Hello Doug,
The length of the tear and its location radially (from the thick to
the thin side distance) will determine the limitation the resection
will impose on knee function. The term "complex tear" usually
dictates tears in more than one plane, radial, vertical or horizontal;
some combination. If the tear is long circumferentially (vertical)
and close to the posterior (thick or back) side of the posterior horn,
the remaining portion will not act as an ancillary stabilizer
especially in the posterior direction. In contrast, if more of the
posterior rim remains after a menisectomy it will perform this job
better. If too thin then it may roll when loaded.
Since the report indicates that the tear is in the posterior horn and
doesn't mention the body (middle section between the anterior horn and
the posterior horn), you may not have a bucket handle tear which is
good. Short vertical tears typically do well with inside/inside
suturing if the blood supply is good; a recently injury. Post op
rehab limiting range of motion with repaired poeterior tears helps to
reduce weight bearing while the "fresh and bloody" vertical pieces
grow back together. Problem is that capillaries supplying o2 to
connecting tissue are predominantly growth capillaries. This means
that their ability to supply o2 diminishes over time. The older you
are the longer the healing takes.
Tough part is resecting in this area. This is due to location,
access, and available instrumentation. Traditional instrumentation and
techniques for arthroscopic meniscal resection include various angled
handheld basket punches, scissors, and rotary mechanical shavers. The
problems is that good outcomes typically occur due to obtaining
acceptable resection edge contours which are difficult to achieve and
manual instrumentation access to the posterior horn area is difficult,
especially so in medial compartments. Unacceptable edge contour
examples include superior leaflet (flap on the top like a surf
wave)remnants and rough surfaces. The spot is just hard to get to.
What percentage of the tear is removed is dependent on how big the
area that is torn. Calculating this requires a good MRI tech and both
a lateral and coronal view slices. Wherever there are tear(s) tissue
should be removed.
Will you be able to return to your activities you ask. You are
apparently not overweight and active in balance required activites.
It is the landings that impose the greatest forces when balance is
lost and in sports where balance can be affected by opponents
(basketball), even without any injury the risk of injury is greater.
In you case reinjury risk is greater than say swimming, etc.
The alternative, doing nothing, will inevitably take you down the road
to osteoarthritis so rather than pain with certain activities, you can
have pain in various degrees more of the time when mayby doing nothing
or sitting or standing in certain ways. Maybe so within 10 to 20
years, significantly, maybe not. You certainly won't end up with an
18 year old knee in either event (surgery or doing nothing).
You may also have other injuries that were missed by the radiologist
(they're human and only as good as their rad tech takes images).
Finding a good surgeon is very important and sometimes being able to
do that is not easy.
Regards |
