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Author Topic: How should I manage a meniscus tear?  (Read 1276 times)

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Offline happydappy1

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How should I manage a meniscus tear?
« on: June 05, 2015, 10:26:37 AM »
I have been diagnosed with a suspected meniscus tear in both my knees, but I have to go for an MRI scan to confirm it. If there is one, then I probably will have to have surgery. What should I do in the mean time?

Should I just rest it? I was doing stretches in the past. Should I continue them? Would rubbing help?

It's not clear where about in the knee is, which is why I have been sent for an MRI. (I'm in the UK, so the waiting time for an MRI is about four weeks)

Thanks for any help!  :)

Offline Vickster

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Re: How should I manage a meniscus tear?
« Reply #1 on: June 05, 2015, 11:53:46 AM »
What symptoms are you having?

If you can bend and straighten fully, and the pain is manageable, I'd leave well alone for as long as you can. Maintaining meniscus is key, once it's gone, arthritis and more tears are more likely. Try physio first, don't rush into surgery, especially if the knee is good otherwise. But obviously take the surgeons advise, assuming that he is an experienced knee surgeon :)

I have lateral and medial degenerate tears in my left knee, confirmed on MRI 18 months ago, they don't give me any great bother, so I'm leaving well alone (especially as I already had lateral meniscus removed from it 5 years ago and it has arthritic changes)
« Last Edit: June 05, 2015, 11:55:24 AM by Vickster »
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 happydappy1

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Re: How should I manage a meniscus tear?
« Reply #2 on: June 05, 2015, 05:43:02 PM »
It's very painful and I have great trouble walking. After a few minutes, I have to stop.

I've been this way since November. (It's was hurting before, but November was when I couldn't walk properly).

I did Physiotherapy from Jan to Apr and was then discharged. They said to keep doing the exercises while I wait for a referral to Orthopaedics/Trauma department.

I saw the Orthopaedics/Trauma department yesterday and they thought it might be a tear (in both Knees) but they want to send me for an MRI (as I'm only 32!).

Since, they examined it yesterday it has become more painful then using and is burning (probably because of all the poking they did!). I'm not sure if I should keep on doing the physio exercises once the pain goes back to how it was before they examined it, or if I should just rest it until the MRI scan.

Thanks for any help.

Offline dal_knee

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Re: How should I manage a meniscus tear?
« Reply #3 on: June 05, 2015, 06:23:17 PM »
Happydappy,

I was in a similar situation that you describe....young 30s with burning pain, both knees diagnosed with meniscus tear.   I tried all the conservative options (PT, rest, icing etc) and then at 6 months, I made the dumbest most regrettable decision I have ever made in my life:  I went in for the surgical resection of the tear.     My life has never been the same.     After this surgery (performed by well-respected, well-known, experienced and reputable surgeon), I was never able to ever take a single step again without "pain".  He made my knee much worse and gave me new problems that I never had before.  That was about 8 years ago...it's an everyday struggle for me due to the amount of dysfunction I have now.         

My takeaway for you , is that not all the conservative options had been exercised before I had surgery.    Looking back (I was unaware of these below at the time though)  I wish I would have discovered and  'tried'  :

1) Dry Needling on all major muscle groups -- glutes, hams, etc and not just quads
2) ART
3) PRP
   
You may be able to get some relief right away with dry needling, and then assuming you have inflammation, the PRP will help that without damaging your cartilage further.    (The reason I say that is that the local anesthetic that is included in steroid injections (common treatment ) is known to cause cartilage cell death).     Some claim that PRP can help heal a meniscus tear as well.    The data is dodgy though.   

Anyhow, also, keep in mind, your surgeon's job is to get you in and out of surgery and he has zero consequences if he damages your knee that day....he still gets paid.    His life is unchanged.     I think that's something that really needs to change.     I hope you find someone conservative and up on the latest data that shows meniscus surgery is a "dodgy" one to have.....there is more evidence that it harms rather than helps.   
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: How should I manage a meniscus tear?
« Reply #4 on: June 05, 2015, 08:48:54 PM »
Happydappy
Dal_knee gives good advice. However, I don't believe ART is available in the UK. PRP is highly unlikely to be available to you on the NHS, unless there's a trial going on. You can probably get it privately, but bear in mind, a consultation with a private specialist will likely cost in the region of 150-200 every time and PRP is up to 500 an injection and likely you will need several. Dry needling may be available if you access to a good sports medicine team (NHS or more likely privately)

I've had lateral menisectomies on both knees now, one back in 2010 which was unavoidable as the knee was locked and 5 months of conservative waiting didn't work, indeed I ground more meniscus away. The locking was resolved and I recovered well. I had the other done 4 months ago, no ill effects from the op and I'm now cycling 100+ miles a week (I'm early 40s). No regrets here

There are always risks with any surgery but they are more uncommon than common. Hundreds of people have arthroscopies every day in the UK alone, most walk out of the hospital unaided and don't look back. You have to weigh up the possible risk against the more likely benefit for your quality of life and pain. Make sure you are fully informed and be prepared to ask questions about the op, the rehab, the risks etc. make a list, take someone else with you to the consulatation with the specialist

Get the scans, speak to the surgeon, if concerned request a second opinion. Where in the UK are you?

Good luck :)
« Last Edit: June 05, 2015, 08:53:02 PM by Vickster »
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 UK86

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Re: How should I manage a meniscus tear?
« Reply #5 on: June 06, 2015, 05:29:16 PM »
Happydappy,

I was in a similar situation that you describe....young 30s with burning pain, both knees diagnosed with meniscus tear.   I tried all the conservative options (PT, rest, icing etc) and then at 6 months, I made the dumbest most regrettable decision I have ever made in my life:  I went in for the surgical resection of the tear.     My life has never been the same.     After this surgery (performed by well-respected, well-known, experienced and reputable surgeon), I was never able to ever take a single step again without "pain".  He made my knee much worse and gave me new problems that I never had before.  That was about 8 years ago...it's an everyday struggle for me due to the amount of dysfunction I have now.         

My takeaway for you , is that not all the conservative options had been exercised before I had surgery.    Looking back (I was unaware of these below at the time though)  I wish I would have discovered and  'tried'  :

This is a bit disturbing!  I'm not even in my 30s yet but they recommended arthroscopy and osteotomy to sort out my tear.  Never been offered physio, injections or anything like that.    Then again I can't kneel or squat or walk without pain already.


Some of the stories on this board are quite depression.
Nov 2015 - HTO & Lateral Release

Offline Vickster

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Re: How should I manage a meniscus tear?
« Reply #6 on: June 06, 2015, 06:02:06 PM »
Presumably if an osteotomy is being suggested, you have some degree of malalignment and also damage to the articular cartilage on the bones. Therefore, physio may not be of benefit at this stage, but for rehab after an operation

Get a second opinion, however well regarded your surgeon is. Given the suggestion of osteotomy,mi would try to see Adrian Wilson in Basingstoke), he's an expert in such surgeries.

This is the website for his private practice (he does NHS too, could transfer across if he concurs with surgery and you are comfortable with that). Don't be pushed into anything, this is major surgery

http://www.hampshireknee.co.uk
http://www.hampshireknee.co.uk/knee-procedures/knee-realignment-or-osteotomy-surgery
« Last Edit: June 06, 2015, 06:06:03 PM by Vickster »
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 happydappy1

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Re: How should I manage a meniscus tear?
« Reply #7 on: June 07, 2015, 09:49:17 AM »
dal_knee & Vickster, thanks for the advice. I guess the best thing for me is to wait for the MRI to see how bad it is. Then I can decide  the best course of action.

I've got to say that I'm not happy with how I've they handled me, as when I was examined back in November they should have spotted the tear. Instead, they made me do lots of phyiso, so I hope it hasn't made it worse.

Although I've started getting similar stabbing pains in both my elbows now, so I wonder if something else might be up.

Quote
Get the scans, speak to the surgeon, if concerned request a second opinion. Where in the UK are you?
Lancashire, North West.

Thanks again for all the help! I really do appreicate it.

Offline Vickster

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Re: How should I manage a meniscus tear?
« Reply #8 on: June 07, 2015, 12:00:32 PM »
If you are having multiple joint issues, see your GP for blood tests to check for other possible causes such as rheumatoid arthritis or other inflammatory conditions. I've never really had stabbing pains with meniscus tears, more aching or the mechanical issue. I never needed to use crutches
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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