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Sports Medicine

Treatment of Meniscus Blunting

02/15/2011

Question:

A left knee MRI revealed the following: (1) Mild blunting of the free edge of the body and posterior horn of the meniscus (2) Small joint effusion and Baker`s cyst (3) Moderate patellofemoral degeneration with near full thickness fissuring along the lateral facet.

Surgery (partial menisectomy) has been recommended. Issue has been going on for about 4 months now and symptoms have progressed (more pain, more catching, more clicking and snapping when walking). My question is this:

Will a cortisone injection or any other conservative therapy solve this problem or is surgery the only sure way to fix the issue?

Answer:

An MRI scan may or may not reveal the basis for a person's symptoms. Although this MRI report doesn't mention a meniscus tear, that doesn't necessarily mean the meniscus is not symptomatic, and meniscus tears don't always show up on an MRI scan. However, the most significant finding noted in this MRI report is the patellofemoral degenerative changes, which may or may not be responsible for or contributing to the symptoms you've noted.

Before part of a meniscus is removed, it would of course be preferable to be fairly certain the meniscus is the cause for a person's symptoms. Whereas removal of meniscal tissue is irreversible, less drastic treatment options would include cortisone (steroid) injection, a trial of knee bracing, Physical Therapy, oral and/or topical anti-inflammatory medications, activity modification, cross-training, weight loss if appropriate, etc.

The best treatment for this knee problem needs to be based on an accurate diagnosis. So you should discuss with the surgeon how certain is it that the meniscus is the cause for the symptoms, whether nonsurgical treatment options have been exhausted, and the long term implications if partial meniscectomy were to be performed.

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Response by:

Brian L Bowyer, MD Brian L Bowyer, MD
Clinical Associate Professor
Physical Medicine & Rehabilitation
College of Medicine
The Ohio State University