About the author:

Howard J. Luks, MD

Howard J. Luks, MD

A Board Certified Orthopedic Surgeon in Hawthorne, NY. Dr. Howard Luks specializes in the treatment of the shoulder, knee, elbow, and ankle. He has a very "social" patient centric approach and believes that the more you understand about your issue, the more informed your decisions will be. Ultimately your treatments and his recommendations will be based on proper communications, proper understanding, and shared decision-making principles – all geared to improve your quality of life.

17 comments on “Knee Pain … How Everything Is Connected — Why Can’t We Treat The Whole Person?

  • Hello Dr. Luks. My name is Jeff, a 54 year old, fit male living in Ohio. Very active in my business and other physical activities. last Thursday 12-17, I had my right knee scoped to repair a medial meniscus tear
    ( removed 40% – no repair ). What is troubling me is that, when I awoke from surgery my Surgeon informed me that there was only a ” nub ” left of the ACL with a small bone fragment dangling from that. He cleaned that out while there ( did not repair it ) .I was very shocked and disappointed that is was torn. Back Story: The original examination in his office did not include any hands on testing for ligament tears. He only did what I later researched to be The McMurray Test after I explained symptoms of occasional locking while sitting on the floor ( Indian Style) and certain time instability, like slippage in the joint. He did an MRI in his office that showed ACL intact and the meniscus tear.

    So after all that rambling I would like to ask if there is anything else that could have been done to diagnosis ACL tear ? Is this normal procedure ? Thank You very much !

    • HI Jeff …
      A comprensive exam will usually pick up an ACL tear. We use the MRI primarily to confirm suspicions. Except in very swollen and painful knees where a patient will not allow us to examine them.

  • I am an active 50 yr. old female. Recently diagnosed with tiny R knee meniscus tear, no pain able to cross fit train with no problems…… My L knee for years could become mildly uncomfortable but nothing worth mentioning….. My coaches and I are conservative with my workouts……. Last week while doing air squats my L knee started to hurt…. Now, I cannot lock out my knee, I’ve fallen because it just gives out….. For the most part any bending or manipulation of the knee causes discomfort if not pain……. My question assuming it’s torn, can I do more damage if I continue working out?

    • giving way is one of those issues that alarm us… because it means you can hurt yourself. It usually means that you have a torn flap or loose piece of meniscus.

  • Thank you, Dr. Luks……. I’ll schedule an appointment …… Most importantly thank you for your well written informing posts, you are a true asset to this aging athlete…

  • Thank you Dr luks for being a great humanitarian. To give your time and expertise so unselfishly to those of us who are in shock with a torn maniscus.The realisation that with this injury we are getting older and with your brilliant advice,
    especially your treating the (whole body)
    article.I have gotten great conciliation and clearer understanding all your posts and comments. Thanks again!..Frank…..Dublin, Ireland.

  • Hi Dr Luks,

    Firstly, I’d just like to say I think what you’re doing online here is enormous. I agree with some of the comments, that more and more doctors should be taking your approach to medicine and health.

    Secondly, I was wondering if I could seek your opinion on a “Complex Meniscus Tear” that I have recently been diagnosed with. My side of the World, the soonest I can see a specialist is a month away, and to be quite honest, anxiety is getting the better of me. That and my apprehension toward surgery.

    A bit of back story, about 2 weeks back I engaged in a 30 minute run/jog and the very next day I felt pain in my left knee. Thinking nothing of it other than my muscles getting used to running again (as it has been about 1 month since I stopped running), the next day I went for another run, pushing through the pain. The day after this, my left knee began to hurt more and I couldn’t seem to walk unless I kept my leg straight and the pain was more pronounced when I climb stairs. I’m in my early 30’s.

    After a consult, my local GP sent me to get an X-Ray and MRI.
    The X-Ray confirmed no bone fracture or fluids present.
    The MRI is the one my GP couldn’t give me any definite information on, other than it is a Complex Meniscus Tear and referring me to a specialist.

    The MRI Findings:
    – ACL, PCL, MCL and lateral collateral structures are normal in appearance.

    – There is a complex tear within the body of medial meniscus, this consists of a 9mm oblique tear extending to the inferior articular surface at the peripheral third of meniscal substance, with superimposed vertical radial tear in the mid body, involving the inner 50% fibres and separated by 3mm. Moderate adjacent reactive marrow oedema and synovitis is present. No displaced meniscal flap.

    – Lateral meniscus normal in size and configuration. Tibiofemoral articular surfaces are preserved.

    – Patellofemoral articular surfaces are preserved apart from early grade 1/2 chondrosis within the medial patellar facet.

    Extensor mechanism unremarkable. Moderate effusion with mild synovitis. No intraarticular body. Popliteal fossa unremarkable.

    Not sure what it all means, but the word “Complex” doesn’t have a good ring to it.
    Any insight into the results would be greatly appreciated.

    Thanking you in advanced,
    Christian

    • That report is your knee telling you you need to rest a bit — the bone marrow edema is present because the bone is reacting to the fact that you have a vertical/radial tear. That changes the way that force crosses the knee and it concentrates the force more locally. That causes bone marrow edema and eventually it can lead to a stress fracture.

      Many of these tears at your age are repairable. Repairing vertical/radial tears has been studied over the past few years and it has good results … despite the fact that we never thought these “white zone” tears would heal.

      Good Luck ! Find someone who repairs (sutures) tears together often. Most docs just like to trim out the torn part.

  • Thanks for your feedback Dr Luks, much appreciated!
    So are you highly recommending I consider surgery for my left knee?
    I’m guessing my results aren’t reflecting a tear that can heal on its own over time?

    • I am not highly recommending it… I can’t offer treatment advice — only for patients I see in my office.

  • Thanks again Dr Luks!

    I shall wait to consult a specialist next month, since I am on the other side of the world and as much as I’d love to seek your professional advice in person, it’s just not practical.

    Christian

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