About two months ago, I injured my knee playing racquetball. The most significant symptom is that it hurts on the outside of the knee when I squat or go up/down a flight of stairs. By googling (before visiting a Dr.), I learned that it's the common symptom of a lateral meniscus tear.

So about two weeks ago, I visit an orthopedist that specializes in the knee, and suggests that I may have a meniscus injury. Then he tells me to get an MRI.
That same day I after getting the MRI (but without the radiologist's reading), I visit him again and by looking at the MRI images, he suggests that I have a lateral meniscus tear, and that arthroscopic surgery is probably needed. He's not entirely sure, so he tells me to come back with the radiologist's take on it.

So today I pick up and read the radiologist's readings of the MRI, and this is what I find very odd and confusing. The reading says that there's a joint effusion, an oblique tear of the posterior horn of the medial meniscus, an ACL sprain. But the lateral meniscus is intact. It says that there's some myxoid degeneration in the posterior horn of the lateral meniscus, but it's not part of the "IMPRESSIONS" list, so I guess it's not urgent.

I'm no doctor, but why doesn't the inner part of my knee hurt then? And why does the outer part of my knee hurt when I squat, if there's really nothing wrong with it.

I'm just wondering if I'm the only one that finds that very odd

Thanks again.

rbhatup

About two months ago, I injured my knee playing racquetball. The most significant symptom is that it hurts on the outside of the knee when I squat or go up/down a flight of stairs. By googling (before visiting a Dr.), I learned that it's the common symptom of a lateral meniscus tear.

So about two weeks ago, I visit an orthopedist that specializes in the knee, and suggests that I may have a meniscus injury. Then he tells me to get an MRI.
That same day I after getting the MRI (but without the radiologist's reading), I visit him again and by looking at the MRI images, he suggests that I have a lateral meniscus tear, and that arthroscopic surgery is probably needed. He's not entirely sure, so he tells me to come back with the radiologist's take on it.

So today I pick up and read the radiologist's readings of the MRI, and this is what I find very odd and confusing. The reading says that there's a joint effusion, an oblique tear of the posterior horn of the medial meniscus, an ACL sprain. But the lateral meniscus is intact. It says that there's some myxoid degeneration in the posterior horn of the lateral meniscus, but it's not part of the "IMPRESSIONS" list, so I guess it's not urgent.

I'm no doctor, but why doesn't the inner part of my knee hurt then? And why does the outer part of my knee hurt when I squat, if there's really nothing wrong with it.

I'm just wondering if I'm the only one that finds that very odd

Thanks again.

Before I read about the details of your injury I thought it was Illiotibial Band Syndrome, which has classic pain on the outside of the knee with the activities you just described. But this is a chronic type of injury often seen in runners, and your injury seems much more severe. It could be the ACL sprain which seems the most serious aspect of the injury. Radiating pain is common and with the swelling inside your knee, any part of it can hurt. Does it hurt to press on the outside of your knee, or the inside?

Anyways, it sounds like the orthopaedic and radiologist are in agreement so I would listen to them and forget about trying to diagnose your injury. Spend your energy and focus on getting healthy again.

I would ask the same questions to your doctors. Sounds odd to me and before anyone chopped into my knee I'd be really sure that they were operating on the correct item or what would be the point? Maybe they mixed up MRI's or something...

It's hard to say really. Depends on the effusion, sometimes that hurts as bad as the actual tear. Not to mention minor tears are can be missed on MRI's. Pretty much sounds like you'll need to surgery to clean it up regardless and once he gets in there with the scope he'll be able to see in there more clearly.

Thanks for the replies.

That's the problem: the radiologist and the orthopedist have completely different views. One says it's the lateral meniscus while the other says it's the medial.

I ended up going to a sports medicine clinic for some therapy and rehab, plus lots of rest for healing.

Maybe a third opinion?

Longtime lurker here, this post made me register to reply. . .

I'm no doctor, but I do have experience with this injury. I had a lateral meniscus tear with an ACL strain (partial tear) about 12 years ago. I was put in a leg immobilizer for 6 months and I eventually healed. I had trouble with my knee locking up throughout the next 10 years, but largely ignored my symptoms and treated with ice/compression until one day I decided it was time to go back to the doctor. I went back to the doctor in 2008 and they did an MRI, diagnosing me with a "complex lateral meniscus tear." surgery was recommended and I had surgery in Feb of 2008.
The orthopedic surgeon told me in my post operative recovery room that the tear was "the worst I've ever seen" and had to do a complete meniscectomy. He theorized that I had ignored the injury for long enough I had continually re-injured myself playing racquetball.
Long story short, I was on crutches for 3 months (a long time for a meniscus surgery) and I only recently (last month) felt comfortable enough with my recovery to play racquetball again. The doctor told me I should no longer play racquetball.
I never had any pain on the inside or outside of my knee, I only had periodic "lockups" of the joint.. I'd get a 3rd and 4th opinion, but DO NOT ignore it.

Thanks for the reply.

My biggest concern is not the injury itself, but who to trust. From experience it seems orthopedic surgeons do not have my best interests in mind. Just so you have an idea of what the doctors have told me...

* I go to an orthopedic surgeon, and the guy says that I may have a lateral meniscus tear and I should get an MRI. Keep in mind that it doesn't lock up or click. I only have pain on the outside part of the knee when I go down the stairs.
* I go to that same orthopedic surgeon with the MRI, and he says that my knee needs to be scoped because he 'sees' a lateral meniscus tear. He goes on with the "I don't treat images, I treat patients", and "I don't care what the mri reading says", but then says that he'd like to see the MRI reading. He wants to scope my knee, doesn't care what the MRI reading says, but WANTS to read it? Makes no sense.
* I go to a physician and he also says that I may have a lateral meniscus tear, but that therapy and exercise will be the bet way to go. He encourages me to get the MRI reading.
* I get the mri reading, and it only says that I have oblique tear of posterior horn medial meniscus... no lateral meniscus tear (where the pain resides). It only says that I have "myxoid degeneration in the posterior horn of the lateral meniscus".
* I go to the same physician, and says that the best way to go is therapy and rehab for a month.
* I go to another orthopedic surgeon with mri and readings, and he tells me that I have a lateral meniscus tear. I tell him about what the mri says, and he says "I don't treat images, I treat patients". I insist on the reading, but basically wants me to ignore it.

So, as you can see, every doctor says something completely different. I'm inclined to trust the radiologist and the physician because they don't benefit from the injury. For an orthopedic surgeon it's a $10K payday for a 20-min surgery.

I'm thinking of taking the MRI to another radiologist. I've let the knee rest for about 4 months (it feels better), and this month I'll do therapy and rehab, plus I'm swimming. In mid-october I'll begin playing racquetball again with a brace.

And I forgot to mention that the mri reading says that I have an ACL sprain (no mention of a tear), but both orthopedic surgeons say that, through their ckeckups, my acl is fine. So let me ask you... who am I going to trust?

It sounds rather sketchy to me as well.

It sounds as though the surgeon and the physician see things differently. I'd definitely get a referral to a different surgeon. Believe me when I say that surgery does not normally make anything better when it comes to knees, backs etc... You're best possible outcome is normally "not any worse." So, if I could get someone to say physical therapy would be the way to go, I'd jump on it and take it very seriously. It all comes down to whether you feel surgery is going to be better or worse than dealing with the pain you've got. If you'd go back and ask me before I had the surgery, knowing what I know now, I'd have passed on it (surgery).

I'd be hoping for PT, but prepared for surgery. I wouldn't let the guy who says "MRI's don't matter" do it either way. You're right to be wary, get somebody to give it to you straight.

Thanks for the post.

I'm hoping that the PT goes well.

Unfortunately two surgeons told me to disregard the MRI reading. In these cases, I think the best way to go is to take the MRI to another radiologist.

Pain doesn't have to follow a pattern and your brain takes priority first, so with multiple injuries you will get different pain registration. Post Horn is the most common meniscus location IIRC, and I believe is the most likely to heal under non-operative conditions. I believe it has the greatest blood supply which aides the healing process.

The overall picture in my limited, read your internet post, opinion is functional testing is what determines your condition here. In other words I've seen torn ACL's show no sign of instability and full participation in other activities without pain. A good sports Ortho is who you should consult for an in depth evaluation of your knees functional capacity. Best of luck for a speedy and safe return.

Forget the Radiologist's opinion. They are experts at taking pictures, not trained like a doctor to interpret them.

Definitely get another ortho doc's opinion. I speak from personal experience.

Vic Heat Fan

Forget the Radiologist's opinion. They are experts at taking pictures, not trained like a doctor to interpret them.

Definitely get another ortho doc's opinion. I speak from personal experience.

Actually Vic Radiologists are the experts are interpreting them not surgeons. Technologists are the ones doing the exams. I am a Technologist.

Hmmm.... My surgeon must have God complex cause he sure convinced me! I should have known!

Vic Heat Fan

Hmmm.... My surgeon must have God complex cause he sure convinced me! I should have known!

Very typical with surgeons actually.. But.. Here's a back round of Radiogist training..

Diagnostic radiologists must complete at least 13 years of post-high school education, including 4 years of prerequisite undergraduate training, 4 years of medical school, and 5 years of post-graduate training. The first postgraduate year is usually a transitional year of various rotations, but is sometimes a preliminary internship in medicine or surgery. A four-year diagnostic radiology residency follows. The Radiology resident must pass a medical physics board exam covering the science and technology of ultrasound, CTs, x-rays, nuclear medicine and MRI. Core knowledge of the radiologist includes radiobiology, which is the study of the effects of ionizing radiation on living tissue. Near the completion of residency, the radiologist in training is eligible to take the written and oral board examinations administered by the American Board of Radiology (ABR). Starting in 2010, the ABR's board examination structure will be changed to include two computer-based exams, one given after the third year of residency training, and the second given 18 months after the first.
Following completion of residency training, radiologists either begin their practice or enter into sub-speciality training programs known as fellowships. Examples of sub-speciality training in radiology include abdominal imaging, thoracic imaging, CT/Ultrasound, MRI, musculoskeletal imaging, interventional radiology, neuroradiology, interventional neuroradiology, paediatric radiology, mammography and women's imaging. Fellowship training programs in radiology are usually 1 or 2 years in length. [5]
Radiographic exams are usually performed by radiologic technologists, (also known as diagnostic radiographers) who in the United States have a 2-year Associates Degree and the UK a 3 year Honours Degree.

VinceB

Vic Heat Fan

Hmmm.... My surgeon must have God complex cause he sure convinced me! I should have known!

Very typical with surgeons actually.. But.. Here's a back round of Radiogist training..

Diagnostic radiologists must complete at least 13 years of post-high school education, including 4 years of prerequisite undergraduate training, 4 years of medical school, and 5 years of post-graduate training. The first postgraduate year is usually a transitional year of various rotations, but is sometimes a preliminary internship in medicine or surgery. A four-year diagnostic radiology residency follows. The Radiology resident must pass a medical physics board exam covering the science and technology of ultrasound, CTs, x-rays, nuclear medicine and MRI. Core knowledge of the radiologist includes radiobiology, which is the study of the effects of ionizing radiation on living tissue. Near the completion of residency, the radiologist in training is eligible to take the written and oral board examinations administered by the American Board of Radiology (ABR). Starting in 2010, the ABR's board examination structure will be changed to include two computer-based exams, one given after the third year of residency training, and the second given 18 months after the first.
Following completion of residency training, radiologists either begin their practice or enter into sub-speciality training programs known as fellowships. Examples of sub-speciality training in radiology include abdominal imaging, thoracic imaging, CT/Ultrasound, MRI, musculoskeletal imaging, interventional radiology, neuroradiology, interventional neuroradiology, paediatric radiology, mammography and women's imaging. Fellowship training programs in radiology are usually 1 or 2 years in length. [5]
Radiographic exams are usually performed by radiologic technologists, (also known as diagnostic radiographers) who in the United States have a 2-year Associates Degree and the UK a 3 year Honours Degree.

Get a second or 3rd opinion from an orthopedic surgeon. You can get copies of your MRI and bring it to the orthopod. Just because you have later pain doesn't mean it is not coming from the middle. Pain is often referred and cannot always localize a lesion.

rbhatup

Thanks for the reply.

My biggest concern is not the injury itself, but who to trust. From experience it seems orthopedic surgeons do not have my best interests in mind. Just so you have an idea of what the doctors have told me...

* I go to an orthopedic surgeon, and the guy says that I may have a lateral meniscus tear and I should get an MRI. Keep in mind that it doesn't lock up or click. I only have pain on the outside part of the knee when I go down the stairs.
* I go to that same orthopedic surgeon with the MRI, and he says that my knee needs to be scoped because he 'sees' a lateral meniscus tear. He goes on with the "I don't treat images, I treat patients", and "I don't care what the mri reading says", but then says that he'd like to see the MRI reading. He wants to scope my knee, doesn't care what the MRI reading says, but WANTS to read it? Makes no sense.
* I go to a physician and he also says that I may have a lateral meniscus tear, but that therapy and exercise will be the bet way to go. He encourages me to get the MRI reading.
* I get the mri reading, and it only says that I have oblique tear of posterior horn medial meniscus... no lateral meniscus tear (where the pain resides). It only says that I have "myxoid degeneration in the posterior horn of the lateral meniscus".
* I go to the same physician, and says that the best way to go is therapy and rehab for a month.
* I go to another orthopedic surgeon with mri and readings, and he tells me that I have a lateral meniscus tear. I tell him about what the mri says, and he says "I don't treat images, I treat patients". I insist on the reading, but basically wants me to ignore it.

So, as you can see, every doctor says something completely different. I'm inclined to trust the radiologist and the physician because they don't benefit from the injury. For an orthopedic surgeon it's a $10K payday for a 20-min surgery.

I'm thinking of taking the MRI to another radiologist. I've let the knee rest for about 4 months (it feels better), and this month I'll do therapy and rehab, plus I'm swimming. In mid-october I'll begin playing racquetball again with a brace.

And I forgot to mention that the mri reading says that I have an ACL sprain (no mention of a tear), but both orthopedic surgeons say that, through their ckeckups, my acl is fine. So let me ask you... who am I going to trust?

A sprain can show up as inflammatory changes under MRI...doesnt mean that a physical exam will be positive. The surgeons just check for ACL laxity. You should just get multiple opinions from other doctors. They know what they are doing, most of the time.