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Knee docs, thoughts on cyst without meniscus tear treatment
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Lots of pain and swelling on the outside led my knee doc to believe I had a meniscus tear with a cyst. I had a race coming up so the first step we took was to drain the cyst so I could get through that. It worked and I was able to race withiut much discomfort.

After that I had an MRI to confirm the tear. But there isn't actually a tear, just the cyst. Which as I understand it is actually more complicated. It's a Hoffas fat pad ganglion cyst. And it sounds like it's not very common.

According to my doc I've got a couple of choices:

1. Have the cyst, or cysts as on MRI it looks like four, drained by a radiologist so we can make sure we get them. Issues here are that they will fill back up over time(how long I don't know) and that having the one drained before hurt like hell.

2. Remove the cyst(s). This would have been easy if there was a tear because they'd be in there already. But since there is no tear to go through with the camera they will have to come from the outside. Which means cutting throught the IT band.

I'm obviously going to choose option one for now and hope for the best.

But is option two really the only other course of action?

What I don't understand is why they're able to get to the cysts to drain them externally but have to cut through the IT band to remove them.

The surgery method is scary because of the potential for scar tissue and all sorts of other stuff. Plus the down time. And I already have a snapping IT band. Other than the cysts the knee looks pretty good.

Here's the MRI report:


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Re: Knee docs, thoughts on cyst without meniscus tear treatment [Max Daddy] [ In reply to ]
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Max - sorry to hear of your difficulty. Cysts in a variety of locations in the knees are pretty common. But many are not the source of pain so I don't think you need to feel pressured into making an immediate decision. As I read the MRI, you have tear of the medial meniscus and at least some degree of fibrillation (read arthritis) of the articular cartilage. Be nice to see the whole report actually.

If you undergo aspiration of the cyst(s) under fluoro, assuming the doc is successful, you would know whether or not the cyst was the source of your problem. Without an operation. I'm going to go out on a limb and say that's less likely rather than more likely, and to keep looking for an additional pain generator.

Does that help?

John

John H. Post, III, MD
Orthopedic Surgeon
Charlottesville, VA
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Re: Knee docs, thoughts on cyst without meniscus tear treatment [johnpostmd] [ In reply to ]
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That is helpful. Should I go for a second opinion?

Here's more of the MRI report.


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Re: Knee docs, thoughts on cyst without meniscus tear treatment [Max Daddy] [ In reply to ]
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Thanks, that's better. This is an MRI interpretation that's talking to you but not shouting. Lots of little things but to say which single entity is causing distress is tough. This is where your doc and your face to face symptoms and hands on physical exam come in. From what you say, a second opinion may be of benefit but it sounds like your doc has the bases covered. If it ever does come to surgery, just make sure whomever you have do it has lots of arthroscopy experience (read > 100 knees/year.)

John

John H. Post, III, MD
Orthopedic Surgeon
Charlottesville, VA
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Re: Knee docs, thoughts on cyst without meniscus tear treatment [johnpostmd] [ In reply to ]
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Thanks again John.

The comment on scoping is what I'm still not understanding.

She said that since there's no tear to take the camera through a scope to get to the cysts is ruled out. She said she would have to go externally, and much more invasively, through the IT band.

Is that really the only option?

As for the pain, draining the cyst definitely helped that.
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Re: Knee docs, thoughts on cyst without meniscus tear treatment [Max Daddy] [ In reply to ]
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MD - everybody has their own way of doing things. In my patients, and if it were my knee, you're already having an operation, you're already having an anesthetic, you have some questionable findings on MRI, what's the downside of a quick (maybe) look inside the joint and document what is found? Photos. It would give the operating surgeon a chance for a thorough exam of the entire joint, possibly treat it and maybe give you a better idea of your future...like the chondromalacia patella.

But that's just the way I was trained.

John

John H. Post, III, MD
Orthopedic Surgeon
Charlottesville, VA
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Re: Knee docs, thoughts on cyst without meniscus tear treatment [johnpostmd] [ In reply to ]
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John, the concern I have is that there won't be any scope procedure because there's no tear to fix. So the plan to get rid of the cysts would be to go from the outside and through the IT band. Which sounds like a bit risky deal. Is there another way to get rid of the cysts?

Agree that actually being in the knee would allow for further diagnosis.
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Re: Knee docs, thoughts on cyst without meniscus tear treatment [Max Daddy] [ In reply to ]
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Your doc has a huge advantage over me with both the knee in question as well as the MRI to review. Maybe you need to run your thoughts by your physician before signing on the dotted line. All I can say is that in some quarters, surgery on this knee would include an arthroscopic component for the reasons previously stated.

John

John H. Post, III, MD
Orthopedic Surgeon
Charlottesville, VA
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Re: Knee docs, thoughts on cyst without meniscus tear treatment [johnpostmd] [ In reply to ]
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John, I've gone to another very well respected knee doc and the plan now is to go after the medial tear and at the same time go in with a scope on the lateral side to get the cysts.

He says recovery for full activity should be around 6 weeks. But I know this can vary greatly.

Is there anything I can do pre surgery to set myself up for an easier recovery? Should I be working quads like crazy or something?
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