The WAITING ROOM => GENERAL KNEE QUESTIONS and comments (good for new threads) => Topic started by: happyB on November 26, 2014, 05:29:56 AM

Title: Preparing for meniscectomy this Friday
Post by: happyB on November 26, 2014, 05:29:56 AM
I am in Australia (Darwin) and had an appointment with my specialist this Monday and he said that with the kind of tear in my lateral meniscus, he would just remove it instead of repairing it. He also said he sees a tear in the other side meniscus although the radiologist's findings dont say anything about it.

As I was categorised to be a patient who needs to be looked into within a year and while I was still researching on life without menisci and how it leads to an early onset of arthritis and other problems with the knee, the public hospital called and asked if I could come in for a surgery this Friday !

Meniscus transplant isn't performed in Australia. There were a few procedures done in Sydney with very poor results.

How efficient are meniscus transplants ?
I am willing to go to a foreign country (Germany?) to get appropriate care.
I am just blind sided by this sudden phone call and can't seem to think straight.
Will a complete removal of one or both meniscus lead to an early osteoarthiritis ? I spoke with one of the registrars (dr.s helper?) and he said they wouldn't remove the entire meniscus - but I darn well remember the doctor saying so. Also, from internet research it looks like the decision really can be made only when the doc is in the knee.
How long will it take for me to get back to my desk job after the surgery ? I am already overweight and believe will need some rigorous rehab.

Any advice please ?  :-\
Title: Re: Preparing for meniscectomy this Friday
Post by: Vickster on November 26, 2014, 09:28:42 AM
Depending on the type of tear, it is unusual nowadays to remove the whole meniscus.  As the registrar said, the surgeon will usually just trim away as much is needed to remove the tear.

I would recommend you contact the surgeon directly, by phone or email if you can and ask for clarification.  Alternatively, could you postpone the operation until the new year.  The internet is full of scary , so it really is best to discuss your own case with your surgeon.  You don't need to consent to anything.  If you don't want the surgeon to proceed with the surgery if he feels that a full meniscus removal, you can specifically request that he ends  the operation and closes up.

 I had 15-20% of my lateral meniscus removed nearly 5 years ago and although there is arthritis in the knee, it's not only down to the menisectomy.  I had to have the surgery, I tried physio for 5 months, but my knee was locked bent and it started to buckle and grind.  Indeed the tear had got worse over that time, so depending on the tear, it may be best not to wait too long.  What symptoms do you have?

I went back to work after 3 weeks, when I was also allowed to drive then (my surgeon's instructions).  I was probably back exercising after around 8 weeks.  Every surgeon has a different protocol and every patient recovers at a different weight.  You should work with a physiotherapist after the operation.  If you wait, it's also good to do some pre-hab to get the leg muscles strong.

Have a read of the meniscus information in the information hub

Meniscus transplants do seem to have a fairly low chance of success still, also there are few surgeons who do very many of them (the top guys here in the UK only do 5-10 a year max I understand).  Your age will also have a big bearing on whether you are a suitable candidate.  I don't recall anyone on here having the transplant in Germany specifically, a handful in the US and UK (read through the meniscus section).  Meniscus transplants are very painful open surgeries, with a long period on crutches and a long rehab, which may mean you'd need to be away for many weeks

Good luck :)
Title: Re: Preparing for meniscectomy this Friday
Post by: happyB on November 26, 2014, 10:25:27 PM
Thank you so much for replying mate.
The only symptoms I have are the outer part of the left knee (lateral) hurts like hell after I have even jogged/sprinted for more than 5 meters. I can take a few flights of stairs. But thats it. If I dont do any exercise, then the knee is fine. I can walk many miles and I do.
The sad part is I got the tear in my knee 12 years ago when I was lifting very heavy weights. After which I just stopped weight/any training. I just walk. Now a days, whenever the knee flares up, it hurts real bad.
I am 31 and a recently diagnosed diabetic. I am 6'2 and weigh about a 135 kilos and will need to knock off some weight. I used to weight lift in the 115 kilo category 12 years ago. about 2 kilos a year is a healthy weight gain I reckon, just that, now it has to turn the other way round and reduce at least 4 kilos a year.

Would you know if bone on bone (no menisci) cases are common place ? Do most people have issues after having their menisci pulled out ? If this leads to an early onset of arthritis and knee replacement is almost a given in another 10 years, then I wonder why the doctors dont just replace the knee and be done with it.

I think I will ask the surgeon to not remove all of the meniscus. I would rather suffer with some cushion still between the knee bones :)
Title: Re: Preparing for meniscectomy this Friday
Post by: Vickster on November 26, 2014, 11:17:40 PM
Doctors won't replace the knee until there's no other option especially in younger (under 60 or 65) as the parts don't last forever, especially in younger more active patients, and revisions are not ideal. It's also a major surgery that Involves removing the ends of the thigh and shin bones, so if those aren't destroyed, no surgeon should be rushing to do that.

If I was in your shoes, with no mechanical symptoms, I'd leave well alone for now and simply not run.  Get a good sports physio to help strengthen the knes..  Use swimming or cycling for exercise and weight loss, running is pretty horrible for knees especially if carrying excess weight

Surgeons now try not to remove the whole meniscus if there's any option, so total menisectomy is less common.  The video I linked to is really good, I watched it this morning. Well worth watching to under stand the consequences of the surgery versus none for example.

You need to talk to the surgeon, if just to understand his plan and for reassurance :)
Title: Re: Preparing for meniscectomy this Friday
Post by: happyB on December 03, 2014, 12:29:00 AM
I went in for my surgery the past Friday. I told the registrar that if the situation so be that the entire meniscus has to be removed, I be let the way I am and stitch me up.

I was kept under observation for a day - and the next day the head surgeon came up and said they had removed the torn lateral meniscus. No stitching business for the lateral meniscus as they are bound to tear up again - per the doc. He said there is reasonable meniscus left in the knee - though I dont know what a reasonable amount is. I have a follow up this Friday.

Am on crutches with 30-40kilos of load bearing on the operated knee. I feel a lot of pain from the middle of my heel covering the entire arch on the feet. I dont know if this is because of limping. But the pain is too much when I am standing up, bearable when I am sitting and non existent when I am lying down. Hope I dont have a new problem now. Is this common ?

Also, the doc said no squatting or kneeling for 3 months, but I have a neighbour who got his cartilages fixed and said his doctor said exercise as much as possible and as soon as possible. I dont know who I should listen to. Is exercise of the knee recommended immediately after a surgery ?
Title: Re: Preparing for meniscectomy this Friday
Post by: Vickster on December 03, 2014, 07:20:30 AM
Listen to your surgeon who has seen in your knee and not your neighbour.  However, if you have questions about the rehab, ask, in a non confrontational way, why it's different.  I had 20% of my lateral meniscus removed, I used crutches for a week and then on and off for the next 3.  I went back to my desk job after 3 weeks and could drive. Physiotherapy exercises are important after knee surgery to get the ROM back and keep the muscles firing but follow the physio's lead (you'll start gently and then work up to weight bearing exercises etc).  I can't remember when I went back to the gym, at 8 weeks maybe. 

All the best :)
Title: Re: Preparing for meniscectomy this Friday
Post by: happyB on December 04, 2014, 10:27:36 PM
Thanks for replying mate. Good on'ya.
Yeah, I am going to trust a qualified professionals advice versus the experience of a sparky with a surgery :)

I was cleared to sit from day one - meaning the joint could be bent at max  90 degrees - so I could sit on a chair/pot. I dont see this very different from sitting in a car. Its my left leg and I only need my right one to drive. So I have driven a few short distances. Matter of fact I be driving this noon to see the doc.

Were the benefits of the menisectomy visible immediately for you ? How long does it take to know if the surgery was actually a successful one ? Are you allowed to run and do weights ?
Title: Re: Preparing for meniscectomy this Friday
Post by: Vickster on December 04, 2014, 10:52:30 PM
The locked knee that I'd had for 5 months had resolved by the time of my post op follow up at 6 weeks.  I think I had full rom after a couple of weeks, I don't recall any restrictions on bending after the op, I could do  heel slides after 24 hours

In terms of running, I haven't been able to for 5 years but that's probably more down to the damage to the bones than the meniscus...hate running anyhow ;) weights aren't my bag either but I do force myself to use some of the machines at the gym when I can be bothered

Cycling's my thing, but right now that's not doing my knees any favours after having an accident in February, but that's another story!

Good luck for your recovery, don't overdo it, more a 10k with a menisectomy than a sprint.  If something hurts, stop
Title: Re: Preparing for meniscectomy this Friday
Post by: happyB on December 10, 2014, 07:03:09 AM
Alright. So I had a follow up visit yesterday. Unfortunately the doc who saw me wasnt the surgeon who operated. This doc said I should walk without crutches from now on. However, I remember the surgeon talking to me after surgery saying full weight bearing will take 4 weeks - this surgeon is also known to be very conservative. I am completely unsure now. Should I walk without crutches or not. I repeatedly asked the doc seeing me about this and he said as long as it was just a menisectomy I should start walking.

I did walk a few steps without the crutches and I seem a bit unbalanced. There is no pain or swelling in the knee. I see the PT on Friday. I have started putting more weight on the knee and use the crutches only to help me balance. Am I stuffing myself ? Any pointers? 
Title: Re: Preparing for meniscectomy this Friday
Post by: Vickster on December 10, 2014, 08:38:28 AM
If the meniscus was trimmed and not stitched, there is no reason why you shouldn't be able to bear weight.  Doctors generally like you off crutches as soon as possible if there's no repair to protect or fracture to heal

If you are unsure, wait for the physio appointment on Friday.  I only used crutches when making longer outings after the first week, not at all around the house.

Everyone is different and every surgeon, sometimes no crutches are required after menisectomy

All the best :)
Title: Re: Preparing for meniscectomy this Friday
Post by: happyB on December 10, 2014, 09:46:48 AM
Vickster, your replies have been so helpful mate. Thanks.

Yeah, no stitching business was done. Just the meniscus was trimmed. This was made clear from my first appo onwards. Supposedly, the  lateral meniscus tears (or may be tears like mine) are pointless to be stitched as they keep tearing over and over.

I live in Darwin - tropical - very, very, very humid. So I was asked to stay almost a 100% of the time in an air conditioned environment for two weeks so the incisions/holes wouldn't get infected.
When you first started bearing weight on the knee, did it feel like something was missing in the knee ? My knee feels a bit funny :)  I haven't put too much weight on it in the past 12 days so walking in itself feels funny.
Title: Re: Preparing for meniscectomy this Friday
Post by: Vickster on December 10, 2014, 09:57:57 AM
Yes, probably as there will be swelling and the joint has been through a pretty big trauma despite the small holes!  You'll also lose some muscle strength/bulk

I'd say it is best to get off crutches, especially if you are just bimbling around the house, so as not to lose strength or become reliant.  Need to get confidence back in your knee :)

My knee had been locked for 5 months so when that started to resolve I'm sure it did feel odd (5 years ago nearly, hard to recall)

I was never not weight bearing, I was just using the crutches for support, my foot was always on the ground :)

Title: Re: Preparing for meniscectomy this Friday
Post by: WonkeyDonkey on December 10, 2014, 04:38:45 PM
If it's any help. the first arthroscopic meniscus tear procedure I had, I did not have any crutches to help, and was told it would be uncomfortable for the first few days and then ok. Basically I needed help just to walk to the loo fro a couple of days!! The second time I had this done, I had a set of crutches at home for a previous op and used them for a couple of days just to be able to get myself around easier without relying on my family. I only used them for 3 days and then was FWB.
First time I had 7 weeks off work, simply because I could not pick up the children I cared for, the second time I had 2 weeks off and was back at work.
Everyone is different and recovery can vary. If in doubt ring your OS/Secretary.
Good luck with your recovery.
Title: Re: Preparing for meniscectomy this Friday
Post by: happyB on December 17, 2014, 05:47:57 AM
Hello again,
Did any of you have swelling in the feet (of the leg whose knee was fixed) after the surgery ?
I have a bit of a swelling - not too bad though - I can feel the part, where we tie shoelaces, rub against the straps of my thongs/slippers. I can wear my runners and walk around and it isn't painful. I showed this to the GP and he was of the opinion that due to the inflammation in the knee this was expected.
But, saddened by the grasp of the medical fraternity here (where the surgeon said crutches on till 4th week, the registrar said no crutches on from 2nd week, and the physio commenting how I should have gotten off them crutches ASAP (!) and the GP saying "it is safe to be on crutches". I just want ONE medical opinion ! - I almost don't believe these people here any more) I thought I'd do some online research. I have been walking without crutches for a week now. Just taking baby steps and walking real slow. My knee hasn't popped as much in its 12 years of injury than how much it has popped in these last 2 weeks :) - I am hoping that is alright

Title: Re: Preparing for meniscectomy this Friday
Post by: Vickster on December 17, 2014, 09:31:38 AM
I suffered from dependent oedema after the injury and surgery to my shin and my left ankle, the worse side, Is always a bit puffy. You need to keep your feet elevated as high as possible while sitting and ankle pumps and circles help too

Getting back to walking as normally as possible is the aim

You might want to edit your language a little in your post as there are minors who use the site too :)
Title: Re: Preparing for meniscectomy this Friday
Post by: happyB on December 17, 2014, 11:28:19 AM
Done. I am appalled by the knowledge various doctors around here have.
Good to know this swelling/puffing is normal. Cheers.
Title: Re: Preparing for meniscectomy this Friday
Post by: Vickster on December 17, 2014, 11:42:12 AM
You could try an ice pack on the ankle as well as the knee too.  Or an anti-inflammatory pill if you can tolerate them

All doctors and physios have different approaches - because they are different, doesn't mean any one is wrong, 10 medics, 10 opinions, some are more conservative, others more aggressive.  Physio is about getting you back to normal function asap so not surprised they said to ditch the twigs.  GPs have different views too, but I'd always go with a physio's view on knee matters than a GP (a good GP is one who knows to refer when necessary)!  If you are young and fit, they want you back to normal as soon as, which is as it should be.

From my own experience and others on here, using crutches for much time after a partial menisectomy is quite unusual.  I expect my surgeon recommended them for me as a way to give the knee a rest - as I didn't really do so after the injury!  After my second arthroscopy (basically a tidy up), crutches weren't even mentioned and I was back driving in under 10 days