I have a radial tear in my right meniscus. Actually, the orthopedic PA said, “It’s beginning to fray”. But I get ahead of myself.
About a year ago, I started having some twingy pain in my right knee. It came and went and wasn’t really causing me any problems so I ignored it … like you do. Last fall it started to get worse, and I was finishing hikes with my knee feeling sore and tired. I could power up hills with no problem, but going down, when my free leg was just swinging in the mountain breeze, was starting to be increasingly uncomfortable. And God forbid I knock that free leg against a rock or slip and put lateral pressure on that knee – that would send me through the … well, let’s just say that it was a good thing that there was nothing above me but sky. Except tree limbs … and the occasional rocky overhang. I prefer not to think about it. Regardless, it was starting to seriously interfere with my enjoyment of the trail, so I decided to get serious about fixing it.
Several months prior, I had gotten the knee x-rayed; that film brought no clarity. So, after my New England hiking trip (read here, here, and here), I got myself an appointment with an orthopedic surgeon. He ordered an MRI. Yay. I dragged my feet on that, but on February 18 I finally got my shit in one sock and went for the test. When I arrived, the technician asked me the routine questions: “What medications are you taking? Are you allergic to sulfites? Have you been cutting metal recently?”
That seemed out of the blue. What made the random question seem prescient was my answer. My job as a theatrical designer and production manager does not typically require metal work. I have probably needed to cut metal about twice in the last twenty years. The second of those instances occurred on each of the three days immediately prior to this appointment. Had I not procrastinated, putting off this test by several weeks, my answer would have been an easy “no”. Instead, it was a puzzled, “Uh, yes”. The tech’s face clouded. “Welp,” she said, “we’re going to have to x-ray your eyes before we can get you into the MRI.” Damn it. It was my own fault – the metal I was cutting was for scenery of my own design.
“‘Metal workers can get little shavings of metal in their eyes and not even know it,’ explains Dr. Alex Georges, a CDI Musculoskeletal Radiologist. ‘The risk with metal in the MRI is that it can heat up and cause burns or it can migrate or move around.‘”
The tech marched me down to x-ray and plopped me down on a chair in a small waiting area where I sat, muttering about how I had picked a lousy time to decide to design something in steel. Fortunately, the wait was not too long. In a twinkling, I got my peepers irradiated and was cleared for the MRI. Always wear your safety glasses, kids.
So, after forty, loud minutes in the click-clack machine I headed home to await my results. They were as follows:
EXAMINATION: MRI RIGHT KNEE NO CONTRAST, 2/18/2021 3:45 PM EST
TECHNIQUE: Multiplanar, multisequence MR imaging per standard departmental protocol.
IMPRESSION: Radial tear at the junction of the medial meniscal body and posterior horn. No additional internal derangement seen.
Well, I guess I was glad to discover that my knee was not excessively “deranged” … but what does all this mean? What exactly is a “radial tear at the junction of the medial meniscal body”?
“A torn meniscus is one of the most common knee injuries. Any activity [like hiking?] that causes you to forcefully twist or rotate your knee, especially when putting your full weight on it, can lead to a torn meniscus.
Each of your knees has two C-shaped pieces of cartilage that act like a cushion between your shinbone and your thighbone (menisci). A torn meniscus causes pain, swelling and stiffness. You also might feel a block to knee motion and have trouble extending your knee fully.
Conservative treatment — such as rest, ice and medication — is sometimes enough to relieve the pain of a torn meniscus and give the injury time to heal on its own. In other cases, however, a torn meniscus requires surgical repair.“
Rest and icing were not helping, so, what was the next step? Surgery? Fortunately, the answer was no – there was an intermediary option. I returned to the orthopedic surgeon. There I learned that this “fraying” of my meniscus was typical, and even expected, at my age. Many people experience no pain from this “wear and tear”, which could not be a more apropos description. I was not so lucky. “So what do we do?” I asked. “I’m going to give you a shot of cortisone,” the PA told me, “that should reduce the inflammation and alleviate the pain.” I explained that I was a hiker and asked if this was a long-term solution. The PA explained that the only other option was to surgically remove the meniscus. That might more effectively alleviate the pain in the short term, but, without the cushioning action of the meniscus, my knee would eventually begin to hurt chronically – and cortisone wouldn’t help. “Okay,” I said, “stick me!”
That sounded pretty enthusiastic. While I was keen to be rid of this niggling pain, I was definitely not enthusiastic about this injection. A couple of years ago, I was the lucky recipient of a cortisone shot to my ankle. The doctor twisted the needle in various directions in order to better distribute the steroid. It was not comfortable. At all. This time I felt little more than a pinch, then the sensation that a pint of fluid was being garden-hosed into my knee. I could see the syringe; it couldn’t have held more than a half-ounce. Actually, it was a total of five cubic centimeters (one-sixth of an ounce). The feeling was strange but not uncomfortable. The administering physician explained that the knee is like a balloon, and even though the tear was on the inside of the joint, the medicine, which was injected into the outside of my knee, would, as he put it, “get there”. Five minutes later I was on my way home.
So, that’s where we are. The cortisone is supposed to reach full efficacy in a few days to two weeks. I can get these injections as often as every four months if necessary and can compliment them with oral anti-inflammatorys. The injection may keep the pain away for much, much longer. I shall remain hopeful and celebrate by getting back out on the trail. And I’ll keep you updated. And now that we’ve had a chance to discuss my meniscus, hopefully I will have no more need to diss / cuss my meniscus! ♦