Arthroscopic meniscal tear repair may not be enough: When a meniscal tear actually means total knee replacement.

Arthroscopic meniscal tear repair may not be enough: When a meniscal tear actually means total knee replacement. 1024 535 Best Practice Health TV

From our YouTube channel visitor:

“I tore my medial collateral ligament and medial meniscus. I had the steroid injection which lasted about a month. I then had three injections of hyaluronic acid. I’m 52 and active so I really do not want a knee replacement. One day last week I was carrying an IV pump, a bag of IV fluids, and another machine and I had a sudden sharp pain and felt like my knee gave out and I dropped everything. I’m trying to prepare my boat to go sailing around the world, so I need my knee to work without fail.”

Zonkers. That boat trip around the world sounds really good right now. But you are super smart to take care of your knee first. I’m glad you sent the comment because it sounds like you are on the wrong track.

You have severe knee pain after an industrial incident and a torn meniscus despite physical therapy, intra-articular steroid, hyaluronic acid, and stem cell injections. You mentioned MRI; however, in my mind that’s the wrong test to decide what you need to do next.

What you need is an x-ray. Radiologists use the Kellgren-Lawrence scale to rate arthritis from 1-4. If you are a 3 or a 4 then meniscectomy or even arthroscopic meniscal tear repair is not likely to get you back on the boat.

How to tell if you need a total knee replacement

I get that you don’t want a total knee replacement; however, you may need one. The are three reasons why total knee replacement is done:

  1. Severe knee pain in several episodes lasting longer than 3 months.
  2. Failed physical therapy, NSAIDs, and in your case steroid, HA, and stem cell injections.
  3. X-ray evidence of at least grade III arthritis.

Fifty-two is certainly not old, but these days no one is too young for total knee replacement surgery. The Australian Registry data shows the likelihood of your new knee failing over 20-years is less than 6%. And there is no sign yet the numbers won’t look similarly impressive in ten more years.

This has big implications for you because you are probably seeing the wrong knee doctor. Meniscal tears are best treated by board-certified orthopedic surgeons who specialize in sports medicine. What you need now is an orthopedic surgeon who specializes in joint replacement. What you want is a 5-star surgeon.

I’m sorry you’re dealing with all this right now. And this was not the advice you were looking for. I worked with nurses my whole career and they are amazing. But I don’t think even you are  going to be able to sail around this world without a new knee.