Partial meniscectomy not guilty?

[LifeSentence]

I tore my meniscus 5 years ago and have since suffered recurrences of stiffness and swelling.  Recently it has become painful as well.

I saw a surgeon who has had decades of meniscal experience and written papers on meniscal repair - and he said that repair was a waste of time in my case - mainly because the tear is in the avascular zone.

I accept his judgement, but he also added something that I had never read.  I thought it might be worth putting up with the pain because all the technical papers suggest that partial meniscectomy leads inevitably to premature arthritis.

He said that was true, but that I was missing the point.  The point was that my meniscus lost much of its shock-absorbing ability at the moment it was originally torn.  My journey to premature arthritis began at that point.  A partial meniscectomy won't take me there any faster, but just in a less painful way.  A partial meniscectomy will not make my knee a worse shock-absorber than it already is.

Can anyone give me internet references to confirm this?  Or anecdotal evidence?

One other question:  My tear was accompanied by "joint effusion" (aka "water on the knee").  Does partial meniscectomy relieve that too?

[jathib]

Well, I can give you first hand experience. I tore my meniscus at age 15 right after I had my ACL removed. They didn't do arthroscopic surgery or ACL recons back in those days. After I tore my meniscus the doctor wanted to go back in and remove it. My parents didn't want me to go through another surgery so I walked on a torn meniscus for 17 years. By the time I had it fixed I already had arthritis. Once the torn bits were removed I felt a lot  better even with the arthritis. In my opinion, meniscus tears almost inevitably lead to arthritis whether you have them taken care of or not. You're damned if you do and damned if you don't. I agree with your doctor, it's less painful to have the torn pieces removed than it is to just leave them there. You'll have less inflammation in your knee which will likely reduce the amount of swelling.

[wsanders]

Ask about the risk that that suddenly and very painfully, maybe in a place where you can't get immediate medical help, the tear will worsen and your knee will lock up. That's what happened to me, except it happened at home. I have a partial meniscectomy a few weeks later. 

The other, bigger risk, is that living with knee pain over the years will decease your mobility and motivation to stay in shape, and that's a risk that can actually shorten your life more considerably that getting arthritis later.

My doc said repair wasn't really worth the trouble, and he has fairly strenuously downplayed the risk of arthritis later. I'm 50 - so if I get arthritis at age 70 and have to give up running marathons - well I don't do that now so no great loss. If knee-unfriendly sports like running and backpacking were a big part of my life I might have taken on more risk but I wanted to get back on my feet ASAP.

And who knows, 20 years form now they might be able to do knee replacements arthroscopically, or with nano-robots.

[LifeSentence]

Thanks, both.  I get the impression from other posts in this forum that jathib is not alone in developing early arthritis after a meniscal tear.

I agree wih wsanders that it's a matter of choosing the least bad option. I've been fanatically trying to exercise without incurring pain in my bad knee. I've had a stiff neck & stiff back from trying to sit & sleep with a straight leg, pain in the lower back from trying to pick things up the "wrong" way (without bending the knees), and now my other knee is starting to complain that it's doing the work of two.  It's crazy.  My good limbs are paying the price for my bad limb.  In nature no mother looks after her runt at the expense of its healthy siblings.

I do find the range of options for treating a torn meniscus is incredibly narrow.  I thought it would be like going to the dentist. After all, teeth are the other part of the body without a blood-supply to promote healing.  You can choose from various types of filling, porcelain or gold crowns, dentures or root canals, etc etc.  But what does the knee-surgeon offer?  Partial meniscectomy or nothing.  It's like a dentist treating decay by offering to pull out the tooth.  It's 100 years behind the times.  Why are teeth more important than menisci? If I had to choose between them, I'd choose a good set of menisci any day.

[DeniseC]

Love the teeth metaphor.  Listen, there's life after meniscectomy.  Another way to look at it is something an MD said to me after I had a spontaneous tear following 20+ years of living with a torn meniscus on both sides - the inflammation over the years not only predisposed me to arthritis (which I now have in both knees), but it also created a "fire in the house" and the meniscus just kind of mushed out one day, causing me to fall.  After that happened I had lots of pain and went ahead with meniscus surgery.  It was so helpful that I got the second knee done.  Still have arthritis and pain, some bone on bone stuff, but 'way better than the many years with shreds floating around in there.  I can exercise now (no marathons and no pivot sports, but I'm in better shape than I've ever been) where I couldn't before the surgeries.  You'll know when you're ready for it.  Sounds like you're getting close as you take stock of all the adaptations you and your body are making.  (and you're right, this is all very unfair.)

[jathib]

I do find the range of options for treating a torn meniscus is incredibly narrow.  I thought it would be like going to the dentist. After all, teeth are the other part of the body without a blood-supply to promote healing.  You can choose from various types of filling, porcelain or gold crowns, dentures or root canals, etc etc.  But what does the knee-surgeon offer?  Partial meniscectomy or nothing.  It's like a dentist treating decay by offering to pull out the tooth.  It's 100 years behind the times.  Why are teeth more important than menisci? If I had to choose between them, I'd choose a good set of menisci any day.

Teeth and menisci are two totally different things. You really can't compare the two. Just because there are more options for treating teeth doesn't mean they're more important. It's really not that simple. It's pretty easy to work on a tooth. But you have to knock someone out and cut them open to work on a meniscus.

There have been a lot of advances in knee surgery in the 34 years since I tore up my knee. Back then there were no MRIs, no ACL reconstructions and no arthroscopic surgery. The solution for a torn ACL was to remove it completely. Same with a meniscus. And to accomplish that they had to cut you wide open with 4-5 inch incision. I spent four days in the hospital where nowadays I would have spent about four  hours.

Advancements in joint replacements are happening all the time. Just ten or so years ago a partial knee replacement wasn't an option. My doctor didn't do them because they were new and had a high failure rate. Now they are commonplace. My current OS said my PKR may last 10 years but by then there will be something better to replace it with.

Consider yourself lucky to have only torn your meniscus five years ago. Your life may have become more painful but it's not over.

[Shewolf16]

Hello,
     I was wondering if anyone could give some advise, answers or uncouragement. I injuried my left knee in February 2007 and had surgery April 2007. My OS removed a large section of my medial Meniscus and also removed a large piece of cartilage that broke off under my Patella, and then shave it to smooth it out. I currently am still in PT and the grinding and pain when I extend my leg is awful. People hear it standing 4 feet away! I cannot go down stairs, but I can mage going up stairs with a lot of pain. I also just developed tendonitis due to all the PT. My theropist also said I have Petella baja, so he tapes my knee to keep the kneecap up, but I do not want to tape my knee for the rest of my life.  My OS also said that the grinding and pain will go away with time, as the cartilage smooths itself out.
I would like to know if it will smooth out or just get worse?
Will the petella baja heal with more strength excercise?
Anyone gone through this and how did it turnout for you and what did you do?
Thank you for any advise or help

[jathib]

In my experience, all that grinding, clicking and whatnot goes away once the muscles get built up. Stairs are usually the last skill to come back.

[LifeSentence]

Teeth and menisci are two totally different things. You really can't compare the two. Just because there are more options for treating teeth doesn't mean they're more important. It's really not that simple. It's pretty easy to work on a tooth. But you have to knock someone out and cut them open to work on a meniscus.

Pretty easy to work on a tooth?  Dentists might disagree ...

Teeth and the inner menisci have this is common:  they do not have a blood supply and hence they do not heal without intervention.

Surgery is as old as dentistry.  Open surgery has been practised at least since Julius Caesar was born.  What has made both surgery and dentistry more palatable in the past 150 years is the discovery of anaesthetics: operations no longer need several strong men to hold down the writhing patient, and for that I am profoundly thankful.

I think the main reason that so much more money is poured into dentistry is that over 90% of people suffer from tooth decay, whereas fewer than 1% suffer acute meniscal tears.

Also, the meniscus has been misunderstood for years.  In 1887 it was referred to as "the functionless remains of a leg muscle".  Right up until the 1970s total meniscectomy was the standard operation for acute meniscal tears, despite the drawbacks identified by Fairbank in 1948, and despite a 1935 finding by Herzmark that menisci were "very important structures for weight-bearing knees".

Certainly options for arthritic patients have improved greatly. I'll bear that in mind as my bones grind away for want of a meniscus!

Sheep trials with stem cells are encouraging, though they are probably too late for most members of this forum.  I emailed the details to a friend, and he replied:

If you like I can get some sheep stem cells and inject them into your knees, I have a stainless-steel cake-icer which should do the trick nicely.

Laughter is the best medicine ...