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Author Topic: Meniscus piece floating loose - will it dissolve on its own? Torn ACL replace?  (Read 1235 times)

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Offline bighonu1

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Hi Everyone - great reading on this forum yet yet I couldn't find the answer about if meniscus chunks will dissolve on their own?

41 years old - December 2016 playing volleyball I landed from a big spike jump (30" vertical jump...at least until my injury) and my knee felt dislocated. MRI revealed complete ACL tear, bone bruising, and a piece of my meniscus completely broken loose and floating around. MCL and everything else ok but bruised a bit I guess.

1 month with a cane and brace, month 2 with just a brace, month 3 walking fine with slight pain but full range of motion, it's now April and I've gone surfing 4 times (with a brace) and I'm moving around pretty good, almost completely pain free.

Doctor said I should have the piece of meniscus removed - he also said if I want to play sports again I need ACL replacement and suggested allograft as I'm older and it would be less recovery time.

My questions -

# 1 - Since I'm almost completely pain free and haven't experienced any locking or motion issues do I really need to have the piece of meniscus removed? Seems like a scope pretty much guarantees higher rate of arthritis later.

# 2 - Will a chunk of meniscus over time dissolve on it's own? Months, years?

# 3 - Do I go through with the ACL repair? I can tell my knee isn't as stable and jogging still hurts during but not to bad after. I don't know if the pain is from the bone bruising still healing (doctor said it could be 6 months before that pain went away) or the meniscus maybe causing pain, or the ACL tear causing pain?

Volleyball was my sport (25 years coaching & playing / both for recreation and profession at one point). I miss it but at the same time I was starting to get to the point where if I could tell my level of physical play was dropping. I'm okay with walking away because at some point if I couldn't play at the level I wanted due to age I didn't really want to play anymore. Not fun to play with 20 years olds when you can't keep up anymore and you're used to playing at an elite level :) I could still coach without being able to jump.

I tried playing soccer the other day and that lasted about 2 seconds - as soon as I tried to juggle the ball and was on only the leg without ACL I felt the instability and a little crunchiness and said - maybe this isn't a good idea.

If I'm pain free and can surf, golf, hike, and jog without much issue, do I bother to get ACL replaced or even to have the chunk of meniscus floating removed?

Do I give up soccer, basketball, tennis, and just play golf and surf? Or at some point will I not be able to even do that anymore?

I read that study out of sweden that many ACL replacement could be avoided but I doubt those people were as active as I am -https://www.sciencedaily.com/releases/2010/07/100722075224.htm

This program sounded cool - but it's in trial and I'm way outside their window anyway (within 30 days of injury). http://www.childrenshospital.org/centers-and-services/anterior-cruciate-ligament-program/bridge-enhanced-acl-repair-trial

I feel like within the next 5-10 years they'll figure out a way to regrow the ACL - too bad it hasn't happened yet :)

Thank you so much for any feedback.

Offline Vickster

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Yes, meniscus removal will potentially leave you with the risk of arthritis (if you're active you may more than likely have wear and tear starting already anyhow). Leaving the tear could also lead to it getting bigger especially if you stress the knee, then more will need to be removed...and thus an even greater risk. I tried to rehab a torn meniscus, got worse over the 5 months and needed surgery in the end anyhow.

I've never heard of meniscus dissolving, if it's loose anyhow it's no longer giving you the shock absorption so that arthritis risk is already there. Getting it tidied to a stable rim could reduce the risk of further damage

Leaving an unstable ACL deficient knee also carries a risk of arthritis and further damage to the knee structures and bone surfaces

if you want to stay active without needing appliances, consider the surgery, get another opinion too if needed, although your surgeon sounds sensible
« Last Edit: April 18, 2017, 08:41:05 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 bighonu1

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Thank you for the reply! The meniscus piece is completely detached, not a tear that is hanging or anything. A chunk free floating. That's why I thought it might dissolve or disappear over time.

Offline Vickster

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I can't see how, as the meniscus is made of quite tough fibrocartilage, where would it disappear to?
.  It also has likely left a raggedy edge, would be best to have tidied to avoid further tearing (at 41 this is possible due to degenerate meniscus tissue, typically starts to become brittle age 30 onwards)
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 jackson7

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That floating piece could be wearing on your other cartilage.  My os said that the meniscus flap i walked on for a year (mri was wrong) probably wore on my femoral chondyl, so he had to do a chondroplasty.

I think you're doing way too much, too soon, on your damaged knee and just making it worse.  Personally, i would get the chunk removed and the acl allograft as soon as possible and just retire high impact sports for good.  Surfing is "the source" (of happiness), anyhow, so i'd be satisfied just doing that for the rest of my life.

Btw, Tom Carroll had an acl reconstruction when he was 17 and went on to win several surfing world championships.  He's now 55 and still surfing with no limits, so whatever arthritis the surgery might have caused him must manageable.
« Last Edit: April 24, 2017, 11:00:45 PM by jackson7 »
12/2015: slow speed bicycle crash
1/16: many x-rays & 2 MRIs only show tendinosis
3/16: bone scan shows uptake in all compartments
8/16: cortisone jab (no effect)
3/17: diag scope (part med meniscectomy, med fem chondroplasty, full synovectomy)
4/18: Pain finally diminishing. 65% function.

Offline The KNEEguru

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The 'loose body' - if it is derived from the meniscus - is living tissue. It will be nourished by the joint fluid (synovial fluid) that washes the inside of the knee, and may in fact slowly get larger rather than smaller.

Loose bodies can 'hide' in capsular folds at the back of the knee, and not cause any trouble and even may not be seen on arthroscopy. But then suddenly a particular movement may make the loose body shoot out into the joint fluid and may cause 'catching'. Recurrent episodes may damage the joint cartilage.

They can be seen on X-ray, but often only by an experienced eye.

A loose body is also called a 'knee mouse', and some get big enough to be palpable if they float to the front of the knee joint, and then they suddenly 'disappear' back into their hiding holes at the back of the knee.

It is best if they are removed, but it is not generally urgent.
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