Banner - Hide this banner





Author Topic: Knee reconstruction with Menisci tears - OA risks ??  (Read 1206 times)

0 Members and 1 Guest are viewing this topic.

Offline fabienzan

  • Regular Poster
  • ***
  • Posts: 59
  • Liked: 0
Knee reconstruction with Menisci tears - OA risks ??
« on: February 25, 2015, 08:37:51 PM »
Hi,

I am 43 years old, fit and not overweight. I injured my knee playing basketball and had a knee reconstruction 5 months ago. My recovery is going normally.
My big worry is OA . I have 3 menisci tears that were left in situ during surgery. My understanding is that menisci tears will lead to  OA. The medial meniscus tear is very peripheral and might heal itself that is what my surgeon mentioned. The lateral one is unlikely to heal (small one) . I am not sure how relevant is a small partial thickness tear . I am wondering if anyone had this type of tear and how they are going after knee reconstruction.
See below my surgery report.


Examination Under Anaesthesia:
No effusion. 0  Recurvatum to 140 flexion. Lacham 1+ with an equivocal end point. Pivot shift 2+. No collateral laxity

Operative procedure
A tourniquet was applied and anthroscopy performed using anterolateral and anteromedial portals. No abnormality was seen in the patellofemoral compartment. In the medial compartment the articular surface was intact. Probing revealed an inferior surface partial thickness vertical longitudinal tear on the inferior surface of the posterior horn of the medial meniscus. The tear was very peripheral and was approximately 12 mm in length. As it was stable, it was felt that there was little to be gained by trying to suture it, given the patientís age. In the intercondylar notch there was a proximal rupture of the anterior cruciate ligament. In the lateral compartment the articular cartilage was intact. There were small inferior surface and superior surface partial thickness vertical longitudinal tears on the posterior horn of the lateral meniscus . These were stable and were not addressed surgically.

Offline vickster

  • Administrator
  • SuperKNEEgeek
  • *****
  • *
  • *
  • Posts: 4861
  • Liked: 409
  • Neelie knee!
Re: Knee reconstruction with Menisci tears - OA risks ??
« Reply #1 on: February 25, 2015, 09:03:51 PM »
My understanding is that it is much better to leave a stable meniscus tear in place. It is the removal of the torn meniscus and the loss of shock absorption that causes the arthritis as the forces in the joint are affected and the bones come into contact with each other. If there are mechanical issues in the knee, then surgery to trim or stitch is usually required.

I have two further tears in my left knee which are not symptomatic, medial and lateral, and are being left well alone. I've just had the lateral trimmed in the other knee due to symptoms. I already have cartilage damage in both knees

You'd be best to discuss your concerns with your surgeon  as well as the types of activity which are advised or not to preserve the health of your knee
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

Offline Osiris

  • MICROgeek (<20 posts)
  • *
  • Posts: 7
  • Liked: 3
Re: Knee reconstruction with Menisci tears - OA risks ??
« Reply #2 on: February 26, 2015, 02:26:31 PM »
I've had a significant meniscus tear in my right knee for more than 5 years, and have several in my left knee.  The advice I've always been given is to leave the cartilage in place as long as the knee is free from locking up.

The tear itself will not lead to OA.  OA is a general term often used to describe worn down cartilage in the knees.  In anyone who has been active, by the time you reach your 40's there will be significant wear of the cartilage on the inside of the knee joints.  Wear does not mean exercise and activities have to be curtailed.

What kind of surgery was performed?  I've also been told that ACL surgery will tighten up the joint, which can accelerate cartilage wear.  This advice was given to a friend of mine at about age 50, who has been a life long athlete.  He and his surgeon decided to live with the ACL tear.  He competes at the club level in tennis with no problems.

Offline fabienzan

  • Regular Poster
  • ***
  • Posts: 59
  • Liked: 0
Re: Knee reconstruction with Menisci tears - OA risks ??
« Reply #3 on: February 26, 2015, 08:39:14 PM »
I've had a significant meniscus tear in my right knee for more than 5 years, and have several in my left knee.  The advice I've always been given is to leave the cartilage in place as long as the knee is free from locking up.

The tear itself will not lead to OA.  OA is a general term often used to describe worn down cartilage in the knees.  In anyone who has been active, by the time you reach your 40's there will be significant wear of the cartilage on the inside of the knee joints.  Wear does not mean exercise and activities have to be curtailed.

What kind of surgery was performed?  I've also been told that ACL surgery will tighten up the joint, which can accelerate cartilage wear.  This advice was given to a friend of mine at about age 50, who has been a life long athlete.  He and his surgeon decided to live with the ACL tear.  He competes at the club level in tennis with no problems.
Hi Osiris,

Can I ask you how old you are ? Tears can be due to several things. Arthritis being one, traumatic tear another. If not symptomatic they tend they can be left alone and can possibly heal themself if in an area supplied by blood .
ACL reconstruction or injury tend to speed up the degenerative process because of the important injury to the joint. It is not yet well understood why but having a menisectomy is a strong factor to develop OA.
The risk of leaving tears in the knee is that they might extend meaning more resection if needed later on. All this could lead to a knee replacement down the track. I am only 43 and this is my first major injury . I am very active and I have to say this is stopping me from doing anything. I am almost scare to walk for too long.

Offline vickster

  • Administrator
  • SuperKNEEgeek
  • *****
  • *
  • *
  • Posts: 4861
  • Liked: 409
  • Neelie knee!
Re: Knee reconstruction with Menisci tears - OA risks ??
« Reply #4 on: February 26, 2015, 09:30:08 PM »
Arthritis itself doesn't lead to degenerate meniscus tears, but with age (30 onwards, while arthritis (damage to the articular cartilage on the bones) is more likely in the older age group) the meniscus tissue starts to dry out, becomes brittle and can thus tear without any clear trauma.

Meniscus removal can  lead to damage to the bone surface as the cushioning is gone.  Yes tears can get worse, this happened to me in the left knee but this was because the knee was locked by the trapped torn meniscus and bending the knee ground it away further while trying to rehab conservatively!

I asked my specialist today what having had lateral menisectomy in both knees means for the future of my knees - he said not too much as long as I avoid impact activities, i.e no running.  Cycling which is my thing is ok, more likely to harm the back of the knee cap, so it's important to optimise pedalling action

You should discuss your concerns with a sports physio who can help you lead an active life without risk to your knee, which is presumably why you had the ACL reconstructed

My knees don't stop me doing what I want to do if asymptomatic, life's too short as it is :)
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

Offline fabienzan

  • Regular Poster
  • ***
  • Posts: 59
  • Liked: 0
Re: Knee reconstruction with Menisci tears - OA risks ??
« Reply #5 on: February 26, 2015, 10:42:29 PM »
Actually lateral menisectomy lead to a quicker wear and tear than medial as the lateral meniscus is more mobile. It is well documented on the net. How much of your lateral meniscus did they trim and when ? (It can take up to 10 years to develop OA on that side).
OA will weaken your cartilage and is more likely to generate meniscus tears.
I am surprised that your surgeon didn't mention that. Also lateral tear are often related to ACL injury or weight. Medial meniscus tear are more often seen than lateral tear.
I guess with my tears they appears to be all non symptomatic but this is for now and I am worry they might become symptomatic in a couple of years and then I will be in big trouble.
I would be interested to hear from people who had partial thickness meniscus tears at time of knee reconstruction and for whom they heal.

Offline vickster

  • Administrator
  • SuperKNEEgeek
  • *****
  • *
  • *
  • Posts: 4861
  • Liked: 409
  • Neelie knee!
Re: Knee reconstruction with Menisci tears - OA risks ??
« Reply #6 on: February 26, 2015, 10:52:12 PM »
I don't know on the right knee, it was a trim of a frayed edge. The left knee 5 years ago, 20% perhaps. There is damage to the lateral condyles in both knees, in the left an osteochondral defect from the accident that tore the meniscus too. I have another lateral and medial tear in the left knee, No operation planned. I've also had both kneecaps tidied. Medial compartment is fine on the right, beginning to deteriorate in the left from the latest MRI. Ligaments and tendons are all tickety boo

I am slightly knock kneed and struggle with my weight. I don't run, but I try to cycle at least 2000 miles a year.

I didn't ask him in great depth. I don't want to get overly hung up on it, hyaluronic acid injections seem to keep the left in check. Hopefully the right will be fine after the arthroscopy
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

Offline Osiris

  • MICROgeek (<20 posts)
  • *
  • Posts: 7
  • Liked: 3
Re: Knee reconstruction with Menisci tears - OA risks ??
« Reply #7 on: February 28, 2015, 03:50:55 AM »
I've had a significant meniscus tear in my right knee for more than 5 years, and have several in my left knee.  The advice I've always been given is to leave the cartilage in place as long as the knee is free from locking up.

The tear itself will not lead to OA.  OA is a general term often used to describe worn down cartilage in the knees.  In anyone who has been active, by the time you reach your 40's there will be significant wear of the cartilage on the inside of the knee joints.  Wear does not mean exercise and activities have to be curtailed.

What kind of surgery was performed?  I've also been told that ACL surgery will tighten up the joint, which can accelerate cartilage wear.  This advice was given to a friend of mine at about age 50, who has been a life long athlete.  He and his surgeon decided to live with the ACL tear.  He competes at the club level in tennis with no problems.
Hi Osiris,

Can I ask you how old you are ? Tears can be due to several things. Arthritis being one, traumatic tear another. If not symptomatic they tend they can be left alone and can possibly heal themself if in an area supplied by blood .
ACL reconstruction or injury tend to speed up the degenerative process because of the important injury to the joint. It is not yet well understood why but having a menisectomy is a strong factor to develop OA.
The risk of leaving tears in the knee is that they might extend meaning more resection if needed later on. All this could lead to a knee replacement down the track. I am only 43 and this is my first major injury . I am very active and I have to say this is stopping me from doing anything. I am almost scare to walk for too long.

I am 55 years old.  The MRI on my right knee was done in 2009, but the injury itself happened around 2004 at a time when I was active in self-defence and was leg pressing too much weight - 10 x 630 pounds.  At that time, my right knee hurt on the inside edge of the knee cap, but was not diagnosed at the time.  There was no swelling and the pain disappeared after I stopped pushing so much weight.  This is my analysis rather than backed up by an MRI.  I was 45 at the time of the initial injury to the right knee.

My current issue is the tear in the left knee.  What has helped me is Functional Movement Screening (worth googling), which is a way to determine limitations in rotation and lack of symmetry, which leads to assessing what the cause of each limitation is, which leads to physiotherapy which in my case was one session of active release therapy, followed by exercises that are designed to sustain the change achieved by the active release.  After one week of the sustaining exercises, I added strengthening exercises under the direction of my physio.
« Last Edit: February 28, 2015, 04:00:22 AM by Osiris »