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

Had meniscus surgery, knee drained, cortisone shots, MRI shows arthritis. Should I get a lower back MRI?

User rating for this question
Very Good
Answered by

Orthopaedic Surgeon
Practicing since : 1994
Answered : 9631 Questions
Question
had meniscus surgery March 23. Large tear. No relief post-op. Doctor said take time. Had knee drained (bloody liquid) and two cort shots and four weeks PT. Asked for MRI again. Contrast MRI shows similar to first -- bone on bone, arthritus. I think the degeneration resulted in loss of stability and the men tear. I asked the surgeon how he could have missed all the degeneration. Have to have knee replaced. 47-year-old mother of three (ages 4, 8 and 10). Doctor wants me to get a lower back MRI. Spouse/PT say waste of time. Doctor says he missed all the damage because of the arthritic knee. He says if MRI comes back fine, will schedule replacement ASAP. Not sure what to
Pain and swelling and clicking in right knee for more than a year. PT no help. In Feb 2012, twisted bad knee and tore menicus through and through.
Mother of three children: age 47 / 5-11/ 193 lbs/ active/ healthy overall

MRI 1 March 2012 -- Horizontal tear of the posterior horn and mid zone of the medial meniscus, which extends to the inferior articular sufrace and free edge;
slight thickening of the medial collateral ligament with minimal periligamentous edema, compatible with mild sprain;
large joint effusion;
1.5 mm area of articular cartilage loss involving apex and medial facet of the patella.
Minimal subcond marrow edema and small (6mm) scleritic foci within medial and lateral femoral condyles. Spiring of the tibial spine.

Chiro and radiology tell me my knee is bad. Dr.'s PA says my knee is "shot." Dr. never reviewed MRI. Examines me and says, "I don't need to see the MRI. I can tell you have a torn meniscus." I ask before surgery if they will have a good look around. I am told they will.
March 23, 2012 Dr. fixes meniscal tear. No post op call. Surgery pics are reviewed with patient in first follow up. PA says arthritus and tear. Never mentions any additional problems.
Post op pain and swelling continue to get worse. Repeated visits to the doctor. Told things take time. Knee has to be drained (bloody fluid) twice. Dr. does 2 cort shots. No relief. Dr says he has no idea what the problem is. Says he is stumped. Tells patient to wait 2 more weeks (putting us at 9 weeks post op). Patient requests another MRI.
MRI #2 with contrast 5/14/12
Results: The medial meniscus is moderately diminitive in size through the midzone and to a lesser externt the posteriorly consistent with propr partial meniscal resection. There are horizontal signal alterations within the midzone extending from the truncated free edge which do not significantly enhance. These finding are therefore unlikely to represent meniscal tearing by MRI artho
and they are more likely to represent fibrovascular granulation tissue
There is partial thickness condral loss affecting the medial and to a lesser extent the lateral compartments of the knee. The lateral meniscus is in tack.
The fibular collateral and medial colleral ligaments are in tact. The quadriceps and patellar tendons are intact. There are moderate to advanced chondromalacic changes along the medial patellar ridge.

Dr. reviews MRI and says still no ideas what is causing pain and swelling and thinks problem could be ghost pain from my back.

5/16/12 sends me for MRI of the spine. The back shows a couple of bulges, but I have not had any problems with my back. Chiro who has worked on patient off and on through pregnancy and one elbow surgery says the problem is not my back. It's my knee.

Question: Is it possible that in his rush to fix the meniscus (obvious), the doctor missed the underlying degeneration issues. I have three young children (ages 4, 9 and 11) and a busy life. I just finished graduate school and started teaching college part time. I am scheduled to teach in August. However, the set backs post op have put my life on hold. I can barely walk or drive. Our family life is really in a tailspin. I have already met my $5,000 deductible with the first sugery and other medical expenses. So if I am going to have to have the knee replaced in a year or so, I would rather do it now and be upright to see my kids off to college. I have had several doctors tell me the knee will have to be replaced because of the cartilage loss and arthritis. So why is the surgeon who repaired the tear, who has done thousands of knee replacements, saying he does not know what is wrong? Getting so many mixed signals that I just don't know what to do.
Can someone give me some insight into what the MRI findings show? I would rather get the knee replaced and get back to life than keep suffering like this. Please help. Supposed to see doctor on Tuesday. But I am afraid and feel that something is off
Posted Sun, 10 Jun 2012 in Bones, Muscles and Joints
 
 
Answered by Dr. Praveen Tayal 9 hours later
Hello,
Thanks for posting your query.
I have studied your problem in detail. After a meniscus injury, surgical repair is the best option to restore the knee to normality. After the surgery, the complications like collection of blood was not expected. The degeneration of the knee joint at such a young age is also not common.
All this degeneration might be related to the injury itself. Most of the cases do recover with steroid injections and physiotherapy. In case the symptoms are persistent and the discomfort is gradually increasing then knee replacement is kept as the last option.
The degenerative changes in your knee joint are not so severe and you can try taking lubricating agents like chondroitin sulfate or glucosamine sulfate on regular basis for 4-6 weeks and see if this helps with your symptoms.
I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
Please accept my answer in case you do not have further queries.
Wishing you good health.
Regards.
Dr. Praveen Tayal.
Above answer was peer-reviewed by
 
Follow-up: Had meniscus surgery, knee drained, cortisone shots, MRI shows arthritis. Should I get a lower back MRI? 2 hours later
MRI 1 March 2012 -- Horizontal tear of the posterior horn and mid zone of the medial meniscus, which extends to the inferior articular sufrace and free edge;slight thickening of the medial collateral ligament with minimal periligamentous edema, compatible with mild sprain;large joint effusion; 1.5 mm area of articular cartilage loss involving apex and medial facet of the patella.Minimal subcond marrow edema and small (6mm) scleritic foci within medial and lateral femoral condyles. Spiring of the tibial spine.

So these findings mean that as long as the meniscus was fixed, I should have a good prognosis, right? I have terrible pain down the bones in my lower leg. Is this just part of the healing process. I have been taking the glucosamine for some time. Also, excercise causing swelling. However, should I keep going with biking and swiming? It won't do more harm than good? At some point will the knee have to be replaced? I know I am young, but age aside, what does the MRI say about the bone loss and damage?
 
 
Answered by Dr. Praveen Tayal 13 hours later
Hello.
Thanks for writing again.
The changes shown on the MRI are mostly inflammatory changes. There is no bone loss. These changes are most likely reversible with adequate rest and lubricating agents. You can continue with swimming and biking.
Right now knee replacement is not indicated. May be at a later stage, this can be considered as the last option.
Hope my answer is helpful.
Do accept my answer in case there are no further queries.
Regards.
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 Procedures
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