Could This Be a Meniscus Tear?
**Background Information:** I am a 34-year-old male, standing 6 feet 3 inches tall and weighing 180 pounds. I previously competed as a collegiate track athlete, specializing in hurdles. *Disclaimer: Some details may not be relevant, but my physician indicated they could be significant.* During my time in college, I experienced a rupture of the tendon that connects my Semimembranosus muscle to my tibia. The surgeon advised against surgery, allowing it to heal naturally, which resulted in atrophy and the development of scar tissue. Consequently, an unusual "faux tendon" formed behind my right knee, linking my hamstring to my shin. After earning my degree, I transitioned into a career as a chef, which demands that I spend long hours on my feet. In 2022, I began experiencing sharp, pinching pain deep within my right knee. An MRI revealed the presence of a ganglion cyst on my ACL. I underwent surgery to remove the cyst, and after approximately three months of rehabilitation, I felt significantly better. However, by the following year, the pain resurfaced. A subsequent MRI indicated that the cyst had returned, now measuring about 18x17x21mm. My doctor recommended the same procedure again, which I had last August. Previously, he had been cautious about removing the cyst to avoid damaging the tendon, but he adopted a more aggressive approach this time, leading to immediate relief. Unfortunately, less than two months later, the pain reappeared. **Current Situation:** An MRI conducted this past Monday showed that the cyst is back and is roughly the same size as before. A biopsy of the previous cyst indicated there was nothing harmful or malignant. I consulted my doctor today, who explained that the cyst has formed *within* my tendon. This is likely why it has reoccurred and suggests that further excisions would not be effective. His only recommendation at this point is to proceed with a complete ACL reconstruction to fully eliminate the cyst from the tendon. Seeking additional insights, I obtained a second opinion from The Stone Clinic in San Francisco. They suggested that the problems I am experiencing may stem from a posterior medial meniscus tear. However, I have shown my MRI results to three other radiologists, all of whom did not diagnose a meniscus tear. What are your thoughts on this matter?
Answers (1)
2/5/2026, 6:40:48 AM
OpenHealth AI
It sounds like you are dealing with a complicated knee condition that involves multiple factors, including the recurring ganglion cyst and potential meniscus issues. The conflicting opinions from various specialists, along with your history of knee injuries, can understandably leave you feeling uncertain about the best course of action.
Key Points:
- Potential Meniscus Tear: The suggestion of a posterior medial meniscus tear is a possibility, particularly with your history of knee pain. Although other radiologists did not confirm this, symptoms and clinical examinations are critical for diagnosis.
- Recurring Ganglion Cyst: The fact that the cyst originated within your tendon complicates treatment, as conventional excision approaches may not be effective.
- Surgical Recommendations: An ACL reconstruction may be the most definitive solution to address both the cyst and potentially any underlying structural issues like a meniscus tear.
Explanation:
The meniscus acts as a cushion and stabilizer in your knee. A tear can cause pain, swelling, and occasionally a feeling of locking or catching in the knee. Given your active lifestyle and prior injuries, it's plausible that your symptoms could be linked to a meniscus tear even if imaging hasn't shown it. On the other hand, the recurrent cyst raises concerns that surgery needs to focus on the underlying issues rather than just removing the cyst.
Next Steps:
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Symptom Tracking: Keep a detailed record of your knee pain symptoms, including intensity, location, duration, and any particular activities that exacerbate the pain. This may help in discussions with doctors about the nature of your pain.
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Seek a Third Opinion: Since you’ve received different diagnoses, consult with an orthopedic specialist who has experience with both meniscal repairs and cyst management. Ask specifically about the criteria used to identify a meniscus tear.
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Explore Non-Surgical Options: Consider conservative treatments such as physical therapy focused on strengthening the muscles around the knee and improving stability, which may alleviate some symptoms while allowing you time to decide on surgical options.
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Consider Advanced Imaging Techniques: Residual scarring and the complexity of your situation might necessitate advanced imaging like a 3D MRI or ultrasound to give better insight into soft tissue structures, potentially identifying any meniscus issues.
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Evaluate Surgical Timing: If surgery, such as ACL reconstruction, is a viable option, discuss timing and preparation, especially if you’re experiencing significant pain or decreased functionality.
Make sure to communicate openly with your healthcare providers about all your concerns, and advocate for a plan that feels right for your needs. The goal is to help you regain as much function and quality of life as possible. Let me know if you have further questions or need more specific guidance!
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