more meniscal woes

[infoseeker65]

It's been 2 years since a small tear was diagnosed in the medial meniscus..... for 2 years everything seemed to stabilize and feel good without any surgery.  1 month ago (right at the end of ski season) my knee began catching... couldn't bend it all the way without pain.. even had pain at night when I bent it in my sleep. Now that I haven't skied in a month the knee is much less painful but still has problems bending all the way and still likes to clunk and have pain if torqued at all.   The doctor suspects a piece of the medial meniscus is getting caught in the joint.

New MRI ......
results:  tear in inferior articular surface of the posterior horn medial meniscus is more irregular than previous study. New tear in posterior horn of lateral meniscus that extends slightly into the body.  Thickening of the distal IT band without evidence of tear.

That's all the radiologist has to say... I'm seeing the ortho in a few days to discuss what he sees.  With all the controversy these days concerning the effectiveness of scope jobs on degenerative tears I'm wondering if surgery is really the best option since it's calming down on it's own somewhat.  On the other hand will just strengthening and stretching really get me though ski season next year?  

How do people decide when to have surgery these days?

I'm an avid skier who is not giving up the sport anytime soon.  


This discussion is related to meniscus tear.

[Nae1]

Hello.  I am not a doctor, but an athletic trainer.  As an athletic trainer, I specialize in orthopedic injuries and I help prevent, diagnosis and rehabilitate injuries.

With meniscal tears, I would suggest surgery if the following is an issue for you:

1) pain (too much pain for you to handle, type pain)
2) 'catching' or 'locking' feeling when walking or going down stairs

Your question about ski season next year is a toss up.  You can go through physical therapy, help strengthen the muscles around your knee, but there is no guarantee that your tear won't get worse or cause you troubles at some point in your season.

Therapy may end up helping the piece of meniscus (if caught) dislodge, but once again, that is a toss up if it will happen or not.

My suggestion is: if you are weary of surgery, try physical therapy for a couple of months.  If that is not helping - opt for surgery.  With the type of surgery you will get (it should only be to clean up the area, not removal of the entire meniscus) is only a couple to a few month recovery which would be enough time to return for your ski season (I would ask your doctor specifically recover time from the surgery to plan for your ski season).

I hope this helps you some.  If you have any questions, please let me know.

[infoseeker65]

Thanks for the update... I just had a conversation with my ortho and since the locking/catching symptoms and sharp pain has subsided so much since the end of ski season (the catching i think is gone but painless clunking is still there) the piece may have dislodged itself.  The doc showed me where he thinks he sees a piece of displaced medial meniscus (anterior side of the posterior horn).  He said surgery is completely my call... I also have moderate post traumatic arthritis on the lateral side from a 19yr. old lateral tibial plateau fracture and lateral meniscus repair (yes sutured up).

I let him give me 1 cortisone shot... figuring that would quiet most arthritis pain... and I'm going to do a lot of strengthening for the next month (and some stress testing of the knee).  If I'm still leery that the piece is still causing any symptoms at all I'm going for the scope.  The doc told me average recovery time to full activity is about 6 weeks.  I'm going to make sure I have at least 2-3 months before ski season starts again.  Once I'm on skis I'm on skis every weekend for Dec. to March and sometimes into mid-April.

[Nae1]

Sounds like you appointment went well and a plan is in place!  Very good.

Best wishes on a speedy recovery and a great ski season this coming year!