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Thread: Posterior Horn Medial Meniscus Tear

  1. #1
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    Default Posterior Horn Medial Meniscus Tear

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    Well, shortly after I think I'm ready to start power cleaning, I get my MRI results for my right knee - which has been slightly problematic over the past 2 years. It would start hurting if I hiked/walked over 4 miles... mainly downhill. Then navigating stairs started becoming more painful. Only after experiencing a sharp pain on the last rep of my third set of squats recently, I decided to get it checked out.
    I was hoping some of you could help me make sense of this and steer away from anything that would compound my problems.

    FINDINGS:
    Everything said "No significant abnormality" except for the following:
    Medial Meniscus: Horizontal cleavage tear of the posterior Horn with extension to the body segment junction.
    Joint Effusion: small joint effusion.
    Cartilage: Full-thickness chondral fissuring in the trochlear through. Low to moderate grade partial thickness cartilage loss in the weightbearing medial compartment. Low-grade partial thickness fissuring of the weightbearing and non-weightbearing lateral femoral condyle.
    Bone Marrow: No acute fracture. Trace likely reactive in the medial tibial plateau. Additional tiny foci of edema-like signal abnormality are noted scattered throughout the marrow.
    Subcutaneous Soft Tissues: Mild subcutaneous edema.

    IMPRESSION:
    1. Tear of the posterior Horn medial meniscus
    2. Mild tricompartmental cartilage abnormalities with small area of full-thickness cartilage loss in the trochlear trough.
    3. Tiny foci of scattered marrow edema-like signal abnormality, nonspecific through possibly sequela of disuse.
    4. Small join effusion.

    If you've read this far, I would hope you might have a better understanding of this terminology than myself. Any guidance or tips to avoid worsening my condition would be appreciated. My knee pain has actually receded in the past couple of months, but before that I could barely kneel or do a lunge. Doc recommends no lunges, running, or jumping. Also said to avoid deep squats, maybe consider box squats... which I did NOT want to hear. Aside from that one instance and about two weeks afterward, my knees never hurt when squatting. Actually, now that I think about the past few months, most times when my knees hurt at the gym was when I went up or down the steps outside.

    Thank you,
    Kevin

  2. #2
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    Quote Originally Posted by KevinHP View Post
    Well, shortly after I think I'm ready to start power cleaning, I get my MRI results for my right knee - which has been slightly problematic over the past 2 years. It would start hurting if I hiked/walked over 4 miles... mainly downhill. Then navigating stairs started becoming more painful. Only after experiencing a sharp pain on the last rep of my third set of squats recently, I decided to get it checked out.
    I was hoping some of you could help me make sense of this and steer away from anything that would compound my problems.

    FINDINGS:
    Everything said "No significant abnormality" except for the following:
    Medial Meniscus: Horizontal cleavage tear of the posterior Horn with extension to the body segment junction.
    Joint Effusion: small joint effusion.
    Cartilage: Full-thickness chondral fissuring in the trochlear through. Low to moderate grade partial thickness cartilage loss in the weightbearing medial compartment. Low-grade partial thickness fissuring of the weightbearing and non-weightbearing lateral femoral condyle.
    Bone Marrow: No acute fracture. Trace likely reactive in the medial tibial plateau. Additional tiny foci of edema-like signal abnormality are noted scattered throughout the marrow.
    Subcutaneous Soft Tissues: Mild subcutaneous edema.

    IMPRESSION:
    1. Tear of the posterior Horn medial meniscus
    2. Mild tricompartmental cartilage abnormalities with small area of full-thickness cartilage loss in the trochlear trough.
    3. Tiny foci of scattered marrow edema-like signal abnormality, nonspecific through possibly sequela of disuse.
    4. Small join effusion.

    If you've read this far, I would hope you might have a better understanding of this terminology than myself. Any guidance or tips to avoid worsening my condition would be appreciated. My knee pain has actually receded in the past couple of months, but before that I could barely kneel or do a lunge. Doc recommends no lunges, running, or jumping. Also said to avoid deep squats, maybe consider box squats... which I did NOT want to hear. Aside from that one instance and about two weeks afterward, my knees never hurt when squatting. Actually, now that I think about the past few months, most times when my knees hurt at the gym was when I went up or down the steps outside.

    Thank you,
    Kevin
    Easily the most troubling finding on your MRI findings, and the thing that marries up best with your reported symptoms, is the focal chondral loss in the trochlear trough. If you are over the age of about thirty, the posterior horn tear doesnít mean hardly anything, as most of us have things like that.

    Perhaps, you could pass the Hagen Hartmann articles to your doc and see what he thinks about the biomechanical loading of the knee in a partial depth squat. Iíll save you the suspense and tell you that the compressive forces on the patellofemoral joint is much greater in a reduced ROM squat.

    Stay out of your knees in the squat, squat to depth, control your knees and squatting should be fine.

  3. #3
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    Thanks for the input! Perhaps I should have mentioned my stats... 47, 5'10",218lb, and have been training with the SS program since last summer.
    My current 5RM lifts are:
    Squat 295
    Dead 310
    Bench 235
    Press 140

    Your feedback is encouraging regarding squats, but I'm unsure if I should start implementing power cleans in my training at this point. I have a spinal fusion that I've tiptoed around my whole life and was just feeling confident enough to try them thanks to the program. I've only ran a few sets of 45, 65, 85 recently, but not sure if I need to continue adding weight to a jumping movement now that I know my knee could be problematic. Considering my condition, are Power Cleans something you'd discourage, or would it be unreasonable for me to take a "try it and see" approach? I want to continue to push myself to my physical limits, but do not want to cause any further damage.
    He also mentioned arthroscopic surgery as an option, but it doesn't hurt enough for me to consider that at this point.

  4. #4
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    Omit the cleans, but other than that do the program. These numbers are very light for 7 months of training. Any reason?

  5. #5
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    Thanks, Rip. I've taken a cautious approach with the deadlift, missed a couple of weeks worth of training due to injury, pain, and work schedule, and deloaded 8-10% twice. With a spinal fusion of T11/T12/L1 vertebrae, I have no illusions that I will ever be an advanced trainee. Just trying to get a little stronger every day, and doing my best not to let the old man in.

    Will- Now that I think about it, it is interesting that you brought up the chondral loss while my orthopedic doc didn't even discuss that and mainly focused on my torn meniscus. Looks like I have some reading to do, along with the Hartmann articles.

  6. #6
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    Quote Originally Posted by KevinHP View Post
    Thanks, Rip. I've taken a cautious approach with the deadlift, missed a couple of weeks worth of training due to injury, pain, and work schedule, and deloaded 8-10% twice. With a spinal fusion of T11/T12/L1 vertebrae, I have no illusions that I will ever be an advanced trainee. Just trying to get a little stronger every day, and doing my best not to let the old man in.

    Will- Now that I think about it, it is interesting that you brought up the chondral loss while my orthopedic doc didn't even discuss that and mainly focused on my torn meniscus. Looks like I have some reading to do, along with the Hartmann articles.
    It's not that interesting at all. The ortho doc has nothing in his bag to treat the focal chondral loss that would be worth pursuing, but, he can treat the posterior horn meniscal tear. Honestly, most could care less if that is the cause of the symptoms. It IS a finding, and insurance companies will cover the surgery. The chondral loss can be taken care of in the future when it is time for a total knee arthroplasty.

    Meniscal tears should really only be indicated for surgical intervention when there are clear and present mechanical symptoms, to include mechanical locking of the joint. If a meniscal tear does not present with mechanical locking, it should be a very deliberate physical assessment to determine if the meniscal tear is the cause of the symptoms. Meniscal debridements were shown to be inferior to a sham surgical treatment in a study that excluded anyone with mechanical symptoms.

    If your knee only hurts, really, going up or downstairs, think of what position your knee is in when navigating the stairs. Then, refer back to what I said about the Hartmann articles that showed the most patellofemoral compressive forces at the quarter or half squat position. Then, refer to my analysis that the trochlear chondral loss (trochlea being an important part of the patellofemoral joint) being the most likely issue here.

  7. #7
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    Thank you for the clarification, that makes more sense to me now. I have not experienced mechanical locking and my pain is occasional, so I will continue my training sans cleans until further modification is necessary. If my knee is going to wear out, I need to be as strong as possible when that time comes.
    Aside from omitting cleans, any other precautions or considerations you'd recommend as I continue my strength training and conditioning?

  8. #8
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    Generally, I think your idea of omitting cleans is pretty sound, simply because you donít have near as much control over your knee position as you do in everything else. For specific recommendations and developing a tailored plan to your knee condition and also being S/P a multilevel spinal fusion, Iíd have to suggest a professional consultation. Thatís a bit much to just throw darts in the dark over.

  9. #9
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    Quote Originally Posted by Will Morris View Post
    Generally, I think your idea of omitting cleans is pretty sound, simply because you donít have near as much control over your knee position as you do in everything else. For specific recommendations and developing a tailored plan to your knee condition and also being S/P a multilevel spinal fusion, Iíd have to suggest a professional consultation. Thatís a bit much to just throw darts in the dark over.
    Thank you, I understand. I've reached out to a couple of coaches, but so far, no luck getting an in-person consult. Not many in my area so may contact Nashville or Atlanta and make a weekend road trip out of it.

  10. #10
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    starting strength coach development program
    There are coaches experienced with Orthopaedic issues that can do remote consultations. If you desire an in person coach, Starting Strength Memphis has a very experienced coach that I work with routinely named Scott Acosta, and he is very good at working with rehab cases. Adam Martin from Starting Strength Atlanta is someone I work with routinely, and I have done numerous remote consultations with clients from there. I work with both locations often, so I can personally vouch for their proficiency.

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