Tell me about meniscus surgery...

[peterslovo]

So I've been having this bad ache (even at night) in the medial and lateral parts of my right knee for several months. I can still ski, play racquetball, etc., but it feels a little "loose" when driving with the right leg, and gets real sore after activity at both points. Anyway, I finally went to see my general practitioner (damn healthcare system ) to get a referral to the ortho - he suspects meniscal tears to the medial meniscus and said my acl felt "loose" in my right leg. What that means, I don't know - I don't remember tearing it. Referred me to an ortho - I'm there next week to find out exactly what's up. Probably will ask about the left knee too while there (it sounds worse, like a bucket of bolts in there, and hurts as well, but not as much). Who knows, maybe it'll turn out to be nothing.. :

I've hyperextended, bruised, bashed, twisted both knees (especially the right knee_ many times over the last 10 years, and can only think of 1, well maybe 2, or 3 times when I actually could have done damage to the meniscus, or even the ACL.

So question to fellow gimpsters: can you strain your ACL without a full tear? Can you just injure your meniscus (i thought they usually were injured in conjunction with other ligaments)? If it turns out being meniscus-related, how is surgery and recover for just meniscus tears? Thanks...

[Snow Ranger]

meniscus repairs suck - I think on average of about 6-8 weeks non weight barring.

Hopefully you don't need the mesniscus repaired.

[house]

if the tears are minor they can just shave off the loose ends. thats what they did for me, and i was only on crutches for a couple days (just cause the doc said so, i could have walked right out of the clinic). if they need to repair the meniscus, however, its a bit more complicated. the lessened blood flow to cartilage makes it heal slowly. hopefully it isnt that serious.

[Tyrone Shoelaces]

can you strain your ACL without a full tear?

yes.

Can you just injure your meniscus (i thought they usually were injured in conjunction with other ligaments)?

yes.

If it turns out being meniscus-related, how is surgery and recover for just meniscus tears? Thanks...

i dunno.

Now for your viewing pleasure, here's a pic of my slightly torn meniscus that my doc took while he was in repairing my ACL. He just poked it a little and deemed it such a minor tear, that I won't have any problems with it for now. (and so far he's been right). He said that if it ever starts bothering me, he'll just "snip it up and I'll be good to go..." whatever the heck that means...

[Vinman]

Anyway, I finally went to see my general practitioner to get a referral to the ortho - he suspects meniscal tears to the medial meniscus and said my acl felt "loose" in my right leg. Referred me to an ortho - I'm there next week to find out exactly what's up.

I've hyperextended, bruised, bashed, twisted both knees (especially the right knee_ many times over the last 10 years, and can only think of 1, well maybe 2, or 3 times when I actually could have done damage to the meniscus, or even the ACL.

So question to fellow gimpsters: can you strain your ACL without a full tear? Can you just injure your meniscus (i thought they usually were injured in conjunction with other ligaments)? If it turns out being meniscus-related, how is surgery and recover for just meniscus tears? Thanks...

If you do end up with a meniscus tear, if possible have the repair done. It is a longer recovery but a better outcome. The more meniscus they can preserve in your knee the better. As far as injury goes it is also very possible to injure the menisci without associated ligament injury.

As far as the "loose" assessment from your GP about your ACL goes, he may or may not be right. In my experience GP's generally don't have a great feel for evaluating ACL laxity. Not saying/ he/she is wrong but don't stress on this part until you hear it from your ortho.

As for spraining the ACL without a tear, yes that can and does happen and will result in a loose feeling upon testing the ligament.

[justcuz]

I had arthroscopy (did I spell that right?) done on my knee and I walked out of the place. I had mine done Oct. 31 and was skiing within a month.

[grrrr]

I got the roto-rooter treatment and walked out of the hospital. Took 6 weeks of PT to come back to full strength.

[peterslovo]

All - thanks so far for the input - it makes me feel better to hear from people who've had it done!! I am now going to stop stressing about it until I see the ortho, or at least try....

My fingers are crossed that if it is in fact meniscus, it's only small tear(s) that can be "trimmed" and I can be on my way. My knee does not lock or anything - I can still ski, etc. but it gets real stiff, swells a little on the medial side, and is stiff and painfull especially after having it extended for a period of time, like for icing. It does click a bit, but I think that's more kneecap on bone rather than meniscus-related.

When I asked about activities, my GP told me to go ahead and do whatever I wanted exercise-wise (ski, gym, etc.) until I see the ortho. That seemed like a weird recommendation!?

[justcuz]

My fingers are crossed that if it is in fact meniscus, it's only small tear(s) that can be "trimmed" and I can be on my way. My knee does not lock or anything - I can still ski, etc. but it gets real stiff, swells a little on the medial side, and is stiff and painfull especially after having it extended for a period of time, like for icing. It does click a bit, but I think that's more kneecap on bone rather than meniscus-related.
:

Dude, if this is anything maniscus related you'll be fine. Mine was "locking up", clicking, cracking, swelling, farting....whatever. I thought I had some serious issues. Went to the dock, had an MRI, and he said there's a really good chance that it could be trimmed......more so than a repair. But as I recall, this is something that was decided like....during the surgury after they scoped it.

Moral to the story: I think they can tell from the MRI if something needs to be done, but not what kind of something. The decision as to repair it or trim it (for me) was done during the surgury.

[altagirl]

Moral to the story: I think they can tell from the MRI if something needs to be done, but not what kind of something. The decision as to repair it or trim it (for me) was done during the surgury.

That's pretty much it. They trimmed mine and I walked out of the hospital feeling better than I did walking in. But going into surgery not knowing how long you'll be rehabbing kindof sucks. Just have a surgeon you trust to make the best decision for you.

[peterslovo]

I've been on the vitamin I diet for days now - i need it to get to sleep at night, otherwise i lay awake from the damn knee!

haven't been doing much (no ski, no racquetball, etc.) except the bike at the gym. getting fed up with the gym so i decided to give the surf a go, thinking it would be easier on the knees. we've had a nice 4-6' swell here. anyway, was doing fine, caught a couple waves, knee felt okay...sore, but okay. found myself down the line and saw a lip section set up, so i figured what the hey, launched it and landed in the trough...mistake - something tweaked (well, grinded or ground sounds more like it) in the left knee as I went down... believe it or not, it felt like the SAME exact spot (medial joint line) just on the left knee!!!!!

now i'm hobbling from one knee to another . feel like a total gimp now! we'll see how it feels later - hoping it's not the other meniscus, but man, does it feel similar - minor pain on the lateral joint line and quite a bit of pain on the medial joint line when pressured, just farther away from the kneecap than my right knee.

so much for the 'go ahead and do the usual sports you do' recommendation from my GP. needless to say, don't see any surfing or skiing in the immediate future until i see the ortho!

at least maybe my ortho will offer a '2 for 1' deal now ?

[peterslovo]

Well, got back from seeing the ortho. She thinks highly probable tear of the medial meniscus in the right knee, with probable Grade II tear of the MCL as well. ACL is a touch loose in both knees (especially the left), but good endpoint attachment in both.

Joint line pain, and she held my upper leg and moved the lower leg to the side and things were loose and ground in there and hurt - probably confirms the meniscus + MCL damage, she said. I get the MRI Thursday but don't go back to see the ortho for a followup til April 13th (she's away...ugh...i hate waiting!!!). Meanwhile, she said no ski, no surf (damn, we've got waves too!), just stationary bike and elliptical machine. Bummed about that... spring NE backcountry season is around the corner, one of my favorite times of the year (though right now it's still raining cats n dogs). I was hoping maybe to buy some kind of brace and be able to get out, but that's probably not a good idea.

She looked at the left knee and thought no meniscus damage, but mostly early stage arthritis, plica syndrome (whatever that is...google here i come), and PFPS. Wants to keep an eye on it though.

Guess it could have been worse!

[LAN]

I have a torn meniscus, but have opted out of surgery. I can deal with the aches, clicks and occasionaly wobbly feeling. The ortho doc told me he could scope it if I wanted, but a mild meniscal tear doesn't warrant surgery. It all depends on the severity of the tear and how it's impacting your life. But ... surgery is surgery, so give it some thought.

[altagirl]

I have a torn meniscus, but have opted out of surgery. I can deal with the aches, clicks and occasionaly wobbly feeling. The ortho doc told me he could scope it if I wanted, but a mild meniscal tear doesn't warrant surgery. It all depends on the severity of the tear and how it's impacting your life. But ... surgery is surgery, so give it some thought.

Yeah, if you can live without it you might be better off. I'm sure I had my tear for a while and only noticed it as a problem whem my knee locked bent up on top of thirds and I couldn't straighten it - luckily you can ski with your legs bent - I just couldn't walk at all once I got off my skis. ER doc manipulated it so I could walk, but I couldn't put enough pressure on it to even ski pow (couldn't click into bindings either - I had to use my hands, which should have made me turn around and go home right then...) At which point there was no question.

[Vinman]

I too probably have lateral meniscus injuries in both knees right now. I have had the right one for about a year after slipping on some ice in the dog encloure last march. The left one has been around for about 6-7 months after slipping on a wet log hiking. The doc I work with looked at them both for me and confirmed what I though. It is probable that I have either pinched or slightly torn my menisci.

The menisci are funny little structures. Many people believe that they do not have any blood supply, but actually they do have some blood supply to the outer regions and are capable of limited healing.
If the tears are small enough and in this outer region where there is some blood supply they can heal. It will however take 6-8 weeks for them to do so, providing you don't irritate them. And there is no gaurentee they won't get re-torn after they heal. I just re-injured my right one in a tangle with a sapling about 2 weeks ago.

I have also seen both sides of the waiting game. I have had athletes wait the 6 w-8 weeks in hopes it would go away and still end up having surgery. I have also seen these kinds of tears heal up just fine.

One last note about MRIs. They are not the end all see all for everything. They can and do miss stuff. Especially on the lateral meniscus, for some reason they can miss a good percentage of lateral meniscus tears, it is a bit more specific for the medial side but they can still be missed as well. I have had other athletes with suspected mensuc tear have the MRI and have it come out negative. But knowing based on the symptoms the doc went ahead and scoped the knee only to find a huge bucket handle tear in there.

[peterslovo]

Interesting views LAN, altagirl, and Vinman. Thank you - these are extremely helpful.

Being new to this knee injury, I'm just starting to get all the info in front of me. I understand that surgery is surgery, but was always under the impression that meniscus surgery, in general, has a very high success rate, and that it is a good idea if a meniscus tear is bothering you to get it scoped as early as possible, since if the tear is small (and caught early enough) it can be stitched up instead of removed, which is usually the case if the tears get bigger. As I understand it, more natural meniscus in your knee means less arthritis later in life. That way you literally 'nip the problem in the bud', instead of waiting for it to get worse, which most likely it will. And also, if you 'live' with a tear, isn't that predisposing you to earlier arthritic problems? (just a hunch, i have no clinical experience or research to back that up ) However, I never knew that small meniscus tears can actually heal without surgical intervention.

i'm from the 'oh it'll go away' school when it comes to injury and pain management, but this one has bothered me for some time now.

[altagirl]

Interesting views LAN, altagirl, and Vinman. Thank you - these are extremely helpful.

Being new to this knee injury, I'm just starting to get all the info in front of me. I understand that surgery is surgery, but was always under the impression that meniscus surgery, in general, has a very high success rate, and that it is a good idea if a meniscus tear is bothering you to get it scoped as early as possible, since if the tear is small (and caught early enough) it can be stitched up instead of removed, which is usually the case if the tears get bigger. As I understand it, more natural meniscus in your knee means less arthritis later in life. That way you literally 'nip the problem in the bud', instead of waiting for it to get worse, which most likely it will. And also, if you 'live' with a tear, isn't that predisposing you to earlier arthritic problems? (just a hunch, i have no clinical experience or research to back that up ) However, I never knew that small meniscus tears can actually heal without surgical intervention.

i'm from the 'oh it'll go away' school when it comes to injury and pain management, but this one has bothered me for some time now.

Well - I agree with that too - if you catch it early enough and commit to really staying off of it so a repair can heal - that's probably your best long term option. I didn't really know there was anything wrong in my knee until it locked up - my doc said I seem to have a pretty high pain tolerance and therefore didn't think much of minor clicking or little aches and pains until all of the sudden I couldn't walk. If I knew it was there before, they probably could have saved more of it when they went in and did the surgery.

If it's bothering you on a regular basis - I'd get it fixed. It would be worth the improvement. I just meant that from the standpoint where I've read that most people have meniscus tears that they don't even know about - if you know it's there but it's no big deal - I guess I'd leave it alone, considering how hard it is to get a firm diagnosis on an MRI. If you feel pain from it, I'd guess that's a signal that you're making it worse and should fix it - but that's just my opinion.

[Vinman]

I agree with AG on this, if it is bothering get it fixed. My last post was only to point out that there are options, and was not meant to sway you either way.

For me personally, I was able to function at my desired level of activity (60+ days of skiing this year and now training for triathlon season) without pain or mechanical symptoms like clicking/locking/catching etc so I decided to not have surgery.

good luck with it.

[peterslovo]

One last note about MRIs. They are not the end all see all for everything. They can and do miss stuff. Especially on the lateral meniscus, for some reason they can miss a good percentage of lateral meniscus tears, it is a bit more specific for the medial side but they can still be missed as well. I have had other athletes with suspected mensuc tear have the MRI and have it come out negative. But knowing based on the symptoms the doc went ahead and scoped the knee only to find a huge bucket handle tear in there.

Just got my MRI update - good news! I just got off the phone with my ortho's assistant and found that the radiologist's read of the MRI appears negative for the meniscus tear. The ortho still has to look at it. She said the exact same thing as you quoted above, Vinman, that even though the MRI appears negative, the physcial exam is pointing to a tear, so there might still be a tear that simply was not picked up by the MRI. Weird. I'm being re-evaluated on the 13th when my ortho gets back from vacation.

On the MCL side, there was "thickening possibly indicating scar tissue", which is being interpreted as a previous injury. Anyway, that'll be looked at as well again when I go back. So I guess the waiting game continues! I'm still supposed to "take it easy" until my next appt...damn...surf's on the way...again!

[peterslovo]

So anyway...finally another update...

Saw the ortho again today. Apparently, I tore the MCL in a prior injury, and it did not heal properly, leading to Grade 2 laxity of the MCL. The MRI on the meniscus did not pick up any apparent meniscus tears, though there was something the radiologist classified as an inconsistency in the signal in the medial interior meniscus - meaning there could possibly be a tear.

My ortho wants to play it conservative, which makes perfectly good sense after what I've read here and read up on the net - work on tightening the MCL and seeing how the knee/meniscus responds. Off to 6 weeks of rehab I go, then re-evaluation. If the PT works, we go no further, if not, then they'll scope it to see what's up.

While I'm at rehab, they're treating my left knee as well. Patella femoral syndrome, plica, and pes anserine bursitis. Should be fun!

In the meantime, she cleared me for some skiing, within pain limitations - if it hurts, stop skiing. Yay, I get to finally harvest some corn! Just got to see whether I can make the skin up Tucks or not now...