Fast Track Yourself to a Knee Replacement: Get Arthroscopy!
Patient thought her arthroscopy was for meniscal repair, but she received a resection - the case of Brenda from Boston Prolotherapy would have been a much better option!
Brenda from Boston came to Caring Medical with the desire to avoid getting bilateral knee replacements. She was already told by a surgeon that she was a great candidate for knee replacement surgery. Brenda is 70 years old. When she was 54 she received bilateral arthroscopies on the same day! According to Brenda during her first visit, she said she had meniscal repairs and that was the reason for her arthroscopies in 1994. Let me ask you this. Do you see anywhere on her left knee arthroscopy report below that Brenda had meniscal repairs? It looks like they were removed to me! (See reports below).
Initial Evaluation: 10-5-94
Diagnosis: 1. Torn medial meniscus left knee
2. Torn medial meniscus right knee
3. Status post right lateral meniscectomy
HPI: Fifty-four year old female who is active playing golf and tennis. She has had left knee problems for about a year, but it has been quite bothersome over the last six months. She was not able to play tennis this summer because of pain and she reports swelling in the knee. The right knee over the last couple weeks has also begun to become symptomatic with pain in the medial aspect and occasionally locking of the knee.
PE: Small effusion to the left knee, tenderness in the medial joint line, (+) McMurrays sign, no instability. In the right knee, she has arthroscopic portals which are well healed, tenderness in the medial joint line posteriorly and mild pain with McMurrays maneuver. No fluid in the knee today.
Standing AP, Routine Lateral and Sunrise x-rays of both knees reveal no bony abnormalities.
Recommendations: Ive recommended bilateral arthroscopies with medial meniscectomies. I gave her the option of MRI scans, but she is claustrophobic and prefers not to have these done. Shell be scheduled in the near future.
Preoperative diagnosis: Torn medial meniscus, left knee
Postoperative diagnosis: Torn medial meniscus left knee, grade III and IV chondromalacia left medial facet, left patella.
Procedure: General anesthesia with endotracheal intubation. One gram of IV Kefzol. Tourniquet control of leg holder were used. Routine prep and drape. Arthroscopy revealed a degenerative flap tear with horizontal component of the posterior horn of the medial meniscus. This was trimmed with the basket forceps and shaving device. There was some mild grade II and III chondromalacia on the posterior aspect of the medial femoral condyle. The anterior and posterior cruciate ligaments, lateral meniscus and lateral articular surfaces were normal. The patellofemoral interval revealed a normal trochlea, but there was over most of the area of the medial facet of the patella, areas of grade III and IV chondromalacia. The loose articular cartilage flaps were debrided and chondroplasty was performed, suctioned dry, injected with Marcaine and epinephrine and a dry, sterile compression dressing was applied. She tolerated the procedure well.
Postoperative diagnosis: Torn medial meniscus right knee, grade III and IV chondromalacia right patella, medial plica right knee.
Procedure: General anesthesia with endotracheal intubation. One gram of IV Kefzol. Tourniquet control of leg holder were used. Routine prep and drape. Arthroscopy revealed a horizontal tear of the posterior horn of the medial meniscus with a flap component posteriorly. This was debrided and excised with the basket forceps and shaving device. Chondral surfaces medially and laterally looked normal, as did the anterior and posterior cruciate ligament and the lateral meniscus. There was a medial plica abutting the medial femoral condyle and this was excised. The loose articular cartilage flaps were debrided and chondroplasty was performed, suctioned dry, injected with Marcaine and epinephrine and a dry, sterile compression dressing was applied. She tolerated the procedure well.
Let me say this again you need to look at your arthroscopy reports because you may be shocked to find out what was actually done! Brenda ended up with partial bilateral meniscectomies. This means that back in 1994 she probably had most of her medial menisci removed both on the same day!
The meniscal tears were not repaired, they were removed! In other words, most of the cushion of the inside part of her knees was removed. Guess what Brenda complains of now? You are correct bone on bone cartilage degeneration. The surgeon now wants to perform bilateral knee replacements!
Read your arthroscopy reports! More importantly, if you are contemplating arthroscopy, at least get a Prolotherapy evaluation before going right for surgery. Almost all (99%) people who look at their arthroscopy reports will realize that Prolotherapy is a better option. Almost all (99%) will reveal chondromalacia or that the orthopedist removed a large part of the meniscus! Left alone post-surgery, a knee with 60% of the meniscus removed (yes, that is the typical partial meniscectomy) will quickly develop severe degenerative arthritis. A quick ticket to severe degenerative arthritis is also a fast way to being faced with a total knee replacement. If you or a loved one wants a knee replacement, then sign up for arthroscopies. However, if you are like Brenda and think you received a meniscal repair so that seven years later the doctor did more arthroscopies to clean up the joint, think again! Why did the joint need cleaning up? Because the knee became arthritic due to the meniscus removal done back in 1994! There has to be a better way.
The better way is Prolotherapy. But before we start talking about Prolotherapy, I just wanted to mention one other point. Brenda received a lot of anti-inflammatory medications and cortisone shots from her traditional medical doctors prior to seeing us at Caring Medical. If you have not read our extensive article on cartilage degeneration caused by NSAIDs, click here to read it. After reading that article, you will hopefully stay far away from NSAIDs!
Back to Brenda lets see Brenda had one, two, three, four standard medical treatments that all contributed to the further degeneration of her cartilage. Is it any wonder that Brenda is having a difficult time walking now? I am telling you, there has to be a better way! That way is Prolotherapy.
Fortunately for Brenda after four visits to Caring Medical (Yes, she traveled from Boston, as many of our clients do), she was back to golf, gardening and paddle ball. Ill be honest with you, I dont know much about paddle ball. However, but I would think that a 70 year old who was told she needed bilateral knee replacements who now is able to play paddle ball after Prolotherapy would be pretty good evidence that the Prolotherapy is stimulating repair. What do you think?
If you want to learn more about Prolotherapy as an alternative to knee pain, consider reading the book Prolotherapy: An Alternative to Knee Surgery where we have written a lot about treating knees with Prolotherapy, as well as outlined some of the problem with traditional therapies. This book is available at amazon.com or benuts.com.
Most patients with severe knee pain from osteoarthritis require Prolotherapy about every four weeks. Depending on the severity of arthritis, they will need anywhere from 4 to 8 visits. I can generally give most patients an approximate number of visits I feel it will take and if there is anything else that needs to be addressed. In Brendas case, we also addressed her hormone issues and she began natural hormone replacement therapy, which also helped jump start the healing process! Why would a 70 year old take hormones, you may be thinking? This is one active 70 year old! She also wanted to get back to playing tennis! This is how we all should be when we are 70 years old!
I wrote this short article so that you could view Brendas arthroscopy reports through a different set of eyes and let you know that even a smart active lady from Boston such as Brenda was totally uninformed regarding her 1994 arthroscopies! She received no meniscal repair, just meniscal shaving/removal! If you have had a meniscal injury, what would you rather do? Stimulate repair with Prolotherapy in an office setting or undergo general anesthesia and have an orthopedist remove your meniscus? What will be best for you long term? If you have already gone down the traditional route and received or are still taking NSAIDs, cortisone shots, and arthroscopies, I unfortunately think that you are just waiting around in your rocking chair until you succumb to a knee replacement surgery. In my opinion, it makes much more sense to see if Prolotherapy can get you back to an active lifestyle! Most likely it can! If you would like to send us your report to review your MRI, you can always email it to email@example.com.
Until the next injection, Ross A. Hauser, M.D., Physiatrist, Editor-in-chief Journal of Prolotherapy