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Knee & Hip Problems Message Board


Knee & Hip Problems Board Index


Hi WALLEYE,

I too, have never heard of a meniscal strain. Don't think there is such a thing, but I am seeing both my physical therapist and Ortho surgeon later this week so I can ask both if there is such a thing. (I personally doubt it!)

Since your knee has subsequently buckled and given way on you (Which is how all MY knee problems started in Sept. of 2005), I am pretty sure that you now have a fairly sizable meniscal tear in that knee. If the knee feels like it is "grinding" at this point and you were told previously that you have some osteoarthritis in there, it sounds like your cartilage has worn away almost completely and it is bone on bone which IS EXTREMELY PAINFUL! (Been through that, done that, with both knees which is why I needed TKRs in each knee within a year of each other!) That's the "grinding" you are feeling.

As for whether meniscal tears do or don't show up on MRI, I believe they do and it has EVERYTHING TO DO WITH THE SKILL OF THE ORTHOPEDIC SURGEON IN READING THE MRI!!! (And/or X-ray for that matter.) I'll give you a short example - when I tore the medial meniscus in my right knee in the fall of 2005, my previous surgeon did an arthroscopic repair that December. Only problem was - he cleaned out WAY TOO MUCH CARTILAGE and the rest wore away completely from Osteoarthritis over the next 4 1/2 years! In June of 2010, I went back to this moron because the knee was hurting badly again and starting to "grind" and "buckle" on me. I asked him for a new handicap parking permit and he said he had to take x-rays to justify it. Well, he took those x-rays and told me my knee was STABLE so no new permit! Feeling that something was drastically wrong with the knee and unhappy with this guy's care (or lack of it, I should say!), I switched back to my original Orthopedic Surgeon in October of 2010. (Don't ask me why I didn't follow him when he left the other guy's practice in '95 to form his own - I still don't know to this day!) Anyhow, better late than never, as it turned out. When I went for my first appt. back with my original surgeon, he took ONE LOOK AT THE SAME X-RAYS the other jerk had taken four months earlier, and turned to me in abject horror and said, "Carol, you need a TOTAL KNEE REPLACEMENT ASAP! - YOU HAVE NO CARTILAGE LEFT IN YOUR RIGHT KNEE AND IT'S BONE ON BONE!! THAT'S WHY YOU'RE IN SUCH PAIN!!!" Knowing he used to be in the same group as the other guy while he was establishing his own awesome reputation, I could see the wheels spinning in my current surgeon's mind, like, "How the HECK could Magill MISS THIS ONE!!!?" Oh yeah, just to be sure, my surgeon sent me for a confirming MRI that November, and sure enough, when he read it in December of 2010, it confirmed his suspicions from the x-rays. My point on this - MY CURRENT SURGEON KNOWS HOW TO PROPERLY READ MRIs AND X-RAYS, which, obviously, THE OTHER GUY MISSED on a SIMPLE X-RAY!! So it DOES DEPEND ON THE SKILL OF THE SURGEON READING THE MRI!

Anyhow, we scheduled the TKR for the following April (4/5/11) and I had to go for pre-surgery physical therapy to build the muscles surrounding the knee so I would have a really good outcome. About a month or so before that surgery, I developed pain in my left knee from compensating with that leg. I didn't want my surgeon doing both TKRs within the same hospital admission, but did agree to let him do an arthroscopic repair of the left knee during the right TKR surgery. When he opened the left knee during that surgery to scope it, he discovered that not only had I torn the meniscus, but also the ACL (anterior cruciate ligament) which may or may not have shown up on the MRI of the left knee that I had just before surgery. (I suspect my surgeon saw that on the MRI but didn't want to upset me so may have chosen not to tell me at the time, since he was going to repair it anyhow.) Unfortunately, through no fault of my surgeon, the left knee went bad again 8 months later (last Dec.) and I was back in his office telling him that I was now in pain with the left knee. He took a new x-ray and saw that the cartilage was almost gone and that the knee was verging on bone on bone! He tried two cortisone shots in the knee six weeks apart to give me some more time before needing the left TKR. But the shots didn't help, and since I could not take the liquid cartilage injections of Synvisc because of a severe allergy to one of its main components, I got my surgeon to agree that it was now time to schedule the left TKR ASAP. Went in 3/23/12 and had it done. This time, my surgeon told me later in Recovery, that when he opened the left knee to start the TKR surgery, the knee was a LOT WORSE than he expected to find. The osteoarthritis had completely worn away, not only all the cartilage, but also the previously torn ACL!! He said he had to clean all of that out before he could even start cutting the bones to fit the prosthetic knee!!! So, thankfully, he caught this one in time. I recovered a LOT faster from the left TKR because I had the stable right prosthetic knee to work with this time in rehab. Matter of fact, I was SO MOTIVATED going in to this second TKR surgery, that I told my surgeon, that since mine was the first case of the day on 3/23, that if I got to my Ortho Unit room from Recovery early enough in the afternoon, I was going to get up on the walker the SAME DAY OF SURGERY! He said it was fine with him. (They usually make you wait till the next morning.) I walked 200 FEET on the walker THAT AFTERNOON THE SAME DAY OF SURGERY!! No one had the chance to tell my surgeon this that day, because he was in the O.R. all day with other joint replacement surgeries. When he came on rounds two days later, I asked him if anyone had told him how far I had walked the day of surgery and he said no. So, with a huge grin on my face, I told him it was 200 FEET, and he was absolutely astounded and thrilled! He nicknamed me "Rascal" after that, because I was always up on my walker the entire hospital stay! (When I wasn't sleeping, that is!). I'm all healed up from both TKRs now and it's such a pleasure to be able to walk PAIN FREE FOR THE FIRST TIME IN SEVEN YEARS!! (I do have back pain issues that had been brewing before the knee problems which I am getting treated for. Once those back issues are resolved, the new prosthetic knees, and the fact that I'm now walking normally and well balanced, should help take future pressure off my hips and back.) My surgeon is the most kindhearted surgeon I've ever had in my entire life (and I've had many surgeries for other medical problems). He did the most amazing job giving me my new knees and I did the rest. I did EVERYTHING THAT HE AND MY PHYSICAL THERAPIST ASKED OF ME POST SURGERY, and thus have two excellent outcomes because of my willingness to be a full partner in my own care. My Ortho surgeon is my Medical Hero!

Back to your knee issues. I get the feeling, based on what you said you are feeling in your knee as far as pain and "buckling' and "grinding", that you may be headed for a total knee replacement at this point. That arthritis you were told you had previously, sounds like it's progressed to full blown osteoarthritis which is wreaking havoc on your knee!

(When I got the surgical reports for both TKRs in June, it showed that I had "end-stage" osteoarthritis in BOTH KNEES so the TKR surgeries really were MY ONLY OPTION! And boy, am I glad I had them done!!)

Let me know what your surgeon says about the results of the MRI and whether he thinks you need a TKR. If so, please don't hesitate to keep posting here and ask ALL THE QUESTIONS you need to in order to prepare yourself for TKR surgery.

As noted above, been there, done that twice and I'm happy to answer your questions on what to expect during the surgery and post surgery rehab.

In the meantime, to alleviate the pain, there are several things you can do to help yourself.

1. Get a sturdy adjustable knee brace and wear it when you have to do a lot of walking. It will help stabilize the knee a lot better in the interim until you have surgery. (Ask your pharmacist for the best one.)

2. Ask the surgeon for a strong painkiller for the meantime until he determines you need a TKR. (If you can take any of the NSAIDS like Aleve, take that if he won't give you a stronger med via prescription.) If he's willing to give you a script, ask for either Tylenol #3/Codeine OR Oxycodone/Acetaminophen at the lowest dose so it doesn't cause you nausea. (If he gives you the Oxy Rx, MAKE SURE YOU EAT AROUND THE SAME TIME YOU TAKE EACH DOSE and that will help your stomach from being upset by it - IT IS STRONG STUFF!)

3. At your pharmacy (again, ask the pharmacist for help), get one of those hot/cold packs and get two of them to cover the entire knee. Put the packs in the freezer as soon as you get home and allow them to get cold for at least a couple of hours before use. The packs come with a cover so you don't get "freezer burn". Put the ice packs in the covers which each have an adjustable belt that you wrap around the knee and hold in place with velcro. Use the ice packs for 20 minutes at a time at least 4 to 5 times a day and keep the leg of the bad knee elevated, both while icing it, and when you sleep or lie on your couch watching TV. That will help bring the swelling and internal inflammation down to a "bearable" level! I would hold off on any intense sports activities for now, or even prescribed Physical Therapy, until your surgeon tells you what the plan of treatment will be - another scope at best or a TKR surgery at worst.

Hope all this helps.

Keep me posted as to what your surgeon decides to do to fix your knee. (If I were you, given what you describe here, I would ask him if he's willing to do the TKR surgery. Sounds like you really DO need it.)

Regards,
Carol





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