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Author Topic: Anybody have meniscus work done first and THEN ACL later? (sorry, long)  (Read 2074 times)

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Offline JennBennC

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Hello all,

I'm new to this site, and have had quite an ordeal (as I'm sure you all have) with this knee injury of mine.† Here's my history (i'll make it as short as possible)

Injured myself tripping on a step on Halloween weekend.† Had MRI done shortly after and found ruptured ACL, torn MCL and torn meniscus.† Advised to have surgery within a few weeks - while continuing to keep strength up and ROM as best as possible.† Should have had surgery done by mid-to late November HOWEVER I decided to postpone the surgery only because my mother-in-law was having very delicate brain surgery and they didn't know if she'd make it through her surgery on the first of december.† So, I didn't want to have surgery in late November and be a few days post op with knee reconstruction when she went in for HER surgery, just in case there was a bad outcome for her etc.†

So, since Halloween, I've been in therapy and regaining muscle strength and ROM, however I STILL CANNOT FULLY EXTEND MY KNEE.† I've got good flexion (110 degrees) and almost full extension (-5 degrees), but can't seem to fully extend.† Therefore, everyone's thinking my meniscus is "caught".†

My mother-in-law has come through her brain surgery with flying colors and so I was ready to move on mentally and physically to my Jan. 4th surgery now.....then comes the call from my surgeon's office on Monday.† Unfortunately, my surgeon had to have some emergency surgery himself over the weekend and is now "out of commission" for 4 to 6 weeks.† This means that not only will I have postponed my surgery for 6 weeks already, I may have to postpone it for 6+ more weeks.

Here are my questions:

1) Because I don't have full extension yet (almost though), they think my meniscus is caught in the joint.† I have heard from other people that I should NOT have my ACL reconstructed at the same time as my meniscus repair/removal if I don't have FULL extension pre-op.† Is this true?† Supposedly, I should deal with my meniscus arthroscopically and THEN come back for a second surgery after more rehab and full extension to get the ACL worked on.† I was hoping to get it all done in one big swoop -- one surgery; one recovery.

2) Has ANYONE OUT THERE put off surgery as long as I will be when your meniscus was involved?†People wait YEARS if all they have is a torn ACL.  They just are careful etc.  But, with a torn meniscus, supposedly you should have it fixed ASAP?   My surgeon (and a second opinion surgeon) told me I should have the knee fixed pretty soon after injury because of a torn meniscus.   However, with my MIL's brain surgery I felt I HAD to postpone it.† Would I be doing any damage to the knee by postponing a torn meniscus and ruptured ACL for up to 3-1/2 months post injury?†

3) Has ANYONE OUT THERE had their meniscus repaired/removed AND had their ACL reconstructed/repaired EVEN THOUGH you didn't have full extension yet?† How was the outcome?

Thank you so much in advance for any advice.† I'm a bit frazzled at this point!† ‹

Jenny
Slip/twisting/fall accident 10/29/05
MRI 11/12/05
Awaiting meniscus (and?) ACL recon surgery in Jan or Feb '06
Hoping not going to need two separate surgeries!

Offline jb-knee-geek

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Re: Anybody have meniscus work done first and THEN ACL later? (sorry, long)
« Reply #1 on: December 21, 2005, 09:38:03 PM »
jenny, sorry about your injury and your MIL's surgery. Do not be in a hurry to have knee surgery.....

you don't mention an MRI, did you get one? Or, is the process to do the artho and find out the extent of you knee problems?

In the US, it is common to have an MRI to determine the extent of knee injury. If you have instability in your knee due to ACL problems AND you have pain due to meniscus problems, then, it is common to have both done at the same time.

I've been told an advantage of having both sugergies done at once is one rehab not two.

I was contemplating having the meniscus done, rehab successfully then do the ACL. My meniscus problem does not seem to be too severe so, I wil lhave both surgeries done at once..... In my case, my ACL instability problems are getting worse, though not severe at this time..... And, I have delayed ACL surgery for 3 years, and have meniscus damage to show for it  :-[

good sites for you: http://steadman-hawkins.com/patientEducation.asp

http://orthoassociates.com/Sports_Topics1.htm#topics


good luck and keep posting
torn RK ACL March 2001, surgery Aug. 14 2006, after 4 knee sprains since Oct. '05.  Allograft, ~40% medial meniscus removed, some wear in the trochlear groove. Everything else looks good.

Post-op diary: http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=29749.

Offline BMW

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Re: Anybody have meniscus work done first and THEN ACL later? (sorry, long)
« Reply #2 on: December 21, 2005, 10:09:01 PM »
I had meniscus surgery, am 9 weeks post-op, and still am -4-5 degrees on extension.† I was at PT today and had a 5 lb. ankle weight draped over my kneecap, with a rolled towel elevating my foot. Right after, I could feel that I had more extension in the knee.†
Others are probably more qualified to answer your locking question but I'm wondering whether or not you hear, or have some sort of scraping  or squeking sensation as you extent your leg. It would seem to me that something like that would be present if a piece of cartilage was wedged in the joint somewhere.† Good luck in your surgery and recovery.

Offline JennBennC

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Re: Anybody have meniscus work done first and THEN ACL later? (sorry, long)
« Reply #3 on: December 22, 2005, 04:08:30 AM »
JB,

Yes, I had an MRI done - it showed ruptured ACL, torn MCL and torn meniscus (I forget specifics of meniscus tear - lateral, etc.)

That's EXACTLY how I feel - one rehab versus two in having the surgeries done at the same time.† Why go "under the knife" twice??† However, on other knee boards etc. I've read that a lot of doctors won't even TOUCH a patient's ACL in surgery if that patient doesn't have full extension (and flexion? but mostly extension they're worried about) prior to the surgery!† That is exactly my problem -- lack of extension right now.† I have definitely improved my extension since the date of injury, but I'm still short about 5 degrees to get to full extension.

I guess I'm just really confused -- there seems to be a general "urgency" out there to get someone's meniscus fixed.† Yet, if you don't have full extension, they won't touch your ACL.† The reason I can't get that last 5 degrees of extension yet (although I've only been working really hard on it for a few weeks now) is because they think my meniscus is "caught" in my joint.† I don't have any of the typical "caught meniscus" locking symptoms or anything, so who knows if it's caught truly or not??

I'm just reading and hearing conflicting advice when talking about meniscus repair/removal and ACL reconstruction -- one surgery or two??†

All in all, I really highly doubt that waiting until mid-february (which puts me at 3+ months post injury) will do my knee THAT much damage.† Who knows, though, am I wrong?† †I really can't do it any sooner than that because of lack of help during recovery -- my husband will be traveling for work on and off until mid-feb.† After that, I'm free and clear for surgery.

Ugh!† I'm sick of the drama and complication that comes with this whole stupid knee injury.† I'm getting frustrated at this point.† But....VERY glad to have found a board like this one!

Thanks!

Jenny

Slip/twisting/fall accident 10/29/05
MRI 11/12/05
Awaiting meniscus (and?) ACL recon surgery in Jan or Feb '06
Hoping not going to need two separate surgeries!

Offline JennBennC

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Re: Anybody have meniscus work done first and THEN ACL later? (sorry, long)
« Reply #4 on: December 22, 2005, 04:13:55 AM »
BMW,

No, I don't hear any locking, clicking or scraping noises or anything.† My knee does not lock up at all -- so that's why I'm not exactly sure I agree with them saying my meniscus is caught.† I guess we'll find out soon enough when they get in there for surgery!† Anyhow, one of the other main reasons they suspect a caught meniscus is because I cannot get full extension.† They think the caught meniscus is in the way of the joint and not allowing me that last 5 degrees of extension.†

I've been doing the same exercise you talked about -- only I'm using just a 3 lb. weight at this point.† I definitely see an improvement after that exercise and after my whole physical therapy session in general.† It is definitely encouraging.†

Do you have an ACL problem as well?† If so, are you going to have your ACL done soon?† If so again, why did you do two separate surgeries -- meniscus first and then ACL?† That's where i'm confused in my personal case -† not sure who to listen to or what to do...

Thanks again for your input - much appreciated!† Good luck to you too - speedy recovery!

Jenny



Slip/twisting/fall accident 10/29/05
MRI 11/12/05
Awaiting meniscus (and?) ACL recon surgery in Jan or Feb '06
Hoping not going to need two separate surgeries!

Offline SPK

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Re: Anybody have meniscus work done first and THEN ACL later? (sorry, long)
« Reply #5 on: December 22, 2005, 07:06:34 AM »
I've had my meniscus done first and now I'm waiting for my ACL.

I really highly doubt that waiting until mid-february (which puts me at 3+ months post injury) will do my knee THAT much damage

So do I.

It is true that leaving a damaged meniscus can lead to other problems, but generally speaking 3-4 months isn't that long. If you were talking, maybe 12-18 months then that'd be a different story but I don't think you're likely to do any additonal damage in the time you're talking about.

For me personally, I had about a 10-11 week gap between my injury and scope and it was fine. I had ACL damage as well† but I got my flexion and extension back fairly quickly because the swelling didn't last as long as it normally does. Mine was swollen maybe 48 hours.

If you're really concerned about leaving it, then try and arrange to see another surgeon who can do it sooner.

good luck.
« Last Edit: December 22, 2005, 07:08:10 AM by SPK »
May 05 - Injury playing Rugby League; Torn Lateral Meniscus, High Grade partial tear to ACL
August 05 - Partial Lateral Meniscectomy
ACL Reconstruction - November 28th 2006

"I don't know how to put this but... I'm kind of a big deal."

Offline JennBennC

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Re: Anybody have meniscus work done first and THEN ACL later? (sorry, long)
« Reply #6 on: December 22, 2005, 03:03:59 PM »

Hey SPK!

Thank you so much for your post -- I feel much better now!†


 It is true that leaving a damaged meniscus can lead to other problems, but generally speaking 3-4 months isn't that long. If you were talking, maybe 12-18 months then that'd be a different story but I don't think you're likely to do any additonal damage in the time you're talking about.

That's how I feel too - I don't think 3-4 months is horrible either.† In general,  I'm not in pain (until I'm really working hard at ROM exercises).† I AM limping (which my PT wants to get rid of as best as possible) and, I'm ALMOST at full extension.† My PT says he WILL get me there.†


For me personally, I had about a 10-11 week gap between my injury and scope and it was fine. I had ACL damage as well† but I got my flexion and extension back fairly quickly because the swelling didn't last as long as it normally does. Mine was swollen maybe 48 hours.

Do you remember what shape you were in during those 10-11 weeks of waiting?† Were you also doing pre-op physical therapy?† Were you lacking any extension, and that's why they didn't do your ACL at the same time as the meniscus?† What was the reason (or was it your own choice) for doing two separate surgeries in your case?

If you're really concerned about leaving it, then try and arrange to see another surgeon who can do it sooner.

That's what I've got planned for next Friday -- another OS to see.† Maybe he'll be just as good..... and, I've found out he can get me in by Jan 3rd.† So, we'll see.....† †Then again, I really feel comfortable with my original surgeon.† He was supposed to do my surgery around that Jan 3rd date himself but then just this last weekend ended up needing emergency surgery himself!† So, he's out of commission for doing surgeries on his patients until mid-february.† I'm totally fine waiting until then too (it would work out better for me planning-wise) AS LONG AS it's not going to do me a ton of damage etc.

Again, thanks for your input - I really appreciate it.† This whole knee thing has been a trip, I swear!

Jenny


good luck.
Quote
Slip/twisting/fall accident 10/29/05
MRI 11/12/05
Awaiting meniscus (and?) ACL recon surgery in Jan or Feb '06
Hoping not going to need two separate surgeries!

Offline SPK

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Re: Anybody have meniscus work done first and THEN ACL later? (sorry, long)
« Reply #7 on: December 23, 2005, 12:11:45 AM »
Do you remember what shape you were in during those 10-11 weeks of waiting?  Were you also doing pre-op physical therapy?  Were you lacking any extension, and that's why they didn't do your ACL at the same time as the meniscus?  What was the reason (or was it your own choice) for doing two separate surgeries in your case?

I was in reasonable shape. It was the start of the Rugby season so I was fairly fit but definantly not at my peak. I did a little bit of Physio but then I stopped because it didn't seem to be making much of a difference for me and I couldn't see the point. I wasn't really in a lot of pain unless I tried to run or squat. My extension and ROM was excellent but I had some trouble with hyper extension.

The 2 surgeries wasn't really my idea. We thought I'd just torn the Lateral meniscus but the MRI showed a tear in the ACL so they had a look during the scope and saw that there were still some fibres attatched to the femur and it was 'clinically' stable, so they left it alone.

In the last few months since the scope though the knee has had some instability and I had physio for over 3 months to try and see if that would help. It didn't really help, so my Physio spoke to my OS and I went back for a second consultation and he told me that if, after 4 months it was having stability problems they were unlikely to go away and would probably go worse so he recommended the Reconstruction and after a bit of hesitation I agreed.

Now I have to wait roughly a year no matter which choice I take. My Private Insurance won't cover it for 12 months and that's basically the same amount of waiting time through the public system.

I would strongly recommend keeping your Quads as active as possible. Mine were quite big and I thought 'Nah, they'll be fine, I won't get atrophy'. Wrong!

Hope that helped!

May 05 - Injury playing Rugby League; Torn Lateral Meniscus, High Grade partial tear to ACL
August 05 - Partial Lateral Meniscectomy
ACL Reconstruction - November 28th 2006

"I don't know how to put this but... I'm kind of a big deal."

Offline BMW

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Re: Anybody have meniscus work done first and THEN ACL later? (sorry, long)
« Reply #8 on: December 25, 2005, 08:10:44 PM »
According to my O.S. the rest of my knee looked fine during the arthroscopic surgery.  I don't really have any instability that would indicated a problem with my ACL. The O.S. said that I'd sprained my MCL but my ACL was fine.  My exension is still iffy (about 4-5 degrees short), even after hitting the PT pretty hard and consistently.  This seems to effect my being able to walk naturally so I'd really like to get that flexibility back. I we can do is keep up with the PT and hoped that a little good is happening each time.
I sure wish that I'd have checked out this valuable resource prior to my surgery.  At the very least I would have seen the importance of continuous exercise and the shockingly rapid atrophy without it.  Good luck

Offline Audice

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Re: Anybody have meniscus work done first and THEN ACL later? (sorry, long)
« Reply #9 on: December 25, 2005, 09:25:31 PM »
2) Has ANYONE OUT THERE put off surgery as long as I will be when your meniscus was involved?†People wait YEARS if all they have is a torn ACL.† They just are careful etc.† But, with a torn meniscus, supposedly you should have it fixed ASAP?† †

Hi Jenny ~ I can address this question based on my experience & my what my OS has advised me. In one injury I ruptured my ACL, tore the medial meniscus (posterior horn to the articular surface) & tore my MCL. There'll be no ACL repair as I'm past the age where my OS says it's worth repairing. The MCL healed itself in time & my OS's comment about the meniscus, which like your tear doesn't lock on me, is that it can be repaired at any time I can no longer deal with it.

I can't straighten my leg completely but almost, & walk several miles daily with the dogs. I ride my horse, work at the farm & do just about everything I ever did - but with more thought to avoid twisting. I do have a brace which I wear now & then. I remain active & will have repairs made when the time comes. But I feel no need to rush into surgery based on the minimal aggravation the knee is giving me right now. FWIW...Ellie (pushing 68)
April, 2005 - ACL rupture, medial meniscus tear within posterior horn to articular surface, abnormal signal within lateral meniscus, partial tear MCL, bone contusions tibia/fibula, Baker's cyst.
No repairs.















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