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Author Topic: Should I have surgery?  (Read 1432 times)

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Offline elissa

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Should I have surgery?
« on: January 29, 2006, 03:07:57 PM »
Help - I need advice. Three surgeons have told me that I need surgery for a torn medial meniscus from an accident in November.  I have been working very hard to strengthen my quads and lose my limp.  I take glucosamine/chondroitin and cod liver oil and now have very little pain.  The burning is almost gone and I can walk (even run) downstairs perfectly.  I have almost full range of motion and no limp.  I just need three more degrees to straighten knee.  The surgeon says I STILL need surgery (because I couldn't hop for him)!

MRI says I also have severe OA of the patella.  The doctors says I'll be walking without a limp in 4 weeks.  Normal in 8 weeks.  Didn't mention possible work he might do on the patella.  He also said his job is to get me back to functioning normally - I am functioning normally.  I can't get into child's pose (kneeling) or sit cross legged - but I couldn't do that before (due to prior injuries?) and he said that I won't be able to do that after surgery either. So what's the advantage (besides the supposed increased risk for OA that I'm hoping the G/C supplements will keep at bay)

My sister had a terrible experience with arthroscopic surgery (was never pain free afterwards and needed knee replacement which was done poorly and had to be re-done!) She is in chronic pain, on advil, and tells me not to start on a downward cyle of surgeries. 

Others I meet say it's a piece of cake with an easy recovery.  This site is WONDERFUL - an essential forum for us.  Please advise me.  My tendency is to give it more time.  I know that it doesn't "heal" on its own but it sure feels fine to me now. 

Offline jb-knee-geek

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Re: Should I have surgery?
« Reply #1 on: January 29, 2006, 05:13:24 PM »
I'm in a similar situation. Giving your injury time to heal can only help. Especially if you are able to do the activities you want, you are not in pain, there is no locking or instability.

The steadman site says to give the injury 2-3 months to heal. I'm at 3 months, and have delayed surgery (again!)

I was active in pivot sports until Oct. I had been playng baseball with a torn ACL (I had a brace), I sprained my knee, diagnosed medial meniscus tear, scheduled surgery in Jan.

I went for 2nd opinion nearer my home, my meniscus was improving with rehab, so much so that my OS told me if I am doing all the activities I want with no pain, locking or instability, surgery could wait. 

I've replaced pivot and bouncing sports completely (swimming, cycling, gym work). I have no pain, or instability. Other athletes may prefer surgery to changing activites. It is a choice.

The key is rehab and change in activities.  If your meniscus continues to improve, (no pain, locking, instability) you can  change activities for fitness, you may be able to escape surgery.

check this site and the book:

http://steadman-hawkins.com/meniscus/overview.asp

http://www.amazon.com/gp/product/0446678198/qid=1106693736/sr=1-2/ref=sr_1_2/104-2931604-5081545?s=books&v=glance&n=283155

Here's another version of glucosamine, with HA to try.....

http://www.gnc.com/product/index.jsp?productId=2133465&cp&keywords=triflex&searchId=10508302276&parentPage=search


good luck, 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 Janet

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Re: Should I have surgery?
« Reply #2 on: January 29, 2006, 05:21:39 PM »
I can't tell you whether you should have surgery. But if you can't get full extension (fully straighten your knee), you won't be able to walk with a normal gait. It is really important to get full extension. Walking with an altered gait is hard on the knee, and also on other parts of the body like your hips and back. Just something to think about.

Janet
Torn quad tendon repair & VMO advancement 4/99, MUA with LOA 10/99, Patella baja and arthrofibrosis, LR & medial release & LOA 5/01, LOA & chondroplasty 6/03,TKR on 11/06, MUA 12/06. From perfect knees to a TKR in 7 years, all from a fall on a wet floor...and early undiagnosed scar tissue.

Offline stgiles16

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Re: Should I have surgery?
« Reply #3 on: January 29, 2006, 06:00:25 PM »
I cant tell you whether to have surgery or not either BUT, if I were in no pain, no instability, and could function normally, there is NO WAY that I would have surgery right now. I went in for meniscus scope 5 yrs ago and next month  I will recieving a PKR.  If I could do it over again, I would take the minimal pain that I had then to the constant severe pain that I have now. i will admit that i am NOT  the normal case. Most people do bounce back well and move on. I am an exception but if you dont hurt, why would you want to have surgery? I wish you luck in whatever you decide. If you decide to have surgery, please seek a really good knee surgeon and I hope that it works out perfectly for you with no complications.

missy
2 ligament recons right ankle
2 arthroscopic,
5 open knee procedures
2 Plica removals
bone spur removal
2 microfractures
4 debridements
2 open LOAs all on left knee
Arthritis,both knees, ankles, shoulders, elbows, hands,spine
Fibromyalgia
Arthrofibrosis
LOA & PKR 2/15/06
RA
in pain mgmt
TKR JAN 2012

Offline elissa

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Re: Should I have surgery?
« Reply #4 on: January 29, 2006, 07:20:23 PM »
Thanks so much for all your responses.  I feel part of a community. I am learning so much.  I am going to postpone again.  Interesting points...
1. without full knee extension you can never have a normal gait. True, at least not a wide gait, i'm fine with a shorter step (no hip pain, etc).  My next goal will be to see if PT can get me full extension, if not, then I'll reconsider.
jb-do you have full extension?
2. I actually went to see the author of the book you recommended and he told me that I needed knee surgery and that PT would NEVER be sufficient - Hmmm - I dont' know
3. Changing physical activities- giving up step classes doesn't bother me.  We are a bicycling family.
4. The Steadman Hawkins site is great!
5. I will look into adding HA to my Glucosamin/chondroitin/msm/cod liver oil
6. I suppose with these injuries and OA we should all know about the microfracture technique.. My next subject for investigating

Missy - you may not be the normal case, but my sister was just like you and told me she would KILL me if I elected surgery after what she's been though.  I really hope the PKR goes smoothly and gives you relief- keep us filled in. 
« Last Edit: January 29, 2006, 07:46:50 PM by elissa »

Offline xisbum

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Re: Should I have surgery?
« Reply #5 on: January 30, 2006, 12:59:15 AM »
Each case is different, I suppose, but here's what happened to me. I tore my medial meniscus during a tennis match and was anxious to get it fixed so I could return to the court. I had read all the reports of athletes returning to their sports within 4 to 6 weeks and thought I could do the same.

The OS was more than eager to lead me down that path. He never talked about any physical therapy, any braces that might take the pressure off the injured area, or any other remedy other than rest, glocosamine/chondroitin and weight loss.

I had at worst occasional pain in the 3-4 range before surgery; most of the time it was just uncomfortable and nagging, maybe something in the 2-3 range.

After surgery, I have never been without pain, even though I lost about 37 pounds and did everything the OS told me to do, which still has no included physical therapy of any kind. He neglected to tell me that arthroscopic surgery to repair or remove torn meniscus material often aggravates arthritis, which is what happened to me. He's tried cortisone shots and Synvisc, neither of which worked for longer than a month. So I'm one who would shout to anyone considering surgery, GET ALL THE FACTS FIRST AND MAKE SURE YOUR OS DOESN'T GLOSSY OVER ANYTHING.

Baby boomer and tennis nut raging against reality.

Offline jb-knee-geek

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Re: Should I have surgery?
« Reply #6 on: January 30, 2006, 01:09:18 AM »
Hi Elissa, yes I have full extension, flexion and I can do all activites except pivot sports with confidence.

I'm at the point (3 months since a knee strain) where I will be back to strenuous hikes (6-10+ miles),  moderate mountain biking, light yoga soon. Stairs, up and down, squatting are no problem.  No pain, no instability. We'll see if I can continue to avoid the surgeon's knife,  ;)

I'd say if Grelsamer says you need surgery, that's an uphill battle, 'fer sure.

Good luck, take your time.
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 mrmkbk

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Re: Should I have surgery?
« Reply #7 on: January 30, 2006, 01:36:40 AM »
this is what the mri report tells us....is this a bad tear?

MENISCI: There is mild-to-moderate intrameniscal degenerative signal intensity noted in the posterior horn of the medial meniscus with a horizontal linear component that appears to extend to the inner peripheral free edge compatible with a non-displaced horizontal linear tear through the posterior horn of the medial meniscus measuring up to 8mm AP dimension
torn acl 12/1/05
torn meniscus 12/1/05
fibroma right femor

Offline Cindysphynx

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Re: Should I have surgery?
« Reply #8 on: January 30, 2006, 04:27:10 AM »
I had surgery for a torn meniscus.  I run and play tennis, and I too wanted to get back on the court ASAP. 

My limp didn't respond to PT.  PT made the swelling go down, but the minute I tried to play again, I'd have swelling for days afterward.  My leg was very slow to respond to the simplest command, and it was unstable such that walking on an uneven surface was difficult.  The OS said I had a "complex" tear, which I think worsened because I tried to avoid the surgery and kept playing tennis.  I also had a plica ressection for inflammed plica, a secondary condition due to the fact that I had repeated cycles of inflammation.

The surgery was successful in that I can now play tennis and do stairs and suchlike without trouble, but I'm having some post-surgery problems that preluce running.  This may or may not get better. 

My opinion is that there's no rush to have the surgery if you can do the things you want to do without it.  You can always change your mind later.

I limped like crazy with a 5 degree deficit in straightening, so I'm impressed that you don't limp!

Cindy
partial meniscectomy and plica ressection -- Sept. 05
chondromalacia patella -- Jan. 05

Offline Heather M.

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Re: Should I have surgery?
« Reply #9 on: January 30, 2006, 07:01:13 AM »
Well, the good news is that you don't have any pain.  And your normal activities aren't apparently being impacted.  The bad news is that an extension deficit is very bad news! ;D  Look up those keywords and read all about it...this is a surefire way to other problems with muscles, joints, and even low back pain down the road.  If your extension has been improving, that's one thing.  But if you physically can't straighten your leg, and if there is no major swelling, then it's logical to look at what might be preventing full extension.  If that is a chunk of torn meniscus, it's not good news at all, because that sucker could dislodge at any time and literally drop you to your knees.

On the other hand, knee surgery is rarely a matter of life or death!  So you certainly can take your time and do your homework and get comfortable with your decision.  Clearly you're still looking for information that will tilt the balance one way or the other, and we can all respect that...and wish we'd done it!  I feel like I really did my homework, but ended up with a very rare complication anyway.  That will teach me to try to control all the variables!

By all means use the board as a resource, but keep in mind that most people on this board have ongoing problems.  Someone who had a meniscus surgery and recovered without issue isn't likely to be posting here....

And just to add some more food for thought, I'll tell you this:  I had a supposedly simple surgery (including partial menisectomy) and though I went into it with a positive attitude  and absolutely no knowledge of the potential complications, I apparently developed just about every single one.  Go figure.  But my brother has had two partial menisectomies and recovered well each time.  Once it took him about a week to get back to normal activities, and the other time about five weeks.  He had more impact from the anesthesia than the meniscus removal.  He is absolutely normal in every way and has no limitations whatsoever from his procedures.  I figure I got his complications for him--and then some.

Anyway, you have a tough decision to make.  I absolutely respect Dr. Grelsamer, and if he said I needed surgery I'd probably be booking the OR.  But again, there is no rush on anything...if the tear in your knee is stable.  That would be the question to ask.  Because the risk with a torn meniscus is that the tear will get bigger and that a significant portion of the meniscus will have to be removed.  That is a one way ticket on the TKR express.  So that would be the question I'd ask of any surgeons I saw for opinions and second opinions and so forth.  It might even be worth repeating the MRI if it was done a few months ago, just to see if anything has changed.  Now one of my questions would be the info about the 'degenerative' tear, because didn't you say you had an injury?  What was the knee like before the surgery--did you have any limitations from this presumed 'severe OA of the patella?'  (I say presumed because no one can really verify the state of your cartilage with an MRI, you have to look...and sometimes, even looking with a scope is deceptive as it can apparently maginfy areas of focal damage and make them look extreme, but when visualized through an incision the areas don't look as bad--this from Dr. Grelsamer.)

I agree that you should ask questions about/be concerned that surgery could set off a previously dormant condition.  On the other hand, your knee could just be a ticking time bomb, waiting to explode one cold and damp morning when you get out of pain and think WHAT THE HECK IS GOING ON IN THAT JOINT??  Arthritis is a tricky, finicky, impossible to predict beast.  Some people have widespread damage and absolutely no pain/limitations.  Others have small areas of relatively minor damage, but are nearly crippled.  It all has to do with where the nerves are, where the damage is, and some mysterious combination of luck and anatomy that no one has yet managed to quantify.  Or control.

So in your situation, you could seek another consult or even another opnion.  You could ask the surgeon what is the worst that could happen if you don't have surgery.  And what might be the best outcome without surgery.  And ask him/her the MOST LIKELY outcome with and without surgery.  This is very different from the BEST outcome, and many people don't seem to realize this.  No one can give you hard and fast percentages, but should be able to give you a realistic idea of what your most likely outcome would be based on your current situation and their previous experience. 

And then you can ask the surgeon the same question, only with you surgery as the variable this time.  What's the best outcome with surgery?  What's the worst?  And what is the most likely?  Be honest with the doctor and yourself about your current and desired activity levels and sports, and what things aggravate the knee.

Anyway, just wanted to put out there that many people have had this surgery and recovered just fine.  But I'm living proof that the Bell Curve is just that--averages.  And there are outliers!  I'm probably not helping much....just keep in mind that there are about 2+ million knee surgeries performed in the US every year.....

Heather
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
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