•     Mild tibio-femoral and to lesser extent patello-femoral osteoarthritic changes are seen expressed by regional denudation of the articular cartilage more at the medial tibial
•     Condyle. Underlying cortical fibrillation and subtle sub-chondral edema exhibiting bright signals on STIR WIs is seen with small medial compartment osteophytosis.
•     Similar yet milder regional denudation of the articular cartilage is noted at the medial patellar articular cartilage. No sub-chondral cysts.
•     Peri-retinacula subcutaneous edema is noted more appreciated medially, This exhibits bright signals on STIR WIs. These are suggestive of sprain post traumatic consequences.
•     Extensor Mechanism: Intact Quadriceps and patella tendons are normal.
•     Soft tissues: Adjacent muscles normal. Normal flow void in popliteal artery and vein.
•     Other: No other significant finding

Treating Surgeon is requesting to do Arthroscopic partial meniscectomy and chondroplasty of the femoral condyle.

Please confirm if the requested procedures are really necessary for our member as per International best practice guidelines and as per your experience in this field.

Thank you for the reply.

please let us know what will be other treatment options for this member in order to have permanent solution if arthroscopy will relieve her for only 1 year. Which treatment she will require after 1 year?

Please comment also about meniscectomy option only in this case? And if she will require Total knee replacement in future keeping in mind the osteoarthritis changes?