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meniscus tear
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meniscus tear

A little background.... I'm a 46yo fem skier symptoms of joint line pain and stiffness in the right knee.  No locking or serious instability although the knee has given a couple of times.  

18years prior I had a broken tibial plateau that required bone graft (freeze dried cadaver bone) with 2 screws and meniscus repair on the lateral side.  Screws were taken out and the plateau had to be reshaped on both the lateral and medial sides to due excess bone growth from the repair.  I've been skiing ever since.

MRI findings..... Tear of the undersurface of the posterior horn of the medial meniscus. Significant artifact from magnetic susceptibility apparently due to residual metal filings in the lateral aspect of anterior tibia.  Artifact partially obscures some significant cystic change in the anterolateral edge of the lateral tibial plateau. The cystic changes were not well displayed on plain film.  Ligaments are intact. No popliteal cyst or chondromalacia.

The radiologist did not grade the meniscal tear or mention size etc.... just said it's torn and seemed really frustrated by the obstruction from the metal filings.  

If I choose to clean up the meniscus am I at greater risk for accelerating degeneration in the joint?  If I leave well enough alone what's the probability that one day something will get caught in the knee and I'll suffer greater injury by the fall?   Is the arthritis in the lateral compartment a worse problem?   I'm seeing my ortho next week to discuss it... I'm just curious as to others thoughts.  
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I always tell patients with a meniscus injury, its not the meniscectomy that causes post-traumatic arthritis, its the injury the meniscus.  There really is no way to tell whether you are worse off leaving the tear in place and living with it, or having it removed. However, you are less likely to have pain if you have it treated.
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Thanks for the reply.  I saw the orthopod who specializes in sports medicine and he didn't read the radiologists report but did read the mri.  He thinks the medial meniscus tear is small and he is more concerned about the extensive arthritis on the lateral side.  

I have a new dilemma... the radiology report says the lateral meniscus looks intact... the ortho thinks the lateral meniscus is torn.  Since that meniscus was sutured 18 years ago and the metal fragments make the lateral side hard to see on MRI  I'm wondering who is right?

We're going to shoot some cortisone in there and I got a new hinged brace.  I'm going to ski about 8 days next month on it and see how it feels.  We'll make the decisions about where the pain is coming from then.

Next actions..... TBD
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A related discussion, more meniscal woes was started.
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