Left Knee Arthroscopic Debridement / Meniscectomy

This shows the insides of the left knee of a 68 year old patient with osteoarthritis (lateral compartment more affected than the medial compartment). Patient's symptoms include impingement & foreign body sensations, pain (especially on weight-bearing & ambulation), joint effusion/swelling, reduced range of motion.

Just looking at the X-ray images alone, it's clear that the patient is a candidate for total knee joint arthroplasty. However, the patient is still not ready for such a procedure; and the patient DOES have mechanical signs -- (+) McMurray & (+) jointline tenderness, in particular. This arthroscopic debridement serves as a stop-gap measure, something that will buy the patient more time until the patient is ready for that joint replacement surgery.

Arthroscopic findings:
hypertrophic fat pad & medial plica
lots of inflammed synovial tissue (not surprisingly)
Grade 2-3 cartilage lesions of the medial, lateral & patellofemoral joints
no Grade 4 lesions thus far (exposed subchondral bone)
no free cartilage fragments floating about
degenerative tears of the lateral meniscus free border (which I trimmed off)
what appears to be a "lateral hypertrophic plica" (which I chompped & trimmed off)

I scoped both left & right knees; but the right knee was a lot less inflammed, and had no meniscal tears, so it was a breeze to do compared to the left knee.

About 36 hours after surgery, I was with the patient and patient's next of kin (I happen to be a family friend); we had lunch, went shopping at the local mall, and enjoyed the rest of the afternoon prior to their flight back to Manila. By the time they reached Manila, patient was already striding faster & more confidently, with significantly improved range of motion -- but most importantly, patient was walking PAIN-FREE.

Yes, they flew here to Cebu just to have this procedure done -- they wanted me to do it, and they wanted to avoid the huge expense which they would've otherwise incurred in the process, had they done this procedure in a big private hospital in Manila.

Cost of having the procedure done here was around P45k, the sum total of O.R. charge, plus O.R. surcharge, plus confinement of one day, plus medications. O.R. fee got a 35% surcharge because we extended past 5pm (patient's flight to Cebu got delayed by over an hour, so the procedure got started around 4pm instead of 3pm). But that total hopital bill is still without the senior citizen & PhilHealth discounts!

Anesthesiologist charged P15k net professional fee, but I of course didn't charge (since I consider the patient & next of kin like extended family anyways). Although, even if I was to post my own fee, the total expense still comes out cheaper than if they had the procedure done in Manila. This way, they managed to save a considerable amount, and even got a chance to vacation a bit in sunny Cebu for a couple of days.

Oh yeah, they say that if they ever have that joint replacement, they'll most probably fly back here and have it done by me. Wise choice -- save about 40% to 50% on total hospital & doctor expense if they have it here in Cebu versus there in Manila; same quality of services anyway.

^_^

Category:

Education

Tags:

• knee
• osteoarthritis
• arthroscopy
• meniscal
• degenerative
• tear
• plica
• meniscectomy

[mrforest123]

Hi dr, i just want to ask ur medical opinion. I am 20 years old male, 1 and half years ago i got left knee meniscus injury probably lateral meniscus. One month after the injury i got better for a while and then the symptom came back untill now. I can walk but i can feel something catching when xtending and flexing my knee, could it be the torn piece of meniscus? i cannot stand for a long time. also a lot of popping sound from the knee, especially when flexing fully. thank you doctor

[d36u9]

@mrforest123

the symptoms you describe sound like those of a meniscal tear that got bigger over time. get an MRI scan of your knee. minimize weight-bearing & walking/running for now. go see an orthopedic surgeon -- the type who does arthroscopic knee surgery (which i'm willing to bet would be something you're gonna need for your knee).

[mrforest123]

@d36u9 iam getting my scope next month, now i am just staying home. what do u think my prognosis would be like?

[d36u9]

@mrforest123

it's hard to state your prognosis without knowing other data, like how old you are, how active you are, what internal problem is being suspected in your knee & how did you sustain this problem/injury. also, what appears upon doing the scoping matters a lot -- sometimes a different problem is discovered all together once the inside of the joint is revealed.

[2mariebl]

Thanks for sharing

[d36u9]

@2mariebl

you're very much welcome. ^_^

[d36u9]

will the patient's knee cartilage continue to wear out? YES, definitely.

will knee pain return? YES also.

how soon will knee pain return? given that no subchondral bone was yet exposed, and given that it was only the weight-bearing areas that showed cartilage wear, i'd estimate a year's worth of good pain relief. but that's just a rough estimate. progression really depends a lot on how active she'll be from here on.

did she know all this prior to flying here? most definitely YES! ^_^

[d36u9]

before some people rise in arms to protest, let me make it clear:

the indication for doing arthroscopy was the meniscal symptoms/signs of the patient's knees -- not the osteoarthritis per se. arthroscopic debridement may alleviate degenerative / inflammatory knee pain, but it does not repair the worn out cartilage. OA is a problem due to cartilage wear&tear, the definitive treatment of which is total joint replacement (arthroplasty).

[d36u9]

If this were done in Manila, P45k wouldn't even fully cover the O.R. fee ALONE! (P45k used to be the O.R. fee for arthroscopic meniscectomy procedures under spinal anesthesia in the hospital where I trained in -- but that was back in 2007, when I first started my practice. You can imagine how much that O.R. fee has gone up now, especially with the rapidly rising cost of healthcare in Metro Manila.)