Anyone dealt with torn meniscus before?

**Out_to_lunch** · 09-29-2006, 02:20 PM

Cross post from gimp central. I have a feeling I'll get some more response here.

While playing ultimate Monday night I did something to my knee. It hurts when I go up or down stairs, but is fine when I walk on flat ground, do lunges, and other things (really anything but go up and down). I went to the doc here at school and he said it's probably one of two things:

1) I bruised my patella. Not too bad of a situation, it should heal in a week or two.
-OR-
2) My thigh bone has torn some meniscus in my knee. A good bit worse than the bruise, and probably requiring surgery.

If It is still hurting by the time I finish up the naproxen he gave me I'll be going back for an MRI. I've had a problem with this knee once before leading me to believe (and hope) that it is just a bruise on a weaker part of my knee from the previous problem.

Based on the idea of hoping for the best and planning for the worst, I ask this question. If anyone has dealt with this kind of thing before, what kind of down time would I have because of surgery and what kind of physical therapy would I have to go through? Anything else helpfull would be greatly appreciated as well.

**Froman** · 09-29-2006, 02:47 PM

search in gimp forum for more info, but if you need surgery, recovery time depends on how they do the repair. If they clip the torn piece, the recovery will be quick. If the tear is in the right area, with enough blood flow, they can stich it back into place, and the recovery time becomes much longer. If is a minor tear, you might not need to have surgery. Does your knee lock up?

check out this thread for more info:
http://www.tetongravity.com/forums/s...ad.php?t=62056

**Jim S** · 09-29-2006, 03:04 PM

Your thigh bone has a torn meniscus?

**Out_to_lunch** · 09-29-2006, 03:04 PM

Originally Posted by Froman

search in gimp forum for more info, but if you need surgery, recovery time depends on how they do the repair. If they clip the torn piece, the recovery will be quick. If the tear is in the right area, with enough blood flow, they can stich it back into place, and the recovery time becomes much longer. If is a minor tear, you might not need to have surgery. Does your knee lock up?

check out this thread for more info:
http://www.tetongravity.com/forums/s...ad.php?t=62056

Thanks for the link, I don't know how I missed that, I guess I should read better...

I'm not getting any locking at all in my knee and there was never any visible swelling

**Out_to_lunch** · 09-29-2006, 03:09 PM

Originally Posted by Jim S

Your thigh bone has a torn meniscus?

My femur possibly tore meniscus in my knee...

**Sinecure** · 09-29-2006, 03:16 PM

Jim S has seen more torn cartilage than I have, but I've torn more than he has.

Recovery from arthroscopy (if they just go in and cut out any messed up stuff) will be quick. If they repair it, you may not get much skiing this season.

As long as you don't have to pay for it, I'd get the MRI done. X-rays are useless IMO, although they always seem to do them before doing an MRI - I guess b/c an MRI is expensive (somebody has to make those payments on Jim S's BMW).

Start taking Glucosamine/Chondroitin now and plan on taking it for the rest of your life. It will help maintain some cushion in your knee.

Ice will help with any swelling. Don't overdo the NSAIDS (Aleve, Ibuprofen, etc.) or your gut will fight back.

Good luck.

**Jim S** · 10-01-2006, 12:05 AM

Originally Posted by Sinecure

Jim S has seen more torn cartilage than I have, but I've torn more than he has.

Recovery from arthroscopy (if they just go in and cut out any messed up stuff) will be quick. If they repair it, you may not get much skiing this season.

As long as you don't have to pay for it, I'd get the MRI done. X-rays are useless IMO, although they always seem to do them before doing an MRI - I guess b/c an MRI is expensive (somebody has to make those payments on Jim S's BMW).

Start taking Glucosamine/Chondroitin now and plan on taking it for the rest of your life. It will help maintain some cushion in your knee.

Ice will help with any swelling. Don't overdo the NSAIDS (Aleve, Ibuprofen, etc.) or your gut will fight back.

Good luck.

I have no idea why people order x-rays in these situations. No matter what one sees on an xray in this clinical setting, you need an MRI. I agree with Sincure. If I were king, nobody would ever have lumbar spine xrays either. Soapbox off.

Remember, I don't order the studies; I just read 'em.

**Cyber Cop** · 10-01-2006, 12:12 AM

Originally Posted by Sinecure

Start taking Glucosamine/Chondroitin now and plan on taking it for the rest of your life. It will help maintain some cushion in your knee.

Any suggestions on a good brand? Liquid or pill etc? Any good cheap brands?

**hway2** · 10-01-2006, 09:46 PM

I have a torn medial meniscus. If I remember correctly, the meniscus is shaped like two crescent moons tip to tip of each other. There is one in the front and one in the back (I could be wrong). In my case, the front crescent is frayed at the end that is on the inside of the knee (it showed up on the MRI). The doctor thought its probably in an area where there is not enough blood flow to sew it together, so he wants to snip it. Apparently that may increase the likelihood of arthritis and generally cause the knee to get older faster. It really only hurst when I run, which I dont do anymore because of it. I can ride a bike and it does not mess with skiing, xc skiing or hiking. So, I am living with it just fine. I would say give it some time and see if you can live with it. My tear is minor though.

**Jim S** · 10-01-2006, 10:02 PM

The meniscus is shaped like a crescent and as we look at it on MRI, we normally see it as the shape of one or two triangles or as a bow-tie configuration.

This is an axial view or as seen "from the top or bottom"; a view that is not the most frequently used in MRI.

Here is a sagittal view or look "from the side" and one posterior horn or triangle of the meniscus is circled.

Very generally, the outer third of the mensicus has good blood supply while the inner third is relatively avascular: does not receive good supply. To overly simply this:

Peripheral or outer tears can be repaired or/and resected
Inner tears are more likely to be resected than repaired

**Tippster** · 10-01-2006, 10:07 PM

My doc shot me up with some Novacaine and a little cortizone, then wrote me a scrip for a nice custom knee brace which I still own. It healed right up after 3 weeks. Total cost - $40 (2x $10 copay for the initial visit and followup, $20 copay for the brace.)

You only need the MRI if it doesn't heal - this means (according to him) that the tear is in the inner part of the meniscus where there is less blood flow and thus less able to heal naturally. He recommended against getting an MRI too soon because people tend to take that as step one in "needing" surgery and will not rest their knee as they should.

Doctor McNamara in DC is smrt.

**Jim S** · 10-01-2006, 10:09 PM

How will you know your mensicus is torn without an MRI?
You won't. Period.

I can't tell how many MRIs I read every day where the referring clinician suspects a meniscal tear and on MRI there's no tear of the meniscus but there is other pathology. O sometimes nothing at all.

I'm not saying everybody with post traumatic knee pain should get an MRI. But if you want to know if the meniscus is torn, it's the way to go.

**Tippster** · 10-01-2006, 10:15 PM

His point was if it (whatever "it" may be, I guess) doesn't get better in 2-3 weeks THEN get an MRI. He's not a hater, it's more of a Zen thing - giving your body a chance to heal itself first before getting into an invasive "go in and fix this" mindset.

**altagirl** · 10-01-2006, 10:16 PM

There's no right answer, as far as I can tell.

You can try to live with it. That's great if it heals up. But... it could also get worse and instead of having it scoped and having a very small piece trimmed, you could lose a large portion once the tear catches and rips and now you're really screwed.

Both of my meniscus surgeries were after my knee locked up. To me, that's where I can't live with it anymore. But with the first one (left knee), he had to trim out a good amount - it was just shredded when he went in there because I tried walking and skiing on it when it was torn. If I had just had the surgery right away instead, maybe he could have saved more of it.

But there's no way to tell exactly what's going on in there without surgery. An MRI is a good start, but I know they're not always right and sometimes miss tears or see phantom things in there. I think you just have to go with what it feels like and try and make a judgement call on whether it's getting worse or better. With an ACL - it's there or it's not. But with a meniscus tear, it's not a very clear cut decision unless it's really bad and you can't bear weight on it at all.

**Jim S** · 10-01-2006, 10:20 PM

Originally Posted by Tippster

His point was if it (whatever "it" may be, I guess) doesn't get better in 2-3 weeks THEN get an MRI. He's not a hater, it's more of a Zen thing - giving your body a chance to heal itself first before getting into an invasive "go in and fix this" mindset.

Oh, OK. Sorry if I came across with guns blazing. I concur with that.
My right knee catches sometimes but it's not that bad so I haven't had an MRI of it either.

I mean, heck, I can get my plaid skirt on and off no problem.

**Tippster** · 10-01-2006, 10:23 PM

Originally Posted by altagirl

But with the first one (left knee), he had to trim out a good amount - it was just shredded when he went in there because I tried walking and skiing on it when it was torn. If I had just had the surgery right away instead, maybe he could have saved more of it...

Ergo the whole "getting a brace and giving your knee a chance to heal" thing.

**altagirl** · 10-02-2006, 05:17 AM

Originally Posted by Tippster

Ergo the whole "getting a brace and giving your knee a chance to heal" thing.

I was just following my doctor's advice. Go ahead and try to do your daily activities and see if you can live with it or not (or we can just go ahead and schedule surgery if you want) And at the time it seemed like overkill to do surgery when it sounded "optional".

Anyway, what good would a brace do? You'd need to be on crutches to give it a chance to heal.

**Tippster** · 10-02-2006, 08:38 AM

Heh - the doc said the brace was merely to remind you that you were hurt. He absolutely agreed with you that it doesn't do much (it does stabilize the knee laterally a bit, but not much.)

Seriously - this guy was a hoot.

**altagirl** · 10-02-2006, 09:18 AM

Originally Posted by Tippster

Heh - the doc said the brace was merely to remind you that you were hurt. He absolutely agreed with you that it doesn't do much (it does stabilize the knee laterally a bit, but not much.)

Seriously - this guy was a hoot.

Yeah, I think for your meniscus to heal it needs to not be squashed - which is a weight bearing issue, not a stability issue. And for the record, I skied one run, on a powder day, was dying in pain and went home to make my appointment for surgery.

And I guess with the chance of it healing on it's own being pretty small (or at least an unknown) - staying on crutches for 4-6 weeks only to find out that you need surgery, could end up with a repair and now need another 4-6 weeks on crutches... screw that. Just have the surgery and make sure it's on it's way to being fixed. Can you imagine what kind of a wasted twig of leg you'd have after 12 weeks of non weight bearing??

**Vinman** · 10-02-2006, 04:27 PM

Originally Posted by Jim S

How will you know your mensicus is torn without an MRI?
You won't. Period.

I don't agree with this. Clinical exam if done by someone with experience/ knows what to look for can be pretty good for diagnosing meniscal tears.

Originally Posted by Jim S

I can't tell how many MRIs I read every day where the referring clinician suspects a meniscal tear and on MRI there's no tear of the meniscus but there is other pathology. O sometimes nothing at all.

I do agree with this. I have seen many meniscal tears with go on to have MRI and come up negative for meniscus pathology only to go on tho have the scope/ repair, partial meniscectomy anyway because of a positive clinical exam.

Originally Posted by Jim S

I'm not saying everybody with post traumatic knee pain should get an MRI. But if you want to know if the meniscus is torn, it's the way to go.

This I partially agree with. Just because you have knee pain after an injury, you don't necessarily need an MRI. A good doc should be able to diagnose most joint pathology from history and exam. But these days people EXPECT to have an MRI or at times demand it even though there is a clear diagnosis on clinical exam.

As for bracing a meniscus.....worthless. There are no good braces to protect or prevent a meniscal tear. It is almost im possible to prevent the flexion+ rotation that that causes most meniscus tears.

I am going on the table for a partial meniscetomy in about 1.5 wks. The injury is 2 years old on the knee that I have had 2x ACL recon/meniscus repair. I've likely torn out the previos repair and since it has been so long the edges of the tear have been without blood supply for a while and are likely beaten up a bit. BTW no MRI for me. History, clinical exam and my own experience tells me and my ortho this.

**The Suit** · 10-02-2006, 04:37 PM

Originally Posted by Out_to_lunch

I went to the doc here at school and he said it's probably one of two things:

1) I bruised my patella. Not too bad of a situation, it should heal in a week or two.
-OR-
2) My thigh bone has torn some meniscus in my knee. A good bit worse than the bruise, and probably requiring surgery.

I had an almost identical diagnosis after an initial examination a few seasons ago. Subsequent MRI showed a tibial plateau fracture. After six weeks of rest/crutches/brace it was (seemingly) good as new.

**Nohillsnearby** · 10-02-2006, 07:03 PM

Originally Posted by Vinman

This I partially agree with. Just because you have knee pain after an injury, you don't necessarily need an MRI. A good doc should be able to diagnose most joint pathology from history and exam. But these days people EXPECT to have an MRI or at times demand it even though there is a clear diagnosis on clinical exam.

Especially if you don't trust your doctor's expertise. Which I didn't and he was right that I just had a partial MCL tear and not a bad ACL.

**altagirl** · 10-02-2006, 07:43 PM

Yeah, I didn't have an MRI with my last torn meniscus either. But hell, my knee was locked. My doc said I could get an MRI if I wanted, but I just said to schedule surgery for tomorrow. It's not like knees completely lock up for no reason.

**NewHampie** · 10-03-2006, 10:50 AM

I've had meniscus tears in both knees within the last 3 years, each time had some pain and a lot of swelling after exercising. In each case had an MRI which eliminated any doubt about the diagnosis, and had arthroscopy under general anaesthesia. Both times it was a day procedure and I left the hospital on crutches. The first time I felt so good I went out and mowed the lawn (about a half acre) the next day...not a good choice. Take time and rehab with a PT to make sure you don't have any setbacks. Both knees are fine now, even at my advanced age of 57 can still play soccer & tennis, run, ski, etc without any braces. I started taking glucosamine when I tore the first one and just started taking MSM. Good luck to you, people say to take a marker and write "good knee" on the one not bothering you before any surgery.