Mr Z is a 42-year-old gentleman who presented with severe right knee pain after an accidental slip and fall at home, and landed onto the right side of his body. He waited for about one week before seeking medical attention. He came to the clinic and our clinical evaluation revealed a painful gait, with his right knee very swollen and tender over the medial (inner) side of the knee. His knee was also not able to bend fully. X-rays done at another clinic did not show any fractures. We arranged for a MRI to be done later that same day. (Pic 1)
Mr Z returned for a review consultation the next day, and MRI of the right knee showed a large segment of the meniscus which has torn and flipped back onto itself, thus blocking knee movement. There was also cartilage damage as a result of the displaced meniscus segment, with underlying bone swelling as well.
Surgery was recommended for Mr Z as the meniscus was blocking knee movement, and causing damage to the knee cartilage and should not be left untreated.
Day 14
Mr Z went home to think about the surgery, and decided to undergo surgery about 2 weeks later.
During the surgery we discovered a large piece of meniscus that was flipped to the front of the knee, causing impingement. (Pic 2) It was not reparable as most of the tear was through the white-white zone of the meniscus. Therefore removal of the torn part of meniscus was performed.
There was also a full thickness cartilage defect measuring 1.5 cm by 1 cm over the inner aspect of the knee. (Pic 3)
The cartilage ulcer was cleaned up to stable edge, and microfracture(drilling small holes) was performed. These holes allow the stem cells from the marrow to migrate out to the area of defect. The defect was then filled with a hyaluronic-acid-based-scaffold, enhanced with bone marrow concentrate harvested from the pelvic bone. (Pic 4)
Day 30
At one month Mr Z was walking well without crutches, his knee also had good range of motion 0 to 130 degrees that was pain-free.
He initially experienced some residual weakness but had since progressively improved with strengthening exercises.
Insurance/Medisave Coverage
Mr Z was able to claim his outpatient visits and inpatient hospitalisation bill from his Personal Shield plan, Medisave and Personal Accident insurance plans, though the outpatient visits had to be paid first and reimbursed later when claims went through. For the inpatient hospitalisation bill, Mr Z was only required to pay about $400 plus and this amount could be claimed from his Accident plan.
Early intervention can help prevent severe permanent damage to the cartilage. Mr Z sought medical attention early and his access to surgery was fairly quick, thus the cartilage damage was still reparable.
At Hip & Knee Orthopaedics, we believe that every patient deserves to receive comprehensive, prompt, and personalized care for their musculoskeletal conditions, so they can regain their independence, mobility and enjoy quality time with their loved ones.
