DEAR DR. ROACH: I have been suffering from strong pain on my left knee for a long time. An MRI was performed, which showed an “extensive degenerative tear throughout the body and a posterior horn of the medial meniscus.” It also showed a “flap tear of the body and an anterior horn of the lateral meniscus, with meniscal tissue displaced adjacent to the anterior horn.”

Is there anything I can do to alleviate the pain and try to walk normally again? — E.R.

ANSWER: The menisci are two structures (medial and lateral) that are made of fibrous tissue and cartilage. They are on top of the tibia, which is the bone in the leg that is in the bottom part of the knee. The menisci provide shock absorption and structural support of the knee.

The majority of tears in the menisci do well with physical therapy and do not need surgery. Initial treatment with rest, ice and anti-inflammatories, followed by physical therapy, is often effective and is almost always the initial management. Unfortunately, with the anatomy of your meniscal tears, and given how severe your pain is and how long it has lasted, I would be concerned that yours may not get better without surgical treatment.

Although meniscal tears in young people are usually a result of trauma to the knee, in older people (sadly “older” in this case generally means above 50), degenerative tears in the knee may happen without identifiable trauma. A flap tear may occur from an injury or due to degeneration of the meniscus.

I would refer you to an expert in knee surgery were you my patient. Your surgeon can give an educated opinion on the benefits and risks of surgery. The current surgical technique is to remove as little meniscus material as possible since removing more meniscus material means a higher risk of arthritis in the future.

DEAR DR. ROACH: I am working on losing weight, but I have been told that they can’t do my planned hip replacement surgery until I lose about 35 more pounds. I have swelling and lymphedema in my legs, and my legs are still large even with weight loss. Is this standard? — A.U.

ANSWER: There is some justification for wanting people to lose weight before a hip replacement therapy when people are very overweight. The risk for needing to do a second surgery is higher in people with a BMI over 35. (The BMI is a flawed measure but remains commonly used. It may be particularly flawed in your case because of lymphedema as you have fluid in your legs that accounts for some part of your weight.)

Still, a well-done study showed that people with obesity do get improvement in their hip pain and function, and most are satisfied with the outcome despite a small increase in the infection rate.

I do not agree with inflexible rules about weight loss prior to surgery. Obviously, doing exercise, which is an essential component to healthy weight loss, is very difficult for people with such severe hip arthritis that they need surgery. Many people find that weight loss is easier after surgery. A medication treatment, such as a GLP-1 drug like tirzepatide (Zepbound), might be appropriate.

Finally, aggressive treatment of your lymphedema before surgery is critical since lymphedema treatment may be more difficult in the period of time around your surgery. Lymphedema is a risk factor for a poor outcome after hip surgery, so your lymphedema specialist and surgeon need to work together closely.

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. (c) 2025 North America Syndicate Inc. All Rights Reserved