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Suggest treatment for meniscus injury resulting in arthritis

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Posted on Mon, 6 Feb 2017
Question: I went to an orthopedist in December with what I thought was an injury to my knee. I was diagnosed as having an sprained MCL and was given a shot of cortisone and recommended for 6 weeks of physical therapy. The pt seemed to aggravate the condition so I stopped going. When I returned to the doctor today, he said it was not an injury but arthritis (X-ray only, no MRI). He gave me another shot of cortisone (although the ER doctor I saw at the end of December said it was too early) and recommended a series of gel injections. The doctor had told me in the earlier visit that my arthritis was minimal. I think this is an injury and don't want to subject myself to gel injections if I don't have to. XXXXXXX YYYY@YYYY
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Answered by Dr. Shoaib Khan (2 hours later)
Brief Answer:
?? Meniscus injury resulting in arthritis, will progress

Detailed Answer:
Hello ma'am and welcome.

Thank you for writing to us.

I have gone through your query with diligence and would like you to know that I am here to help. I would like to take this opportunity to try and educate you on the knee injury you could have sustained and how it progresses into the arthritis your doctors have been treating you for.

The meniscus is a cushion like cartilage in your knee joint which allows for the weight of the upper body to be carried without friction between the thigh bone and the bone of the leg. When this cartilage is injured or damaged, slowly but surely the bones on both sides are effected.

If the cartilage is damaged or reduced in any manner, this causes the weight of the body from actions like jumping, walking, etc; to be carried and felt at the knee joint; resulting in the bone ends to rub against each other (due to the absent or reducing cartilage that acts like a cushion).

This eventually progresses with time, and when these bone ends continue to feel the friction result in achondroplasia, which then results in arthritis.

Now that you know this, you should know:

+The gel injections suggested were most probably hyaluronic acid which acts like the cushion (but is temporary); and prevents friction, and thus prevents the development or progression of arthritis
+The arthritis might be minimal now, but in time, it will progress
+Steroids given are the treat the arthritis

So in conclusion, I am sure you understand that if you take the gel injections, you can temporarily (as long as the effect of the gel injection lasts) prevent the progression of arthritis until the next injection is due.

I hope I have explained things in a manner best understood by you. Please do not hesitate to write to me for any further clarifications, I am always here to help.

Best wishes.
Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Follow up: Dr. Shoaib Khan (41 hours later)
Dear Dr. Kahn: Thank you for your prompt response. I don't see how my doctor could look at the same x-rays one month apart and have two different diagnoses: first, that it was an MCL sprain and then one month later that it was arthritis. I am going to seek another opinion. My questions are:
Will an MRI show a sprain or only a tear?
If it is an MCL tear, can it be corrected through arthroscopic or other surgery?
Given the side effects of the gel injections, I don't want to proceed with this until I can determine what the problem is--whether it is a sprain, tear or arthritis.
I would appreciate your opinion.
Thank you. XXXXXX
doctor
Answered by Dr. Shoaib Khan (26 minutes later)
Brief Answer:
MRI can show swelling associated with a sprain, and a tear

Detailed Answer:
Hello once again ma'am.

An MRI show some amount of swelling which can be associated with a sprain, and also a tear.

If it is a simple arthroscopy, it is only for diagnosis, but if the surgery chosen is arthroscopic reconstruction. But before surgery is considered, there are many conservative methods that can help resolve the issue in most cases.

In that case, I would suggest an arthroscopy as it provides great insight on the exact status and diagnosis, which can then direct a diagnosis.

I hope this helps. Please feel free to write to me for any further clarifications, I am always here to help.

Best wishes.
Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Shoaib Khan (19 hours later)
Thank you Dr. XXXXXXX It seems my next step should be to get an MRI and see what that reveals. Thank you for your assistance.
doctor
Answered by Dr. Shoaib Khan (24 hours later)
Brief Answer:
Yes, I concur, it would be the next best step

Detailed Answer:
Hello once again and sorry for the delay.

I have not been keeping well, which is why I couldn't log in to respond to your query in a timely manner, my sincere apologies.

Yes, an MRI is a non-invasive method (as compared to the arthroscopy) and so you can go ahead with the MRI, but certain information will come only from an arthroscopy, but yes, an MRI shoild be our next step.

Sorry once again, and please do not hesitate to write back to me, I am always here to help.

Best wishes.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Dr. Shoaib Khan

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Practicing since :2009

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Suggest treatment for meniscus injury resulting in arthritis

Brief Answer: ?? Meniscus injury resulting in arthritis, will progress Detailed Answer: Hello ma'am and welcome. Thank you for writing to us. I have gone through your query with diligence and would like you to know that I am here to help. I would like to take this opportunity to try and educate you on the knee injury you could have sustained and how it progresses into the arthritis your doctors have been treating you for. The meniscus is a cushion like cartilage in your knee joint which allows for the weight of the upper body to be carried without friction between the thigh bone and the bone of the leg. When this cartilage is injured or damaged, slowly but surely the bones on both sides are effected. If the cartilage is damaged or reduced in any manner, this causes the weight of the body from actions like jumping, walking, etc; to be carried and felt at the knee joint; resulting in the bone ends to rub against each other (due to the absent or reducing cartilage that acts like a cushion). This eventually progresses with time, and when these bone ends continue to feel the friction result in achondroplasia, which then results in arthritis. Now that you know this, you should know: +The gel injections suggested were most probably hyaluronic acid which acts like the cushion (but is temporary); and prevents friction, and thus prevents the development or progression of arthritis +The arthritis might be minimal now, but in time, it will progress +Steroids given are the treat the arthritis So in conclusion, I am sure you understand that if you take the gel injections, you can temporarily (as long as the effect of the gel injection lasts) prevent the progression of arthritis until the next injection is due. I hope I have explained things in a manner best understood by you. Please do not hesitate to write to me for any further clarifications, I am always here to help. Best wishes.