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When to have arthroscopic surgery
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saxophonic posted:
Hi out there,


I am 58 and about 3 years ago suddenly developed an odd sensation behind my left knee, following a 4 mile walk. I went to see an orthopedic doc right away. He diagnosed it as a Baker cyst and ordered an MRI. The MRI showed mild arthritis plus lateral and medial meniscus tears. He recommended arthroscopic surgery for the tears and felt I was a "good candidate" due to the lack of any significant arthritis. I decided to get a second opinion. The second orthopedic doc also recommended surgery. Meanwhile, I knew of 2-3 people that had arthroscopic surgery which did not go well. Either they had to have a second surgery or they continued to have problems with their knee and the pain was worse. So I was hesitant to have the surgery.


I researched orthopedic doctors in my area, looking for just the right one that had a lot of experience in this type of injury. I thought I found an excellent doctor and made an appointment. A second MRI was done (this was only a year after the first MRI) and it showed the arthritis had gotten a lot worse. This new doctor advised against arthroscopic surgery to fix the meniscus. She recommended a more conservative approach, consisting of first aspirating the cyst, injecting cortisone, followed by euflexor (later synvisc) injections. She believed that given my age and the progression of the arthritis, I should try to keep my cartilage and not mess with the knee (which she felt could aggravate the situation). So I went with this more conservative approach and had the cyst aspirated last year (March 2011). But the cyst returned a few weeks later and so did the pain. I returned to this doctor last Feb and I had another MRI. It showed grade 3-4 chondromylacia which meant the arthritis was getting even worse! Now she really doesn't want to scope my knee. She insists that the Baker's cyst is from the arthritis and not from the meniscus. She believes that doing the arthroscopic surgery to fix the meniscus will likey not make the cyst go away (and could aggravate the arthritis).


HERE'S WHAT BOTHERS ME: IF THE BAKER'S CYST IS FROM THE ARTHRITIS, WHY DID I HAVE IT WAY BACK 3 YEARS AGO, WHEN THE FIRST MRI SHOWED VERY LITTLE ARTHRITIS? HOW QUICKLY DOES ARTHRITIS PROGRESS? I'm thinking I should get yet another opinion but I am tired of all these doctors.


Has anyone had a similar experience or have any insight to share? I would greatly appreciate it.


Thanks,
Reply
 
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_swank_ responded:
Unfortunately, with meniscus tears, you're damned if you do an damned if you don't. Leaving a tear in your knee can cause more irritation and make your knee worse. Removing it means taking away some of the cushion in your knee and causing more irritation. Arthritis just happens and there's little you can do to stop the progression no matter what you do. In my experience, I had several scopes to remove bits of torn meniscus. After each surgery I felt better for a couple years or so before I tore my meniscus again. If I had to do it over again I would. Arthroscopic surgery wasn't a big deal for me. A week or two of downtime and that was it. I eventually had a total knee replacement which ended the cycle.

The Baker's Cyst is a symptom of something wrong in your knee. There's probably no way to know what's causing it but it doesn't really matter. It will go away when whatever is causing it gets fixed. Mine went away with the TKR.

Hate to say it, but you're probably heading for a total replacement. You can opt for some temporary relief now or wait. The only thing you know for sure is that if you do nothing you will only get worse.
 
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georgia888 responded:
Hi Saxophonic,
In response to your question concerning the progression of arthritis, it varies. There's really no predicting its course but managing it by keeping weight down & exercise should help us sufferers.

Best of luck to you.

georgia
 
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meribel replied to georgia888's response:
no problem walking/climbing stairs etc but problems walking down stairs
 
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Kamlhj responded:
Sax-
My story is similar. I'm 59. About 2yrs ago I started having pain behind my right knee. It progressed quickly to the point where I could hardly walk. About 2mos later I had orthoscopic surgery for a torn meniscus. After the surgery, the doctor told me that I also had moderate arthritis in that knee & could start having pain from it.
After the operation, I was able to walk again normally in about 1mo. About 2mos later the same pain started coming back. I now have moderate pain if I walk about 1 mile or work a 5 day week. If I take a longer walk (5 to 10 miles) I'll have the same pain severity as before the operation. If I sit at home & hardly move for some 10 days, the pain is all gone.
Like meribel, I can walk up stairs much easier than down.
 
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saxophonic replied to _swank_'s response:
Hi Swank, Appreciate your response and advice. Did you ever have to wear a brace and did it help?
 
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saxophonic replied to Kamlhj's response:
Kamihj, thanks, sounds like a no win. I may try a brace, we'll see. Thanks for responding...Sax
 
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_swank_ replied to saxophonic's response:
I never wore a brace. And braces are meant to do different things so don't wear one without running it by your doctor first. You could make things worse. The only reason I know of to wear one for a torn meniscus is when you have a tear on only one side of your knee. Then your doctor might recommend an unloader brace which is designed to take the weight off the bad side of your knee and move it to the good side. But these are special braces that must be custom fit and adjusted by a professional.

In general though, you're better off without a brace. It will force you to use your muscles. The last thing you want to do is let the muscles in your leg get mushy. Keep them strong no matter what you do.
 
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saxophonic replied to _swank_'s response:
Swank, you sound like you know an awful lot about this stuff. Really appreciate your great advice. Hope the TKR helped you and your knee is relatively back to normal. Take care and thanks, Sax


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