I have had medial knee pain for some time, I went to a new sports med doctor and basicaly he said my meniscus isn’t causing the problem is it close to bone on bone in the medial area of my knee. Below is what what stated in my MRI. Dr. does not believe meniscus repair and removal of cyst is warranted. He gave me a cortisone shot in the medial mensicus area. I assume any real running is in my history, however would like to avoid knee replacement. Am I done for? THANKS!
There is a large cystic mass within Hoffa’s fat pad. This mass
measures 2.5 cm in craniocaudal dimension x 2 cm in AP dimension x 3.2
cm in transverse dimension. Differential diagnoses would include a
ganglion or synovial cyst, however, the MR appearance is nonspecific.
I see no underlying bone abnormality.
The anterior and posterior cruciate ligaments are intact. The medial
and lateral collateral ligaments are intact. The quadriceps and
patellar tendons are intact.
There are advanced degenerative changes of the medial knee joint
compartment with joint space narrowing, cartilage loss, and osteophyte
formation. Subchondral edema is seen involving the medial tibial
plateau with underlying cystic change.
There is a complex degenerative tear of the posterior horn and body of
the medial meniscus.
The lateral meniscus is intact.
No osteochondral lesion of the patella is seen.
CONCLUSION:
Large cystic mass in Hoffa’s fat pad. Differential diagnosis would
include ganglion or synovial cyst, however, neoplastic process cannot
be excluded and if clinically indicated, repeat examination with
intravenous gadolinium may add further information.
S & B - bad news, this is all just a nice way to tell you that you have pretty significant arthritis of the medial compartment, along with your meniscus tear. I did a three part blog (see below) on this recently that may be of benefit. Good luck.
Upon researching, some suggest a lateral wedge in my shoe of like 4 degrees (on the outside) may help pain. I have seen some cheap glue on ones or go full custom.
You could also ask your doctor about an unloader brace (custom). I had one for my lateral compartment, and it was great. Light, pretty colors, can do anything you want in it–run, bike, hike, skate, even water ski or snow ski, if you like.
Yeah, I agree with John, medial compartment arthritis with a degenerative meniscus tear is all too common in my practice. Your sportsmed doc is right. I even try to avoid getting an MRI when the weight bearing X-rays show bone on bone (or near it). The bone marrow edema is often the source of pain out of proportion to the x-ray findings. And the cyst does not need to be removed. An unloader brace is, indeed, a good option.
I never tell my patients not to run. I do tell them to lower their expectations and try to minimize the stress across their knee. Trail running, new or better shoes, every other day running, lower mileage, quicker cadence, even considering a change to forefoot running (which may be controversial).
Today I have been researching the Ossur One Custom brace, it supposed to be 50% lighter than other unloader designs. Would use it only for sports other than cycling. I spoke to my doctor today he agrees with the brace approach, he wasn’t familiar with the Ossur. My primary objective is to be comfortable mountain climbin/hiking…
Steve - you’re getting a lot of good information here. If you look at the treatment of medial compartment djd and resultant pain, some get by with NSAIDs, some glucosamine/chondroitin, some various injections, etc. An unloader brace can be one of those tools but it’s often a second line therapy. If you get that far, your insurance company may have already negotiated with one of the orthosis companies and that, if you want them to pay for it (minus your deductible), you’ll go with the suggested brand.
This information would be pretty easy to obtain by phone from the insurer. Once you have it, I’d suggest a separate thread to find out the experience of the ST gang. That way you’d really have the knowledge to make the best decision for you!
Thanks for everyones help. Fortunately I have decent insurance, Blue Cross, with no deductable on durable medical. I talked with the Ossur rep, he is going to get in touch with my doctor and insurance. Dr suggested celebrex but with my diabetes thought best if if avoid it for heart risk. (I have always been told to treat diabetes as if you were a regular person who has had a heart attack). Hoping to keep things going long enough till newer less invasive techniques such as regrowth of cartilage becomes more available, anything but knee replacement…