Joe A Shaw PA-C - 3/4/2009

Question
QUESTION: I HAVE A 10 YR OLD DAUGHTER WITH PAIN BEHIND HER LEFT KNEE SHE HAD AN MRI WITH THE DX AS MYXOID DEGENERATION OF THE MENISCUS, POSS. TEAR. ORTHO DR. WANTS TO DO A SCOPE TO REPAIR AND CLEAN UP. IS THIS NORMAL PRACTICE ON A CHILD AND IS MYXOID DEGEN. SOMETHING TO BE ALARMED ABOUT IN A PERSON OF HER AGE? THANKS!

ANSWER: Melanie,
It's not common in someone that young..does she dance, play sports,gymnast etc..?
The meniscus is avascular so it can't repair itself like muscle which has a great blood supply.
Myxoid degen. is typically the result of aging and/or wear and tear on a joint,or a reaction to an injury but its cause remains largely unknown. It is a softening and swelling of the meniscus. It is not a tear on the surface but a intrasubstance degeneration. Some feel it is a "pre-injury" state. It is sometimes referred to as cystic degeneration when talking about the lateral meniscus.
I would get a second opinion by an ortho who sees a young/athletic population. Most likely a radiologist read the report so you need to make sure the ortho also reviewed the actual films too. MRI's are about 90-95% accurate..not 100%.
If you answered yes to above question then it makes more sense..but I wouldn't rush to surgery if it were my daughter until I had some more info either way.

---------- FOLLOW-UP ----------

QUESTION: "Yes", is the answer, she has danced for 8 years and is involved in sports... .more specifically cheerleading. However she is not doing these things to her full potential because it causes her too much pain. She is completely tired of dealing with it. Her Ortho did review the films and suspects a tear as well, and feels it needs to be "cleaned up", to get her back on her feet. My concern is the myxoid degeneration, I acquaint anything degenerative with much older people and am afraid this could be the beginning of a lifetime of problems, let alone maybe something more serious. What are some of the potential problems this could be? Again, thanks for you time. I so appreciate it!

Answer
Degeneration IS typically associated with age..(there are other factors)but really that is just because they have had more time for the joint to undergo more wear and tear over the years,however in some young athletes like this the wear and tear can be greatly accelerated. It is well documented that some young gymnast can have an array of joint problems over the yrs from wear and tear. Lets say that the typical 10 yr old jumps from 3 ft and lands or his/her feet 2-3 x wk thats 8-12x mo and 144x yr...some gymnast etc/may do that in a couple of wks!..so the knee is under going excessive amount of use relatively speaking. Genetically some can handle this wear and some can't and if the knee/joint surface is just a tad out of alingment where maybe one portion of the joint surface is touching more than the other side..it will start to show wear and tear there first and earlier if the knee undergoes more use than normal.
Three options IMO..
*stop cheerleading:( take a break for 6-12mos and see how it does..(use ice/heat,advil,biofreeze,knee support.. http://www.carpal-tunnel-symptoms.com/carpal-tunnel-store.html  )
*Have the scope and clean up and dont engage in too many physical type sports over the yrs.
*or have the scope and clean up and go back to doing what she was doing before..with potential of reinjury and another scope and more degen etc..
I think if you do 1 or 2 there is less likely this will be a lifetime of problems..if you choose 3 its a roll of the dice.