Should I Consider Surgery for My Knee Issues? Expert Insights

Is surgery necessary?

Dear Dr.
Shih,
I am 41 years old.

1.
Background: About six months ago, after a badminton practice, I first experienced pain on the inner side of my left knee.
Two weeks later, my left knee swelled with fluid, and 30 ml was aspirated at that time.
I was unable to run or squat.
Three months later, the swelling recurred, and I visited an orthopedic clinic where another 30 ml of fluid was aspirated.
X-rays of both knees showed a narrowing of the medial joint space, and the physician at the clinic diagnosed me with knee osteoarthritis.
2.
Subsequently, I underwent quadriceps strengthening exercises, electrical therapy, infrared therapy, and heat application, along with medication.
However, three months later, the swelling in my left knee returned, and this time 20 ml was aspirated.
3.
The physician at the clinic then recommended PRP (platelet-rich plasma) therapy.
After the treatment, I had an X-ray two months later, which showed that the joint space in my left knee had improved.
I was also able to jog and squat, although squatting still caused some pain.
Fortunately, I have not experienced any swelling in the past six months.
The physician at the clinic referred me to Taoyuan General Hospital for further evaluation.
An MRI at the hospital revealed: "Ligaments are normal, intact lateral meniscus; increased fluid in the suprapatellar bursa and left knee joint; medial meniscus tear; and osteoarthritis changes," with a diagonal tear in the medial meniscus.
The physician at Taoyuan General Hospital recommended surgery.
I would like to ask:
1.
Is it possible for me to avoid surgery and only receive PRP or amniotic growth factor treatments?
2.
If I choose not to have surgery and only receive PRP or amniotic growth factor, will I still be at risk for knee osteoarthritis in the future?
3.
I am concerned that if I choose surgery, is there a possibility of suture failure or re-tearing of the meniscus? If so, what percentage of patients do you see experience this?
Finally, I hope you can help clarify my confusion.
Thank you for your time and assistance.

Jie Ke, 40~49 year old female. Ask Date: 2023/04/20

Dr. Shi Guozheng reply Orthopedics

If the meniscus is torn, undergoing arthroscopic surgery can indeed improve the condition, while PRP (platelet-rich plasma) injections may not lead to complete healing.

Reply Date: 2023/04/20

More Info

Dear Patient,
Thank you for reaching out with your concerns regarding your knee issues. Based on the information you've provided, it seems that you have been experiencing significant knee problems, including swelling, pain, and a diagnosis of osteoarthritis and a meniscal tear. Let's address your questions one by one.

1. Non-Surgical Options: It is indeed possible to manage knee issues without surgery, especially in the early stages of osteoarthritis. Treatments such as Platelet-Rich Plasma (PRP) injections and amniotic growth factor injections can provide relief and potentially promote healing. These treatments aim to reduce inflammation and stimulate tissue repair. However, their effectiveness can vary from person to person. Since you have already experienced some improvement with PRP, it may be worth continuing this approach, especially if you can maintain a good level of function and pain control.

2. Long-term Outcomes Without Surgery: If you choose to avoid surgery and rely on PRP or other non-surgical treatments, it is important to understand that while these methods can alleviate symptoms and improve function, they may not halt the progression of osteoarthritis. The underlying degenerative changes in the joint can continue over time, potentially leading to further issues down the line. Regular monitoring and maintaining a healthy lifestyle, including weight management and appropriate exercise, can help mitigate some of these risks.

3. Surgical Concerns: Your concerns about surgery are valid. Surgical interventions, such as arthroscopy for meniscal repair or debridement, do carry risks, including the possibility of complications like suture failure or re-tearing of the meniscus. The likelihood of these complications can depend on various factors, including the specific surgical technique used, the skill of the surgeon, and your overall health and activity level. While many patients do well after surgery, it is essential to have a thorough discussion with your orthopedic surgeon about the risks and benefits specific to your case.

In conclusion, the decision to proceed with surgery or continue with non-surgical management should be made collaboratively with your healthcare provider. It is crucial to weigh the potential benefits of surgery against the risks and to consider your lifestyle, activity level, and personal preferences. If you feel uncertain, seeking a second opinion from another orthopedic specialist may provide additional insights and help you make a more informed decision.

In the meantime, continue with your rehabilitation exercises, maintain a healthy weight, and consider incorporating low-impact activities such as swimming or cycling to keep your knee active without excessive strain. Regular follow-ups with your healthcare provider will also help monitor your condition and adjust your treatment plan as needed.

Wishing you the best in your recovery and management of your knee issues.

Sincerely,
Doctor Q&A Teams

[Your Contact Information]

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