Login required to started new threads

Login required to post replies

Is Meniscus diagnosis possible without an MRI?
Quote | Reply
So back on 6/13 I jumped into a pool while playing with my kids. It was really weird as it was like the water didn't catch me or slow me at all. Water was 5' deep and I ended up compressing down to almost smacking my butt on the bottom of the pool. I remember thinking "that was weird" but didn't really give it much else of a thought. By the evening my right knee was getting sore but was generally fine to walk on. We flew home and I could tell the next day it was a bit swollen but still felt mostly fine. I thought maybe I sprained or jammed my knee when I jumped in the pool. About three weeks later it was still bothering me but I was still training for muncie so I was going for 3-5 mile runs, biking and swimming. Running hurt to start but would eventually loosen up and feel fine. Uphill was the worst but flat and downhill were mostly normal. I started going to my Chiropractor since it was obviously not getting better. She's not the voodoo witch doctor kind and I trust her a lot. Helped me rehab my left knee a few years back after I came about as close to tearing my MCL and ACL as you can without actually tearing it. At the time she said she thought 3 weeks and I should be back to normal. Things would start to feel like they were getting better and then my knee would pop and it was like I hit a reset button. I also still couldn't really bend my leg back all the way but straightening it out was fine and while range of motion was limited it was not really affecting running or biking.

After 3 weeks and still not better I offered to stop running and she agreed that was probably for the best to help it heal and recover but she wanted me to keep biking and to do stairs to strengthen up my knee and leg.

Two weeks ago I was sitting at my desk and it popped out of nowhere. I was literally not doing anything just sitting there. It hurt like a bantha but the weird thing was my range of motion flipped. All of a sudden it no longer hurt to bend my knee but it did to extend it. I saw my Chiro a few days later and asked her if we were dealing with something more severe than she originally thought. She told me she feels it is getting better. She is wondering if there is a small meniscus tear but (here's the kicker) since I have metal in my knee I can't get an MRI. She said I could get a CT scan but it probably wouldn't show much.

I just put in for an E-visit with my PCP to find out what kind of CT options are available in my network. I have read some of the newer CT machines can produce imaging almost as good as an MRI but how the heck am I supposed to know if that's what Im getting if my PCP orders me a CT scan? Also if its not a newer or better machine is it even worth getting it done?

Really trying to not freak out over the thought of a meniscus tear but I'm at day 79 since I injured it and its been like 4 weeks since I last ran.

Any help or suggestions on what to ask for in regards to the CT scan is greatly appreciated. Oh and here is my knee. The metal is left over from when I broke my femur in 98 playing soccer.

________________________________________________

God's in his heaven, alls right with the world -Nerv
Last edited by: suparuki: Aug 31, 20 9:38
Quote Reply
Re: Is Meniscus diagnosis possible without an MRI? [suparuki] [ In reply to ]
Quote | Reply
The good news here is that it doesn’t really matter. Many individuals over the age of 20 have meniscus tears, most are asymptomatic. In fact, it’s entirely possible you already had this year that you might have aggravated. There’s no indication for imaging as it sounds like the injury is slight and there’s no reason to expect anything more significant. Surgery yields the same outcome as physical therapy when measured at one year according to formal research. So... find a PT, improve your range of motion and you should do fine.
Quote Reply
Re: Is Meniscus diagnosis possible without an MRI? [suparuki] [ In reply to ]
Quote | Reply
I AM NOT A DOCTOR.

From what I understand in my limited, anecdotal experience, true diagnosis isn't really even possible with an MRI. If you want to see what's really going on in the knee, you really need to scope it, everything else is just a guess at some level. I believe this is due to knee architecture and blood circulation levels, someone much smarter than me can add to this.

Please let's have an actual doctor chime in,

I'm just this guy ya know?
Quote Reply
Re: Is Meniscus diagnosis possible without an MRI? [AndrewL] [ In reply to ]
Quote | Reply
I did see an article talking about PT vs surgery with similar results. I dont understand why the only surgical option seems to be removing part of the meniscus? How is that even helpful? seems like a one way ticket once you start down that path.

________________________________________________

God's in his heaven, alls right with the world -Nerv
Quote Reply
Re: Is Meniscus diagnosis possible without an MRI? [blanco] [ In reply to ]
Quote | Reply
I didn't know that about the MRI. Very interesting and helps explain why my Chiro is less enthusiastic about a CT scan.

________________________________________________

God's in his heaven, alls right with the world -Nerv
Quote Reply
Re: Is Meniscus diagnosis possible without an MRI? [suparuki] [ In reply to ]
Quote | Reply
The outer rim of the meniscus loses blood supply as we age and therefore doesn’t really heal. That is why some opt to remove it. However, it does scar down and typically becomes asymptomatic. Many of us are walking around with these tears without problems.
Quote Reply
Re: Is Meniscus diagnosis possible without an MRI? [suparuki] [ In reply to ]
Quote | Reply
I'm not a doctor.

I just had an appointment to see an orthopedic surgeon based on pain in my right knee. He immediately touched the sensitive spot on my knee (and I went through the roof) and stated it was a meniscus issue. He then checked for ACL damage and figured it was either ACL damage or that both menisci were damaged. He ordered an MRI to confirm the diagnosis and to see to what extent the ACL might be damaged. The MRI showed multiple menisci tears and a stable ACL.

In my case, my doc nailed the meniscus tear diagnosis and used an MRI as confirmation. Seems like an experienced orthopedic surgeon can diagnose menisci issues with a great deal of accuracy and will simply use an MRI to determine magnitude.
Quote Reply
Re: Is Meniscus diagnosis possible without an MRI? [Pathlete] [ In reply to ]
Quote | Reply
So what is he recommending for you? Surgery or PT?

________________________________________________

God's in his heaven, alls right with the world -Nerv
Quote Reply
Re: Is Meniscus diagnosis possible without an MRI? [suparuki] [ In reply to ]
Quote | Reply
Arthroscopic meniscectomy and chondroplasty which is doctor for removing the damaged parts of both menisci and grinding away any calcification (arthritis) on the bones. There are some good videos on the process on youtube, etc.
Quote Reply
Re: Is Meniscus diagnosis possible without an MRI? [suparuki] [ In reply to ]
Quote | Reply
My case , if it helps:

(sorry about my broken english)

In 2017 I broke my right knee medial meniscus . After months of dealing with pain I was told to get a meniscectomy , so I went to a different doctor and he injected Hyaluronic acid (Ostenil Plus) on the knee. 2 days later I resumed running with no pain . I got no pain since that injection even though its said that Hyaluronic is reabsorbed by the body and you need to reinject every 6-9 months.

2 months ago I broke my left knee medial meniscus . This time I went directly to the same doctor that injected me Hyaluronic Acid. Same process . And back to running with no pain.

I was dvised by my doctor to avoid as possible the removal of the meniscus , not always possible though. There are also other treatments .

Hope it helps.

There's some articles about this kind of treatment :
https://www.ncbi.nlm.nih.gov/...articles/PMC5509579/
https://www.peertechz.com/articles/AMM-1-108.php
Quote Reply
Re: Is Meniscus diagnosis possible without an MRI? [suparuki] [ In reply to ]
Quote | Reply
Sorry to hear. I'm battling a different injury at the moment so feeling (a little of) your pain. We had an ortho surgeon on the podcast talking about the value (or actually not) of MRIs. He was pretty fascinating - definitely not the ortho surgeon party line and some valuable food for thought for us endurance athletes. Here's a link to the episode: https://www.buzzsprout.com/204059/2592997

The guy (HJ Luks) is also a good follow on Twitter and has written quite a bit on related subjects. He's also an endurance athlete himself, which helps to know. This episode has ended up being one of our most popular of all time (just ahead of the Chrissie Wellington interview!).

Hope it helps!
Quote Reply
Re: Is Meniscus diagnosis possible without an MRI? [suparuki] [ In reply to ]
Quote | Reply
There is the McMurray test for meniscus tears, I think most MDs and PTs should know how to do it. It's a way of rotating the leg and knee that makes a click depending on the way the leg is manipulated and the type of tear. That was how my tears were diagnosed prior to confirmation by MRI.
All the best
Quote Reply
Re: Is Meniscus diagnosis possible without an MRI? [Donjek] [ In reply to ]
Quote | Reply
My physio thought I had a meniscus tear around 8 years ago so sent me to a specialist. He lay me on the bed, stuck his finger into my knee in a certain place, and then rotated my foot in a particular way. I nearly jumped off the bed with pain which subsided instantly he stopped. Apparently that confirmed to him that I had a meniscus tear and needed an arthroscopy.

He was expecting to slice off part of the meniscus and I would walk out of surgery, but when he got in there he discovered the tear was quite long, but on the part of the meniscus that does have blood supply, so he opted to stitch it back together. The downside of that was I had 3 months in a knee brace whilst walking (though I was allowed on an stationary bike in flat shoes after a couple of weeks). I ended up making a full recovery and was very relieved that he made the decisions he did.
Quote Reply
Re: Is Meniscus diagnosis possible without an MRI? [suparuki] [ In reply to ]
Quote | Reply
20 years ago when I was in high school I tore my Meniscus. No MRI, no CT scan, just an expert surgeon who knew his way around a knee. Scoped it and I ran a 5k three days later(not my best life decision). Oh how I wish I still healed like that. To answer your question; yes, any good Dr. and I'm sure PT or PA could tell you without the scan. If I were you, I'd use my contacts, especially those who are or recently were in the upper end of amateur sports and see who they recommend in the area. I've got a friend who played semi pro baseball and the dr. who put his knee back together is the same dr who puts all the professional athletes knees back together. You might be surprised how easy it is to get into to see some of the best dr. in any area. There are only so many broken knees I guess. I suggest that because those Dr. are probably going to give you options for continuing to SBR rather than just walk the dog. Good luck.
Quote Reply
Re: Is Meniscus diagnosis possible without an MRI? [AboveGround] [ In reply to ]
Quote | Reply
I had a bike crash last year that caused pain in the left knee. They did the tests with the pressure on the meniscus and turning the leg which hurt like hell. The MRI confirmed that there was a meniscus tear and the dr I saw figured the surgeon would scope and clean it up as I am 51 and that was the best we would get, due to blood flow, etc. Last Monday I went in for surgery with the surgeon not sure what he would do until he surveyed it real time. Needless to say ,he felt he could repair it and I am not in a brace for 8 weeks and non wight bearing for 6.This is the longer recovery but they feel if all heals well I will be good to go and avoid future surgeries. They sewed the meniscus together and drilled holes in the bone to release bone marrow. The bone marrow works as a natural stem cell treatment I was told since the meniscus doesn't like to heal. I'm not like 8 weeks in a brace but if it can postpone a knee replacement i can live with it. I had follow up today and they say I'll be good for my ironman races next year, just have to be smart about waiting on the healing process.
Quote Reply
Re: Is Meniscus diagnosis possible without an MRI? [suparuki] [ In reply to ]
Quote | Reply
I have some experience with this as I just had lateral/medial meniscus surgery in May. MRI is way overrated, maybe 60% accurate for meniscus tears. Also, like another poster said, many people have tears that cause no pain or symptoms at all. In my case my MRI was inconclusive. My symptoms and pain were consistent with a medial meniscus tear and never went away after rehab, cortisone, etc. I waited almost a year and went back to ortho, he wanted to try PRP injections or another round of steroids. I know my body, and knew that it was something structural. I asked for a scope which he was still somewhat reluctant to do. Long story short, he was able to see all the damage during the scope and I had a menisectomy performed on both sides of my left knee. I have zero regrets. The surgery was easy and I was back to light jogging in about 3 weeks. Pain free now.
Quote Reply
Re: Is Meniscus diagnosis possible without an MRI? [suparuki] [ In reply to ]
Quote | Reply
Sorry for my delayed reply.

Wall Sits... lots and lots of wall sits. And when you get tired of wall sits. Add some weight to your wall sits.

Oh and some reverse hyperextensions.
Last edited by: gall1972: Sep 9, 20 9:00
Quote Reply
Re: Is Meniscus diagnosis possible without an MRI? [dks] [ In reply to ]
Quote | Reply
I just scheduled my CT scan for next Wednesday. Doc knows I have IMTX in a month and said she will have a better idea of what to tell me when she sees the CT. She did have me get a patellar strap last week to help take the pressure off my meniscus and that has made a world of difference. The whole knee feels a lot better and after seeing the doc today she said its b/c the strap has take a lot of the pressure off the meniscus and is giving that whole area some time to recover.

Hopefully things look pretty good and she feels its ok for me to start running soon.

________________________________________________

God's in his heaven, alls right with the world -Nerv
Quote Reply
Re: Is Meniscus diagnosis possible without an MRI? [suparuki] [ In reply to ]
Quote | Reply
 I went to four different PTs and was diagnosed with four different problems. Finally I went to a good, orthopedic sports Dr in my area and he put his hand into my knee and it hurt, so had a hunch it was the meniscus, but the only way to really tell was the MRI (unfortunately for you). I did all of the YouTube diagnosis, and as I said, four different PTs and none of that worked. The MRI was very obvious.

First thing, yes, part of the meniscus can heal on its own. But, part of it can't. If the outer part is torn and can't heal, the scope procedure is your best (perhaps, only) bet. I was walking the same day. Running conservatively five weeks later.

The thing is.. if it's torn, it's torn. So if you can run on it now, you can run on it for IMTX in a month and it's not likely to get any worse. If you can't run on it though, there's no way you can get a procedure and be healed enough to run 26 miles in a month. Sure, you could wing it and survive.. but you risk a lot of damage if you do that.

I did the surgery and was paranoid about the downtime. Like standard Type A endurance athlete, stressed over missing five weeks of training in the midst of racing season. Looking back almost a year later.. it was nothing. I missed some races, I slowed down a lot, but I'm back to where I was before the surgery and feel better for doing it.

Not sure this answers your question, but without looking at it in surgery or doing a MRI, I don't know if you can know 100%. And you do run the risk of seeing endless Drs and PTs who swear it's XYZ, but no one will really know in my opinion.
Quote Reply
Re: Is Meniscus diagnosis possible without an MRI? [phoenixR34] [ In reply to ]
Quote | Reply
I'd been dealing with a strongly suspected meniscus tear for the last 10 months or so. I happen to swim with my ortho doc who said to wait and see if it improves. It didn't. I went in to be examined in March. Because it seemed to improve (but with very low and easy running miles), he recommended a continued wait and see. No change. If I didn't run, it would be no problem. However, I love running long and want to get back to marathons and ultras. I had a MRI that showed some meniscus fraying and maybe tear. I had the scope a week ago. Good news is he only had to clean up the fraying. no procedure to repair the meniscus.
Quote Reply
Re: Is Meniscus diagnosis possible without an MRI? [suparuki] [ In reply to ]
Quote | Reply
that metal is not a contraindication to MRI. It will produce artifacts that could render the scan non-diagnostic, but there are newer MRI sequences that can minimize the artifact and may allow for a diagnosis. For a CT scan to be sensitive for a small meniscal tear you would probably also need to have dye (contrast) injected into the knee joint.

______________________________________________________________

Quote Reply
Re: Is Meniscus diagnosis possible without an MRI? [tristorm] [ In reply to ]
Quote | Reply
Yup I’m getting a dye job!

________________________________________________

God's in his heaven, alls right with the world -Nerv
Quote Reply
Re: Is Meniscus diagnosis possible without an MRI? [suparuki] [ In reply to ]
Quote | Reply
Got my CT results. General consensus on if im screwed or not.

There is localized moderate cartilage loss at the inner aspect medial femoral condyle along the posterior weightbearing surface coronal image 25 and sagittal image 16 with approximately 50% cartilage loss. More peripherally in the medial compartment cartilage appears to be relatively preserved at the medial femoral condyle and medial tibial plateau surfaces

Within the lateral compartment there is a focal nearly full-thickness cartilage defect which is relatively small in the lateral tibial plateau posteriorly best appreciated coronal image 28. This measures approximately 3 mm transverse and is suboptimally visualized on the sagittal images. It is visualized on axial image 47 approximately 75% thickness

Remaining lateral compartment cartilage relatively preserved

Assessment of the menisci demonstrates a normal CT arthrographic appearance of the lateral meniscus.

The medial meniscus demonstrates a horizontal tear in the anterior body segment contacting the superior surface sagittal image 11. This extends into the anterior horn where becomes somewhat more vertical as on coronal image 19 also contacting the superior surface. No definite inferior surface contact in this location. In the posterior horn there is very subtle increased density on sagittal image 11 which appears to contact the inferior surface of the posterior horn medial meniscus. This is not visualized on contiguous images and is such would not meet strict criteria for diagnosis of a tear. It is not as bright as surrounding contrast.

. Meniscal roots appear to remain intact

The CT arthrographic appearance of the ACL, PCL, MCL, and fibular collateral ligament are within normal limits

There is incidental note of a moderate Baker's cyst filling with contrast. No asymmetric muscle atrophy

________________________________________________

God's in his heaven, alls right with the world -Nerv
Quote Reply
Re: Is Meniscus diagnosis possible without an MRI? [suparuki] [ In reply to ]
Quote | Reply
not a dr

had ACL (hamstring graft)/meniscus repair done at end of may. so been thinking about it alot, here's a couple of thoughts.

i've not heard a meniscus tear described as a "pop" whereas this is a pretty common way ppl describe ACL/MCL injuries.

i had quick access to a couple of very good sports knee surgeons who both thought it was very likely I tore acl but the xrays were inconclusive however it was easy to see on the subsequent MRI.

meniscus damage in active ppl is pretty common, doesn't always require surgery. you can be active without ACL/MCL (no soccer though). I was injured in mid-Feb but bc of Covid didn't get surgery until end of May. Once i got past the initial trama, I was able to return to riding/swimming w/o pain. i was told not to run but was walking pretty extensively so could have run I'm sure

final thought is, there's a wide range of quality in surgeons/PT's/trainers etc. there's a reason all the pro athletes in your city end up at the same couple of drs. (FFS, a PRIME example is your chiro telling you, no MRI's bc of a surgical screw!??!)

good luck.

Fuze
calling...
Can't complete call
We're sorry about that. Please try again or contact support if you continue to have issues.
CancelRetry
[/url][/url]
Fuze
calling...
Can't complete call
We're sorry about that. Please try again or contact support if you continue to have issues.
CancelRetry
[/url][/url]
Last edited by: ccddmm: Sep 19, 20 14:56
Quote Reply