The SPECIALIST'S OFFICE > Meniscus

Avoiding surgery for a torn meniscus - how do you do it?

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Vickster:
Hello and welcome :)

I tried conservative treatment for a lateral meniscus tear (physio, no cortisone, minimal painkillers) which appeared very small for 5 months after the injury, during which time I was swollen, limped and unable to straighten my leg, once the buckling started, it wwas time to get it fixed as I couldn't function.  I was 38 at the time.  During the scope, it was confirmed that I had a nice defect in the femur caused by the accident (healed over with scar tissue so no repair required) plus softening to the tibia.  I had a subsequent scope (now a year a go) and the damage to the tibia is more extensiive - I am knocked kneed, so the lateral menisectomy may have contributed to the worsening of the lateral damage but it was there at the time of the menisectomy (patella has been cleaned up too). 

I had around 15% of my lateral meniscus removed, but have no regrets as I can now fucntion, can straighten my leg, cycle, walk, squat carefully, none of which I could do before the surgery.

However, I would say if the pain is intermittent, you can do almost anything you want and there is no locking and buckling, I would leave well alone.  My menisectomy achieved everything it was meant to - but, there are members here who are worse off than before.

Yes, I will likely end up with arthritis (but most people do, the joints just wear out) and may need the wonky alignment fixed.  Best to avoid anything that hurts the knee or places it at further risk of damage if you can (running and skiing say can be horrible for knees), make sure you have a bike that is the right size and correctly set up etc

Plenty of folks live with meniscus tears that they don't even know exist - mine was small, but it got worse, bending my knee caused all sorts of horrible grinding and the surgeein said I had worn part of the meniscus away. The surgeon went in planning to do a repair of the tear but it was too complex

I am in the UK where it seems surgeeons aren't so keen to rush in and operate if the patient can function (money has something to do with this, although not in my case as I have private healthcare - my surgeon was just conservative and wanted all the injuries to settle down before chopping (I had a nasty painful bone bruise too).

I would carry on doing what you are doing, don't overdo it, ice after exercise, if it starts to affect your day to day quality of life, then that would be the time to revisit the surgical options. 

Good luck :)

Ilya:
If you ask me it is better to have the knee slowly wear our over time doing all the things you love vs doing none of the things you love and then reinjuring it doing something stupid like running to catch a train or something and face the same decision over and over, surgery or not.  Its like living in limbo...

I had the surgery (about 20% removed) and am fine.  I am more active now then ever and have 0 pain doing anything.  I cant wait for the coming winter so that I can hit the slopes on my skis.  Would not be able to do this if I avoided surgery and would be very upset.  My mantra is live life in the present, and when the future comes worry about it then.  I had the surgery almost 3 years ago and feel great.  I tried avoiding surgery for 6 months after the injury, and it just got really annoying NOT BEING ABLE TO DO ANYTHING and always worried about my knee.  I would say if it does not heal in 6-12 months it will never heal and be a constant bother.  Not a good way to live in my opninion. 

What situation would you rather be in.  70 years old with arthritus but dealing with it looking back at life at all the things you have done and regretting nothing.. or living your entire life worrying about your knee and avoiding the things you love, like playing football with your son or showing off your volleyball skills in front of some hotties.  Think about it....

From my research I have read that the risk of arthritus is very low if you have less than 25% removed, any more is when the problems start.  I made sure to express this to the surgeon that if he feel he needs to take out more than 25% to NOT DO IT.  I am blessed the way everything worked out, but every situation is different.  If you decide on surgery make sure you get the best surgeon available and make it clear to him/her exactly what you want and how you are feeling. 

Good luck to all and God bless. 

You can read my post op diary here:

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=46205.0

Ilya N.
 

casual runner:
Well for me, "70 years old with arthritis" is not such a remote possibility. I have lived an active life for 51 years, so I have no regrets in that regard, However, being 51, I have had a number of opportunities to realize I could have made better decisions earlier in life, with an eye toward the long-term consequences. That has to be balanced with the short term benefits-undeniably, if I could walk without pain after surgery that would be great. But I also want to be active when I'm 70, 80, 90. I have many other options for being active now, but I will have fewer when I'm that age. Being able to walk and hike when I'm older is of paramount importance to me.


Ideally I could find a knee specialist to see, but there are none within a couple hundred miles. I'd have to apply to the Mayo Clinic. So my short term decision is to see a sports medicine orthopedist and see if he has ideas on helping me remain active. I found one who is active in AOSSM http://www.sportsmed.org/apps/findadoc/finddoctor.aspx

"AOSSM members are physicians and allied health professionals who demonstrate scientific leadership, involvement and dedication in the daily practice of sports medicine.

Members must demonstrate continuing active research and educational activities in the field of sports medicine. Such activities may include service as a team physician at any level of competition, educating persons involved with the health of athletes, service to local, regional, national and international competitions, and the presentation of scientific research papers at sports medicine meetings.

The unifying interest of the membership is their concern with the effects of exercise and the monitoring of its impact on active individuals of all ages, abilities and levels of fitness."

I noticed none of the other doctors I've seen are listed there, although they are fine orthopedists.

rru2s:
As often happens on medical message boards, those who heal disappear after a while but those who are still symptomatic are still posting.  I am replying because my email inbox contained a link to this thread in which another meniscus injury patient wondered about my prognosis 5 years post-injury.

I'm happy to report that, as of this date in 2012, the lateral meniscus oblique tear injury from summer of 2005 is no longer an issue whatsoever.  For several years now, I have been running at my pre-injury mileage of three separate 10 mile runs every week, generally without knee pain.   Also, I am able to run the old way - heel striking or however it was I ran before the injury.  And I never had surgery.

The history summarized in the following stages:
(1) Lateral meniscus tear - oblique tear - which folded inside the joint in July 2005 during a volleyball game.  Could not straighten knee or walk without serious pain - forget even think about running - for several weeks.
(2) MRI was not able to be scheduled for almost a month - so I did reading and high motion non impact knee exercise meanwhile.  After roughly 1.5 weeks of sitting in a chair doing imaginary "air bicycle" motions for 15 min to 1 hour per day, the cartilage unfolded and slipped back into approximate conformation allowing me to straighten my knee to within 2 or 3 degrees of fully extended.
(3) MRI came back as a tear, surgeon recommended surgery, but also said I could try a wait and see approach as it would not likely hurt me further.  So I did elliptical of approximate duration similar to my previous running regimen -- 100 minutes of elliptical on three days each week.
(4) I tried running a few dozen feet after 6 weeks, but it felt like bone of bone slamming impact on my knee.  Obviously, the cartilage horseshoe shape was not covering the surface of the bone during running.  So I kept up elliptical for a year, and didn't try much in the way of joggin until 6t months later.
(5) After 6 months I tried "Pose" method running on my toes/balls of feet - just 1/4 mile at a time, walking in between.  I worked up to 6 miles within the next 11 months.  By 17 months post-injury, I thought I might be able to get back to my old long distance running.
(6) Pose running never felt comfortable for me, I got very tired.  In fact, in December 2006 after 11 months, I got a severe injury in my right groin area, which I thought was a pull of the illiopsoas.  When I gave it 2 weeks rest and tried running again, the pain was excruciating after 1.5 miles.  I went for a MRI and found out I had a stress reaction (similar to a stress fracture) of the insertion area on my femur, right where the illiopsoas muscle inserts.
(7)  The hip stress fracture took almost a year to heal.  I did a lot of swimming and bike riding meanwhile, and after 5 months a bit of easy walking.  So the timeline was - 2005 - knee pain, only elliptical - 2006 - still not able to fully straighten knee, lots of elliptical.  - 2006 small doses of Pose running with no knee pain.  2007 Hip stress fracture, no running until fall.  Late 2007, resumed running again, this time I realized my knee NO LONGER HURT REGARDLESS IF I RAN ON MY TOES OR ON MY HEELS.  So I decided the Pose Method had been causing awkward biomechanical forces and culminated in ahip sterss fracture and gave up on Pose for good.
(8) 2008 - Focused on building up normal running mileage - I now felt no knee pain, but my opposite leg felt cramping in my  lower back - perhaps from the couple years that my knee didnt straighten 100 percent - even though by now there was 100% extension.
(9) 2009 - I managed to build back up to 9 mile runs by summer. My right lower back and glute area were sore after long runs, kind of tired, but my left knee NEVER hurt.
(10) 2010 - Had the best running year since 2004 - a total of 1400 miles, with some nice really long runs in the fall -- a couple of 18 milers and 20 milers, and a whole bunch of 13 to 15 milers.  Since then I have had no knee issues and no hip issues, and I run three 10 mile runs each week.

casual runner:
Thank you for coming back to update us! I had a feeling you were still doing well, and that's why you weren't here anymore.
That is a pretty remarkable story that goes against the grain of what most of us are told, ie that we have to have surgery or we will always have pain. You had a pretty serious tear and you are fine now. That is very encouraging. I am determined to join you and my friend mentioned above in the ranks of middle aged (IIRC you were 48 at time of injury)  people who have recovered without surgery, even if it takes a while. I'm not sure if I will succeed-you seem to have recovered more quickly than I am- but I'm giving it everything before giving in to surgery. I'm not sure I can count those 6 months or so I was under the influence of cortisone as part of my recovery, I was just masking the problem. If I subtract those I'm only at 4.5 months, and though I don't foresee running soon I did a 4.5 mile walk yesterday, my longest since the injury.

I don't know if you are still here or not but if you are, how long did it take for all of the swelling to subside for you? Did you take NSAIDS or other medications doing your recovery?

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