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Tuesday, Novmeber 13, 2012

I am age 64 and because of my left knee pain, I had an X-ray which was interpreted as showing mild arthritis. Then  my internist sent me for an MRI
MRI report:

1) Horizontal tear throughout the posterior body and posterior horn of the medial meniscus with superimposed degenerative type medial femoral condyle articular surface erosions

2) Moderate to severe patellofemoral joint degenerative changes. Patchy Grade 3/4 chondral thinning within the patellar cartilage

3) Multilocular Bakers Cyst
I am scheduled for arthroscopic surgery. Should I see you first?
My Reply

The MRI interpretation is commonly seen in patients over age 55 with knee pain. It is indicative of the arthritic cascade. What the MRI doesn’t explain is that which is causing your pain. The Multiloculated  Bakers Cyst is a result of chronic fluid production from your arthritic disease, it is not an independent entity. That chronic fluid production is from synovitis, an inflammation of the lining of your knee. The tearing of your meniscus is part of the degenerative process as well. The only indication for surgical removal of a torn degenerative meniscus is mechanical change- locking, giving way, “clunking” as that degenerative tear of your  meniscus is not a pain generator but rather part of the arthritic process. The degenerative thinning and erosion of your articular cartilage both on the weight-bearing femoral condyle and under the patella are again, part of the degenerative changes. You have a bio- immune process, degenerative arthritis, begging for regenerative medical management. Evidence Based Medicine has statistically shown that arthroscopy for arthritis doesn’t work; so much so that payers will no longer pre certify said surgery.  From Health Affairs: 31(10)2242-9: “Evidence of no benefit from knee surgery for osteoarthritis led to coverage changes and is linked to decline in procedures. “The reduction in arthroscopy for knee arthritis in Florida between 2001 and 2010 translates into a national savings of  $82-$138 million annually and changes in practice patterns. Yet patients and surgeons are reluctant to abandon widely used treatments even when they have been found to be ineffective. Is there an alternative to surgery for arthritis? You bet, it is called Bone Marrow Aspirated Concentrate- Stem Cells. I will explain further at the time of your consultation.

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