Hello I am a 45yo female, labor & delivery nurse for 15 years, and overall pretty healthy., I am a little confused over my most recent MRI. I had arthroscopic surgery in 11/2007 after an MRI show a complete tear of the mid and anterior horn of the lateral meniscus, I have continued to have severe pain, swelling (3x it's normal size), limited mobility, unable to staighten my leg, feeling that my knee was going to lock up and give away. I demanded another MRI, which I had yesterday. I received my report, this morning 1) complete absence of cartilage in lateral joint compartment, 2) subchondral edema and 3) chronic appearing complete tear of the mid anterior horn of the lateral meniscus. My doc. has been blaming my pain on age, arthritis and weight. I just want to know why there is a tear in the meniscus at what appears to be the same location as last time. My md was supposed to have cleaned, and removed the tear. Could it be possible that I have another tear to a different part of my knee. I'm just confused! I have a doc. appt. next week for a second opinion. Any input just to put my mind at ease, would be appreciated. Thanks :)
The main complication at this stage of treatment is the absence of healing and failure of symptoms to resolve. The natural history of a short (<1 cm), vascular, longitudinal tear is often one of healing or resolution of symptoms. Stable tears with minimal displacement, degenerative tears, or partial-thickness tears may become asymptomatic with nonoperative management. Most meniscal tears do not heal without intervention. If conservative treatment does not allow the patient to resume desired activities, occupation, or sport, surgical treatment is considered. Surgical treatment of symptomatic meniscal tears is recommended because untreated tears may increase in size and may abrade articular cartilage, resulting in arthritis.
If symptoms persist, if the patient cannot risk the delay of a potentially unsuccessful period of observation (eg, elite athletes), or in cases of a locked knee, surgical treatment is indicated.
The basic principle of meniscus surgery is to save the meniscus. Tears with a high probability of healing with surgical intervention are repaired. However, most tears are not repairable and resection must be restricted to only the dysfunctional portions, preserving as much normal meniscus as possible.
Surgical options include partial meniscectomy or meniscus repair (and in cases of prior total or subtotal meniscectomy, meniscus transplantation). Arthroscopy, a minimally invasive outpatient procedure with lower morbidity, improved visualization, faster rehabilitation, and better outcomes than open meniscal surgery, is now the standard of care.
Partial meniscectomy is the treatment of choice for tears in the avascular portion of the meniscus or complex tears not amenable to repair. Torn tissue is removed, and the remaining healthy meniscal tissue is contoured to a stable, balanced peripheral rim.
Meniscus repair is recommended for tears that occur in the vascular region (red zone or red-white zone), are longer than 1 cm, involve greater than 50% of meniscal thickness, and are unstable to arthroscopic probing. A stable knee is important for successful meniscus repair and healing. Thus, associated ligamentous injuries must be addressed. The most commonly associated ligamentous disruption is complete tear of the ACL, which must be reconstructed to prevent recurrent meniscal tears. Fortunately, the increased blood and growth factors in the knee during meniscal repair combined with cruciate reconstruction significantly improves the outcome of the meniscal repair. In ACL-intact knees with isolated meniscal tears, healing rates are less than in ACL-reconstructed knees but are higher than in ACL-deficient knees.
The principles of repair include smoothing and abrading the torn edges and bordering synovium to promote bleeding and healing. Likewise, needle trephination of the meniscal body (poking holes to create vascular channels) can be performed. Meniscus repair fixation techniques are numerous and variable. Fixation can be accomplished with outside-in, inside-out, or all-inside arthroscopic procedures. The outside-in and inside-out methods are usually performed with sutures and require additional incisions. Suture repair can be accomplished with vertical or horizontal stitches. The all-inside method is currently very popular, and a plethora of commercially available meniscus repair devices are available (eg, biodegradable arrows or darts). A word of caution may be appropriate. Peer-reviewed clinical studies regarding the efficacy of these new devices are lacking. The criterion standard to which these devices must be compared remains the inside-out vertical mattress suture.
Human allograft meniscal transplantation is a relatively new procedure but is being performed increasingly frequently. Specific indications and long-term results have not yet been clearly established. Meniscus transplantation requires further investigation to assess its efficacy in restoring normal meniscus function and preventing arthrosis.
Reported complication rates for arthroscopic meniscectomy range from 0.5-1.7%. Complications can occur intraoperatively or postoperatively.
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