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To Your Good Health: Two Views on Surgery for Torn Meniscus

Dear Dr. Roach: I suffered a severe torn meniscus at age 67. I reached a point where I could no longer walk. Six weeks of physical therapy was recommended. I decided to consult another physician.

I had arthroscopic surgery about a week later.

My surgery started about 11 a.m. and I walked out of the hospital unaided and without a cane or crutches about two hours later. I was able to drive a standard-transmission vehicle within 48 hours.

The only residual effect was a stiff knee joint, which took several weeks to alleviate through home exercise. It was sore, but with consistent exercise I overcame it without a single pain reliever.

I highly recommend that, unless there are side issues, get this fixed and get on with your life! Life is too short to waste time. — J.W.

Dear Dr. Roach: I had a torn meniscus in late March 2013 and tried ice, time, anti-inflammatory pills, physical therapy and cortisone to improve it before having arthroscopic surgery. The orthopedic doctor said it was my only choice of action left, but that it was a quick recovery. I even went to get a second opinion and was told I had no other choice.

Here I am today, five months later and no better than before surgery and still in almost constant pain.

I personally have talked to dozens of people who were over 60 years old and underwent the surgery, only to need a knee replacement within a year or less because the arthroscopy was a complete failure. As is my case, the knee gets worse after the surgery because most of the cartilage was removed.

From what I see, arthroscopy is overused and not a good solution for 50 percent of the patients it is done on. — J.G.

Answer: While most people will do well after surgery for torn meniscus, not everyone will have the ideal result J.W. had, and only a few will do as poorly as J.G.

A paper was published last December that looked at degenerative tears in the meniscus — the kind most common in older people and usually not associated with acute knee injury.

In the study, surgery did not improve recovery time, strongly suggesting that surgery is not needed in most people with degenerative meniscus injury. And, as J.G. noted, it does increase the risk for arthritis later on.

I think surgeons will be more circumspect about this surgery going forward.

Dear Dr. Roach: My friend, who is 79 years old, started having his fingertips split open at random several years ago. The splits resemble small knife slices, and are extremely painful to him, along with limiting his ability to pick up objects as his fingers become numb.

Last year he went to a dermatologist, who diagnosed it as psoriasis and gave him strong steroid ointments.

During the warm weather, his fingertips don’t seem to split, but when the weather starts turning cooler, regardless of these ointments or even wearing gloves over the ointment at night, they get worse.

We are concerned that the diagnosis of psoriasis may not be correct. — S.G.

Answer: Cracking of the tips of the fingers has several possible causes, including psoriasis, but also a condition called dishydrotic eczema. Moisturizers and powerful steroid ointments are appropriate for both conditions.

Many of my readers have reported good results from liquid bandages, some of which have antiseptic properties, and some are a medical form of super glue.

There are other possible diagnoses, including progressive systemic sclerosis (scleroderma), so I think he should have another visit with the dermatologist.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.