Knee osteoarthritis question.

Discussion in 'Health & Fitness' started by Raul_SJ, Nov 13, 2012.

  1. Raul_SJ

    Raul_SJ Professional

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    x-ray and mri shows "mild osteoarthritic changes" in both knees, and small
    tear in posterior horn of medial meniscus of right knee.

    My knees feel stiff when I run. Very little pain, but I can only jog slowly due to the stiffness.

    After completing a jog of 5 miles, the knees begin to hurt a few hours after and it gets worse by the next day.

    I have to rest for a day or two before I can jog again.

    Question:

    Why does rest decrease the knee pain?

    i.e., If the cartilage that cushions the knee is worn down, shouldn't the knees hurt every time I try to run?
     
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  2. maggmaster

    maggmaster Hall of Fame

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    Normally I am all for working through some pain but in this case, find another way to get your cardio in. Bike, use the eliptical, row, find something that doesn't cause your knees to stiffen up. Your body will thank you in the long run.
     
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  3. Raul_SJ

    Raul_SJ Professional

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    The doctor has given me clearance to jog. He says exercise will strengthen the bones. And I don't run regularly, 10 miles a week on average.

    Although there is controversy in the medical community as to whether running exacerbates OS, many doctors feel that it does not and it's beneficial to be active.
     
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  4. Chas Tennis

    Chas Tennis Hall of Fame

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    I believe that there is osteoarthritis, posture issues and many other issues. If a long-time posture issue is aggravating your osteoarthritis, especially when running, would you and your Dr catch it?

    Distinguish between two locations of knee pain. First, in the knee joint with the meniscus, etc. and, second, under the knee cap/patella - patellar-femoral joint. Where is your pain?

    Patellar Chondromalacia
    http://www.nlm.nih.gov/medlineplus/ency/article/000452.htm

    I believe that I have patellar-femoral pain because my rectus femorus is short/tight and it causes my patella to ride poorly in the femoral grove. Other quad muscles can cause the patella to ride poorly, even turn from the femoral grove. The pressures on the patellar-femoral cartilage are very dependent on knee angle - hurts on steps, etc. - so an activity like running might aggravate that cartilage. ?

    These recent knee injury threads have discussions including the rectus femorus issue that I believe people should be aware of.

    http://tt.tennis-warehouse.com/showthread.php?t=437802

    See reply #6 - How Tight is Your Rectus Femorus?
    http://tt.tennis-warehouse.com/showthread.php?t=435344

    http://tt.tennis-warehouse.com/showthread.php?t=414073
     
    Last edited: Nov 13, 2012
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  5. maggmaster

    maggmaster Hall of Fame

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    Ok then if I were going to keep running, I would start an extensive strengthening protocol for my legs as well as a self massage session every day with a foam roller. Pay particular attention to your IT bands along the side of your leg.
     
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  6. ollinger

    ollinger Legend

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    Your MRI findings suggest you should give up running entirely. The combination of arthritis and a meniscus tear means you're on the slippery slope that may lead to joint replacement. Arthritis in the knee means there are little jagged edges that can shred your meniscus until it's of no value. The past few years have seen studies like the highly regarded "MeTeOR" (meniscus tear in osteoarthritis) study (multi center study at top institutions such as Mayo Clinic, Brigham and Women's Hospital, Hospital for Special Surgery, and 3 or 4 others) examining this issue. The emerging consensus seems to be that meniscus surgery in the presence of arthritis does nothing to alter the course of the problem. Stregthening muscles does not alter the vertical pounding the menicus and joint surfaces take when you run; muscles do not support weight. Take up non-impact forms of exercise and keep the running to an absolute minimum.
     
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  7. Chas Tennis

    Chas Tennis Hall of Fame

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    Do you have the MRI report written by the imaging lab specialist? The MRI reports that I have read always contain a detailed check list of the conditions of most of the joint's structures. It is really necessary to locate the structure and its condition. Your Dr or the imaging lab will supply you with a copy.
     
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  8. WildVolley

    WildVolley Legend

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    I second the advice from those who say to replace jogging (impact) with no impact exercise. In your situation, walking should be superior to jogging.

    Weight bearing exercises will help strengthen your bones, but you can always do weight lifting to stress the skeletal structure.
     
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  9. sureshs

    sureshs Bionic Poster

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    Swimming is good
     
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  10. Ronaldo

    Ronaldo G.O.A.T.

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    Try deep-water running
     
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  11. charliefedererer

    charliefedererer Legend

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    On your MRI how mild was "mild"?
    Depending on your age, is the "mild" so small, that your knees have less arthritic changes than seen on most knee MRI's?


    How small is "small"?
    Small like in so tiny only a sharp eyed radiologist could even possibly think there is a tear there? Or is it something that is really a potential problem?




    Too few realize that MRI's are open to much interpretation. What might be "small" to one radiologist interpreting the images might be "moderate" to another. Or he could use the word "small" when it is really miniscule.


    If I were you, I would visit an experienced sports medicine specialist with a special interest in knees and have him examine you and review the MRI (bring it with you) and give an honest opinion of what is going on, and what he would recommend.
     
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  12. Raul_SJ

    Raul_SJ Professional

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    Knee x-ray report.
    Narrowing of knee joint joint and patellofemoral joint space is seen more so in the medial tibiofemur space.

    Osteophytes seen from the condyles of tibia, femur and patellar margins.

    Impression.
    Early osteoarthritis of both knee joints.​


    MRI Right knee

    Findings:

    Osteoarthritic changes noted as evidenced by Marginal Osteophytes from the condyles of Tibia, Femur with mild narrowing of Knee Joint spaces and altered signal intensity.

    Minimal fluid noted in the knee joint and suprapatellar bursal spaces appearing hyperintense on T2, PDFS and hypointense on T1W sequences.

    No synovial hypertrophy.

    ACL and PCL are normal in size and alignment, however minimum irregularity and signal changes noted at the margins.

    Lateral menisci is normal in size, shape and signal intensity.

    Medial and lateral collateral ligaments are normal.

    Muscles, Tendons and Neuro Vascular Structures around the knee joint are normal.

    Patella and Patello Femoral Articulations are normal.

    Hoffa's Fat Pad is normal.

    Posterior horn of the Medial meniscus show small focus of altered signal intensity extending up to Capsular surface and it appears Iso to hyperintense on all sequences.

    Impression:

    Osteoarthritic changes of knee joint.

    Grade II degeneration involving the posterior horn of medial meniscus.

    Minimal knee joint effusion.
     
    Last edited: Nov 25, 2012
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  13. Raul_SJ

    Raul_SJ Professional

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    I am particularly wondering about the mri report:
    Posterior horn of the Medial meniscus show small focus of altered signal intensity extending up to Capsular surface and it appears Iso to hyperintense on all sequences.

    Does this indicate the size of the meniscal tear?

    I am getting conflicting opinions on whether the tear will heal. One doctor has told me that the meniscal tear will heal . Another doctor has told me that the tear will not heal...

    I have heard that meniscal tears close to the blood supply stand a better chance of healing, but I am not clear where the location of my tear is...

    One doctor has recommended exploratory arthoascopic surgery. He said he will take a look inside and then make any necessary repairs or cleaning... I am not clear if the *entire* meniscus is worn out due to wear and tear, in which case the surgery results will not be as good... It sounds like the Doctor needs to take a look inside to see the condition because the MRI does not give the complete picture?

    Other advice from Doctors:

    Strengthen the quadracepp.

    Hamstrings are too tight. The range of motion is too narrow...Do exercise to loosen them.
     
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  14. Chas Tennis

    Chas Tennis Hall of Fame

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    I am not qualified or capable of evaluating a report like this. What I do is search each term and also entire phrases to find information.

    Briefly searched and found information on

    Marginal Osteophytes - found pictures, lots of material

    "Grade II degeneration involving the posterior horn of medial meniscus." Any tear found? or degeneration?
    http://www.ncbi.nlm.nih.gov/pubmed/15875232

    (Last year my injury was
    "LATERAL COMPARTMENT: There is some degenerate signal within the lateral meniscus as well as a focal intermediate-grade, partial thickness tear at the posterior root attachment."
    The Dr thought that the injury probably was not that bad. I took off tennis for 3 months and resumed playing very gradually. That knee injury is OK now. )

    When an MRI says "normal" for a structure that is as good as it gets - but MRI's miss things so always keep them in mind as possibilities. The many "normal"s in your report are one very good result.

    Study the anatomy of the knee structures. Study your knee results until you understand them.

    Injury Location and Posture Issues. Does the location of any of the injury sites on the front (anterior), back (posterior), inside (medial) or outside (lateral) have any relation to your posture? For example, if all your Marginal Osteophytes are on the inside (medial) part of the knee, are you slightly bow legged? Or "Narrowing of knee joint joint and patellofemoral joint space is seen more so in the medial tibiofemur space." - hip muscle posture affects joint cartilage pressure and quad muscle imbalances can cause patella tracking problems.? Complex, subtle issues for a specialist. You need injury location information that may not be in your MRI report. Similar questions.

    Technical reference researching the location of Marginal Osteophytes. For illustration only.
    http://ard.bmj.com/content/61/4/319.full

    Articular Cartilage. In addition to the more mobile meniscus and lateral cartilages the knees have articular cartilages that are part of the ends of the bones. Advanced arthritis often/always? involves damage to the articular cartilages and finally the bones. What was the Dr's prognosis?
    http://en.wikipedia.org/wiki/Articular_cartilage_damage

    Interesting paper just found, I believe it deals mostly with articular cartilage
    http://rheumatology.oxfordjournals.org/content/45/1/79.full.pdf+html

    Lyme disease arthritis is not rare. What are its characteristics? Familiarize yourself with it and discuss with your Dr to rule it out.

    Ask yourself what your goals are?

    Frequently run 5 miles/distance.
    Play tennis.
    Cardiac-respiratory conditioning.
    Maintain leg muscle.

    Is running distance keeping your knees inflammed? Tennis? Dropping things that we really want to do is very tough. Take off for a few months and see how your knees feel? Find alternate exercises.
     
    Last edited: Nov 25, 2012
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  15. Raul_SJ

    Raul_SJ Professional

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    Thanks. I will study this... am wondering if my tear is a good candidate for
    arthroscopic surgery.


    http://www.ncbi.nlm.nih.gov/pubmed/15875232

    MR imaging has emerged as an important modality in the non-invasive evaluation of osseous and soft-tissue structures in the post-traumatic knee.

    However, it is sometimes impossible to determine with confidence if a focus of high signal intensity in the meniscus is confined to the substance of the meniscus or if it extends to involve the joint surface.

    This is a critical differentiation because the latter represents meniscal tears that can be found and treated arthroscopically, whereas the former represents degeneration, intrasubstance tears or perhaps normal variants that are not amenable to arthroscopic intervention​

    I notice that the MRI report says:
    Posterior horn of the Medial meniscus show small focus of altered signal intensity extending up to Capsular surface

    If "capsular surface" = "joint surface" it appears that my tear is amenable to surgical repair.

    But on the other hand, the MRI says it's a "Grade II degeneration" and degenerative tears don't respond well to surgery...

    I'll have to keep studying...
     
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  16. Chas Tennis

    Chas Tennis Hall of Fame

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    What is the capsular surface? (The joint has several surfaces.)

    Does the "Grade II degeneration" refer to the articular cartilage?

    Does the MRI report describe a clear tear? Are your symptoms consistent with a meniscus injury?

    The MRI for my first 1999 knee injury did not clearly show the meniscus tear. It only showed a slight shadowing where the meniscus is thin and hard to image. The slight shadowing was 'consistent' with the Dr's diagnosis of a medial meniscus tear. There was no definitive MRI observation unlike my 2011 injury of the other knee.

    In 1999, I asked the Dr the probability that my knee would heal without surgery. He guessed that without surgery I might have a 25% chance of healing and said it was OK for me to try and heal. I gave it 3-4 months to heal, no running, and it did not improve. I got the arthroscopic surgery in Jan 2000 and the knee recovered. However, your symptoms are not like those of my first meniscus injury. I was afraid to run feeling very insecure and uncomfortable about knee motion.
     
    Last edited: Nov 25, 2012
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  17. ollinger

    ollinger Legend

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    Arthroscopy for the tear would not be of value. As I noted above, studies that have been published earlier this year and also widely reported in the popular press indicate that meniscus surgery repair is not worthwhile if there is arthritis in the joint.
     
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  18. Raul_SJ

    Raul_SJ Professional

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    The Doctor said that strengthening the quadriceps muscles reduces the
    impact on the knees.

    Isn't that true?
     
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  19. ollinger

    ollinger Legend

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    Not true. One is always reminded in anatomy class in med school that muscles have no weight supporting function. If anything, more developed muscles add weight that increase the load on the joints.
     
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  20. Chas Tennis

    Chas Tennis Hall of Fame

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    I wore a Donjoy brace for the first 3 years after my 1999 meniscus operation. Then I lost about 20 lbs and started doing leg exercises, presses, etc. at the gym. When the bigger leg muscles do heavier exercises the muscles hypertrophy. Exercise magazines and books say that the support structures, secondary muscles, ligaments, tendons, etc., also all build up. From my experience it felt and looked as if everything built up, same with arms. These support structures tend to make the joint tighter so that it probably moves in a more controlled way, less lateral wobble, etc. I also stopped using the brace at that time although I probably could have done so earlier.

    For effects other than on the main muscle exercised, see second paragraph, -
    http://en.wikipedia.org/wiki/Strength_training

    With arthritis I am not sure that heavier leg exercises don't do harm. ? With acutely injured joints I have read that isometric exercises are sometimes used to maintain muscle while healing.

    A Dr's advice and perhaps a prescription for some physical therapy for safe exercises would be best.
     
    Last edited: Nov 25, 2012
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  21. Arthuro

    Arthuro Semi-Pro

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    No. I have had a small meniscus tear of the lateral posterior horn of my right knee as well as arthritis in the knee. Today, I no longer have these pains.

    First, the pain in your knee will change based on the differing loads (weight distribution) that occurs with different movements. Running forward on a flat surface might not disturb you posterior horn tear that much, but going down a hill or stepping backwards may.

    Rest decreases the pain because it decreases the load on the joint. The stiffness you feel is most likely from the swelling that occurs with the movement of the tear.

    If your tear is in the white zone it is unlikely to heal by itself. If it is in the red zone (with blood flow) it will probably heal since blood has aMSC to aid the healing process.

    With today's technology you can easily heal such a small tear. A prolotherapy shot and Platelet Rich Plasma (PRP) shot (1-3) will both heal repair your cartilage and heal your meniscus. You can google these shots. They have been used in the U.S for about 20 years, but only a decade or so popularly for orthopedic issues.

    I have MRI evidence that they healed my rotator cuff tear, and meniscus tear.

    Prolo shots are about 500.00 and PRP runs from 900-1200.00 depending on the doctor.

    Make sure that you only go to a physician that makes these injections under ultrasound. It is IMPERATIVE to prevent pain, and make sure the platelets get to the injured area.

    Good luck.
     
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  22. Raul_SJ

    Raul_SJ Professional

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    My understanding is that meniscus tears tears caused by sudden injury are amenable to arthroscopic surgical repair, because the rest of the meniscus is otherwise healthy.

    Whereas "wear and tear" meniscus tears are not surgically repairable. (I guess because the entire meniscus is worn down and repairing a specific tear will not help much?)

    But I am not sure which case my meniscus tear falls into.

    The MRI report says "mild narrowing of knee joint spaces and altered cartilage signal intensity."

    My understanding is that the MRI cannot definitively see the extent of meniscus damage and is inferred by the narrowing of space between the femur and tibia.

    The doctor I consulted said one option was to do "exploratory arthroscopic surgery", he would take a look inside, clean out and try to repair.

    So is it possible that my entire meniscus is not severely damaged and I can benefit from having the specific tear surgically repaired?
     
    Last edited: Dec 8, 2012
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  23. Chas Tennis

    Chas Tennis Hall of Fame

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    Have you stopped the tennis and running? For how long? How do your knees feel?
     
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  24. usta2050

    usta2050 Rookie

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    You should consult several doctors about this. Don't delay the diagnosis and treatment. We are built differently. Good luck :)
     
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  25. Raul_SJ

    Raul_SJ Professional

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    I've been playing doubles 2-3 times a week. I have stopped running.
    Been trying to do biking and walking instead...

    The right knee feels much worse than the left. I usually need to rest the right knee the day after I play. It's not swollen but it is slightly warm, which is an indication of inflammation

    I think I will consider going for the exploratory arthroscopic surgery (doctor says he will take a look inside, try to clean out and repair)...

    I am wondering about the 30-40% loss of meniscus that you mentioned.

    How functional is the knee with so much of the meniscus removed? Are you able to run?
     
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  26. mxmx

    mxmx Semi-Pro

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    I think I may have this. The pain is like they say in the article, in the middle of my knee cap...and i can feel some rough friction when moving the knee...

    Do you guys believe that medicine containing MSM works? Like arthro guard...or fish oil type lubricants in diet?
     
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  27. mxmx

    mxmx Semi-Pro

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    I did not know cartilage can regrow :shock:
    How different is tendonds and cartilage? They only attach tendons right? It cannot physically join again as far as I know...
     
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  28. Chas Tennis

    Chas Tennis Hall of Fame

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    That meniscus surgery was done in 2000. I was playing tennis 5-6 months after the operation. The Dr had me wear a knee brace for the first 2 years as a precaution because he suspected that my ACL might have been a little loose and could had been a contributing factor. The ACL was probably not lose after all as the Dr said I could stop using the brace about 1.5 years after the surgery. I wore it for another 2 years on my own decision. I have played tennis 3-5 times a week since 2000 with a some singles. In about 2004(?) I started going to the gym including leg exercises, presses, etc. The added leg strength, especially the secondary structures around the joint made my knee feel much more secure. I believe that my articular cartilage is in relatively good shape for someone my age as my X rays show good separation - the Dr was somewhat surprised at the separation on follow up visits including last year.

    A friend of mine has had two meniscus injuries and operations in the last two years. On the first operation there was arthritic articular damage, confirmed during the surgery, that had exposed some bone-to-bone contact over a limited area within the joint. The Dr said that my friend will need farther treatment in a few years especially if he plays tennis. He had recently developed a second meniscus injury on his other knee. He is bow legged and the cartilage is narrowed on X rays at the inner/medial side of both knee joints. His second joint meniscus injury is near the narrowed joint separation where you might expect pinching stress from the bow legged condition. I don't know the location of the first meniscus injury. ? His second operation was just 3 weeks ago. I am repeating his story as I remember it so the accuracy of my description is a little uncertain.

    You might consider and discuss with your Dr - stopping tennis for 3 months and seeing how your knees do.

    ADDED 12/11/2012 - Discussion of injury, arthritis and arthoscopy - http://www.hopkinsortho.org/knee_arthroscopy.html
     
    Last edited: Dec 11, 2012
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  29. Raul_SJ

    Raul_SJ Professional

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    I am somewhat confused on degeneration of "articular cartilage" (found at the end of bones) vs. meniscus degeneration.

    There is another thread about a guy having damaged articular cartilage but a normal meniscus.

    My MRI mentioned meniscus tear, but nothing about articular cartilage. Can an MRI detect articular cartilage problems?

    Does knee osteoarthritis typically lead to articular cartilage damage coupled with meniscus damage? Is there a relation between the two in cases of knee osteoarthritis?
     
    Last edited: Dec 15, 2012
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  30. Chas Tennis

    Chas Tennis Hall of Fame

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    MRI's are the best (or one of the best) non-invasive diagnostic tools.
    http://en.wikipedia.org/wiki/Articular_cartilage_damage
    They miss injuries (false negatives) and also have false positives especially since some of the MRI interpretations are of very small signal variations, image shading. My first meniscus injury, that required surgery, was in the central, thin area of the meniscus and did not definitively show on the MRI. A slight shadowing, the result was only 'consistent' with a meniscus tear.

    If you want a better idea research that question as I've seen research papers discussing MRI observations. Discuss with the Dr.

    I don't know the typical pathology of osteoarthritis of the knee. My guess is that usually there is some injury or stress to the meniscus or articular cartilages. Issues of posture and overuse, that the body can't handle under the conditions of running, tennis, age, lyme disease,....... etc may be the cause rather than acute injury (or a series of small acute injuries). There is inflammation and the cartilages deteriorate. The inflammation can also affect adjacent tissue and cause pain.

    I usually view the meniscus as protecting the articular cartilage. Is that an accurate view of how the cartilages function. ? My injuries have been to the meniscus but I know people who's injuries involve both meniscus and articular. Of my friends, a meniscus injury always caused them to stop tennis and see a Dr. Some found additional significant arthritis.

    In 1999 and in 2011 my MRIs also showed arthritis under the knee caps/patellas. In 1999, the Dr said 'you have a little arthritis under the knee cap, about normal for somebody your age'. The 1999 report seemed worse in my opinion. I've been playing a lot of tennis and the knees in that area function OK. I believe that my rectus femorus tends to get tight/short and aggravate that joint, the patellofemoral joint, causing occasional pain. I slack on stretching the rectus femorus when there is no pain but I shouldn't.
    http://www.youtube.com/watch?v=Q-80Qi5cx9o

    My niece is a serious soccer player. She got knee swelling (age 16?). It took several months of considering it an injury before it was diagnosed as Lyme disease. I believe that Lyme disease can cause arthritis.

    Do you know tennis players in your area who have had knee injuries and can recommend Drs?

    When there are injuries there is always uncertainty.
     
    Last edited: Dec 16, 2012
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  31. charliefedererer

    charliefedererer Legend

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    Articular cartilage is the cartilage that coats the ends of bones where they meet at the joint.

    [​IMG]


    The knee is unusual in that in addition to the articular cartilage (that makes up 95% of the cartilage at the knee), there also are the medial and lateral menisci which sit on top of the articular cartilage of the tibia (the lower let bone).

    [​IMG]


    Articular cartilage is rather hard - like the head of a hard rubber mallet.

    The menisci are fibrous - sort of like leather.


    In your MRI report, "mild narrowing of Knee Joint spaces and altered signal intensity" is describing your articular cartilage.
    That there is "altered signal intensity" means that there is damage in the articular cartilage.
    That there is "mild narrowing of the knee joint spaces" means that the articular cartilage is thinner than normal. Therefore the top bone (femur) appears closer to the lower bone (tibia) - hence the joint space between the two bones is narrowed.

    [​IMG]




    There is only one type of meniscal tear that is able to be repared - a longitudinal tear in the "red zone" - "red" because there is good supply here. (The "white zone" has a poor blood supply, and repairs won't heal.)

    [​IMG]



    "Posterior horn of the Medial meniscus show small focus of altered signal intensity extending up to Capsular surface and it appears Iso to hyperintense on all sequences." "Grade II degeneration involving the posterior horn of medial meniscus."
    The "degenerative" designation indicates that there is no tear present - the meniscus instead probably has scar tissue in it to account for the fact that it shows a hyperintense signal.




    My take: Based purely on the basis of the above MRI report [which may or may be a totally accurate representation of your knee], it does not sound likely that you would benefit from your arthroscopy, and seems unlikely that there is a tear in the meniscus (never mind a tear that could be repaired).



    But...

    MRI's are not definitive.
    You would have to discuss how often your surgeon reviewing MRI's similar to yours finds something at arthroscopy that will help you.

    My impression is that most orthopods will have your best interest at heart. Many view arthroscopy as a fairly minor procedure - even if there is nothing to really repair, it is unlikely you will have a difficulty from it. And there may be surprise finding that would help you.

    So there is no right/wrong answer as to whether to undergo the arthroscopy. Hopefully the above information can contribute to your knowledge of what is going on, and help in further conversations with your orthopod, and in making your decision.


    I wish you the best.
     
    #31
  32. Chas Tennis

    Chas Tennis Hall of Fame

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    Incidence of Complications for Arthroscopic Knee Surgery

    I viewed my arthroscopic knee operation for a meniscus tear in 2000 as very routine. My Dr is an excellent surgeon. My surgery and recovery went very well without complications. The results were excellent.

    Unfortunately, since my surgery in 2000 I have had 3 friends that had surgery complications following knee arthroscopy: 1) one with blood clots that resolved after a brief hospitalization, 2) one with blood clots followed by much more serious complications, 3) one with serious complications with hospitalization, maybe a blood clot issue but I don't know.

    Searched - incidence complications knee arthroscopy

    Example find -
    http://www.ncbi.nlm.nih.gov/pubmed/9602771

    For myself, I will look to avoid surgery but would do it with good reason.

    Sorry for the downer view Raul_SJ.
     
    Last edited: Dec 16, 2012
    #32
  33. Raul_SJ

    Raul_SJ Professional

    Joined:
    May 19, 2011
    Messages:
    1,345
    Location:
    San Jose, California
    Thanks charliefederer and chas tennis for the postings.

    I will study this information.

    I am currently uncovered by insurance and am unable to consult with an orthopedist, but hope to do so in the near future...
     
    Last edited: Dec 18, 2012
    #33

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