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Ugh. Knee locking? Displaced fragment.

I don't know much besides reading my MRI report. I'm waiting to hear from my PCP.

Medial Compartment: Nondisplaced horizontal cleavage tear in the posterior horn extending into the body segment with a peripheral para meniscal cysts posteriorly image 18 series 3 and peripherally image 24 series 5, image 19 series 2 in the setting of intrasubstance degeneration with intact root attachments. Preserved articular cartilage.

Miscellaneous: Physiologic joint fluid without effusion. Small intact popliteal cyst. No plica. Popliteal vessels demonstrate normal apparent flow voids. No muscle strain or atrophy. Intact and normal posterior tendons. No localized inflammatory changes, masses, fluid collections, or bursitis and subcutaneous tissues surrounding the knee. Impression: 1. Nondisplaced horizontal cleavage tear posterior horn, body segment medial meniscus with para meniscal cysts without surrounding inflammation or synovitis to suggest leaking joint fluid in the setting of intrasubstance degeneration with intact root attachments. Intact lateral meniscus. 2. Intact and normal cruciate, collateral ligaments. 3. Preserved cartilage throughout the knee. 4. Physiologic joint fluid without effusion. Smal intact popliteal cyst.

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Discussion

jpfrogmd 🏴‍☠️⚡️ 1y ago

im not a carpenter but that usually calls for a repair or partial meniscectomy

Dr. Bitcoin, MD 1y ago

I’m a fan of less is more. The menisci serve a similar function as ball bearings: the keep friction low between two surfaces that must rotate against each other. In the knee, these two surfaces are cartilage. The theory on which surgeons justify operative intervention on menisci is the hypothesis that such intervention can delay time until severe cartilage loss/damage. I would seek evidence in support of this theory; it may not hold in the case of nondisplaced meniscal tear. “Ectomy” means cut out…cutting out part of the cushion that’s in the wrong place (displaced) can help with symptoms like locking and clicking. How this helps with long term cartilage damage is a good question to ask.

I know an ortho surgeon that I trust that I would see if I had these questions (he used to operate in a group with Shawn Baker, if that name rings a bell). Be aware that most surgeons are paid to fix problems and might not be too picky on getting paid.

These are the questions to ask. Joint replacement is for severe cartilage damage, of which you apparently have none per report. If they want to replace the joint, run.

jpfrogmd 🏴‍☠️⚡️ 1y ago

Agreed. Let us never forget the HoG laws: “The delivery of good medical care is to do as much nothing as possible.”

Dr. Bitcoin, MD 1y ago

I like that.

I deal a lot with breast cancer, a disease for which we have good but not great screening tools for. There is always a substantial degree of uncertainty overall, even if we can be certain about individual findings. And there is always something “more” that can be done, usually at escalating levels of expense.

“Recommend” is a very important word in this setting as it means something akin to “based on large samples of women with this clinical presentation, there is substantial bang for the buck to do _blank_”.

But there are things that might be helpful but have low bang for the buck; breast MRI often falls in this zone…it’s expensive and screening with MRI finds more cancers but at the expense of a much higher rate of biopsy; for us to “recommend” MRI, we have to “stock the pond” if you will, to include patients at roughly 3-4x the average risk. But we don’t prevent patients from purchasing the service, as long as they know it triples the biopsy rate and the out of pocket expenses with such diagnostic adventures. It’s not my place to tell anyone how they must or should spend their money or how many needles should or shouldn’t be sampling them. I advise. I give probabilities in understandable terms.

Climbing this wall of worry is an expensive endeavor and can easily be abused by the unscrupulous. I fortunately work in a group of high integrity and uniform adherence to justified uses of imaging.