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Meniscal tear, surgery or conservative management
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Meniscal tear, surgery or conservative management - September 23, 2005 2:51:00 PM
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yves
Posts: 32
Joined: October 1, 1999
From: Nanaimo, Vancouver Island BC Canada
Status: offline
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Hi folks:
My wife's lady friend, 5 foot 9 inches, possibly 210 lbs has a medial meniscal tear, with MRI evidence. This is WCB injury, twist and fall. The Orthopaedic surgeon,a WCB consultant, told her that he would not do surgery because she was too old, ( possibly 52 years old) and that she was too much overweight.
He gave her a $1,300.00 knee bace which is suppose to unload her medial compartment. She finds that this brace hurts her wear.
She is to find a new job possibly clerical.
I examined her knee, and she has essentially good knee flexion, but extension is limited at the inner most range, yet is corrected or restored following a traction manipulation for loose body.
She wants to have arthroscopic surgery to remove the loose fragment. Her treating physiotherapist concurs.
Other than the orthopaedic surgeon, we do not understand his reasons.
My question: is there evidence out there supporting this conservative management ?
I thought that with ongoing weight bearing on a deranged knee, the loose meniscal fragment would scour and gouge the hyaline cartilage and promote degeneration and osteoarthritis of the knee joint.
To have the College of Physicians and surgeons of the province get involved, I need some literature that demonstrates one way or another what happens if you leave this condition untreated.
I hope that some of the accademics out there might be able to help me out. Thanks a lot.
yves
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Re: Meniscal tear, surgery or conservative management - September 23, 2005 4:15:00 PM
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Jon Newman
Posts: 1706
Joined: April 24, 2004
From: Amherst, WI
Status: offline
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Hi Yves,
Here's quite a few links. It seems like your friend is between a rock and a hard place. There are lots of pluses and minuses. It seems like a partial meniscectomy portends OA.
[URL=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10919247&query_hl=1]link 1[/URL]
[URL=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9641438&query_hl=3]link 2[/URL]
[URL=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15346109&query_hl=5]link 3[/URL]
[URL=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15727883&query_hl=8]link 4[/URL]
[URL=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12428228&query_hl=10]link 5[/URL]
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: Meniscal tear, surgery or conservative management - September 23, 2005 6:02:00 PM
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steve
Posts: 470
Joined: May 14, 2003
From: Canada
Status: offline
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Yves,
I just tried to send you a long post with references only to loose it when I pressed the post button. Summary - she has strong predictors for poor outcome (Obesity, workers compensation, older age) and that meniscus tears are commonly seen asymptomatic patients. Are you sure that the tear is what is causing her pain? Does she have concurrent OA (Another poor predictor) and how long has she done conservative management? Is she getting true locking or did you do a traction manip and she got just slightly greater range?
She could always pay for a second opinion out of pocket.
Steve
PS pm me if you want the name of a good island surgeon who will give an honest opinion
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Re: Meniscal tear, surgery or conservative management - September 25, 2005 9:17:00 AM
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yves
Posts: 32
Joined: October 1, 1999
From: Nanaimo, Vancouver Island BC Canada
Status: offline
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Thank you Steve. this lady lives in Edmonton.
Having spoken to her just now, she states that although she felt an immediate improvement in her range, she now has a more pain full knee and more stiffness. I suspect that perhaps the limitation of inner range or end range extension was actually a defensive maneouver!! and perhaps now she is weight bearing through a range which is pathological in her articular tissue.
If she goes on her own with scope and repair or removal of meniscus, then WCB will wash their hands of her, however if she needs a Total knee replacement in a few years, then WCB will look after her.
I suspect that she will perhaps continue with conservative management.
yves
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