Torn Miniscus in knee

Good morning

My xray showed minimal arthritis. The MRI told a different story. Arthritis in all compartments. When the PA told me I had quite a bit, I kind of started to argue that my xray said I had minimal arthritis, she chuckled. I liked my xray's opinion much better than the MRI!

The MRI is much more detailed and will shoe the extent, if any, of osteoarthritis.

If you don't know- ask.
There are options, depending on the tear type and if there is any other damage.
As you mentioned your knee, there are different types of tears and each requires different approach.
I would ask if you went to a surgeon first or an orthopod (my way of saying a non-surgical or medical orthopedist).
if the tear is not creating a worse problem, it should be "left alone". Meniscus tears are common, and more easily happen in the older age groups.

When I say "left alone" I mean do your physical therapy, maybe put on more muscle (less body fat) because the muscle supports the knee. Discuss with your doctor the type of tear you have. In past "clean out' meant removing most of the meniscus-leaving a space where there was once a cushion. It has been found to lead to osteoarthritis faster.

I am an exercise physiologist and have meniscus tears in both my knees. Your shoulders are a major joint that could have that cushion too! I have tears in those. You can live with tears. It is only when it is a problem that you should consider further intervention. I am an exercise physiologist and was very proactive to preventing surgery. If surgery is the answer, I would highly recommend that you try to do "prehabilitation". The afterwards can go a lot better.

I guess I didn’t have any osteoporosis in my knee at the time of the MRI. That was 18 months ago.

I guess I should try physical therapy first before any surgery.

It sounds like there will still be enough of your meniscus left after the surgery to provide some cushioning. I never got gel or PRP injections but they probably would have helped.

I had my entire left medial meniscus removed about 20 years ago. The osteoarthritis, coupled with way too many marathons, destroyed the meniscus and it had to be removed. At the time, the surgeon placed a meniscus-shaped piece of titanium (Unispacer) in my knee to replace the meniscus.

Unispacers had a very poor record in practice. The unispacer was supposed to act literally as a spacer to keep the knee joint and legs level. Most of them failed within a year. I had a great surgeon and never had a problem with the unispacer - for 20 years. After all that time, osteoarthritis had pretty much destroyed both knee joints and I had my knees replaced in 2022 with great success. My unispacer? Makes for a great, small paperweight.

The running certainly accelerated the demise of my knees, but it was my genetic disposition to osteoarthritis that did me in. And that's why I say arthroscopic surgery does not cause arthritis. I'm bone-on-bone in both shoulders and both hips. But my weight is slightly below normal for my height, and I work with a trainer and I'm in the gym everyday. So I have no pain in my hips and one shoulder. I do get pain in my other shoulder, but cortisone shots have helped a lot, along with regular exercise.

I do believe that joint replacement should be put off as long as possible. If gel and PRP injections help ease pain and maintain range of motion, well keep that up until it stops working.

I'm also a big advocate for knee replacement when all other options are not viable. It takes a lot of work on the patient's part to make these surgeries a success, but the work pays big dividends.

I am an exercise physiologist and would say that from a genetic standpoint, we are predisposed to osteoarthritis if we do not find the right balance between the sports we love and the physical activities we need to engage to complement and offset the damage.

Bones give shape.
Tendons and ligaments give support.
Muscles define and keep it all together.

If we can all follow these heuristics, we would have less osteoarthritis. I think the arthritis is more suggestive of something than needs to be addressed and is not the problem itself. Also, if we listen to what our body tells us is good- would we be better to listen to "our own advice?"

I would definitely consult on the trade-off of some of the therapies. They don't work for everyone. Also, knee replacements and joint replacements need to take into consideration whether the individual has an immune response to the materials.

Best,
AMS

My question to you is this: How do you feel about therapy? Would you follow the recommendations, and would you continue it after the therapy sessions were complete?

As I mentioned in my previous post, the type of tear makes a difference. If the therapy (and your soon to be routine) helps, then you are at a great starting point. Be sure of yourself going into it.
Best,
Ann Marie

Your share is interesting. I had a similar experience.
X rays are different from MRI (MRI looks at soft tissue, xray-structure).
I sometimes wonder if AI is a factor here.

I was freaked out when I saw "moderate arthritis" in some areas and got a similar response.

It would be nice to hear from someone why this phenomenon occurs. Are the evaluations to look for something that is otherwise normal? (I don't think arthritis is a normal at any age!)

Hi Ann,

That’s a great question!

I had never had knee issues prior to this injury. Apparently, I wasn’t troubled by my arthritis. I only found out about it because of an injury. I was so happy to think I didn’t have knee problems…until…a large dog in my neighborhood decided to jump my dog and I as we walked by his yard. I went down hard on both knees. My PA did the X-ray as a starting point, not knowing what was going on. I did the usual ice, rest, PT to no avail. Next step was the MRI which showed the large tear on the inside and a smaller on the outside. I had one cortisone injection that took a couple of weeks to feel any difference (strange, I say) but then wore off quickly. So that’s where I am - having surgery on 10/9 for a clean out. Regardless, of pain, I walk my pups daily at least 2-3 miles in hilly terrain, stay active, am working on losing 10 pounds and get on with it!!

So back to your question…I find it interesting that I can show up with moderate arthritis and not felt it at all!