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Author Topic: Can a meniscus tear ever heal without intervention?  (Read 3642 times)

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Offline UK86

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Can a meniscus tear ever heal without intervention?
« on: July 11, 2015, 10:17:08 AM »
Is possible for a meniscus tear to heal without intervention?

They recommended I have arthroscopy and femoral osteotomy to offload the bad part of the knee.  Obviously this is pretty major stuff.  I still have no date for surgery though. 

I've been having pain for 10 months now, swollen knee, can't kneel, run, etc.  The thing is I noticed is last month since we had warmer weather the pain is not as bad, it is still swollen and I can't kneel but I can at least walk reasonable distance without too much pain.

I'm wondering if this is a sign it is healing and if I should not bother with the surgery.

The idea of 2 years of operation + recovery (one leg then the other) just feels like too much right now. 
Nov 2015 - HTO & Lateral Release

Offline Vickster

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Re: Can a meniscus tear ever heal without intervention?
« Reply #1 on: July 11, 2015, 11:15:53 PM »
It depends where it is, whether it has a blood supply and how big the tear is, and what type tear it is

The meniscus primer and video here can explain a bit more

Unfortunately, if you still have symptoms after 10 months, it probably isn't healing, but the knee may have settled. Also, you could be making the tear worse by not attending to it, especially if the tissue is trapped in the joint at all. 

Cold weather can make arthritis pain worse, so that may be why it feels better now it's warm.  damage to the cartilage is presumably the reason for the osteotomy, to offload the damage compartment?

http://www.kneeguru.co.uk/KNEEnotes/primers/meniscus-primer

http://www.kneeguru.co.uk/KNEEnotes/primers/meniscus-primer/what-knee-meniscus

If you aren't comfortable with the surgery ask to postpone, it's major surgery albeit elective. Perhaps the meniscus can be addressed with an arthroscopy, and the surgeon can confirm the overall state of o,at, once recovered, if needed, you can have the osteotomy at a later date. You should get a second opinion before committing. If not committed, you may have a sub optimal rehab. Which is of the utmost importance with knee surgery.

Otherwise you can try conservative measures such as physio and injections

Good luck :)
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 fraz

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Re: Can a meniscus tear ever heal without intervention?
« Reply #2 on: July 12, 2015, 03:14:54 AM »
Vickster raises an interesting point about the cartilage damage in relation to a proposed ostetomy - If this is correct some sort of regenerative treatment for the cartilage would be better like OATS, ACI, MACI or even

chondrofix which is micro fracture with bio absorbable membrane over the top but if you wish to return to sports then I've read only 40% do so with this -

Others are SVF/PRP but you need to keep going back for repeat PRP's-

Also the meniscus will need to dealt with and an implant would cover the defect area and offer the prospect of new tissue if it is successful
Myself personally would be suspicious of anything like osteotomy - You would be best reading about everything and educating yourself over many months and forumulate a plan that suits you the patient and stand your corner with your new learnings so you do not get talked into something that does not match your objectives for the future.

You also need to establish why the meniscus has torn in the first place - I've had one or two injuries to the cruciates that created laxity and because of this the meniscus has torn - this is the most probable* meaning it could be something else-
« Last Edit: July 12, 2015, 03:17:44 AM by fraz »

Offline Vickster

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Re: Can a meniscus tear ever heal without intervention?
« Reply #3 on: July 12, 2015, 09:46:28 AM »
Looking back the OP has been diagnosed with valgus knees, hence the osteotomy. Pain may well be more from using wonky legs than any specific cartilage damage and will probably need correction at some point.  If there is damage and its extensive rather than focal, current repair techniques are less likely to be successful

The OP is in the UK, and presumably using the NHS, so more experimental injections and the like are mostly unavailable outside trials. PRP is expensive here and won't cure misaligned bones
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 fraz

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Re: Can a meniscus tear ever heal without intervention?
« Reply #4 on: July 12, 2015, 01:02:08 PM »
Thanks Vickster for sharing some knowledge-

PRP is expensive here in UK - I telephoned an NHS clinic, got  a reply as I was looking for PRP in the UK instead of flying abroad - :o 800 [extortionate] as an outpatient - These treatments can be good over a period of time with SVF for example but at that cost no way-Its a bit off topic for this thread, sorry-

I stand corrected if there is an alignment problem - But surely there must be a way to straighten the bones as they are meant to be and incorporate the use of the better regenerative techniques like ACI, MACI etc.....with straightened bones.

Then use "CMI" - Actifit implant or similar to cover the defect areas if repair is not possible -

For what its worth I read a medical study online [9 doctors]-who hypothesized the patient would be better with an implant than without - Long story short that was the conclusion as well

If the patient has youth remaining within them irrespective of age then it is worthwhile to seek the best longer term outcome over short term gain-restoration is the key - there must be a way :)
« Last Edit: July 12, 2015, 01:08:52 PM by fraz »

Offline Vickster

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Re: Can a meniscus tear ever heal without intervention?
« Reply #5 on: July 12, 2015, 03:03:02 PM »
Yes a surgeon can do an osteotomy and a Maci at the same time. But you have to find a surgeon expert and licensed  in both surgeries, you need to secure the funding for the Maci (it is rarely available on the NHS now the trials have concluded and private health companies won't often pay, Bupa stopped funding a couple of years ago).

In 2010 after a long fight with my then insurer, I was referred by my surgeon to one involved in the MACI trial to address a femoral defect. I'm also knock kneed, although only minorly. I had the scope to harvest the cells for the arthrotomy but when I came round, the surgeon said he wasn't able to do the transplant due to kissing defects on femur and tibia. My only option for him was a DFO and then a transplant at a later date if required. In his words, the two together would be a massive surgery and he wouldn't put a patient through it. Patients on here have patella realignment and cartilage ops, but I dont recall anyone having a DFO as well

I went back to my local surgeon who felt that the DFO is wholly unnecessary. I couldn't reconcile having it done either, the thought of metal, for an elective surgery doesn't sit well with me. Since then, I've had two rounds of hyaluronic acid and touch wood the knee is holding up. The MRI reads like a mess but while the knee isn't bothering me, I'm leaving well alone. I might have more injections at some point but not needed right now. If it was felt a DFO necessary, I'd seek an opinion from Adrian Wilson who is a UK expert in the surgery. Not sure he does transplants as well but I'm now too old and the knee has damage in all compartments so wouldn't be done
« Last Edit: July 12, 2015, 03:05:14 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 fraz

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Re: Can a meniscus tear ever heal without intervention?
« Reply #6 on: July 12, 2015, 04:07:49 PM »
"Kissing defects on femur and tibia" -If you've lost meniscus this could be expected to happen - Why would this prevent an ACI or similar?

If this was the case because of absence of meniscus then an implant like Actifit could be implanted to cover the defect area to protect the tibia/femur from each other [NOT KISSING THEN]-then the ACI or whatever could be performed -

Other implants exist as well that are not biological eg-permanent feature within knee but [trial stage+ currently]

Isn't the DFO [distal femoral osteotomy] to offload the weight from medial to lateral? or vice versa?

« Last Edit: July 12, 2015, 04:16:31 PM by fraz »

Offline Vickster

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Re: Can a meniscus tear ever heal without intervention?
« Reply #7 on: July 12, 2015, 04:18:39 PM »
Yes I had a menisectomy but the cartilage softening was there before. The defect was caused by a fall that also tore the lateral meniscus. I hadn't had knee issues before
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 fraz

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Re: Can a meniscus tear ever heal without intervention?
« Reply #8 on: July 12, 2015, 04:34:13 PM »
OK you had a menisectomy partial? [<50%] - total? -

 and as a result kissing "articular cartilage defects" on the lateral chondyle and lateral tibial plateau - The surgeon told you he would not do the harvest for the ACI due to kissing lesions.

How much lateral meniscus was removed? - what remains of the lateral meniscus?-

the articular cartilage can be grown back even with SVF over time or improved - My concern [at this minute] is for the meniscus - and what the options are for getting your defect area covered at the ends of the bones :)

I'm currently looking into my own solution too -  ;D :) ;) ;D

You mention metal plates with DFO - thats a no way from me 8)- I thought you meant just altering alignment but without any additions - no thanks-

What age are you Vickster? - [if its not too rude to ask] - you can decline ;)
« Last Edit: July 12, 2015, 05:43:34 PM by fraz »

Offline Vickster

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Re: Can a meniscus tear ever heal without intervention?
« Reply #9 on: July 12, 2015, 06:09:03 PM »
I'm 43...today as it happens  ;D

I believe 15-20% of the meniscus was removed, that was back in Feb 2010.  Long battle with insurers, second scope to assess for the MACI in Dec 2010

Yes, no MACI as only a 20% chance of success given the kissing defects and valgus alignment, those are poor odds and my function was never that bad, I just had pain

An osteotomy involves metal, the bones are cut, shifted and plated together (the plates may or may not be removed once all healed).  DFO offloads laterally to medially, used when valgus (HTO for varus)
Info here http://hampshireknee.co.uk/knee-procedures/knee-realignment-or-osteotomy-surgery

What's SVF?  The proof of articular cartilage being regrown is sketchy at best and many of the experimental options aren't available in the UK.  personally, I wouldn't travel at great cost for something with little long term data.  My cartilage defect is filled with fibrocartilage (in response to the trauma, no mfx for example), although I believe from the most recent MRI that it's not as good as it was (Dec 2013)

These are the highlights of my MRI report Dec 2013

Lesion in lateral condyle, some signal change, attrition of overlying cartilage, and some minor irregularity of the cortex
Further reduction of lateral compartment
Evidence of horizontal degenerative tear of anterior horn. Extends towards inferior articular surface medially but is largely intrasubstance
Medial meniscus essentially normal but evidence of a minor flap of the articular cartilage over the medial femoral condyle
Tiny, multiloculated parameniscal cyst seen just posterior to the medial meniscus
Anteriorally patella femoral joint remains congruent but some minor changes in articular cartilages of the medial facet and also over the interfacetal region of patella
Persistent subchondral changes in medial compartment with secondary degenerative disease that may have progressed slightly since 2010

Summary

Degenerative tear of anterior horn of lateral meniscus
Intact medial meniscus but small cyst near posterior horn
Minor flap tear of articular cartilage over medial condyle
Small joint effusion
Some degenerative changes in patello femoral joint

I also have a small bone spur thing on my fibula noticed on a pre op X ray in Feb

I had an ostenil jab at that time and right now I have no real issues with the knee (the other is more problematic)
« Last Edit: July 12, 2015, 06:11:00 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 fraz

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Re: Can a meniscus tear ever heal without intervention?
« Reply #10 on: July 12, 2015, 06:20:37 PM »
No way are you too old :o-I'm 44- thats why I asked - 3 years ago I ran and will again but I need to get sorted - My health has suffered as a result of being too sedentary [imposed] and I won't be able to do things at all if I don't get a solution that is acceptable to me [I don't mean any arrogance here].

I write what I write to be helpful to get a solution which is why I put the effort in that I put-

I will read your big post now ;D

Offline fraz

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Re: Can a meniscus tear ever heal without intervention?
« Reply #11 on: July 12, 2015, 06:26:27 PM »
I'll send you a pm

Offline Vickster

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Re: Can a meniscus tear ever heal without intervention?
« Reply #12 on: July 12, 2015, 06:28:37 PM »
They generally won't consider MACI after the age of 40.  I don;t think many are being done nowadays in the UK full stop.  I'm not sure what NICE's latest stance is

I don't run, have been advised not to as I've had lateral menisectomy on both knees,  I'm not a runner any how.  I'm a cyclist and I can cycle ok.  I did 78 miles yesterday.  I'm overwight but have strong leg muscles from the cycling (although my muscles are rather unbalanced, with very tight calves and weak glutes). 
Maybe you can cycle or swim?  What symptoms do you have?  Who wants to run unless being chased by something that wants to eat you :D
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 fraz

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Re: Can a meniscus tear ever heal without intervention?
« Reply #13 on: July 12, 2015, 06:46:29 PM »
Its 50 years of age I think for MACI -

Offline fraz

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Re: Can a meniscus tear ever heal without intervention?
« Reply #14 on: July 12, 2015, 06:54:34 PM »
No I can't ride the bike properly - Its hard to get 50% through the right leg on spin scan indoors-

I've ascertained the the level of efficacy for the injection therapy I've had and concluded that the problems are beyond the scope of what injections can do-which is why I undertook many treatments to be able to reach this conclusion

My cruciates need revising [minimum] worst case allograft [hope not]- and the meniscus may well need an implant if it cannot be repaired - I've had no menisectomy previously and the implant in mind is for partial defects that can't be repaired quoted from the manufacturer of the product.

There are small defects in the articular cartilage which may benefit from ACI or MACI or more SVF etc once the ligaments have been stabilized along with the mensical defects.

I've researched this extensively and am close to knowing what is wrong -