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Fast Track Yourself to a Knee
Replacement: Get Arthroscopy!
Patient thought her arthroscopy
was for meniscal repair, but she received a resection - the case of
Brenda from Boston – Prolotherapy would have been a much better option!
Brenda from Boston came to Caring
Medical with the desire to avoid getting
bilateral knee replacements. She was already told by a surgeon that
she was a great candidate
for knee replacement surgery. Brenda is 70 years old. When she was
54 she received bilateral arthroscopies on the same day! According to
Brenda during her first visit, she said she had
meniscal repairs and that was the reason for her
arthroscopies in 1994. (See
A Retrospective Study Shows Prolotherapy is Effective in the Treatment of
MRI-Documented Meniscal Tears)
Let me ask you this. Do you see anywhere on
her left knee arthroscopy report below that Brenda had
meniscal repairs? It looks like they were removed to me! (See reports below).
Patient: BJ
Initial Evaluation:
10-5-94
Dx:
1. Torn medial meniscus left knee
2. Torn medial meniscus right knee
3. Status post right lateral
meniscectomy
HPI:
Fifty-four year old female who is active playing golf and tennis. She
has had left knee problems for about a year, but it has been quite
bothersome over the last six months. She was not able to play tennis
this summer because of pain and she reports swelling in the knee. The
right knee over the last couple weeks has also begun to become
symptomatic with pain in the medial aspect and occasionally
locking (see loose bodies) of
the knee.
PE:
Small effusion to the left knee, tenderness in the medial joint line,
(+) McMurray’s sign, no
instability. In the right knee, she has
arthroscopic portals which are well healed, tenderness in the medial
joint line posteriorly and mild pain with McMurray’s maneuver. No fluid
in the knee today.
Standing AP, Routine Lateral and
Sunrise x-rays of both knees reveal no bony abnormalities.
Recommendations:
I’ve recommended bilateral arthroscopies with medial meniscectomies. I
gave her the option of MRI scans
MRI - (Knee Research Study)
, but she is claustrophobic and prefers
not to have these done. She’ll be scheduled in the near future.
Date: 11/10/94
Operative Report:
Preoperative diagnosis:
Torn medial meniscus, left knee
Postoperative diagnosis:
Torn medial meniscus left knee, grade III and IV
chondromalacia left
medial facet, left patella.
Anesthesia:
General
Procedure:
General anesthesia with endotracheal intubation. One gram of IV Kefzol.
Tourniquet control of leg holder were used. Routine prep and drape.
Arthroscopy revealed a degenerative flap tear with horizontal component
of the posterior horn of the medial meniscus. This was trimmed with the
basket forceps and shaving device. There was some mild grade II and III
chondromalacia on the posterior aspect of the medial femoral condyle.
The anterior and posterior cruciate ligaments, lateral meniscus and
lateral articular surfaces were normal. The patellofemoral interval
revealed a normal trochlea, but there was over most of the area of the
medial facet of the patella, areas of grade III and IV chondromalacia.
The loose
articular
cartilage
flaps were debrided and chondroplasty was
performed, suctioned dry, injected with Marcaine and epinephrine and a
dry, sterile compression dressing was applied. She tolerated the
procedure well.
Patient: BJ
Date: 11/10/94
Operative Report:
Preoperative diagnosis:
Torn medial meniscus, right knee
Postoperative diagnosis:
Torn medial meniscus right knee, grade III and IV
chondromalacia right
patella, medial plica right knee.
Anesthesia:
General
Procedure:
General anesthesia with endotracheal intubation. One gram of IV Kefzol.
Tourniquet control of leg holder were used. Routine prep and drape.
Arthroscopy revealed a horizontal tear of the posterior horn of the
medial meniscus with a flap component posteriorly. This was debrided and
excised with the basket forceps and shaving device. Chondral surfaces
medially and laterally looked normal, as did the anterior and posterior
cruciate ligament and the lateral meniscus. There was a medial plica
abutting the medial femoral condyle and this was excised. The loose
articular
cartilage flaps were debrided and chondroplasty was performed,
suctioned dry, injected with Marcaine and epinephrine and a dry, sterile
compression dressing was applied. She tolerated the procedure well.
Let me say this again – you need
to look at your arthroscopy reports because you may be shocked to find
out what was actually done! Brenda ended up with partial bilateral
meniscectomies. This means that back in 1994 she probably had most of
her medial menisci removed both on the same day!
The meniscal tears were not repaired,
they were removed! In other words, most of the cushion of the inside
part of her knees was removed. Guess what Brenda complains of now? You
are correct – “bone on bone”
cartilage degeneration. The surgeon now wants to perform
bilateral
knee replacements!
Read your arthroscopy reports! More
importantly, if you are contemplating arthroscopy, at least get a
Prolotherapy evaluation before going right for surgery. Almost all
(99%) people who look at their arthroscopy reports will realize that Prolotherapy is a better option. Almost all (99%) will reveal
chondromalacia or that the
orthopedist removed a large part of the
meniscus! Left alone post-surgery, a knee with 60% of the meniscus
removed (yes, that is the typical partial
meniscectomy) will quickly develop severe
degenerative arthritis. A quick ticket to severe
degenerative arthritis is also a fast way to being faced with a total knee
replacement. If you or a loved one wants a knee replacement, then sign
up for arthroscopies. However, if you are like Brenda and think you
received a meniscal repair so that seven years later the doctor did more
arthroscopies to “clean up” the joint, think again! Why did the joint
need cleaning up? Because the knee became arthritic due to the meniscus
removal done back in 1994! There has to be a better way.
The better way is Prolotherapy. But
before we start talking about Prolotherapy, I just wanted to mention one
other point. Brenda received a lot of
anti-inflammatory medications and
cortisone shots from her traditional medical doctors prior to seeing
us at Caring Medical. If you have not read our extensive article on
cartilage degeneration caused by
NSAIDs,
click here to read it. After reading
that article, you will hopefully stay far away from NSAIDs!
Back to Brenda – let’s see Brenda had
one, two, three, four standard medical treatments that all contributed
to the further degeneration of her cartilage. Is it any wonder that
Brenda is having a difficult time walking now? I am telling you, there
has to be a better way! That way is Prolotherapy.
Fortunately for Brenda after four
visits to Caring Medical (yes, she traveled from Boston – people do it
all the time!), she was back to golf, gardening and paddle ball. I’ll
be honest with you, I don’t know much about paddle ball. However, but I
would think that a 70 year old who was told she needed bilateral knee
replacements who now is able to play paddle ball after Prolotherapy –
would be pretty good evidence that the Prolotherapy is stimulating
repair. What do you think?
If you want to learn more about
Prolotherapy as an alternative to knee pain, consider reading the book
Prolotherapy: An Alternative to Knee Surgery where we have
written a lot about treating knees with Prolotherapy, as well as
outlined some of the problem with traditional therapies. This book is
available at
amazon.com or
benuts.com.
Most patients with severe knee pain
from
osteoarthritis require Prolotherapy about every four weeks.
Depending on the severity of arthritis, they will need anywhere from 4
to 8 visits. I can generally give most patients an approximate number
of visits I feel it will take and if there is anything else that needs
to be addressed. In Brenda’s case, we also addressed her hormone issues
and she began natural
hormone replacement therapy, which also helped jump start the
healing process! Why would a 70 year old take hormones, you may be
thinking? This is one active 70 year old! She also wanted to get back
to playing tennis! This is how we all should be when we are 70 years
old!
I wrote this short article so that
you could view Brenda’s arthroscopy reports through a different set of
eyes and let you know that even a smart active lady from Boston such as
Brenda was totally uninformed regarding her 1994 arthroscopies! She
received no meniscal repair, just meniscal shaving/removal! If you have
had a meniscal injury, what would you rather do? Stimulate repair with
Prolotherapy in an office setting or undergo general anesthesia and have
an orthopedist remove your meniscus? What will be best for you long
term? If you have already gone down the traditional route and received
or are still taking NSAIDs, cortisone shots, and arthroscopies, I
unfortunately think that you are just waiting around in your rocking
chair until you succumb to a knee replacement surgery. In my opinion, it
makes much more sense to see if Prolotherapy can get you back to an
active lifestyle! Most likely it can! If you would like to send me your
report or ask me to review your MRI, you can always email me at
drhauser@caringmedical.com.
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