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Should I or shouldn’t I? That is the eternal question that occurs in so many aspects of life: Should I or shouldn’t I eat that twelfth doughnut? Should I or shouldn’t I buy that oceanfront property in Mariland? Should I or shouldn’t I enter that karaoke competition even though I sing like a cat that fell in a pool?
Some of these questions have easy answers. When your knee is clicking or locking, throbbing with pain, or swelling like a balloon, you might suspect a meniscal tear and make the easy decision to go to the doctor. However, your first thought may be, “Oh, great. Will I have to have surgery now?” Despite these fears, surgery is not necessarily inevitable, even in the case of degenerative meniscal tears.
The meniscus is a horseshoe-shaped cartilaginous pad that cushions the meeting points of the femur and tibia bones. Its rubbery thickness acts like super fancy basketball shoes protecting the joint from impact. Unfortunately, some weight-bearing, twisting movements can tear the pad. Even if you’re not an athlete, normal use can cause degeneration of the tissue and make it more susceptible to injury.
There are four main problems evident in patients with painful tears:
● impaired kneecap movement
● restricted muscle use due to pain
● swelling
● impaired stability and balance
Symptoms can also include clicking and popping sounds, and locking or catching of the knee joint.
While pain can be a symptom, it is not a requisite symptom; a study has shown 76 percent of people with no knee pain have had a meniscal tear.
While it is more likely for a tear to happen over age forty, wear and tear of the meniscus can start as early as twenty years of age. 25% of twenty year olds show signs of meniscal degeneration.
Through six studies over twelve years, the British Medical Journal concluded that meniscal tear surgery is not necessarily more effective at relieving pain or improving knee function, and even suggests that it’s “Time to stop meniscectomies for degenerative tears.” Similarly, the American Academy of Orthopedic Surgeons says, “We are unable to recommend for or against arthroscopic partial meniscectomy in patients with osteoarthritis of the knee with a torn meniscus.” They only recommend surgery for acute tears.
Physical therapists have many different therapy options to help control knee pain and start you on the path of strengthening the joint. Medical cupping and myofascial release can relieve tension in the fibers and soft tissues. Even something so simple as a taping technique has helped 70 percent to 80 percent of our clients walk with less pain.
Below is a prime example of how ultrasound can take the guesswork out of diagnosis.
A bad physical therapy experience is one of the primary causes of unnecessary surgery
In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.
Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.
The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.
Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup
Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)
Complete tear of rectus femoris
with large hematoma (blood)
Separation of muscle ends due to tear elicited
on dynamic sonography examination
