It’s well established that arthroscopic surgery that removes meniscus tissue in someone with pre-existing knee arthritis is not better than physical therapy alone, and has the potential to accelerate the arthritic process.  It’s the reason why that surgery should be cautioned in folks with knee arthritis and why other options should be pursued.  I recently evaluated a woman who presented with this exact scenario. As it so happens she also had a pre surgery MRI and a post surgery MRI split apart by two and a half months. What’s impressive about this sequence of MRIs is seeing how quickly and significantly changes develop in the knee after you remove the meniscus that was previously providing support.  

The image on the left was taken on 3/30/2014 prior to surgery. The yellow arrow shows the medial meniscus.

The image on the right was taken on 9/10/2014 after arthroscopic surgery removed 70% of her posterior medial meniscus. The red arrow shows the remaining meniscus. The pink arrows show bone marrow edema that represents significant stress that is being placed on the rest of the knee, specifically the medial femoral condyl and the medial tibial plateau. 

Knee MRI- post menisectomy, now bone marrow edema

The stress that is being placed on the knee will accelerate the arthritic process not just over years, but based on this exam within months after her surgery. It’s also where her pain is focused. A safer non-surgical option would have been an advanced platelet or stem cell treatment to treat her arthritis and meniscal degeneration.

 

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