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Author Topic: Meniscus Tear - Surgery or not?  (Read 14058 times)

Offline Hawkeye

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Meniscus Tear - Surgery or not?
« on: August 26, 2009, 03:14:46 PM »
Mid 50's male with left, medial meniscus tear. Confirmed by MRI. MRI also shows arthritis "consistant with age". I've been trying to rehab the knee to avoid the Sept 25th appt with surgeon. I'm told the tear is in the white area (no blood). Surgeon draws pictures of meniscus and tear. Won't take the time to point to it on the MRI. (Anyone feel like talking me through an MRI reading? The films are right by my side.)

I can't get a straight answer from the surgeon on the following: why does my knee swell when doing rehab exerciese? If the tear is in the white area, it can't be bleeding, right? I have pain only when twisting the knee (when crossing one leg over the other or when foot gets tangled in the sheets and I try to turn over). Is this consistant with a torn meniscus? I pain also when pressing on the inside muscles of my knee. Apparently it's inflamed still.

Surgeon has little patience for talking through these scenarios. Just says "I have a close look during surgery and take care of what I find". Not real comforting!

All coments are welcome. Have any of you managed to rehab a meniscus tear and avoid surgery?

Thanks!

Hawkeye

Offline crankerchick

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Re: Meniscus Tear - Surgery or not?
« Reply #1 on: August 26, 2009, 04:05:29 PM »
Is it possible to see a different doctor? If you aren't satisfied with him, I definitely wouldn't be letting him operate on me.
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
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Offline Hawkeye

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Re: Meniscus Tear - Surgery or not?
« Reply #2 on: August 26, 2009, 05:58:26 PM »
It's not a matter of whether I like the surgeon or not. He's got a great reputation, etc. I don't expect him to know how to rehab w/o surgery. After all, it's what he know best. I'm hoping someone on here has tried it and can enlighten me.

Offline OrthoRep

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Re: Meniscus Tear - Surgery or not?
« Reply #3 on: August 27, 2009, 02:10:02 AM »
What's your activity level?  How long have you had the tear?  What are you long term goals with the knee?

Offline crankerchick

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Re: Meniscus Tear - Surgery or not?
« Reply #4 on: August 27, 2009, 04:03:07 PM »
i meant if he isn't giving you satisfactory answers to your questions, perhaps you could see another doctor for a second opinion.

in terms of rehabing it instead of surgery, i'm just grasping here but maybe a physical therapist could be of help.
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor

Offline Tyana

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Re: Meniscus Tear - Surgery or not?
« Reply #5 on: August 29, 2009, 06:02:36 PM »
Hawkeye,

Your symptoms are indicating a torn meniscus. I experienced the exact same thing. The swelling could come from aggrivating the tear when your knee slides over it, possibly causing it to tear more and more. My OS and his mentor both confirmed this with me when I asked them.

Honestly though if your OS is not giving you the answers you need maybe research it more (like on here!) or seek out another OS. Just my recommendation. As for rehabing the knee, I didn't attempt this because of the extent of the damage to my meniscus. I just knew it was not going to be something that would spontaneously heal on its own.
Complex tear through the body and posterior horn-Med meniscus 6/20/2009
Med meniscus partial menisectomy surgery 70% removed 8/10/2009

Offline Hawkeye

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Re: Meniscus Tear - Surgery or not?
« Reply #6 on: September 01, 2009, 05:11:40 PM »
Thank you all for the feedback. It's been helpful. I think for me, it's not going to be possible to rehab this knee without surgery. I'm glad I tried. At least I know that surgery is the only solution.

I'm a fairly active guy. I run (well, not so much right now), lift, work in the yard, etc. The surgeon says "I can't make your knee like new, but I can improve what you've got". I guess that's my best option right now.

I'm comfortable with the surgeon. I just wish he was more verbose. However, given the choice between good surgery skills and good exam room dialog, I'll take the surgery skills.

I'll keep you all posted on the results.

Hawkeye

Offline perryg114

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Re: Meniscus Tear - Surgery or not?
« Reply #7 on: September 05, 2009, 04:20:22 PM »
I have found that all the surgeons are like that and they don't want to talk to you in detail. It is a business for them and surgery is their business. I have the same problem that you have but I am reluctant to have surgery. My knee hurts but I have been getting by. From the research papers I have read the surgery will reduce pain and restore function for a while but arthritis will be the end result as the increase pressure on the articular cartilage wears away. This is the Teflon like cartilage that is on the end of your femur. If you leave the tear alone it may get worse and hurt. If your knee does not lock when you use it or pop when you are walking then chances are you are going to be ok as long as you donít over stress it. If the tear gets worse then it will either self terminate and become loose or it will reach the blooded area and may even heal some. The research I read said that the meniscus will work normally as long as the outer load bearing (hoop stress) part of it is intact.  The inner non-blooded portion acts as a cushion and transfers loads to the outer portion. You are going to have pain with or without surgery. You will probably get a few more years out of it with reduced pain after surgery but sooner or later you are going to wear that knee out. I am postponing mine as long as I can in hopes that they will eventually find a way to repair it or remove less of it.

Offline crankerchick

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Re: Meniscus Tear - Surgery or not?
« Reply #8 on: September 05, 2009, 06:06:11 PM »
Quote
I have found that all the surgeons are like that and they don't want to talk to you in detail.
Totally disagree with this. It is definitely possible to find a doctor that is accessible and explains things as much as a patient needs. I'm sure of this because I have such a doctor. I ask a lot of questions and he answers all of them in detail, and I'm someone that demands detail--I don't want a shrug it off answer. Further, I believe it's possible to find the doctor that answers questions in detail and is a skilled surgeon. It just takes work by the patient to find such a doctor.
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor

Offline jathib

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Re: Meniscus Tear - Surgery or not?
« Reply #9 on: September 05, 2009, 11:34:03 PM »
Quote
I have found that all the surgeons are like that and they don't want to talk to you in detail.
Totally disagree with this. It is definitely possible to find a doctor that is accessible and explains things as much as a patient needs. I'm sure of this because I have such a doctor. I ask a lot of questions and he answers all of them in detail, and I'm someone that demands detail--I don't want a shrug it off answer. Further, I believe it's possible to find the doctor that answers questions in detail and is a skilled surgeon. It just takes work by the patient to find such a doctor.

I agree. I have two great orthopedic surgeons. Both of them will sit and answer all my questions. They're also very highly skilled surgeons. I have walked away from doctors before that didn't want to talk to me. No sense in wasting time with them.

As for meniscus tears, they're a damned if you do, damned if you don't sort of thing. You'll probably end up with arthritis whether you have surgery or not. In the meantime though, surgery can make you feel better.

Offline CHILLYdogs

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Re: Meniscus Tear - Surgery or not?
« Reply #10 on: September 06, 2009, 04:21:31 PM »

It is definitely possible to find a doctor that is accessible and explains things as much as a patient needs.
I'm sure of this because I have such a doctor.

Wow, crankerchick!!† I agree with you 100%!†Because I too have one such surgeon...

But wait!† What a coincidence...† I guess we have the same great dude for our doc!† ;D


Hello there, little sandasista!†

Nice to see you here and happy.


« Last Edit: September 06, 2009, 04:28:24 PM by CHILLYdogs »
chilly-dogs@hotmail.com

contralateral BPTB ACLr: Nov'08
back to sports, no restrictions: Feb'09
( yep!! that's @ 12 weeks post-op :-)

Thank you, thank you, thank you, Doc Sanders!!!!!!
(http://www.sandersclinic.net/)

Offline crankerchick

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Re: Meniscus Tear - Surgery or not?s
« Reply #11 on: September 06, 2009, 04:32:09 PM »
Quote
But wait!  What a coincidence...  I guess we have the same great dude for our doc!
Haha  ;)

yes, here and happy, just trying to pay forward the great advice i received from members of this community.
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor

Offline CHILLYdogs

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Re: Meniscus Tear - Surgery or not?s
« Reply #12 on: September 06, 2009, 04:46:00 PM »
Quote
But wait!† What a coincidence...† I guess we have the same great dude for our doc!
Haha† ;)

yes, here and happy, just trying to pay forward the great advice i received from members of this community.

Oh, you knew that it would make me so happy to hear that from you!
Thank you.
That is exactly the reason why I still come back here after having shed my knee-sufferer status: to pay it forward.
It is a great, wonderful privilege to be able to do that.
chilly-dogs@hotmail.com

contralateral BPTB ACLr: Nov'08
back to sports, no restrictions: Feb'09
( yep!! that's @ 12 weeks post-op :-)

Thank you, thank you, thank you, Doc Sanders!!!!!!
(http://www.sandersclinic.net/)

Offline SkiTheBlack

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Re: Meniscus Tear - Surgery or not?
« Reply #13 on: September 12, 2009, 08:53:44 AM »
I was interested in this thread.  I am trying to decide whether to have arthroscopic surgery for a torn meniscus.  The tear is apparently in the rear horn, probably with no blood supply, and a small flap (per MRI).  I took a fall skiing about 8 months ago.  Tear is apparently a common type, and the surgeon plans to shave it down.  Results are usually good.

Really, the only reason I am hesitating having the surgery, is that the knee doesn't bother me too much.  I was able to ski last season.  I have minor ache/pain probably twice a week, but it goes away after a while, and doesn't bother me too much.  If I walk on uneven ground this will usually cause the pain.

My inclination is to have the surgery and get this over with, but I wonder if I am being foolish, considering that the pain is not too bad or too frequent.  I wonder, however, whether it will get worse when I ski next season.  I also wonder whether there is any chance it will get better without surgery; I am told the body will sometimes absorb part of the torn meniscus.

I could wait and see what happens this ski season, but if it gets bad I would hate to lose out on part of the season.
Any recommendations?


Offline crankerchick

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Re: Meniscus Tear - Surgery or not?
« Reply #14 on: September 12, 2009, 04:21:55 PM »
i think there is really know way to know if it will get worse or not. i'm in a very similar position to you. my knee does something its not supposed to do, but it doesn't really hurt when it does it. its annoying as all bloody hell but it doesn't hurt. but the question of if it will one day get worse lingers in my mind. i have twisted bones, which certainly aren't going to "heal themselves" but its just impossible to know if the current knee cap going out of place will eventually lead to increased pain and arthritis. I guess the only real difference for you and me is that my activities are limited and my lifestyle is affected due to my knee. The kneecap going out is intermittent and I walk with a severe limp to compensate and there are activities I love that I just am too afraid to pursue because of the fear that my kneecap might go out and I won't be able to stop myself before it happens.

whether or not to do the surgery to me is a question of asking yourself how much does the current condition affect your everyday life and if you can live without the activities you aren't able to perform due to the problem. i think it is also worth finding out the risks of doing nothing. in my case, my patella doesn't track right, and there is a very real risk of arthritis associated with that. then in the end, you just have to weigh all of that and make a decision.

for me, i want to have a family soon, but I can barely walk around because when I don't walk with the limp, my kneecap eventually pops out, usually at an inopportune time like when i'm crossing a busy street. Limping just makes everything take longer to do and puts pressure on other body parts to compensate. I'm now dealing with a possible stress fracture in my foot which I can only correlate with compensating in my walking putting stress on parts of my foot that couldn't take it. For me, the drag that this has been on my life for the last 8 months (and really, all of my life) is indicative to me that I just can't keep doing this for the rest of my life or indefinitely until the pain gets bad enough to really make me want surgery. i've decided that pain is a powerful motivator. if i was in a lot of pain, it would be no question to operate. but since i'm not, i keep wondering if maybe i shouldn't have surgery after all. but then my kneecap goes out or there is something i want to do that I can't and i realize that just cause it doens't hurt doesn't mean it doesn't suck like it is, lol.

 i guess a good question to ask might be how much of your meniscus do u need to have removed? that might help be a deciding factor. if it were to get worse, that is just more of your cartilage that u would need removed later.
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor

 















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