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Suggest Treatment For Partial Posterior Horn Lateral Meniscus Root Tear
Question: I have been diagnosed with a tear of the posterior horn root attachment of the lateral meniscus. I was told it was only a partial tear, but I would like to get a second opinion on this. Based on the MRI, how severe does the tear look? Is the majority of the root still attached? The MRI has been uploaded in DICOM format to my Google Drive account, and the link to download it is below (click the arrow at the top of the screen to view/download):
https://drive.google.com/file/d/0B4peHkrULoWbeF9WZFBGcWdnYU0/view?usp=sharing
https://drive.google.com/file/d/0B4peHkrULoWbeF9WZFBGcWdnYU0/view?usp=sharing
Brief Answer:
There is a partial tear that will likely become asymptomatic with rehab
Detailed Answer:
Hi XXXXXX,
Thanks for writing in to us.
I have read through your query in detail.
Please find my observations below.
1. It is confirmed that you have a partial posterior horn lateral meniscus root tear as viewed on the MRI images. It is a chronic injury that might have developed due to repeated low intensity stress on your affected knee which has happened over the years.
2. There is no extrusion of the lateral meniscus and appears to be a focal tear on the inferior portion at the root of lateral meniscus.
3. Generally such an injury does not require surgical intervention unless you actively participate in high contact sports or there is severe pain.
4. In surgery also there are more than one techniques and different surgeons have views that might vary. However, judging by the intensity of the tear that you have, a surgical treatment is not essentially required.
5. In tears of partial nature and where the tear is less than 1 cm usually heals with resolution of symptoms. Your tear looks smaller than 1 cm and there is a high probability of healing with rest, medicine and rehab.
6. I suggest that you take part in a rehab program for a few weeks as suggested by your doctor and then slowly participate in physical activities like running and if there is persistent pain and discomfort then surgery might be indicated. However this is less likely to be required.
Wishing you a quick recovery.
Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
There is a partial tear that will likely become asymptomatic with rehab
Detailed Answer:
Hi XXXXXX,
Thanks for writing in to us.
I have read through your query in detail.
Please find my observations below.
1. It is confirmed that you have a partial posterior horn lateral meniscus root tear as viewed on the MRI images. It is a chronic injury that might have developed due to repeated low intensity stress on your affected knee which has happened over the years.
2. There is no extrusion of the lateral meniscus and appears to be a focal tear on the inferior portion at the root of lateral meniscus.
3. Generally such an injury does not require surgical intervention unless you actively participate in high contact sports or there is severe pain.
4. In surgery also there are more than one techniques and different surgeons have views that might vary. However, judging by the intensity of the tear that you have, a surgical treatment is not essentially required.
5. In tears of partial nature and where the tear is less than 1 cm usually heals with resolution of symptoms. Your tear looks smaller than 1 cm and there is a high probability of healing with rest, medicine and rehab.
6. I suggest that you take part in a rehab program for a few weeks as suggested by your doctor and then slowly participate in physical activities like running and if there is persistent pain and discomfort then surgery might be indicated. However this is less likely to be required.
Wishing you a quick recovery.
Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr. XXXXXXX thank you for your detailed analysis of my MRI study. I have just a few additional questions to ask.
1.) You mentioned that my tear seems to be smaller than 1 cm. In general, do you know what the total length is of a typical posterior root?
2.) Do you know what percentage of the root is detached, as compared to what percentage is still attached? (For example, "20% detached, with 80% still remaining").
3.) Also, are you able to see if any of the meniscus is detached from the bone as a result of the root tear?
4.) Last question -- would the tear be classified as a radial tear?
Thank you...
1.) You mentioned that my tear seems to be smaller than 1 cm. In general, do you know what the total length is of a typical posterior root?
2.) Do you know what percentage of the root is detached, as compared to what percentage is still attached? (For example, "20% detached, with 80% still remaining").
3.) Also, are you able to see if any of the meniscus is detached from the bone as a result of the root tear?
4.) Last question -- would the tear be classified as a radial tear?
Thank you...
Brief Answer:
Please find details below
Detailed Answer:
Hi XXXXX,
Thanks for writing back with an update.
Please find my observations below
1.) You mentioned that my tear seems to be smaller than 1 cm. In general, do you know what the total length is of a typical posterior root?
The meniscus is a C shaped structure and attaches tightly over the bone. The root being a firm attachment is does not have a length but the tears arising can be measured in distance. In this way a tear more than 1 cm can severely affect the biomechanics at the knee joint and therefore surgical correction is suggested. These parameters are derived by doing research on many patients concerning the tear, its length, symptoms and relief after medical or surgical treatment.
2.) Do you know what percentage of the root is detached, as compared to what percentage is still attached? (For example, "20% detached, with 80% still remaining").
The area of the posterior horn root lateral meniscus is a particularly difficult area to assess on MRI for a tear due to its complex location and due to frequent over estimation of the area of detachment due to influence of adjacent structures on the MRI images. Answering your query, the detachment is mild degree (less than 30 percent I guess). However, if you have more MRI images in different planes then you can upload them to your Google drive and I will have a detailed look and revert back.
3.) Also, are you able to see if any of the meniscus is detached from the bone as a result of the root tear?
This appearance is at times confusing and there can be wrong conclusions derived. The detachment is very small in my opinion.
4.) Last question -- would the tear be classified as a radial tear?
While most radiologists say meniscal root tears are a form of radial tear that involves the central attachment of the meniscus, your tear is not a classical radial tear. A true radial tear is of a greater degree and involves the entire width. I will consider your tear to be more of a small focal tear.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Please find details below
Detailed Answer:
Hi XXXXX,
Thanks for writing back with an update.
Please find my observations below
1.) You mentioned that my tear seems to be smaller than 1 cm. In general, do you know what the total length is of a typical posterior root?
The meniscus is a C shaped structure and attaches tightly over the bone. The root being a firm attachment is does not have a length but the tears arising can be measured in distance. In this way a tear more than 1 cm can severely affect the biomechanics at the knee joint and therefore surgical correction is suggested. These parameters are derived by doing research on many patients concerning the tear, its length, symptoms and relief after medical or surgical treatment.
2.) Do you know what percentage of the root is detached, as compared to what percentage is still attached? (For example, "20% detached, with 80% still remaining").
The area of the posterior horn root lateral meniscus is a particularly difficult area to assess on MRI for a tear due to its complex location and due to frequent over estimation of the area of detachment due to influence of adjacent structures on the MRI images. Answering your query, the detachment is mild degree (less than 30 percent I guess). However, if you have more MRI images in different planes then you can upload them to your Google drive and I will have a detailed look and revert back.
3.) Also, are you able to see if any of the meniscus is detached from the bone as a result of the root tear?
This appearance is at times confusing and there can be wrong conclusions derived. The detachment is very small in my opinion.
4.) Last question -- would the tear be classified as a radial tear?
While most radiologists say meniscal root tears are a form of radial tear that involves the central attachment of the meniscus, your tear is not a classical radial tear. A true radial tear is of a greater degree and involves the entire width. I will consider your tear to be more of a small focal tear.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr. XXXXXXX thanks for answering my questions. Since you said that my tear is on the inferior portion of the root, does that mean that a piece of the root on the underside is torn? (I am thinking of "inferior & superior" as being the same as "top & bottom")? In other words, it's not like (for example) a piece of a fingernail being torn off?
Also, in general, how many weeks/months do you think it should take for a root tear such as mine to heal? For the past few weeks, I have only been exercising on the elliptical (only causes mild pain), but I would like to start running again at some point. However, I am afraid of tearing the root by a more significant degree.
Per your request, I have uploaded all of the MRI files from the disc I received from my doctor to my Google drive, and the link is provided below (However, I am not sure if there any additional planes that were imaged). Please note that the file is much larger:
https://docs.google.com/file/d/0B4peHkrULoWbNEV0WmVzSlRDTFU/edit?pli=1
Thank you...
Also, in general, how many weeks/months do you think it should take for a root tear such as mine to heal? For the past few weeks, I have only been exercising on the elliptical (only causes mild pain), but I would like to start running again at some point. However, I am afraid of tearing the root by a more significant degree.
Per your request, I have uploaded all of the MRI files from the disc I received from my doctor to my Google drive, and the link is provided below (However, I am not sure if there any additional planes that were imaged). Please note that the file is much larger:
https://docs.google.com/file/d/0B4peHkrULoWbNEV0WmVzSlRDTFU/edit?pli=1
Thank you...
Brief Answer:
Please find details below
Detailed Answer:
Hi XXXXX,
Thanks for writing back with an update.
At first, thanks a lot for sharing the complete images with me. There are about 237 images 103 mb in total and the earlier download had only 47 images 19 mb I guess. This gives me more satisfaction to discuss your problem in detail.
1. Inferior signifies the lower surface that is adjacent the tibia. A finger nail being torn off is an extreme imagination in your case. Your injury is among the mildest form and what I can see is a focal 4 to 5 mm small area of weakness that appears as a partial tear at the root of posterior horn later meniscus. This is not a serious concern and I am sure it will heal.
2. Considering the biomechanics at the knee joint, it will help to discuss with your doctor the exact nature of painful movements at the knee joint. Since there is no locking or any other complication, a healing periods of 6 weeks should be enough. I suggest you do rehab under the guidance of a physiotherapist who is also familiar with sports injuries.
3. I surely would like you to continue with your running once your symptom,s are relieved. Please note that when you start running again, discuss the ergonomics and run for short distance at a slow to medium pace. You can also wear knee supports to help you with your running.
4. After a few weeks, under the recommendation of your doctor, you can get the MRI repeated to know the healing changes. Please go for a 3T MRI machine to get the best detail in imaging.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Please find details below
Detailed Answer:
Hi XXXXX,
Thanks for writing back with an update.
At first, thanks a lot for sharing the complete images with me. There are about 237 images 103 mb in total and the earlier download had only 47 images 19 mb I guess. This gives me more satisfaction to discuss your problem in detail.
1. Inferior signifies the lower surface that is adjacent the tibia. A finger nail being torn off is an extreme imagination in your case. Your injury is among the mildest form and what I can see is a focal 4 to 5 mm small area of weakness that appears as a partial tear at the root of posterior horn later meniscus. This is not a serious concern and I am sure it will heal.
2. Considering the biomechanics at the knee joint, it will help to discuss with your doctor the exact nature of painful movements at the knee joint. Since there is no locking or any other complication, a healing periods of 6 weeks should be enough. I suggest you do rehab under the guidance of a physiotherapist who is also familiar with sports injuries.
3. I surely would like you to continue with your running once your symptom,s are relieved. Please note that when you start running again, discuss the ergonomics and run for short distance at a slow to medium pace. You can also wear knee supports to help you with your running.
4. After a few weeks, under the recommendation of your doctor, you can get the MRI repeated to know the healing changes. Please go for a 3T MRI machine to get the best detail in imaging.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr. XXXXXXX thanks for the additional information. This is my last question -- based on the additional MRI images, would you still say that approximately 30% or less of the mensical root is detached? Is this detached portion likely to re-attach as an effect of the healing process?Also, regarding healing, is it normal if I am still having some pain/stiffness/mild catching approximately 6 weeks after I had to stop running due to the injury becoming too painful? I understand that you estimated that the healing time usually isn't longer than 6 weeks, but is it possible that it could take 8-10 weeks to fully heal? The pain and other symptoms have improved considerably over the last 2 weeks, so I am hopeful that it will continue to heal over the next few weeks.
Brief Answer:
Healing will be faster as you are a young adult
Detailed Answer:
Hi XXXXX,
Thanks for writing back with an update.
1. The injury you had is slight focal detachment. It is not an acute injury involving complete tearing of the root of meniscus. With rest and rehab, the detached portion will heal and is expected to repair by itself and the healing will be better as you are a young adult.
2. Your injury is in healing phase and you need to get back to your normal activity in a slow and graded manner, avoiding sudden stress to your knee muscles and movements causing severe pain. Healing of your knee injury requires at least 6 weeks following surgery. This is the usual time taken to regain their strength.
3. The time duration for healing is a subjective variable. Slight stiffness might be persisting, depending on the rate of healing, please do not forcefully participate in any activity involving affected knee joint till you get significant relief of symptoms. It can take 4 to 5 weeks in some and 8 to 10 weeks in few people. In the younger population at your age, the healing is much faster. The injury in you is not an acute one and has occurred over days to months. As you are feeling better since last 2 weeks, healing is certainly taking place as expected.
4. Since you want to continue to run your miles after recovery, I suggest you take guidance from a physiotherapist who is experienced in sports medicine. Please use knee support during the initial days when you start running and maintain a slow pace.
Wishing you a quick recovery.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Healing will be faster as you are a young adult
Detailed Answer:
Hi XXXXX,
Thanks for writing back with an update.
1. The injury you had is slight focal detachment. It is not an acute injury involving complete tearing of the root of meniscus. With rest and rehab, the detached portion will heal and is expected to repair by itself and the healing will be better as you are a young adult.
2. Your injury is in healing phase and you need to get back to your normal activity in a slow and graded manner, avoiding sudden stress to your knee muscles and movements causing severe pain. Healing of your knee injury requires at least 6 weeks following surgery. This is the usual time taken to regain their strength.
3. The time duration for healing is a subjective variable. Slight stiffness might be persisting, depending on the rate of healing, please do not forcefully participate in any activity involving affected knee joint till you get significant relief of symptoms. It can take 4 to 5 weeks in some and 8 to 10 weeks in few people. In the younger population at your age, the healing is much faster. The injury in you is not an acute one and has occurred over days to months. As you are feeling better since last 2 weeks, healing is certainly taking place as expected.
4. Since you want to continue to run your miles after recovery, I suggest you take guidance from a physiotherapist who is experienced in sports medicine. Please use knee support during the initial days when you start running and maintain a slow pace.
Wishing you a quick recovery.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Shanthi.E
Thank you for the advice. I will continue to take it easy with exercise and avoid stressing the knee too much; hopefully, surgery will not be necessary. I will go ahead and close the discussion and rate your responses with 5 stars.
Brief Answer:
Welcome and wish you a quick recovery
Detailed Answer:
Hi XXXXX,
Welcome and thanks for your appreciation and sending in your valued feedback.
Hope I have been to help you out with your problem as you had expected.
I sincerely hope things get better for you without the need for a surgery and that you are able to resume your running.
After closing this thread, should you wish to contact me again for any health related query then please mention "query Id 182087 (Attn Dr.Vivek Chail)" in your query and the moderators will direct your query to me. I will reply back to you at the earliest.
Wishing you a quick recovery.
Regards,
Dr.Vivek
Welcome and wish you a quick recovery
Detailed Answer:
Hi XXXXX,
Welcome and thanks for your appreciation and sending in your valued feedback.
Hope I have been to help you out with your problem as you had expected.
I sincerely hope things get better for you without the need for a surgery and that you are able to resume your running.
After closing this thread, should you wish to contact me again for any health related query then please mention "query Id 182087 (Attn Dr.Vivek Chail)" in your query and the moderators will direct your query to me. I will reply back to you at the earliest.
Wishing you a quick recovery.
Regards,
Dr.Vivek
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Shanthi.E
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