Beginning in early June I started having a dull, generalized “ache” in my left knee. In the course of a month or so it became extremely painful with obvious swelling in the whole leg to include my foot.

Saw the surgeon who replaced my right knee in 2024 to see if it was time for the left one. They took X-rays, but said nothing in them suggested replacement necessary as I had good space between bones throughout the whole joint. I asked him what else might cause the issue and he said it could be a meniscal tear and ordered an MRI.

Had my MRI this morning with the following results:

FINDINGS: MEDIAL COMPARTMENT: Complex tear of the medial meniscus posterior horn and body with extension to the posterior root attachment. This includes a focal radial tear along the posterior horn with mild extrusion of the meniscal body. Diffuse low grade (<50% thickness) cartilage loss with regions of high-grade cartilage fissuring.

LATERAL COMPARTMENT: Lateral meniscal degeneration without tear. No cartilage defect or subchondral edema.

PATELLOFEMORAL COMPARTMENT: Full-thickness cartilage loss of the median ridge with underlying subchondral edema/cystic change. Multifocal full-thickness cartilage fissuring along the lateral patellar facet with underlying subchondral edema. Low-grade, partial-thickness (<50%) femoral trochlear cartilage loss.

TENDONS: Distal quadriceps and patellar tendinosis without tear.

SOFT TISSUES: Small joint effusion. Moderate-sized Baker's cyst with evidence of leak/rupture.

IMPRESSION:
1. Complex tear of the medial meniscus with mild meniscal extrusion and mild to moderate medial compartment chondromalacia.
2. Moderate to severe patellofemoral compartment chondromalacia.
3. Moderate-sized Baker's cyst with evidence of leak/rupture.


From what the surgeon originally said and search results, sounds like possible arthroscopic surgery to either “clean up” or repair the tear as well as PT.

Prognosis for a good surgical outcome doesn’t seem great, not high “success” and the older you are the less likely to be resolved surgically.


I’ve already started on self-directed PT based on the “hunch” diagnosis to try and get ahead of it. I can say the pain has improved along with the ability to bear weight. Still using a cane for safety though and going up/down stairs with both feet on each step instead of taking a new stair with each foot (if that makes sense).

I also joined the YMCA to have access to weight machines and a pool for swimming. I have my exercise bike, elliptical, and real bike at home but I need more variety and also something for upper body improvement.


Will see how soon I can get into doc for follow up and treatment plan. Part of me would just like to jump ahead to another knee replacement and be done with it instead of having multiple other procedures and delaying what will likely be the eventual outcome.


Anyone else have experience with a complex tear, arthroscopic treatment? How was the outcome?

This message has been edited. Last edited by: 911Boss,

I just had second one last month for left knee in PT now. It's very simple and quick recovery. Mine this time was a little more complicated because they also removed two different types of cysts, and did something related to arthritis that I don't recall.

I tore the meniscus in my left knee when I was 18 or 19. This was before arthroscopic surgery had become a thing, and I had a serious phobia about hospitals in general and surgery in particular, so I didn't do anything about it. Even after arthroscopic became common the phobia persisted. Over the years the pain in my knee became more frequent and more intense, until finally a visit to an orthopedic surgeon about 20 years ago revealed that the meniscus had completely disintegrated and some osteoarthritis had set in as well. Now, I have a heavy aluminum/neoprene/velcro knee brace that I have to wear if I'm walking any further than down to the corner to pick up the mail. I can't run at all. I do stairs the same way you do, putting both feet on each step.

The reason I didn't opt for a replacement when I saw the surgeon, other than the phobia that still persists (although lessened after my bout with cancer), was because he told me that artificial joints don't last longer than 10 to 15 years, and then they have to be replaced again. The prospect of having to do the surgery and rehab multiple times, was enough to dissuade me from it.

For you, I'd recommend going ahead with the arthroscopic fix.

quote:

he told me that artificial joints don't last longer than 10 to 15 years

I believe those estimates are assuming that you continue the activity that tore it up in the first place.
My fake knee is in its 25th year. The first 10 yrs I was still working on a fire truck full time.

My Doc told me - NO IMPACT! No running, basketball, etc.
Walk till the cows come home, hiking, hunting, bowling, biking, & snow skiing (if you already know how).
If your knee is trashed with arthritis and bone on bone, they can fix it proper. Mine was bone on bone at 43.
I’m 68 now and my knee feels fine.
I got tired of getting x-rays every 2 years and the doc telling me that it has no loose spots and is still solid. Haven’t had a follow-up x-ray since 2015 or so.

Been there, done that. Had a bad tear in my right meniscus in 2009, and had a scope to fix it. They removed over half of my meniscus.

Recovery from a straightforward knee scope usually isn't terrible. Moderate pain and weakness for a few days, minor pain and stiffness for a few weeks, and with recovery PT you're often back to 100% within a month or two. Obviously other health conditions and complications could extend that.

I had mine done on Wednesday and left on crutches, but was walking stiffly but unassisted by Friday, back to work on light duty on Monday, and back to full LE duty in 1 month. I didn't take any serious painkillers after the first couple days, but used OTC pain meds and icing religiously throughout the following few weeks.

If you have the opportunity, I strongly suggest either renting or buying one of the knee wrap systems with a chilled water recirculation pump. You might have used something similar after your knee replacement. They work great, and beat the pants off ice packs.

The downside is that by removing portions of your meniscus, it hastens further deterioration and arthritis in the future. My knee doc initially estimated that I would need a total knee replacement within 10-15 years, but I'm already past 15 years and not close to needing a total replacement, though in the past 5 years I have started needing steroid injections every 12-18 months due to arthritis starting to develop. I suspect it's holding up better than estimated due to me babying it since then, including switching to low/no impact cardio and especially moving into less physically active job positions like training and court security.

I had to go to Mayo at their sport medicine / orthopedic clinic.
Mine was so bad they just removed all the scar tissue. The surgeon was clear that I was giving up mobility for reliability. There is no more running or dirt bikes for me but I don’t have to worry about my knee going out. I’m 40 and have accepted the limits.

Don’t compromise with local providers.

Saw the ortho guy today. Looks like I’ll be getting surgery sometime in the next 3-5 weeks depending on insurance pre-approval time and scheduling.

The way he explained it is I have a tear at the rear of the medial meniscus (inside of knee). Think of the meniscus as half a donut/horseshoe, the tear starts on the inside and goes towards the outside.

It can’t be repaired and it won’t “heal”. So there are two options:

1. No surgery. PT, build up the supporting muscles and make do. Limit activity to try and avoid re-injury.
2. Surgery, it is the more aggressive treatment. Considering how long it has been bothering me and my desire to get back to a more active schedule, he thinks it is the better choice.


The plan is to do a “partial meniscectomy”. He will remove a semi-circular portion along the inside of the half-donut completely removing the area of the tear. The thought is with the tear removed, it will not continue to tear until it goes all the way to the outside.


He said recovery should be faster and less involved than the knee replacement. On the bright side, if I am going to be laid up best for it to be in the coming months as winter rolls in.

I did 3 knees today and 2 shoulders. All scopes, and with a good PT regimen all five patients should do well (ages 34-67).

Just keep up with the therapy, a locked knee usually means going to sleep really quick for a manipulation, and PT is more painful after that. You. Don't. Want. That.

The loss of the meniscus while somewhat terrifying, is routine. The biters and shavers will leave a nice smooth surface (except where the bone is degenerating, then some emulsification of the remaining condylar surface will help a lot). While the doc is in there he'll most likely try to drain the Bakers Cyst, and remove any plica bands and loose bodies.

Hopefully the procedure goes well and I prayer for a painless recovery (I know, I can pray for it though).

High grade chondromalacia means the scope for the meniscus will only be a temporary fix at best. I see this frequently a mensical tear in a knee with significant degenerative wear. The knee surgeon I work with in these cases usually recommends conservative management and no scope. If conservative management doesn’t control symptoms,replacement

I tore my MCL in my left knee reffing a semi pro soccer game about 20 years ago (42 years old). I had arthroscopic surgery and it healed pretty well. Unfortunately, it didn't help my bone on bone issues and I'm five weeks post op from my left knee replacement surgery. I had my right knee replaced three years ago.

You've had a knee replacement already, so you know what that's like. My advice to you (I'm not a DR!) would be to get the arthroscopic surgery and hope for the best. If your knee is unstable, it needs to be done.

quote:

Originally posted by Skins2881:
I just had second one last month for left knee in PT now…

2nd one on same knee or one in each knee? If same knee, “re-repairing” original tear or a new injury?

My concern is having to deal with this multiple times and then being replaced anyway.

quote:

Originally posted by Expert308:
I tore the meniscus in my left knee when I was 18 or 19. This was before arthroscopic surgery had become a thing, and I had a serious phobia about hospitals in general and surgery in particular, so I didn't do anything about it. Even after arthroscopic became common the phobia persisted. Over the years the pain in my knee became more frequent and more intense…

…The reason I didn't opt for a replacement when I saw the surgeon, other than the phobia that still persists…was because he told me that artificial joints don't last longer than 10 to 15 years…

The pain and trouble this is causing me is far greater than the bone on bone arthritis that resulted in my other knee being replaced. My doc told me my new knee should be good for 20-25 years, had it done last year at 61, so for all intents and purposes, that should equate to a “lifetime warranty”.

quote:

Originally posted by RogueJSK:
…
I had mine done on Wednesday and left on crutches, but was walking stiffly but unassisted by Friday, back to work on light duty on Monday, and back to full LE duty in 1 month. I didn't take any serious painkillers after the first couple days, but used OTC pain meds and icing religiously throughout the following few weeks.

If you have the opportunity, I strongly suggest either renting or buying one of the knee wrap systems with a chilled water recirculation pump…

The downside is that by removing portions of your meniscus, it hastens further deterioration and arthritis in the future…

Doc said easier recovery than the knee. Offered crutches, but I plan on just using cane and walker which is what I did after TKR. He also mentioned the acceleration of the arthritis, but the told me 5-6 years ago I would end up with new knees.

I have one of the circulators, and yes they are great!

As I said in OP, I’d almost rather have it sooner while recovery is easier than later after age has taken a greater overall toll.

quote:

Originally posted by TexasScrub:
I did 3 knees today and 2 shoulders. All scopes, and with a good PT regimen all five patients should do well (ages 34-67).

Just keep up with the therapy, a locked knee usually means going to sleep really quick for a manipulation, and PT is more painful after that. You. Don't. Want. That.

The loss of the meniscus while somewhat terrifying, is routine. The biters and shavers will leave a nice smooth surface (except where the bone is degenerating, then some emulsification of the remaining condylar surface will help a lot). While the doc is in there he'll most likely try to drain the Bakers Cyst, and remove any plica bands and loose bodies.

Hopefully the procedure goes well and I prayer for a painless recovery (I know, I can pray for it though).

Is “lock up” a post op concern/complication? I haven’t had an issue with it locking, but it has given out on me a couple times when I wasn’t paying attention.

quote:

Originally posted by captain127:
High grade chondromalacia means the scope for the meniscus will only be a temporary fix at best. I see this frequently a mensical tear in a knee with significant degenerative wear. The knee surgeon I work with in these cases usually recommends conservative management and no scope. If conservative management doesn’t control symptoms, replacement

Doc told me this was the more aggressive treatment, but would probably give the better outcome to return to my activity level than PT alone. Agree new knee in the future, but it wouldn’t be approved at this point. So while it may lessen the time to replacement, I am hoping that time will be better “quality”.

quote:

Originally posted by blindref:
…

You've had a knee replacement already, so you know what that's like. My advice to you (I'm not a DR!) would be to get the arthroscopic surgery and hope for the best. If your knee is unstable, it needs to be done.

Definite not stable as it is. Doc said the way I am three months in from the injury, he wouldn’t be expecting much more improvement. Says surgery is the more aggressive treatment, but thinks it is the better one in my situation.

Had my surgery yesterday. Doc said it was worse than he expected from the MRI, did what he could then all but told me it was a temporary fix. Arthritis was significant and would have to be kept an eye on.

Got several pictures, some are real obvious in showing damaged tissue others I don’t know what I am looking at. I imagine he will explain them to me at the follow up in a couple weeks.

On the bright side, I can tell that it has helped with the pain. Have a fair amount of pain from the surgery when bearing weight, but it is a “different” pain and the previous pain “inside” seems to be gone (if that makes any sense).

Cycling through Oxy, Ibuprofen, and Acetaminophen for the pain and so far keeping it under control. The Ice Water circulator I bought for my knee replacement last year has been helping as well.

I tore my right one and had surgery. I had more pain after surgery than before and just strengthened the leg muscles slowly.

I tore my left a few years back and decided not to have surgery. It took a couple years but it healed up. Just a thought to consider.

For those who understand, here are the truncated post op “notes” with what he found and did…


Tourniquet Time: 3 minutes

Anesthesia: General

Complications: None

Findings
Central high grade chondromalacia patella
Moderate grade central trochlear chondromalacia trochlea
Intact anterior cruciate ligament
Intact lateral compartment
High grade posterior weight bearing surface chondromalacia medial femoral condyle
Near complete radial tear of the posterior body of medial meniscus tear



Procedure Details
After administration of adequate anesthesia a pneumatic tourniquet was placed at the proximal aspect of the thigh. The left was examined under anesthesia. The knee was stable to varus and valgus stress. There was a negative Lachman, pivot shift and posterior drawer test. The entire lower extremity was prepped and draped in sterile fashion.

The medial and lateral portals were injected with 0.25% marcaine with epinephrine prior to incision. The lateral portal was made and the arthroscope was inserted into the medial compartment. The lateral and medial gutters were inspected for loose bodies. A medial portal was established using a spinal needle under direct visualization. A biting forceps and a shaver were used to débride the areas of pathology. The tear extended into the outer 1/3 periphery. We beveled the medial and lateral flaps back to the apex. The meniscus root appeared attenuated. We debrided the infrapatellar fat pad and performed a chondroplasty of the both the medial femoral condyle and the patella and removed numerus chondral loose bodies throughout the suprapatellar space and lateral gutter, largest of which was 5 mm in diameter.

911Boss,

Post op "notes" are more entertaining when Grok translates into ebonics. Enjoy:

quote:

Yo, here’s the lowdown on what the doc wrote ‘bout your knee surgery, in a way you can vibe with:

Anesthesia: They put you under with some general sleep juice, so you was out cold.
Complications: Ain’t none. Everything went smooth.
What They Found:

The middle of your kneecap (patella) got some serious wear and tear (chondromalacia).

The groove where your kneecap sits (trochlea) also got some moderate damage.

Your ACL (that big ligament in your knee) is all good, no problems.

The side part of your knee (lateral compartment) lookin’ solid.

The back part of your inner knee bone (medial femoral condyle) got some heavy damage.

The cushion in your knee (medial meniscus) got a bad tear, almost all the way through, in the back part.

What They Did:
They knocked you out proper, then strapped a tight band (tourniquet) high up on your thigh to keep things clean. They checked your knee while you was sleepin’ and it was steady, no wobble when they pushed it side to side or back and forth. Tests like Lachman, pivot shift, and posterior drawer came back clean, meanin’ your knee’s stable.

They cleaned up your leg real good and kept it sterile. Then they shot some numbin’ juice (marcaine with epinephrine) into two spots on your knee before cuttin’. They made a small hole on the side (lateral portal) and slid a camera in to check out the inside. They looked around for any loose bits floatin’ in there. Then they made another hole on the inner side (medial portal) usin’ a needle to make sure they was in the right spot.

Usin’ some grabbin’ tools and a shaver, they cleaned up the messed-up spots. That tear in your meniscus went deep, so they trimmed the rough edges back to make it smooth. The root of that meniscus was lookin’ kinda weak, so they cleaned it up too. They also shaved down some fat under your kneecap and smoothed out the rough cartilage on your kneecap and inner knee bone. They pulled out a bunch of loose cartilage pieces from around your knee, the biggest one bein’ ‘bout 5 mm wide.

That’s the deal, fam. Doc fixed you up good, cleaned out the junk, and made sure your knee’s ready to roll. Let me know if you need more breakdown!

quote:

Originally posted by tatortodd:
911Boss,

Post op "notes" are more entertaining when Grok translates into ebonics…

Ha! Didn’t know grok had a ghetto feature, that was hilarious.

Grok can do cajun too. For example:

Medial femoral condyle, dat’s got some serious wear on da back weight-bearin’ part, high-grade chondromalacia, like da bottom of Mamaw’s cast iron skillet.

After we got ‘em snoozin’ good wit anesthesia, we strapped a tourniquet ‘round da thigh, tight like a crab trap.

---

Ego is the anesthesia that deadens the pain of stupidity

DISCLAIMER: These are the author's own personal views and do not represent the views of the author's employer.

quote:

Originally posted by 911Boss:
Had my surgery yesterday. Doc said it was worse than he expected from the MRI, did what he could then all but told me it was a temporary fix. Arthritis was significant and would have to be kept an eye on.

Got several pictures, some are real obvious in showing damaged tissue others I don’t know what I am looking at. I imagine he will explain them to me at the follow up in a couple weeks.

On the bright side, I can tell that it has helped with the pain. Have a fair amount of pain from the surgery when bearing weight, but it is a “different” pain and the previous pain “inside” seems to be gone (if that makes any sense).

Cycling through Oxy, Ibuprofen, and Acetaminophen for the pain and so far keeping it under control. The Ice Water circulator I bought for my knee replacement last year has been helping as well.

This is exactly what I see almost every time, which is why we don’t scope old knees and continue non operative management until the patient is ready for replacement

quote:

Originally posted by captain127:

This is exactly what I see almost every time, which is why we don’t scope old knees and continue non operative management until the patient is ready for replacement

Question - why is this the case? My knee has been bothering me non-stop for almost 4 months. Much more pain and limiting than the right knee caused prior to being replaced.

The doc who did my TKA and the one who did the Arthroscope both said I wasn’t a candidate for replacement (yet) with this knee. If the arthritis deterioration is expected to continue, or possibly even be sped up, what is the point of not scoping or waiting till it gets worse before doing a TKA?

I can tell already the scoping has reduced the pain of the joint and my walking difficulty (the surgery pain is “different”).


So if scoping does provide relief, why would there be hesitation to do it if PT isn’t providing improvement or relief?