Help with MRI results

[michellehofmann]

Pain and swelling and clicking in right knee for more than a year. PT no help. In Feb 2012, twisted bad knee and tore menicus through and through.
Mother of three children: age 47 / 5-11/ 193 lbs/ active/ healthy overall

MRI 1 March 2012 -- Horizontal tear of the posterior horn and mid zone of the medial meniscus, which extends to the inferior articular sufrace and free edge;
slight thickening of the medial collateral ligament with minimal periligamentous edema, compatible with mild sprain;
large joint effusion;
1.5 mm area of articular cartilage loss involving apex and medial facet of the patella.
Minimal subcond marrow edema and small (6mm) scleritic foci within medial and lateral femoral condyles. Spiring of the tibial spine.

Chiro and radiology tell me my knee is bad. Dr.'s PA says my knee is "shot." Dr. never reviewed MRI. Examines me and says, "I don't need to see the MRI. I can tell you have a torn meniscus." I ask before surgery if they will have a good look around. I am told they will.
March 23, 2012 Dr. fixes meniscal tear. No post op call. Surgery pics are reviewed with patient in first follow up. PA says arthritus and tear. Never mentions any additional problems.
Post op pain and swelling continue to get worse. Repeated visits to the doctor. Told things take time. Knee has to be drained (bloody fluid) twice. Dr. does 2 cort shots. No relief. Dr says he has no idea what the problem is. Says he is stumped. Tells patient to wait 2 more weeks (putting us at 9 weeks post op). Patient requests another MRI.
MRI #2 with contrast 5/14/12
Results: The medial meniscus is moderately diminitive in size through the midzone and to a lesser externt the posteriorly consistent with propr partial meniscal resection. There are horizontal signal alterations within the midzone extending from the truncated free edge which do not significantly enhance. These finding are therefore unlikely to represent meniscal tearing by MRI artho
and they are more likely to represent fibrovascular granulation tissue
There is partial thickness condral loss affecting the medial and to a lesser extent the lateral compartments of the knee. The lateral meniscus is in tack.
The fibular collateral and medial colleral ligaments are in tact. The quadriceps and patellar tendons are intact. There are moderate to advanced chondromalacic changes along the medial patellar ridge.

Dr. reviews MRI and says still no ideas what is causing pain and swelling and thinks problem could be ghost pain from my back.

5/16/12 sends me for MRI of the spine. The back shows a couple of bulges, but I have not had any problems with my back. Chiro who has worked on patient off and on through pregnancy and one elbow surgery says the problem is not my back. It's my knee.

Question: Is it possible that in his rush to fix the meniscus (obvious), the doctor missed the underlying degeneration issues. I have three young children (ages 4, 9 and 11) and a busy life. I just finished graduate school and started teaching college part time. I am scheduled to teach in August. However, the set backs post op have put my life on hold. I can barely walk or drive. Our family life is really in a tailspin. I have already met my $5,000 deductible with the first sugery and other medical expenses. So if I am going to have to have the knee replaced in a year or so, I would rather do it now and be upright to see my kids off to college. I have had several doctors tell me the knee will have to be replaced because of the cartilage loss and arthritis. So why is the surgeon who repaired the tear, who has done thousands of knee replacements, saying he does not know what is wrong? Getting so many mixed signals that I just don't know what to do.
Can someone give me some insight into what the MRI findings show? I would rather get the knee replaced and get back to life than keep suffering like this. Please help. Supposed to see doctor on Tuesday. But I am afraid and feel that something is off

[Dee1956]

I am so very sorry for your pain.  I am not a doctor but from what you have said it sounds like the surgeon did just what you said, he repaired but did not take in to account the other problems you have.  He will probably not admit this so keeps telling you he doesn't know what is wrong.  While he reapired the tear there are other things causing pain.
If you can't walk then I would get the knee replace, saying that you should be prepared for any and all possibilities.  I have met people who had knee replacement and are very happy and also just the opposite
I wish you the best.  It is a terrible situation for anyone to be in.  I would be very upset with the surgeon who operated.  He may have thought all you needed was the tear repaired, but then why are all these docs saying you need the knee replace.  Sorry for the rambling response

[michellehofmann]

The first MRI showed bone islands and a bone spiring of the tibia. I normally heal quickly.The doctor now wants me to get an epidural on my back, but I don't have back problems. I am wondering if he may have missed a bone island or a bone spiring and if this could be causing the pain. I have been exercising and did 5 weeks' PT 3 X a week. I was only prescribes 4 weeks PT.  Doctor says the epidural can rule out the back issue. But the issue was the knee before the surgery and still is the knee now. Same pain now as pre-op but without the miniscal pain I had before the fixed the tear. However, the pain and swelling now is just like the pain and swelling I experienced in the year or two before the tear happened. They did a second MRI. Doctor did not review. He said he is stumped. This guy has done more than 6,000 knee repacements. I really don't feel like I am that difficult of a case. How would I know if the bone spurs and bone islands are still in the knee? That could be causing the pain. Not sure why he is acting like this is such a big mystery. I understand back problems can radiate in the legs (I had sciatica when I was pregnant). But this is localized pain to the knee. Any ideas?

[S. Kaul, MD]

Hi there!

Well, the primary issue in the situation seems the meniscal injury with associated ACL sprain and patellar cartilage damage. Meniscal injuries/ tears do not heal and surgery largely involves resection of the damaged part. The injury/ surgery may be followed by inflammation and scar formation which could prolong symptoms/ healing. This can also be compounded by inadequate post operative management/ inadequate physiotherapy. I am not sure if a knee replacement would be a good idea at this time. I would suggest considering a second opinion from another orthopedician, preferably at a university/ teaching hospital to get a fair idea of the current situation, the expected prognosis and the appropriate management plan.
Hope this is helpful.

Take care!