A New Tool for the Arthroscopist's Kit

Interesting case of an athletic male in his late 30s with right knee pain; MRI shows "intermediate" medial condyle signal and no meniscus tear, with a previous resection. He hasn't responded to conservative care.

What is one to do?

My evolving plan for patients like this, when the MRI is equivocal and the patient is not improving, is to consider evaluating another "piece of the puzzle" - the poorly visualized (by MRI) chondral articular cartilage.

This can be done by office or procedure room-based "needle" arthroscopy ( I use the Arthrex Nanoscope system).   In this case, "intermediate signal" turns out to be grade 3 articular cartilage changes with obvious mechanical impingement of flap tears and delamination, in addition to a small recurrent medial meniscus tear. I could also clearly see that there were no full thickness areas of damage.

None of these specific findings were forthcoming on the scan.

Now, I can plan a definitive procedure; whether or not a chondral graft/resurfacing is indicated (in this case, just debridement), and appropriate CPT coding for the staged/treating arthroscopy,  which should also facilitate proper reimbursement.

Dr. Kelly Cunningham           Board Certified Orthopedic Surgeon

Austin OrthoBiologics are your experts in Orthopedic regenerative sports medicine, utilizing cellular "stem cell" and PRP therapy for the treatment of joint and musculoskeletal problems, including shoulder, knee, hip, elbow and ankle.

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Dr. Kelly Cunningham Physician