Get your Health question answered in 3 easy steps
A Doctor will be with you shortly
Ask a Doctor Now
135 Doctors are Online

Done menisectomy for knee meniscus tear. Taking Hilin. MRI shows recurrent injury. How to get rid of knee pain?

DOCTOR OF THE MONTH - Jul 2013
Jul 2013
User rating for this question
Very Good
Answered by

Orthopaedic Surgeon, Joint Replacement
Practicing since : 1996
Answered : 2148 Questions
Question
I've horizontal minuscus tear in my right knee from March 2009, underwent menisectomy surgery in Nov 2011 & felt better for almost an year.

For last 8 months again i'm almost feeling same as before surgery. Present MRI scan shows almost same condition which was there before surgery. Doctor who has done surgery say that i got injured myself again & need another surgery.

My family orthopaedic doctor asked me to wait for 6 months & take another MRI scan to compare whether tear is steady or ditoriating. Right now i'm taking Hilin - GM tablet on doctor's recommendation.

Pls advice me to get rid of this long lasting knee pain.
Posted Thu, 8 Aug 2013 in Bones, Muscles and Joints
 
 
Answered by Dr. K. Naga Ravi Prasad 32 minutes later
Hi Mr XXXXXXX thanks for writing to XXXXXXX

Before I answer your query, I need some more information regarding your past history. Please answer the below mentioned questions and provide any additional information you have though it is not questioned here -
* Does your initial meniscal tear happened due to any injury?
* Are you a sports person? If yes, mention specific sports you play
* What were your initial complaints before you underwent surgery?
* What does it mean by " almost feeling same as before surgery" ? Is it the same symptoms or anything more ? please elaborate
* Please send the scanned MRI REPORT (not images)
* Detail the composition of the "Hilin-GM" tablet

Waiting for your answers ............
Above answer was peer-reviewed by
 
Follow-up: Done menisectomy for knee meniscus tear. Taking Hilin. MRI shows recurrent injury. How to get rid of knee pain? 46 hours later
Does your initial meniscal tear happened due to any injury?

XXXX>>It happened due to car accident in 5th March 2009, i was wearing seat belt & this is the only major injury happened.

* Are you a sports person? If yes, mention specific sports you play

XXXX>>I'm not a sports person, but i do regular work out for last 8 years. Stopped for sometime after accident & also after surgery

* What were your initial complaints before you underwent surgery?
XXXX>>I feel some uncomfort or mild pain in right knee while walking more than 15 mins or sitting in chair without moving leg or while sleeping or if do any leg workout like jogging, cross trainer, squats or other leg exercises with weights. Due to this, I try to put more load on left knee & i feel little strain in left knee these days. But i'm taking care of it now & it's ok.

* What does it mean by " almost feeling same as before surgery" ? Is it the same symptoms or anything more ? please elaborate

XXXX>>After surgery i took some physiotherapy & did some leg strengthening exercises as advised by doctor & felt almost normal for sometime ( 5-6 months). I've done heavy workout with personal trainer's help after 4/5 months of surgery & later sat on the floor with cross leg for some XXXXXXX & also did cross trainer with 30+ levels, squats & running etc., to loose weight.

* Please send the scanned MRI REPORT (not images)

XXXX>>Pls check "Before_Surgery" & "After_Surgery" MRI scan reports.

I feel the after surgery report is almost same as before surgery, but how i felt better after surgery or not sure whether i injured myself after surgery

* Detail the composition of the "Hilin-GM" tablet
XXXX>>

Diacerein IP 50mg
Glucosamine sulphate potassium chloride USP 750mg
Colors: Titanium dioxide IP & Lake of quinoline yellow WS

I get urine in yellow
 
 
Answered by Dr. K. Naga Ravi Prasad 3 hours later
Hi, thanks for getting back.

Its very unusual to see a similar sort of findings (almost carbon copy) in two MRI reports spaced 2 years apart. I have never come across such a scenario in my 13 years of orthopedic practice.

Anyway,Here is the GOOD NEWS FOR YOU. Your 2013 MRI report shows a tear in medial meniscus which is at the level of MENISCAL ROOT posteriorly. We call this most peripheral area as "red/red zone". It means that this part of meniscus is vascular (has blood supply) and is likely to heal naturally (so its a blessing in disguise) provided you do not do any impact activities like jumping, running etc.

To simplify, Meniscal tears located most peripherally at the root are most likely to heal and tears occuring towards the center are less likely to heal as the blood supply to the meniscus decreases.

Also, there is no mention about the length of tear in either of your MRI reports.
Tears less than 15mm are more likely to heal spontaneously.

This is NOT GOOD NEWS for you -
* Presence of intra meniscal and para meniscal cyst. These indicate indicate inherent degenerative changes in the meniscus which is not a good prognostic sign for your age.
* Patients who undergo menisectomy less than 40 years of age are "at risk" of developing early osteoarthritic changes in the knee.

Instead of HILIN-GM tablet, I recommend a triple combination tablet comprising of GLUCOSAMINE SULPHATE, DIACERIN and MSM (methyl sulfonyl methane) which has an additional benefit of MSM and works more effectively in the healing process.

Hope I have addressed all your issues. Happy to help for any more clarifications.

Good day
Above answer was peer-reviewed by
 
Follow-up: Done menisectomy for knee meniscus tear. Taking Hilin. MRI shows recurrent injury. How to get rid of knee pain? 24 minutes later
Thank you very much for in detaled reply & advise.

I've below further questions:

1. Why didn't it heal in 4 years if it's in red/red zone

2. Not sure why length is not mentioned, but can it be assessed from image?
Not sure whether i can scan that & send, what if the length is more than 15mm?

3.In the latest report, it says that "No parameniscal cyst in present study", but intrameniscal cyst is present. Doctor said that parameniscal cyst was due to damage done by tear before surgery as there was no treatment for long time after injury, is that true?

4.I'll cross check with my doctor & change the tablet, Thank you for advice.

5.How long it takes to heal & how long i need to wait & then go for another MRI scan?

Pls clarify above queries.

Thank U,
XXXX
 
 
Answered by Dr. K. Naga Ravi Prasad 2 hours later
Hi XXXXXXX My answers for your questions are as below -
1. Simply presence of a tear in the vascular (red/red) zone doesn't mean to say that it will heal automatically. The prerequisite is that during the healing process, the meniscus should not be subjected to shearing or impact strain over it (this is the reason why i advised you to give up impact activities). Whereas you have done all sorts of heavy work outs as per you answer in the previous questionaire.

The other possibility (though I should not mention here or comment the other surgeon's surgical skill) is inadequate removal while addressing the tear during the surgery.

2. Even I am not sure whether the length of the tear can be measured on the MRI films. It is a standard teaching that meniscal tears more than 15mm length are less likely to heal and have the propensity to further propagate.

3. Delay in treatment after a meniscal injury is a possibility for the occurence of parameniscal cyst.

4. I strongly advice a triple combination for all my patients. Take them for 3 months.

5. It may take anyway around 2-3 months for the healing process ( I once again caution you, keep yourself away from impact activities ). By chance if you are a smoker, please quit. Because smoking has a very detrimental effect on bone and soft tissue healing.
You can get an MRI scan after 3 months

Good luck XXXXXXX
Above answer was peer-reviewed by
 
Share on Facebook
Share on Twitter
Share on Google+
Question is related to
Diseases and Conditions
Treatment/Therapy
Medical Topics

The user accepted the expert's answer

Ask an Orthopaedic Surgeon

© Ebix, Inc. All Rights Reserved.
All the information, content and live chat provided on the site is intended to be for informational purposes only, and not a substitute for professional or medical advice. You should always speak with your doctor before you follow anything that you read on this website. Any health question asked on this site will be visible to the people who browse this site. Hence, the user assumes the responsibility not to divulge any personally identifiable information in the question. Use of this site is subject to our Terms & Conditions
Already Rated.
Your rating:

Ask a Doctor