This 41-year-old male recreational football player presents two weeks following a minor twisting injury. He described developing localised medial knee pain and swelling the morning after the injury. On examination he was found to have a moderate effusion, localised medial joint line tenderness and pain with tibial rotation (McMurray’s test).
X-ray imaging was completely normal. MRI sequences showed linear increased signal within the posterior horn of the medial meniscus suggestive of a cleavage type tear. The articular cartilage is normal. There is a large bakers cyst.
An initial attempt was made to manage this injury non-operatively. A period of activity modification (avoiding running, squatting and pivoting) combined with regular Physiotherapy was trialled. Unfortunately, his pain persisted, and he eventually underwent an arthroscopy with partial medial meniscectomy three months after his initial injury. Over the next six weeks his symptoms improved, and he was able to return to football. He remains asymptomatic nine months after the surgery.
Partial meniscectomy is not a benign procedure and is clearly linked to post-traumatic osteoarthritis. It is important to clearly council patients that the operation will not make their knee ‘normal’. This may mean that they have ongoing symptoms and that they may be at an increased risk of osteoarthritis. There is also a chance the procedure may make their symptoms worse. In addition to this there is increasing evidence that surgery may be no better than time and/or physiotherapy. While this procedure has its limitations, it can be useful on a case by case basis (as this patient illustrates). In general, a trial of non-surgical treatment is advised for up to three months. In cases where this treatment fails, and the articular cartilage is preserved, a partial meniscectomy (with informed consent) could be considered.
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