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Author Topic: Medial meniscus repair for posterior horn tear  (Read 6801 times)

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Offline hessm70

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Medial meniscus repair for posterior horn tear
« on: April 28, 2015, 05:51:30 PM »
All, I am over 8 1/2 weeks out of surgery and it seems my knee is not healing.  Through weeks 1-5, I was stretching, riding a stationary bike and some elliptical.  However, the new did not seem to improve.  On week 6, I went to the doctor and they did a symmetry strength test that hurt my knee.  They decided to give me oral Cortizone to try to help my knee.  They gave me qty 2- Six day packs.  I am now at day 7 and the knee is hurting more than ever.

After being a runner my whole life and being told that I would probably be running in 3 weeks, I am starting to get discouraged a little.   My doctor is a well known doctor that has worked with universities and professional sports organizations. 

Any thoughts?  Is there such thing as the meniscus not healing causing a need for total removal or what is the contingency if this thing doesn't improve?

Age: 44
Weight: 200
Height: 5'7"

Offline dal_knee

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Re: Medial meniscus repair for posterior horn tear
« Reply #1 on: April 28, 2015, 10:43:00 PM »

Try to get a PRP as soon as you can to start the healing process.   

If you do a lot of reading, you'll find that meniscectomies don't work very well and have a tendency to leave you worse off because they destabilize the joint contact surfaces.    It's kind of not a good sign that you are 9 weeks out and complaining of non-healing.   Sorry, I wish I had better feedback and outlook.   

If you can afford it, try a stem cell injection + PRP. 
2007 - partial medial meniscectomy
2010 - full thickness chondral defect & adjacent subchondral edema MFC.   Direct result of stupid partial mensicectomy from 2007.
2014 - Subchondroplasty, chondroplasty, unauthorized 2nd partial medial meniscectomy.
2015 - partial failure of subchondroplasty.

Offline K9Sport

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Re: Medial meniscus repair for posterior horn tear
« Reply #2 on: April 29, 2015, 02:46:15 AM »
Did you have a repair of the posterior root ligament or did  you have a menisectomy?  Recovery is very different...  generally with a repair you are non-weight bearing for 6-8 weeks.
11/2014 - PHMM Root Ligament Repair (failed)
6/2015 - revision of PHMM Root ligament repair, LOA, Chondroplasty

Offline hessm70

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Re: Medial meniscus repair for posterior horn tear
« Reply #3 on: April 29, 2015, 11:44:57 AM »
It was a menisectomy on February 27th.

Offline vickster

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Re: Medial meniscus repair for posterior horn tear
« Reply #4 on: April 29, 2015, 11:55:55 AM »
Usually the meniscus is trimmed back to a stable rim so there's nothing to heal per se.  It is possible to retear  as once meniscus is removed the dynamics in the knee are changed and reinjury is more likely (especially as we age and the meniscus tissues degenerate), or they didn't remove enough/in the right spot in the first place.  Have they tried a direct injection of cortisone to resolve any inflammation from the surgery.  Was it a traumatic (injury) or degenerative tear (age related)?

Perhaps a repeat MRI is required to check for no further issues?  Or get a second opinion?

But recovery isn't linear, there will be ups and downs.  You need to be careful not to overdo the rehab, it's a fine balance.  Yes, people may run at 3 weeks after but everyone is different, as we get older too things take longer to heal 

You do sound like you are quite heavy for your height, keeping weight down is really important for knees generally, especially if a runner (which is the hardest thing of all pretty much for knees in terms of activity).  Perhaps give the gym a miss for a few weeks, try swimming maybe?  Are you working with a physio?
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline hessm70

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Re: Medial meniscus repair for posterior horn tear
« Reply #5 on: April 29, 2015, 02:49:17 PM »
I appreciate the response.  As far as my weight, I am short and very stocky- muscular core.  Most people think I weigh 150 lbs or so and are amazed when I tell them the actual.  Regardless the more weight, the harder it is on the joints.

The doctor gave me oral Cortizone (qty 2- 7 day packs).  They did not try direct injection, yet.  He said it appeared it may have some fluid on the knee causing it to be tight.  That went away with the first few days but then the knee hurt and now after 7 days, the tightness is returning.

I have a stationary bike, elliptical and treadmill at home and had been back to the first two prior to the strength/symmetry step and that killed my knee due to the kicking motion they had me do.

I am stretching regularly and icing as much as possible.
« Last Edit: April 29, 2015, 07:34:35 PM by hessm70 »

Offline dal_knee

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Re: Medial meniscus repair for posterior horn tear
« Reply #6 on: April 29, 2015, 03:37:13 PM »
hessm70
Be cautious with a cortisone injection, as they mix it with a local anesthetic which is actually shown to kill chondrocytes.   And clinically proven.      If you have cartilage issues to begin with, why risk the deleterious effect.   

If you have inflammation, try a PRP.   At least it won't harm the tissues that you are trying to "fix".   

2007 - partial medial meniscectomy
2010 - full thickness chondral defect & adjacent subchondral edema MFC.   Direct result of stupid partial mensicectomy from 2007.
2014 - Subchondroplasty, chondroplasty, unauthorized 2nd partial medial meniscectomy.
2015 - partial failure of subchondroplasty.

Offline vickster

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Re: Medial meniscus repair for posterior horn tear
« Reply #7 on: April 29, 2015, 05:11:36 PM »
He talks of meniscus rather than articular cartilage damage - fibrocartilage rather than hyaline (not sure if it's the same issue with the anaesthetic). 

I've had PRP (elbow tendon) and steroid (knee, elbow and recently hand) and I can say that the PRP was significantly more painful (probably as there's no anaesthetic used)...nor did it work and I had surgery a month or two later to sort the tendon.  But PRP worth a go if able to afford, and likely to need multiple shots.

I've not heard of oral steroids being given for knees before, unless there are other health issues - they have lots of side effects potentially not least, although they shouldn't make the pain worse (you can get a steroid flare with the injection). An anti-inflammatory medication may also help if you can tolerate

RICE is probably the best way to settle the knee now, assuming there's been no more damage done. If there's a lot of fluid, you may need it drained, otherwise, just need patience unfortunately

Good luck :)
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline dal_knee

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Re: Medial meniscus repair for posterior horn tear
« Reply #8 on: April 29, 2015, 05:36:48 PM »

Vickster,
I'm aware he had the meniscus trimmed.    The articular cartilage and the meniscus cartilage don't act as independent units.  They are in constant mechanical contact.   Issues in one affect the other.    He just had a surgery that removed parts of the stabilizing tissue in his joint...he needs to tread very carefully with any future treatments that may affect one or the other.   
2007 - partial medial meniscectomy
2010 - full thickness chondral defect & adjacent subchondral edema MFC.   Direct result of stupid partial mensicectomy from 2007.
2014 - Subchondroplasty, chondroplasty, unauthorized 2nd partial medial meniscectomy.
2015 - partial failure of subchondroplasty.

Offline vickster

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Re: Medial meniscus repair for posterior horn tear
« Reply #9 on: April 29, 2015, 05:40:22 PM »
Of course.  I am well aware, I've now had lateral meniscus removed from both knees myself.  However, I only asked the question about an injection as that would usually occur before systemic steroids with all the potential side effects of those



Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline hessm70

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Re: Medial meniscus repair for posterior horn tear
« Reply #10 on: May 05, 2015, 02:38:23 PM »
Update- Now that I am off the oral Cortisone, my knee feels stiff with potentially fluid on it again.  I am still trying RICE but now going on week 10 since the surgery.   :-[

Offline K9Sport

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Re: Medial meniscus repair for posterior horn tear
« Reply #11 on: May 15, 2015, 08:59:58 PM »
Unfortunately a tear of the posterior horn of the medial meniscus is the same as having no meniscus at all.   I tore mine and had it repaired, and now need a revision which Dr. LaPrade will be doing in a few weeks.

http://drrobertlaprademd.com/posterior-horn-of-the-medial-meniscus
11/2014 - PHMM Root Ligament Repair (failed)
6/2015 - revision of PHMM Root ligament repair, LOA, Chondroplasty

Offline hessm70

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Re: Medial meniscus repair for posterior horn tear
« Reply #12 on: May 18, 2015, 02:31:14 PM »
New twist- my knee feels much better with less swelling after 11.5 weeks.  However, twice as I was sitting in my recliner I have gone to get up and my knee locks up on the initial step then I can work it out.  Thoughts?

Offline hessm70

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Re: Medial meniscus repair for posterior horn tear
« Reply #13 on: June 01, 2015, 05:16:29 PM »
Update 2-  After a month since I have seen the doctor, I have decided to get a new MRI to see if there anything noticeable.  Over the past few weeks, the knee has continued to swell even though I have been icing it in the evening daily.   

Offline hessm70

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Re: Medial meniscus repair for posterior horn tear
« Reply #14 on: June 10, 2015, 11:50:05 AM »
Well the doctor comes in and says, "I have good news and bad news."  Uggh!  The good news is my knee structurally seems good.  The bad news is I have a bone bruise on my femur.   To compound that, it isn't where my knee hurts.  Strangely enough, my left knee hurts at a 1-2 o'clock position as you face the knee.  The doctor says there is nothing there.  So its seems a big mystery.

Offline vickster

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Re: Medial meniscus repair for posterior horn tear
« Reply #15 on: June 10, 2015, 12:20:54 PM »
Referred pain? Nerves are mysterious things!

Patience needed with the bone bruise, 6-12 month recovery not unusual,  you have to let it settle and avoid anything that causes impact especially if the one bruise is on a weight bearing area

Have you tried deep muscular massage from a physio, muscle tightness can also cause all sorts of pains
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline hessm70

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Re: Medial meniscus repair for posterior horn tear
« Reply #16 on: June 11, 2015, 12:04:48 PM »
I am trying electro muscle stimulation and RICE.  I am also going to do some pool work as it is nice enough now to get a hour or so of that and see what happens.

Offline hessm70

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Re: Medial meniscus repair for posterior horn tear
« Reply #17 on: June 17, 2015, 12:00:10 PM »
Update-  The pool workouts were helping my knee significantly then I pushed too hard.  I tried the stationary bike for 30 minutes then the elliptical for 15 min followed by pool work.  My knee has been sore and slightly swollen for the past two days.  I have been icing and using electro muscle stimulation but it has been raining outside limiting the poll work.

Offline hessm70

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Re: Medial meniscus repair for posterior horn tear
« Reply #18 on: July 14, 2015, 12:14:00 PM »
Update-  Well the Midwest US weather has prohibited my use of our pool.  However, I am attempting to bike via my trusty old mountain bike (on road not in woods).  My knee still swells but I am trying to ice it and utilize NSAIDs.  Somewhat frustrated with the pain almost 5 months after surgery.  I question whether it will ever not have pain.

On a side note, I am going to try a copper infused knee compression sleeve to see if that does anything for me.

Offline vickster

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Re: Medial meniscus repair for posterior horn tear
« Reply #19 on: July 14, 2015, 01:53:19 PM »
Have you had an MRI to check the state of the meniscus. Unfortunately, once a meniscus has torn, the probability of retear is higher, especially as you get older
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline hessm70

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Re: Medial meniscus repair for posterior horn tear
« Reply #20 on: July 14, 2015, 05:27:58 PM »
Yes and was told I had a bone bruise on the medial side of the femur.  Curiously, the outside of my knee hurts  Facing the left knee, it hurts at the 2 o'clock position.  My doctor said, There is nothing to be hurting there."   I am contemplating a new opinion of the last MRI taken in June.

Offline vickster

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Re: Medial meniscus repair for posterior horn tear
« Reply #21 on: July 14, 2015, 05:30:08 PM »
Has your physio done a thorough assessment of muscle balance, strength and flexibility. Can get all sorts of weird referred pains around the knee. MRIs won't pick up on such subtleties
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline hessm70

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Re: Medial meniscus repair for posterior horn tear
« Reply #22 on: July 14, 2015, 05:57:37 PM »
"Thorough" is a questionable term.  The last time I went in June the doctor basically said, I can't do anything more for you and the Physio said, "We aren't the only game in town so if you feel you need another opinion, get one."

Offline vickster

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Re: Medial meniscus repair for posterior horn tear
« Reply #23 on: July 14, 2015, 06:05:14 PM »
I'd get another opinion on that basis from a sports physio with lots of experience dealing with post-surgical knees. 

However, after any knee surgery, it is unlikely that you will ever have a fully fixed knee.  Depends whether what you have is usable in the ways in which you wish to use it - that is what you should be aiming for with the new physio.  Be clear with your goals and understand whether those are realistic and how to get there
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline hessm70

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Re: Medial meniscus repair for posterior horn tear
« Reply #24 on: January 28, 2016, 12:12:14 PM »
Update-  Almost one year from meniscus tear removal on my left knee,  my knee swells every time I exercise and I now have tingling down my leg to my foot.

I wanted to start exercising to get back in shape so I purchased a new elliptical and have spent 30min a day in attempt to getting back in some sort of shape but now I am faced with pain everyday.

The last MRI in June 2015 indicated a bone bruise but I was told that the knee structurally was in good shape.  I consulted a 2nd doctor in the area.  He stated the micro-fisuring on the bones meant that I had arthritis in the knee and should not perform any weight bearing exercises.  Other than that, it seemed as if he just wanted push me out of office.  I assume he knows the original doctor (very well known) and probably does not want to go against his diagnosis.

Offline dal_knee

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Re: Medial meniscus repair for posterior horn tear
« Reply #25 on: January 28, 2016, 05:06:25 PM »
hessm70,

Very generally speaking, meniscus tears should not be removed.   This is an idiotic surgery and should always be used as a last step. 

I, too, have unresolved, recalcitrant bone marrow edema due to meniscus tear surgery.    The doc is absolutely correct in advising no high/medium impact whatsoever. 

If affordable, look into Dr Broyles or Dr Saw surgery to regenerate articular cartilage.   My understanding is that it overgrows in such a way as to fill in for the missing meniscus tissue.   This is not  a theory, but observed on MRI.   
2007 - partial medial meniscectomy
2010 - full thickness chondral defect & adjacent subchondral edema MFC.   Direct result of stupid partial mensicectomy from 2007.
2014 - Subchondroplasty, chondroplasty, unauthorized 2nd partial medial meniscectomy.
2015 - partial failure of subchondroplasty.

Offline hessm70

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Re: Medial meniscus repair for posterior horn tear
« Reply #26 on: February 04, 2016, 05:35:02 PM »
Thanks for the advise! I am looking into it.

Offline hessm70

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Re: Medial meniscus repair for posterior horn tear
« Reply #27 on: February 10, 2016, 02:49:11 PM »
Update-  I went back to the original ortho doctor.  He took new x-rays and went back through my MRI from June 2015.  His conclusion was there is nothing structurally wrong with my knee and he cannot pinpoint why the knee hurts and swells after minimal exercise.  He did suggest going to a local sports medical doctor in the hopes that he could diagnose the issue.

My pain at the moment is in the upper outer edge of my patella (not where the medial meniscus is) then there is tingling down the front of my leg to my foot.

Offline sunn

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Re: Medial meniscus repair for posterior horn tear
« Reply #28 on: February 11, 2016, 01:00:40 PM »
good luck and please keep us posted on what happens.  I'm in similar position- knee swells like huge painful balloon on any weightbearing and also if I have to sit with knee bent - I am now at point of spending as much time as possible with knee elevated to try and keep swelling down.

Offline Sri

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Re: Medial meniscus repair for posterior horn tear
« Reply #29 on: March 06, 2016, 09:53:52 PM »
Hi i have seem your posts and eager to know about what treatment your are taking and do you have any improvement i have a medial meniscus tear and i am taking PT classes and i want to know whether prp ansd stem cells work for meniscus re growth? And where you took ur treatment i am i USA can you please suggest any doc here near new jersey?















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