Expert Commentary: Paul Meli MD, FACS 2/1/2010

Injuries to the cartilage of the knee; the meniscus, are one of the most common injuries seen in the knee. A wide variety of activities can cause damage to the knee ranging from professional sporting activities such as football, soccer, or tennis to routine activities of daily living such as working around the house, bending and squatting when playing with children or routine gardening. With cartilage injuries of this nature, there is typically very minimal swelling and the pain is typically minimal. The patient has a feeling of the knee buckling, locking, or giving out that is intermittent.

It is not uncommon for some days for the patient to say they have no pain what so ever. Typically when just walking, the pain is minimal. The only time the pain is reproduced is when patients are twisting their knee.  Typically, it is the medial “inside cartilage” meniscus that is most commonly torn.  The pain is typically radiating to the back of the knee and is made worse when people are sitting, bending or squatting.  It is not uncommon for men to tell me they have difficult time crossing their legs when putting their shoes or socks on and this makes the pain much worse.  

When patients call their primary care physician to report this type of pain, it is not uncommon for the primary care physician to be concerned about the possibility of a blood clot due to the fact that the pain in the blood clot is typically in the calf.  It is extremely uncommon for patients to develop a blood clot in the calf after a meniscal-type injury.  Blood clots are most commonly seen after major surgery such as hip or knee replacements that are extremely uncommon after this meniscal-type injuries or surgery for this meniscal injuries.  If left untreated, these meniscal injuries typically will worsen with time and will damage the articular cartilage of the knee.  This is the cartilage at the end of the thigh bone and the top of the shin bone.  Once this cartilage becomes irreparably damaged, it will lead to the need for a knee replacement. 


In terms of the long term results and prognosis, the best result is to diagnose the problem early and have early successful treatment; that is arthroscopic surgery and six weeks of physical therapy postoperatively.  This will allow the knee to return to a preinjury level.


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