Banner - Hide this banner





Author Topic: Ten year olds meniscus repair surgery/recovery  (Read 1256 times)

0 Members and 1 Guest are viewing this topic.

Offline middletownfan

  • MICROgeek (<20 posts)
  • *
  • Posts: 17
  • Liked: 0
Ten year olds meniscus repair surgery/recovery
« on: July 05, 2006, 04:04:55 PM »
Sorry, posted this on the wrong topic before....

My ten year old had surgery today for a lateral meniscus repair. The surgeon repaired it instead of removing it. At post op, he told us that he would be on crutches for two weeks, in a brace/immobilizer for 4 weeks, and in six weeks be good to go and can resume normal lifestyle in six weeks. He even said he could return to football after six weeks.

That surprised me alot. I know after a meniscus removal, the recovery is short, but after a meniscus repair, I heard the recovery was lengthy and playing sports would take 2-3 months.

Can anyone offer insight or suggestion on this?

Thanks!!!

Offline emphatic

  • Forum Faithful
  • ****
  • Posts: 365
  • Liked: 0
Re: Ten year olds meniscus repair surgery/recovery
« Reply #1 on: July 05, 2006, 09:35:47 PM »
Yes, this sounds like a menisectomy post-op protocol. I know kids heal faster than adults, but if your son really did have a meniscus repair instead of a menisectomy, those timeframes really stretch the bounds of reality... at least as far as anything I've ever heard, read or studied. I think you're right to question it.

You have a couple of choices (that I can think of at the moment):

You can get a copy of a few different meniscus repair rehab protocols and bring them in to show the doctor and ask a bunch of questions about why his protocol is so different. If he really had good reasons for it, then you'll have to decide whether you still buy it. If he doesn't have good reasons, then it's time to find another surgeon, post haste. (There are several protocols on the internet... ask folks on the Meniscus forum for places to look -- the Steadman Hawkins website is one -- and you can also ask if any current repair patients have a copy you could have.)

You can also go directly to another surgeon now (immediately, if not sooner) and explain that you think your son's post-op care is not up to par, and you're really concerned. This approach is dicey... you'd be essentially accusing the doctor of malpractice and other doctors don't like getting in the middle.

You should also request a copy of the operative notes as soon as you can. They are in his medical record and you are legally entitled to them. Just ask for it.

Please let me know (private message is fine) how this all turns out... I'm quite curious about the situation and I really hope you get it sorted out quickly. I'm also happy to help, if I can.

Good luck!

Meg

Offline middletownfan

  • MICROgeek (<20 posts)
  • *
  • Posts: 17
  • Liked: 0
Re: Ten year olds meniscus repair surgery/recovery
« Reply #2 on: July 06, 2006, 02:25:49 PM »
Thanks for the advice Meg! I will keep in touch.

Offline ATsoccergirl

  • SuperKNEEgeek
  • *****
  • Posts: 1394
  • Liked: 1
  • Practice safe sports, use an athletic trainer
Re: Ten year olds meniscus repair surgery/recovery
« Reply #3 on: July 06, 2006, 09:45:41 PM »
The post op protocol seems very resonable and the surgeons I work for using something very similar.  Repairs heal much better in pedatric patients than they do in adults.  Given that your son will be in rehab I don't think 6 weeks is too soon based on my experiance.  With kids, they are not as worried about failure, however your son still needs to have proper muscle control in order to protect against reinjury since his knee will be immobilized for a period of time. 

Research has been showing that mensicus repairs don't need to be protect as much as many surgeons are doing.  This past winter, we had a wrestler return to competition in 4 weeks following a repair.
1999 LR, 2002 ACL/PLC recon, reversal of LR, 2004 ACL revision, 2006 Car accident torn PCL and small fractures resulting in bone chips in my knee.  Torn MCL 3 times.  Wicked screws under IT band and Pes Anserine.  June 2008-Hip Arthroscopy.

Offline emphatic

  • Forum Faithful
  • ****
  • Posts: 365
  • Liked: 0
Re: Ten year olds meniscus repair surgery/recovery
« Reply #4 on: July 06, 2006, 11:37:15 PM »
Obviously, your expertise and involvement in the medical field is a lot more current than mine, so I certainly accede to your information.

I'm wondering one thing, though. A lot of the research about healing times, tissue acceptance, growth and durability has vascillated back and forth over the years (at least in what I've kept up with), and much of it, sadly, seems to be driven by the patient compliance issues -- people simply don't like to be immobilized and on crutches for long periods of time. So, it seems that physicians and researchers look for ways to make surgical procedures work in other ways (often sliding past previously accepted minimal safety margins to do so) that don't require lengthy immobilization and non-weightbearing protocols.

So, I worry. When I hear that a pediatric procedure now has a recovery protocol finishing in a quarter of the time it used to take, I have to wonder if we've gone too far. Has the human body really adapted to be able to heal dramatically faster, albeit with a slightly improved surgical procedure? Or are we really pushing the limits of what the body can handle, all in the name of quicker, faster, sooner?

If the youngster can return to sports in 6 weeks with an intact, healthy meniscus and the physical ability to protect it from re-injury, I'm all for it. I just can't buy that he can be on crutches for 2 weeks, immobilized for another 4 weeks and can then come out of the immobilizer ready to play football at week 6. If the protocol continued with another 3-6 weeks of PT, focusing on stabilization and strengthening, I'd feel a lot better about it.

Just as ACL tears in young girls are happening younger and younger (not to mention the increased prevelance in girls), I worry that medical science has lost sight of what happens when these kids hit age 40 (let alone 60!) and have totally wrecked knees.

Just my thoughts...

Meg

Offline kevc

  • SuperKNEEgeek
  • *****
  • Posts: 767
  • Liked: 0
  • User's Text
Re: Ten year olds meniscus repair surgery/recovery
« Reply #5 on: July 06, 2006, 11:58:04 PM »
"Just as ACL tears in young girls are happening younger and younger (not to mention the increased prevelance in girls), I worry that medical science has lost sight of what happens when these kids hit age 40 (let alone 60!) and have totally wrecked knees."

Why would they have totally wrecked knees at 40???  And where is the oversight in medical science?
07/01 ACL rupture, left knee
08/02 ACL reconstruction (patellar tendon graft)
10/05 Re-tore ACL graft
01/06 Scheduled for ACL revision using hamstring graft

Offline middletownfan

  • MICROgeek (<20 posts)
  • *
  • Posts: 17
  • Liked: 0
Re: Ten year olds meniscus repair surgery/recovery
« Reply #6 on: July 07, 2006, 02:18:47 PM »
Thanks for your insight! Its been helpful. I believe that I am going to hold him out of sports for 8 weeks just to be on the safe side. That additional two weeks he can work on strengthening his leg.

He had his second visit to the dr. yesterday and the dr. still says he is progressing well. Says there is no reason he cant be ready and healthy in 6 weeks.....

Empathetic has some great points which I tend to agree with. I guess technology has advanced to that point. Look at Carson Palmer of the Bengals. His injury was so severe with torn ligaments and tendons, they were talking about a career ending injury. Now it seems he will be back after only 7 months ready to start the NFL season at full go.




Offline ATsoccergirl

  • SuperKNEEgeek
  • *****
  • Posts: 1394
  • Liked: 1
  • Practice safe sports, use an athletic trainer
Re: Ten year olds meniscus repair surgery/recovery
« Reply #7 on: July 08, 2006, 01:02:16 AM »
I don't think we are looking at surgeons catering to their patients by changing protocols nor pushing limits.  We simply have been researching the issues and are beginning, through experiance, to change our protocols to get the best result.  Back in the 70's and 80's at the early stages of ACL reconstruction, people had their operated knee casted for months and ended up with stiff knees that for some never really recovered.  Today, research has shown that an accelerated approach is not only safe but results in a better outcome.  Surgical procedures have definitely improved through the use of arthroscopes, this change alone caused many procedures to become "minor" procedures, such as a mensectomy.  We are going from a concept of an immobilization based recovery to an active recovery.  This active recovery allows to proctection of repairs yet still allows for strengthening and stabilization.  In a pediatric patient, the mensicus is still actively growing, so it is concievable that healing will occur. 

The issue of the prevalence of ACL tears in females was brought up.  Only now are girls competing in sports at a rate equal to boys.  There is just not enough research out their on the female athlete yet to determine an exact cause.  This is not a medical oversight, rather one in which before Title 9, there were very few female athletes and thus the ACL situation was not an issue.  Call it a societal oversight if you wish.  Similarly, this is little research regarding the long term outcomes of these procedures, simply because not enough people have reached that age that have had the more modern procedures done.  The has  been relatively no change in the age versus prevalance of ACL tears in females.  However, just because the sheer prevalance has increased you are seeing more statistical outliers.
1999 LR, 2002 ACL/PLC recon, reversal of LR, 2004 ACL revision, 2006 Car accident torn PCL and small fractures resulting in bone chips in my knee.  Torn MCL 3 times.  Wicked screws under IT band and Pes Anserine.  June 2008-Hip Arthroscopy.

Offline emphatic

  • Forum Faithful
  • ****
  • Posts: 365
  • Liked: 0
Re: Ten year olds meniscus repair surgery/recovery
« Reply #8 on: July 08, 2006, 04:26:41 AM »
Thank you for the discussion on these topics... it's been quite interesting.

This discussion has wandered considerably from the point of the original poster, but I want to raise a couple points which I feel are important and relevant, if somewhat tangentally.

I completely agree with the trend toward active recovery vs immobilization based recovery. I participated in a study of a particular shoulder reconstruction surgery that, when I had it done in 1988, involved 6 weeks of immobilization in what was called an airplane cast. Horrible, horrible recovery and rehab. At the occasion of the 10 year follow-up, I spoke to the surgeon and he said he was no longer doing it that way -- that he could get the same good results without the strict immobilization, as long as he found an acceptable protective substitute for what the prior immobilization performed. The same healing and protection principles were maintained... if adjusted to some degree for new technology. That's expected in a forward-moving technical specialty. At the same time, he also spoke of patient compliance issues, along with patient-driven requests for a faster return to their lives, as a primary motivating force for change. Scopes and other minimally-invasive procedures certainly were developed with considerable impetus from patient impact -- afterall, what's the primary benefit stated when talking about these techniques? Faster patient recovery, quicker return to productivity, less immobilization, less pain, etc., etc. In order for new techniques to be accepted, they must be effective. That's a given.

As for the prevelance of ACL tears in young girls, there is, indeed, considerable research noting it and discussing why that is the case, and finally, some effort being made to train girls differently to prevent ACL injuries. I brought it up because it is a primary example of a significant pediatric problem that was ignored for quite some time... and is obviously still not widely known. The comparative sports participation numbers of girls and boys in the past isn't the issue. It is clear that, of the girls and boys participating in sports now, girls have a significantly higher incidence of ACL tears than boys. I just read a statistic quoted by the St. Louis Rams surgeon -- he does about 100 ACL reconstructions a year, and around 80 of them are on young female athletes.

-----
"Women are anywhere between two and eight times more commonly injured in regards to their ACL than males are," says Dr. Matava. "There's several suspected answers, but the most common reasons are neuromuscular differences, or in other words, the way women's muscles fire around the knee in response to a stress at the knee joint. And several differences between males and females have been shown."

Dr. Matava says there are jumping programs proven to reduce the risk of tears in women, but adequate coaching is important as well.

"There's been some data saying girls are coached inferiorly compared to boys during certain sports activities," says Dr. Matava.
-----

That's just the first article I grabbed. There are many, many more.

The outcome of the modern procedure is also studied quite a bit, although it is with older patients, of course. My comment was that when the young girls who are now having the modern procedures reach their 40s, it stands to reason that the results found in the current patients will extrapolate. I can't help but worry what that's going to look like. The research fight about whether ACL reconstructions and menisectomies lead to a higher incidence of osteoarthritis is very well known. Pick a side.

My point is simple -- surgeries and rehab protocols, especially on pediatric patients, have an impact. It's only prudent to think of it. And the irony in all this, at least to me, is that I've spent an athletic lifetime always pushing for the fastest return -- damn the consequences -- for all of my surgical interventions.

Meg















support