Knee osteoarthritis question.

[Arthuro]

Originally Posted by Raul_SJ

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?

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.

[Raul_SJ]

Originally Posted by ollinger

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.

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?

[Chas Tennis]

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

[usta2050]

Originally Posted by Raul_SJ

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?

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

[Raul_SJ]

Originally Posted by Chas Tennis

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

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?

[mxmx]

Originally Posted by Chas Tennis

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/e...cle/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

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?

[mxmx]

Originally Posted by Arthuro

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.

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

[Chas Tennis]

Originally Posted by Raul_SJ

.................................................. .........

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?

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

[Raul_SJ]

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?

[Chas Tennis]

Originally Posted by Raul_SJ

.................................................. ..............................
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?

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.

[charliefedererer]

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




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).




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.






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.)





"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.

[Chas Tennis]

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.

[Raul_SJ]

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...