I have been laid up with an ambulatory problem for the past week. So bad that I have been unable to return the usual “wai’s” from the staff. I just hope they don’t think I am being rude.
What is this affliction, I hear you ask. Well, it is a tear of the meniscus cartilage in my right knee, which has needed me to use a walking stick to get around. And you can’t “wai” with a walking stick!
Those of you who have had a torn meniscus cartilage, will attest that it is damn painful. The cartilage works like a shock absorbing cushion and load-bearing surface between the thigh bone (the femur) and the lower shin bone (the tibia). And quite honestly it has almost laid me up!
Most sufferers will remember a slip, or a twisting of the knee under load, which makes this very common with sportsmen, especially rugby and soccer players. My days as a sporting hero on the field are long since gone (in fact never started) and I only remember a very mildly twisted knee going up some steps, the day before I began to notice a problem.
What happens, is that while asleep the torn cartilage provokes some swelling in the knee and you only know there is something wrong the following morning. And by that stage you can hardly stand, and the range of movement in the knee joint becomes limited.
That reminds me of the wonderful joke about the orthopedic surgeon and the go-go dancer, where the doctor addresses the knee, saying, “What’s a nice joint like you, doing in a girl like this?” (A parody of the title “What’s a Nice Girl Like You, Doing in a Place Like This?” the 1963 short film by Martin Scorsese.)
But back to my acute knee (acute as opposed to cute), my orthopod, Dr. Suradej, made the diagnosis from the clinical examination and symptoms, but suggested that an MRI (Magnetic Resonance Image) was needed to see the extent of the damage inside the knee. I said I would postpone that test to see if the knee would get better on its own, and Dr Suradej suggested a hydrocortisone injection into the knee joint for the time being.
Let me tell you that hydrocortisone is wonderful. All symptoms gone – but it only lasts around two days and it is back to square one – and you cannot have repeated injections either! Damn!
So it was back to limping, and back to Dr Suradej and the request for the MRI. The MRI is non-invasive, though it takes around 40 minutes lying there with your legs inside the scanner’s tunnel, but at least your head is out, so it isn’t claustrophobic. The final picture was evaluated by the radiologist who happily told me I had osteoarthritis (OA), as well as the torn meniscus cartilage.
So were my symptoms from OA or the torn cartilage? No contest as far as I am concerned, my left knee is exactly the same age as my right knee, and it is not giving me any problems at all. Putting the symptoms down to OA is then a classic case of attempting to treat the test, instead of treating the patient!
I have to bow to the fact that I am somewhat older than the average soccer player, and the wear and tear to the cartilages is such that it becomes easier for one to tear with relatively minor trauma. A slip or twist while the right knee was under load is enough to produce the problem for that knee.
Treatment comes next, and with meniscus tears this is complicated by the fact that the cartilage does not have a good blood supply, so healing is going to be slow (if indeed at all possible). Factor in other items such as weight and age and spontaneous healing becomes far from ‘spontaneous’!
Conservative treatment is then anti-inflammatory medication, some pain killers and judicious physiotherapy, and a walking stick!
If that fails, then it will be operative intervention, usually with an arthroscope inserted into the knee joint to trim the torn cartilage. This has good results, but not something to leap in as first choice!