Don't let anyone operate based on that MRI report. Meniscus wears out as we age. The trouble is that it doesn't wear like the tread on your tires - all smooth, just loosing some material gradually over time. It wears more like a road - looks fine, but is slowly getting small cracks until finally a spot fails and you get a pot-hole. If/when intrasubstance degeneration finally fails, you get a tear that extends to the surface. What to do with these degenerative tears is a matter of debate - some people will do a partial menisectomy, others will avoid surgery at all costs. Menisectory or even meniscus repair works pretty well for acute tears in young people with discrete tears - not as well for the wear and tear types of tears/degeneration we get as we age.

A couple of caveats to that - if your MRI was done on a low-power scanner (less than 1.5 Tesla) or on an open machine, you may have a real tear that doesn't show up on your scan. Second, if you are young, the type of meniscus changes you describe often accompany early osteoarthritis - in the early stages a lot of people get a lot better with physical therapy and orthotics with small lateral wedges. Third, as a rule of thumb, menisectomy accelerates osteoarthritis. If you do have a degenerative tear and the decision is made to operate, make sure you know what you can hope to gain and what you are giving up.

My two cents. I would get more opinions before you let anyone scope your knee again.

Thanks for the input, I should add that I'm 26 years old.

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Jonathan Blyer,
ACME Bicycle Co., Brooklyn, NY

ooh - that is a bit young. Unless you are, or have been, quite overweight, I would expect you to have nice meniscus. I was trying to push you away from surgery before, but 26 year olds are who it actually works on.

If your MRI is more than a year old, try to get a repeat - make sure it is on a good scanner with some dedicated MSK radiologists.

If you let me know where you live, I could probably recommend some places to you.

Good luck
Andy

I imagine that the doctor I'm going to see this Tuesday will recommend getting another MRI, I haven't done much activity since the last one, but I have had the surgery.
What do you think the chances are of the first doc missing it during the scope?

I live in NYC, so there is no shortage of facilities, if you could recommend one however, that would be great.

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Jonathan Blyer,
ACME Bicycle Co., Brooklyn, NY

Anything that "definitely" needed to be resected would have been easy to see on arthroscopy. Minor tears, for which meniscectomy is of questionable benefit, can definitely be missed sometimes.

I don't know many of the NYC surgeons, but a friend who did the same sports medicine fellowship as me practices there. Her contact:

1. Name: Rebecca Demorest MD
Address: Hospital for Special Surgery
: 535 East 70th Street
Business Email: demorestr@hss.edu
Business Phone: 646-797-8835

Hi!

I know this post was a while back, but I'd love to know how things went for you.

I am now 30 years old. In May 2009 I started getting medial/posterior left knee pain which I had an MRI on which showed a "complex tear of the body and posterior horn of the medial meniscus, surfacing inferiorly". I went on to have arthroscopy where the only thing done was shaving a small piece from the ANTERIOR meniscus, and, after 16 weeks, my symptoms were exactly as they were before the surgery, i.e medial/posterior dull ache, worse on running, although thankfully I could cycle an swim ok. Second MRI showed "posterior meniscal tear". Ortho surgeon said could be degenerative meniscus and offered re-scope but tried to put me off, saying he would have to remove alot of meniscus if he say anything "that loked vaguely abnormal". So I went for rehab, which only after 1nother 18 months let me run relatively pain free again.

Now, after 6 months of doing some 10k sessions (I was previously doing more) it has flared up again as bad as ever and the options remain once more:

-Rehab with physio
-Arthroscopy.

Hard to know what to do...

Thanks for your opinions if you are still around!!

Colm, Ireland.

I'm not an ortho so I won't speculate on your injuries but I am going for a meniscus fix on the 17th. This will be the 4th time this knee has had work done to it. Long story. Anyway, I hope you heal up quick and good luck.

How did your arthroscopy go? Are you back running?

Colm

I would be interested in knowing how you are doing. I have similar issues. Hospital for Special Surgery is THE place to go.

I may have the same thing. My MRI report said...
"Minimal globular increased signal intensity is seen in the posterior horn of the medial meniscus most consistent with minimal intrasubstance degeneration."

I've had knee pain (mainly back of knee & tendons of upper calf) since 2008. It's been an awful experience. Knee specialist said he saw nothing after looking at the MRI report & the images. He said 'you could get your knee scoped', but after reading this and his seeming incompetence, I'm glad I didn't do it.

I'm having acupuncture done on the knee. I'll give an update if it solves anything. Most of the acupuncture's work so far has been on the inflamed tendons.

I have been reading your post. My son is 15 and just had an MRI with the same problem. He is not over weight and never has been. He has always been under weight. He does play high school football and has starting working out. With you being younger to I would appreciate any advise. I hope surgery would not be necessary as he is so young. Thank you

We live in Canada.

Bev