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1089 Spadina Road
Toronto, AL M5N 2M7
Ph: 416-483-2654
Fax: 416-483-2654

Child Orthopedics
Spine - Cervical
Spine - Lumbar
Spine - Thoracic

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I saw an orthopedic surgeon for a knee problem I've been having. She and her partner both think it might be a meniscal tear. They are suggesting and MRI and possible an arthroscopic exam. I'm undecided how far I want to go with this. What do you suggest?

Imaging studies can be very helpful when trying to assess the cause, location, and extent of damage contributing to knee pain from injury, trauma, or age-related degeneration. What's the condition of the joint? How bad is the tear? Could it heal on its own? These are all questions the surgeon must address before recommending a treatment plan. Small tears along the edges of the cartilage have a better chance of healing because there is a better blood supply there. An MRI will help show how much blood supply there is and give the surgeon an additional tool when predicting who might get better with nonoperative versus surgical care. Tears on the inner aspect of the meniscus (especially large tears in multiple directions) don't heal well and often need a little surgical help. By taking a look at the cartilage using an arthroscope, it's possible to see what condition the meniscus is in and how much degeneration has occurred. Too much degeneration and the meniscus won't heal itself and can't be saved. Likewise, if the tear is too long, too deep, or too displaced, then it might be necessary to actually remove part (or all) of the cartilage. This procedure is called a meniscectomy. No matter what, the surgeon always tries to preserve tissue and knee function. The most difficult injuries to deal with are large tears in more than one direction (vertical and horizontal) and bucket handle tears. With a bucket handle tear, half the meniscus has pulled up away from the rest -- like a bucket handle lifting up away from the bucket. One end of the meniscus can get folded back on itself. Meniscal repair in young patients with a stable knee and tear in the outer portion of the meniscus is 80 to 95 per cent successful. Athletes or active, young adults in this group are able to get back into full sports and recreation at a level equal to before the injury. Partial meniscectomy in someone who has good articular cartilage underneath has a 90 per cent chance of successful healing. This same procedure is only successful 60 per cent of the time when there's damage underneath the torn meniscus or when the knee is unstable or misaligned. Removing any portion of the meniscus will eventually result in degenerative changes in the joint. This may not happen for five to 10 years, and it is somewhat dependent on how active the patient is -- more activity puts added stress on the joint and increases the risk. Early intervention can help save the cartilage and preserve knee function -- that's one important reason why patients are encouraged to get an early diagnosis and treatment rather than waiting too long and risking further injury to the meniscus and/or knee.


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