Torn miniscus

[SEJ]

Gretchen has a torn meniscus and the ortho wants to do a meniscectomy. Out patient, orthoscopic procedure. Our regular doctor, an ostiopath, advises against it.

Anybody had this done? Any opinions?

We're not sure how to proceed from here, but water ski season is coming!

Thanks in advance, Scott

[Hans]

Had this done 4 years ago, the meniscectomy. The first surgeons where not verry handy with it. Just 45 minutes of work on both the inside and outside meniscus(both were torn in my right knee) and they left a torn in the inside so I had to get back after 2 months because I couldnt stretch my knee enough. They found another torn in my inside meniscus of course. I got a worse fysio so ended after 6 months of hard training with the right fysio. The last fysiotherapist managed to stretch my knee negative within 4 months of therapy. Despite of not stretching my knee I trained so much that I stood on my board after 7 weeks of training after my second surgery (kept a thick knee but you must leave something for snowboarding, it isn't thick anymore if I don't snowboard with too much rotation technique). And I am not that young. So yes here in the Netherlands, that type of surgery is the way to go. I advice you to go to a surgeon which does do many of these surgeons. Just ask him how many of those does he do in a month. After a couple of days just start training, light many repetition of movement and stretch training is important to get the knee mobile and stretching as fast as possible and find yourselve a good fysiotherapist with experience with this type of injury healing. You will be up and running in no time if she is a sport. Important is to get the muscles above the knee as strong as possible. 'Dry' biking and in the end squats (without weight in the beginning) are the way to go. But the first thing is that the knee can stretch properly! Good luck!

Edited May 13, 2014 by Hans

[BobD]

Had a medial tear cut out about fourteen years ago. I tore it without knowing how, just started clicking and popping. It was a little tender for about a year after the op, if I accidentally torqued my leg. It was a lot of inline skating that finally provided the rehab to make it better. I think the lateral leg movements built the muscle to provide stability. Never had a twinge since then.

I still have the photos

Edited May 14, 2014 by BobD

[lordmetroland]

Had the procedure done about 5 years ago. My knee was tender and "catching." Orthopedist suggested it wouldn't get better on its own and the tear would possibly worsen so they shaved it off. No pain, no catching any more. Evidently (from what the doc said) the swelling, stiffness and discomfort post-op has to do with the tweaking they have to do to open up the knee and expose the meniscus during the procedure, not so much the cutting and shaving. Rehab was mostly recumbent biking and some inline skating. Not sure I had full flexion and no tenderness for about a year, but was able to get back to things much faster than that.

[Helmut Karvlow]

Scott, sorry to here that, tell her much love from Ohio.

[two_ravens]

No experience with the surgery, but I wish Gretchen a speedy and full recovery!!!!!!

[dantheman0177]

Vanessa knows quite a lot about this as a physiotherapist, but it's all mumbo jumbo to me. Apparently it depends entirely on individual symptoms (clicking, locking, pain, etc) so she's reluctant to suggest anything either way.

[SEJ]

We've got a lot of other input, and a second opinion from an ortho with nothing to gain. Moving forward with the surgery. Apparently her ligaments are in great shape, and she has good muscle tone, so rehab should go well.

Gotta tell ya, she's been through the wringer

2 spinal fusions (Malformed vertebrae)

Broken arm at shoulder, couldn't cast. (In line skating)

ACL, MCL, spiral tibia fracture, shattered wrist. (Snow skiing)

Broken tib, fractured fib, no surgery (Water skiing)

And now this by getting slammed by a dog in the dog park.

GHEEZ

But, she's a trooper, she'll come through fine, always does. (Makes me feel like a whimp!)

Thanks so much for the input and good vibes

Scott

[Strider]

Hello,

I'm a little late to this thread, but maybe I can help you out a bit since I am an orthopaedic researcher whose specialty is ligament,tendon, and cartilage repair, and I have also had my medial meniscus removed in both knees.

The first tear happened while I was training for a marathon, of which I had already done several. I knew what I had done based on the symptoms, and my primary doc confirmed it. I opted to run through the pain and do my race which was 2 months away. I continued to run and the pain only got slightly worse. After the race, I had an MRI and saw that I had torn the meniscus in 7 places, most of those probably from continuing to run after the initial injury. This meant that I had to have over 75% of it removed. Also, those torn pieces acted like sandpaper on the cartilage in the joint and after seeing the pictures of the cartilage on the bone surface taken during the surgery I could see that my cartilage was grade 4. The surgeon confirmed this as well. To put this in perspective, I was 40 and grade 4 would be expected in someone 70+. The best part is I work with this stuff on a daily basis and still made a stupid choice because I'd never had any type of surgery and wasn't keen on it.

Cartilage degradation is the main cause of ostoearthritis, and eventual knee replacements since your joint is rubbing bone on bone. Joint cartilage is also one of the things in your body that doesn't heal or replace itself so once it is gone/damaged that is it. To date, no one has been very successful with replacement techniques or regrowth either. Eventually we'll figure it out, but not for a while down the road.

The second knee had the same injury the following year and I had surgery within a week of injuring it. They only had to take out a small portion where the tear was and the cartilage in that knee looked pristine. I wish I had done it that way the first time.

Now, some tears are so small, or in a place that they won't sandpaper the cartilage off and if you can deal with the discomfort maybe you leave it alone. However, if you've seen an orthopaedist, especially a knee specialist, and they recommend surgery I'd tend to listen to them as they should have a ton of experience with that type of injury and when surgery is the best long-term option as it may save you from doing more damage like I did.

I hope she has a speedy and pain free recovery. If all goes well she should be back on the board by winter easily.

[gnarfy]

We've got a lot of other input, and a second opinion from an ortho with nothing to gain. Moving forward with the surgery. Apparently her ligaments are in great shape, and she has good muscle tone, so rehab should go well.

Gotta tell ya, she's been through the wringer

2 spinal fusions (Malformed vertebrae)

Broken arm at shoulder, couldn't cast. (In line skating)

ACL, MCL, spiral tibia fracture, shattered wrist. (Snow skiing)

Broken tib, fractured fib, no surgery (Water skiing)

And now this by getting slammed by a dog in the dog park.

GHEEZ

But, she's a trooper, she'll come through fine, always does. (Makes me feel like a whimp!)

Thanks so much for the input and good vibes

Scott

she have a rebuilt title ?

:o

[SEJ]

New title? I've called her "Super G" for years. Might have to get her a new ski jacket with "Timex" on the back.

I think her and Al, (Algunderfoot) seem to be in some kind of competition for the most rebuilds. If you weigh the metal installed, he's got her beat. Not sure about # of surgeries.

Hmmm, not just boards with metal construction, but RIDERS with metal construction!

"Oh man, my riding gotten a lot smoother with the Titinal knees. Can't wait to try the hips!"

Getting a third opinion today, but I think it's a done deal.

Thanks again for all the love and input.

Scott

[Algunderfoot]

Hope that fix works for you G! Summers are just as short as Winters. Around here at least it looks like good Summer to rehab....out west looks pretty warm..

Heal well!

[SEJ]

Turns out the 3rd opinion was the keeper. All this guy does is sports rehab. Pictures of olympians all over the walls with "thanks" written on them. He said over 60% of the people our age have meniscus tears without issues. Canceled the surgery, started rehab. He thinks she'll be on the water in 6 weeks. Save the surgery for last option.

Al, have you had the second hip done yet?

[Beckmann AG]

The first tear happened while I was training for a marathon,...The second knee had the same injury the following year...

Did you reach any definitive conclusions on the actual mechanism of injury, and/or contributing factors?

And also, with the menisci of both knees affected, what are you doing to prevent further degradation of the remains?

[Algunderfoot]

Turns out the 3rd opinion was the keeper. All this guy does is sports rehab. Pictures of olympians all over the walls with "thanks" written on them. He said over 60% of the people our age have meniscus tears without issues. Canceled the surgery, started rehab. He thinks she'll be on the water in 6 weeks. Save the surgery for last option.

Al, have you had the second hip done yet?

That's sounds like a great option! Good luck and be diligent!

Yes, new BHR was installed two weeks ago Thursday, 11 weeks & 4 days to go before my fist tow!

Enjoy your Memorial Day!

[Strider]

Did you reach any definitive conclusions on the actual mechanism of injury, and/or contributing factors?

And also, with the menisci of both knees affected, what are you doing to prevent further degradation of the remains?[/color]

The first injury was a combination of blunt force trauma to the knee in an awkward fall snowboarding while racing. The second one wasn't as easy to diagnose a single event, but meniscus tend to degenerate as we age, and as was stated in an earlier post, 60-70% of (active) people will experience torn meniscus at some point. We've also done a lot of research in our lab that has shown there is probably a sympathetic response in the opposing limb when you injure one limb. this can often lead to degeneration in the opposing limb once you're injured in one.

The only thing that can currently be done to mitigate future degradation is to discontinue heavy load bearing (pounding) type of activities. Tops on that list was running, close behind is mogul skiing/riding which are unfortunately both things I love, but also both of which probably contributed to the injury. As with any overuse injury, the best fix is less use. I still do a ton of stuff, just think more about it now as I don't want to end up with a replacement until I'm at least in my 70's.

Rehab may work to alleviate the pain, but if the tear is big enough it's not going to stop the other potential damage that can be done to the cartilage in there, which is more important for long-term joint health.

[lowrider]

Do you ride a plate on your board ??????????????????

[Strider]

Not before the original accident, but I do now.

[Beckmann AG]

$trider, misread your previous post to understand that the first injury took place as a result of training for that marathon. Subsequent explanation makes more sense...

Could you describe briefly the 'sympathetic response in the opposing limb' or provide a link to reference?

Lack of resiliency/pounding in mogul type situations is closely related to the combined difference in toe/heel height by way of boot/binding ramp, and also forward lean of the boot cuff.

The former has implications for running.

There are a few other considerations, but those two are generally the big offenders, so to speak.

Specific to the individual, and sometimes from one side to the other.

You probably know this already, but it's worth mentioning.

[Strider]

I wasn't overly clear in my first post. The training is what exacerbated the injury. Here's some references (all from our research). Unless you have a good understanding of orthopaedics and bone growth regualtion it may sound like a lot of gobbledgook. The 3 papers cited together explain how it works in bone. We are currently looking at the same thing in soft tissue, ie tendon, ligaments. I can't give you any citations as the work is ongoing. Also, before anyone points out that rats are different than humans, yes we know and understand this. It is also being looked at in higher order mammals as well.

1: Sample SJ, Collins RJ, Wilson AP, Racette MA, Behan M, Markel MD, Kalscheur

VL, Hao Z, Muir P. Systemic effects of ulna loading in male rats during

functional adaptation. J Bone Miner Res. 2010 Sep;25(9):2016-28. doi:

10.1002/jbmr.101. PubMed PMID: 20499374; PubMed Central PMCID: PMC3153405.

2: Wu Q, Sample SJ, Baker TA, Thomas CF, Behan M, Muir P. Mechanical loading of a

long bone induces plasticity in sensory input to the central nervous system.

Neurosci Lett. 2009 Oct 9;463(3):254-7. doi: 10.1016/j.neulet.2009.07.078. Epub

2009 Aug 4. PubMed PMID: 19647783; PubMed Central PMCID: PMC3424266.

3: Sample SJ, Behan M, Smith L, Oldenhoff WE, Markel MD, Kalscheur VL, Hao Z,

Miletic V, Muir P. Functional adaptation to loading of a single bone is

neuronally regulated and involves multiple bones. J Bone Miner Res. 2008

Sep;23(9):1372-81. doi: 10.1359/jbmr.080407. PubMed PMID: 18410233; PubMed

Central PMCID: PMC2586809.

You are correct on the pounding in moguls; however, it also has a lot to do with style. I have always loved moguls on skis and I ski it like you see in competiton; zipline, knees together and fast. This pretty much requires you using your knees as the shock absorbers that they are meant to be, but isn't kind to them either. I used to do the same line on the board, but now I ski them with a more gently flowing line and slower on both skis and board to save the wear and tear on the knees.

With the way the knee joint works, and the function of the meniscus you actually get a lot of loading on the meniscus by lateral motion as well. If you are skiing and loaded up in a tunr there is an incredible amount of pressure on the meniscus and the ligaments in the knee, which is why when the ACL, MCL or PCL fail you usually see a pretty terrific meniscal tear at the same time as a result of whatever action caused the failure.

As far as running, if a person can be a mid-foot striker rather than a heel striker you can save a lot of that pounding, pretty much what you said. Alas, I'm an incurable heel striker and tried to change, but just can't get used to it. Anyway, I have found other ways to stay fit and keep from going insane so running is off the table other than the occasional 5K with the kids.

Edited May 28, 2014 by $trider

[drschwartz]

Gretchen has a torn meniscus and the ortho wants to do a meniscectomy. Out patient, orthoscopic procedure. Our regular doctor, an ostiopath, advises against it.

Anybody had this done? Any opinions?

We're not sure how to proceed from here, but water ski season is coming!

Thanks in advance, Scott

Sorry to be so late weighing in on this subject. It has been a busy couple of weeks and I have not been paying attention to the general forum. I will begin by stating that I am an orthopedic surgeon with 25 years experience, and board certification in sports medicine as well as orthopedics.

Most orthopedic surgeons have a knee jerk response (pun intended) to the diagnosis of meniscus tear of recommending surgery. In a 40-year-old patient, that it is not always the correct treatment. A trial of conservative management is very reasonable and often successful in relieving the symptoms. However, there is one caveat to this: YOUR SYMPTOMS MUST GO AWAY.

So, what the hell does he mean by that, you think.

A little explanation of anatomy. The end of the femur is rather round. The top end of the tibia is rather flat. Both ends of the bone are covered with articular cartilage which forms the joint surface. Think of this as analogous to a bearing surface in an engine. The meniscus is a shock absorber type of cartilage, which goes between these 2 bearing surfaces. It is thicker at the outside and thinner on the inside, kind of triangular shaped. It sits as a ring around the margin of the joint on both the inside of the knee (medial meniscus) and the outside of the knee (lateral meniscus). It is an important structure to distribute the load across the bearing on each side of the joint, so that neither the surface of the tibia or the femur experiences excessive load and premature wear. The best scenario is to have a knee that has no damage to the joint surface and a normal meniscus. In this situation people can continue to be very active with high intensity sports even into very old age. The next best situation is to have some of your meniscus missing, but to have all the surfaces smooth. This does add increased stress to the joint surface and can cause premature formation of arthritis because of altered pressure, but also can be a situation that does very well over the long-term. The worst situation is to have a rough, torn meniscus which acts like a large fragment of dirt in your ball bearing, scratching the surface and causing premature wear of the joint. This is the situation that you want to avoid, as you can have very rapid progression of arthritis in the knee.

So, to summarize, if with conservative treatment your symptoms gradually disappear we can presume that your meniscus tear has smoothed itself out and is no longer acting as an irritant in your knee. On the other hand, if you have persistent symptoms we can also presume that he still have dirt in the ball bearing. Your meniscus is rough, the torn portion is irritating your joint surfaces, and you're at very high risk for having problems down the road. In this situation she should definitely have surgery to remove the torn portion of the meniscus. Ignoring persistent symptoms of pain, catching, and locking would be foolish, and potentially lead to early development of significant arthritis in the knee.

Symptoms can also be tricky to evaluate. The symptoms are often very intermittent. It will seem that the knee has gotten better but every time he try to do something which is more vigorous in nature, the symptoms will recur. In this situation, she should have the arthroscopic surgery. But if her symptoms truly, gradually disappear, and do not return, then conservative treatment is just a successful and has relatively low risk.

Please let me know if you have other questions, and if you are in Northern California at any time, I would be happy to look at her knee and her MRI scan. Best wishes.