I went to my local orthopedic surgeon who ordered an MRI which showed a lateral meniscus tear. He said I need surgery. Do I need surgery? I can run and it only bothers me very infrequently.
Is there anything else I can do? R. H. Great Neck, NY.
Thank you Richard for writing. Many people have this same dilemma. Unfortunately some orthopedic surgeons walk around with a hammer and think everything is a nail! When they see MRI evidence of a reimbursable surgery...they recommend it.
Having not seen you, I can't be sure what you need but given your mild symptoms, you, in fact, may be right that surgery in unnecessary in your case. Many professional and non-professional athletes of all types have played on and had successful careers on lateral meniscus tears.
First, never consider having a surgical procedure without a second opinion from someone you trust. By this I do not mean a family friend, I mean someone with great credentials in your local community.
That said, I am a little troubled by the recommended need for surgery with minimal pain.. I never treat the MRI. Good physicians order MRIs to confirm a diagnosis, not to find one. There are plenty of times that the film may appear to have a tear when the exam is actually normal and when the surgeon directly visualizes it, there was no tear and no need for surgery. And like I said, even if the MRI shows a reimbursable surgical diagnosis, a strong sports medicine doc can help you decide if the surgery is truly appropriate in your case.
A much more sensitive and telltale test, which is a more reliable test than MRI (in regard to whether you can play without surgery), is what we do on the sidelines at football games. If there is a knee with a suspected meniscal tear, we ask the patient to squat down like a duck! If there is no pain squatting like a duck and duck walking, chances are very likely there is no meniscus tear and no need for surgery.
If you have a "duck walk" negative test, I suggest you see a sports medicine physician familiar with runners. You need a real diagnosis based on your physical exam, not your film.
If you are "duck walk" positive, you probably do need arthroscopy. Make sure it is by someone who does this on runners regularly. If you do, your long running career should resume pain-free one month post-op after some good therapy.
Remember the meniscus is cartilage cushioning between the femur and the tibia of the knee. The medical side is a major stabilizer and most often when torn needs surgery. The lateral side doesn't do as much stabilization; it just cushions. So a lateral tear doesn't always need surgery if the pain is minimal or bearable. Blood supply comes from the periphery of the meniscus and decreases toward the center. For that reason a peripheral tear has responded well to Platelet Rich Plasma (PRP) injections.
Regardless of your decision to have surgery, PRP or nothing, a good knee strengthening program is always recommended to increase the efficiency of the joint.
I wish you luck. Let me know what you decide to do.
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