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Author Topic: Meniscus Tear - Orthovisc, Surgery, or PRP?  (Read 8406 times)

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Offline akotha

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Meniscus Tear - Orthovisc, Surgery, or PRP?
« on: November 13, 2010, 05:17:31 PM »
I am struggling with the decision of how best to handle my knee pain/injury. Hoping for some thoughts/advice.

 On 9/16, I injured my knee.  I have all symptoms of meniscus tear and the MRI showed two possible tears along with some degeneration.  I'm now 2 months post-injury and still dealing with quite a bit of pain - aching pain, esp. in the evening, pain with stairs or walking much, and swelling/pain whenever i try to exercise - bike or elliptical.  I have been in PT for 6 weeks.
The pain, clicking, and swelling have improved (the feeling of swelling inside the kneecap has diminished, which seemed to be the biggest issue being able to walk for the first 5-6 weeks), but it is still a 24/7 pain and inconvenience.

I was a runner (~4 miles, ~3x per week).. and it is very difficult to deal with my inability to seriously exercise now.   I have been resting the knee and only a couple wks ago began using the elliptical ~3x/week for 20 minutes.  I always have a couple of days of increased swelling and soreness after exercise.   I also have 2 small children and am now limited with the activities I can do with them, etc.  I'm 40 yrs old.

I have seen 2 surgeons.  The first gave me options of rest, orthovisc, or surgery.  He did not advise one idea over the other, so I went for a 2nd opinion from a highly respected orth clinic.
The 2nd surgeon suggested PT, orthovisc or PRP.  He said that surgery is always an option, but he does not advise it at this point for me.  He wants me to do orthovisc or PRP (platelet-rich plasma therapy).  The PRP is very expensive and not covered by my insurance.  I just rec'd insurance approval on orthovisc.

I am so sick and tired of dealing with the pain..  I want to make the right decision.  Pay $900/shot for 3 PRP injections and hope it works?  Start with orthovisc and deal with more time invested and hope that it helps?  Will the orthovisc just delay an inevitable surgery?  Will it lead me to exercise under less pain and end up damaging more? 
Why is 2nd surgeon so anti-surgery?  I've heard this surgery is short and easy. 

Any thoughts?  Anyone opt for orthovisc instead of surgery and have success?

Thanks in advance.

Offline Nettan

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Re: Meniscus Tear - Orthovisc, Surgery, or PRP?
« Reply #1 on: November 13, 2010, 06:42:59 PM »
I would definately take the surgery even if it's not said that it works perfect all times.
But if there are tears and you have problems I doubt it will be better.
Can I ask in what age are you ? Maybe age is something that makes the second OS hesistate about surgery. Did you question why ?
Surgery 6 times left knee torn meniscus, RSDS,chondromalacia, nervdamage cause constant nervpain,chronic inflamm.
Spinaldamage wheeler 100%.
Right knee damaged aug-06, use brace surgery 4/9-07.LCL tear.

Offline akotha

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Re: Meniscus Tear - Orthovisc, Surgery, or PRP?
« Reply #2 on: November 13, 2010, 08:12:07 PM »
I am 40 yrs old.  Wouldn't you think that being 40 would be a good reason to do the surgery and hope that it can be done and i can move on?
I really don't get it.  Surgeon #2 thinks that the tear(s) could repair themselves potentially.. and that a lot of my pain could be resulting from cartiledge issues under the kneecap.  I have patellofemoral syndrome also (have had that issue for years).

Offline Nettan

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Re: Meniscus Tear - Orthovisc, Surgery, or PRP?
« Reply #3 on: November 13, 2010, 08:21:28 PM »
Yes that is not an old age.
Are any of them specialists in kneesurgery or sportsmeds ?
Cartilage behind kneecap can also be smoothed out during surgery.
Of course you can always try the route with injections first but in longterm and especially if you haven't undergone surgeries before a scope might be the best option.
But you have to be aware of that a surgery even a minor one isn't a quick fix and will require a lot of rehab after.
Do you know where the indicated tears are located ?
Surgery 6 times left knee torn meniscus, RSDS,chondromalacia, nervdamage cause constant nervpain,chronic inflamm.
Spinaldamage wheeler 100%.
Right knee damaged aug-06, use brace surgery 4/9-07.LCL tear.

Offline Nettan

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Re: Meniscus Tear - Orthovisc, Surgery, or PRP?
« Reply #4 on: November 13, 2010, 08:28:29 PM »
I found a site with more about PRP. Check this out:
http://www.orthosupersite.com/view.aspx?rid=37598
Surgery 6 times left knee torn meniscus, RSDS,chondromalacia, nervdamage cause constant nervpain,chronic inflamm.
Spinaldamage wheeler 100%.
Right knee damaged aug-06, use brace surgery 4/9-07.LCL tear.

Offline vickster

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Re: Meniscus Tear - Orthovisc, Surgery, or PRP?
« Reply #5 on: November 13, 2010, 08:36:37 PM »
Meniscus tears aren't very good at self repairing as most of it doesn't have a decent blood supply.  

I had a lateral tear and went for the scope after physio and being careful for 5 months (I was 37 at the time, so not much younger than you are).  My knee was locked, grindy and would buckle.  All of those symptoms were resolved my the meniscus trim so well worth having the surgery for me. I was back in the gym after a month or so (not running but nothing to do with the meniscus, but the other damage in my knee).  I also had the back of amy kneecap shaved due to grade 3 wear and tear - wasn't aware this was going on before the surgery.

I spoke to my OS about Synvisc injections - I have a troublesome osteochondral defect on my femur. Given the other issues, he thought they were very unlikely to help with just the localised damage (which sounds similar to yours).  The advice I was gven post op for the kneecap damage was to keep the leg muscles as strong as possible to support the knee as well as could be
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up















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