meniscus or MCL tear/experiences.

[bdeisle]

I am posting this because my MRI is not for another week and I am backpacking Spain in two weeks. If anyone can share their opinion or experience that would be great.

Monday I went skiing and on a turn my ski caught a patch of ice; so, I went from my side to sliding on my back about 30-35ft. My knee was a LITTLE sore, so it did not set off any alarms and I continued to ski the rest of the day. The car ride home is when I noticed it becoming stiff and by the next morning it was stiff and tender along my inner knee. Article, after med sites, after article I was led to believe I may have injured my MCL or possible meniscus. Went to the doctors the next day and x-rays came back fine. So, now three days later (constant RICE) the tenderness is gone, I feel very little pain or pressure when pressing along the muscle and I can straighten my leg and lift it behind me 120deg roughly. In addition, If i use my hand I can pull it all the way back as if I am stretching the hammy. Right now it is just a little stiff, I can get out of my chair and into a chair smoothly and walk on the flat of my foot just without the full ROM. Oh yeah and I do a few i guess one legged squats and while feeling stiff, did not feel as if it was going to give out.
So, any opinions on what I may have done or any similar experiences?

[gibbssco]

Tore my MCL back in 2005. The third day after i could barely make it up the stairs at work, a week out i went to the doc and got diagnosed...couldn't really bend it past 90 for that first week, and weight bearing was pretty painful so it sounds like your a little better off than i. best wishes for ya! 4-6 weeks of PT and i was back on my feet.

[skatha]

I would guess you sprained your knee. The first time I tore my ACL/MCL/medial meniscus, my knee literally bent the wrong direction when I tried to stand on it. The second time was not as bad but I had a real sense of instability and it swelled whenever I stood on it longer than a few minutes. I'd take it easy for a few weeks and only go back to activities that involve rotation when you can do them completely painfree

[shrtbus7]

You didn't do anything to your ACL, which is a good thing. If you did, your knee would feel really unstable and always go into hyperextension. As for the meniscus and MCL, you should be fine. You have full ROM like you said and can do one legged squats without feeling unstable. If you did tear your MCL, the medical personal would just give you a brace and tell you to take it easy for 6 weeks. If there is no catching, painful ROM or locking in the knee I wouldn't worry about the mensicus either. I tore mine and had to have surgery because my knee was locked at about 25 degrees of flexion and hurt like hell to stand on. If I were you I would get a good knee brace with some good medial/lateral support and have a blast in Spain.

[Porrick]

Sounds like Grade 1 MCL (slight tear/strain). I'm nursing a grade 2 right now from Steamboat 10 days ago and I can walk relatively normally (but still stiff and painful). Hurt like hell when it happened and stiffened up bad the first night despite RICE. Here's some info from random MCL injury googled sitE:

What are the symptoms of a medial collateral ligament injury?
The most common symptom following a medial collateral ligament injury is pain directly over the ligament. Swelling over the torn ligament may appear, and bruising and generalized joint swelling are common 1 to 2 days after the injury. In more severe injuries, patients may complain that the knee is unstable, or feel as though their knee may 'give out' or buckle.

Symptoms of a medial collateral ligament injury tend to correlate with the extent of the injury. MCL injuries are graded on a scale of I to III.

* Grade I MCL Tear
This is an incomplete tear of the MCL. The tendon is still in continuity, and the symptoms are usually minimal. Patients usually complain of pain with pressure on the MCL, and may be able to return to their sport very quickly. Most athletes miss 1-2 weeks of play.

You'll prolly be 100% pretty quick. Good luck.

[caderader]

I think I pulled a nice grade one today over in Christmas tree bowl gonna try to ski on it tomorrow! gotta go for broke when your ski year is at less than 10 days

[owwee]

Any update on your recovery?

I had a meniscus tear that was also in a fluke fall. It didn't hurt much at all and I had full ROM and stuff for a while. But it never got better and finally got worse later.

I posted a description here: [ame="http://www.tetongravity.com/forums/showthread.php?p=2853567#post2853567"]http://www.tetongravity.com/forums/showthread.php?p=2853567#post2853567[/ame]

[LightRanger]

Sounds like Grade 1 MCL (slight tear/strain).

Yeah, I think so too.

I've had similar symptoms and was skiing on it a few days later.

Even my higher grade MCL tears (different time) healed on their own in a few months.

[Kinnikinnick]

I've got my own MCL/Meniscus injury mystery.

First hit an ice chuck skiing in February. Ski jerked to the outside. Felt a bit of a tweak on the inside of knee but no pop. Kept skiing the rest of the day. The next morning some soreness, but no noticeable swelling and when warmed up it felt OK after skiing for a while.

Same pattern for next few months - feels a bit stiff/sore in the AM, but can ski just fine especially after warm up. Been hiking, running, biking without any significant problem.

Last month while skinning the ski tip went under a breakable crust and was held under the crust while I pulled up. Ouch. Again no pop, just pain on the inside of the knee. Still gets uncomfortable with that weight of a ski and skin and that motion of skinning.

The location of the pain is right at the joint, where the MCL is. Both stiffness and a bit of tenderness right there on the outside of the knee joint (on the inside/medial side) ie not deep in the knee joint.

Soreness/stiffness are the main symptom since. At night I'll wake up and feel like its very stiff on that inside/medial side. Stiffness pain to straighten or bend. Stiffens up upon sitting for hours like driving a long distance. I can ski/hike, just gets a bit stiff/sore the next day and that happens with every form of excercise - biking too.

Went to an Orthopedist. He poked and probed and didn't find any major pain points but says he thinks it a Meniscus injury. RX for MRI.

I did my own research and I have NO problem doing the Thessaly test - no pain, instability, popping, swelling. Also reading that for less than catastrophic meniscus/mcl injuries you're better off doing physical therapy than scoping/trimming surgery.

Should I go ahead and get the MRI given that it'll prob just trigger the Ortho to recommend scope surgery?

What does the injury sound like to you? MCL or Meniscus or both?

[North]

Doesn't sound like my meniscus injuries, so I will refrain from going into too much of a detailed comparison. I injured mine under full compression, while twisting slightly. After a few days, I could do everything aside from loading the knee under full compression (ie crouching to tie my shoe, rolling weight onto compressed leg during climbing, etc.). Mine turned out to be a tear on the inside of the meniscus, that didn't make it to the surface - thus all of the sliding surfaces were still smooth.

On your question about surgery vs. PT, that's pretty specific to the injury. In my case doc 1 suggested scope but could not give me specifics of the intended procedure - said he wouldn't know the situation until he got in there. Ummmmm....no thanks. I got a second opinion from M. Boublik (Steadman, Broncos physician, would highly recommend), and he recommended PT - said I could always get surgery later if it never improved. I tore mine in late May, and it probably took until September for me to be 95% confident on it.

I tore the other one about 6 months later in what felt like a very similar manner. Given what I learned on round one, I never went to the doctor, and ~2yrs later neither of them bother me whatsoever. Today I couldn't tell you which one I injured first.

TLDR: Don't know what your injury is, but unless it's really limiting you I'd avoid surgery until it's clear that it's not going to improve on its own. Meniscus tear repairs seem pretty hit or miss, so even the surgery isn't a guarantee.

[Kinnikinnick]

Doesn't sound like my meniscus injuries, so I will refrain from going into too much of a detailed comparison. I injured mine under full compression, while twisting slightly. After a few days, I could do everything aside from loading the knee under full compression (ie crouching to tie my shoe, rolling weight onto compressed leg during climbing, etc.). Mine turned out to be a tear on the inside of the meniscus, that didn't make it to the surface - thus all of the sliding surfaces were still smooth.

On your question about surgery vs. PT, that's pretty specific to the injury. In my case doc 1 suggested scope but could not give me specifics of the intended procedure - said he wouldn't know the situation until he got in there. Ummmmm....no thanks. I got a second opinion from M. Boublik (Steadman, Broncos physician, would highly recommend), and he recommended PT - said I could always get surgery later if it never improved. I tore mine in late May, and it probably took until September for me to be 95% confident on it.

I tore the other one about 6 months later in what felt like a very similar manner. Given what I learned on round one, I never went to the doctor, and ~2yrs later neither of them bother me whatsoever. Today I couldn't tell you which one I injured first.

TLDR: Don't know what your injury is, but unless it's really limiting you I'd avoid surgery until it's clear that it's not going to improve on its own. Meniscus tear repairs seem pretty hit or miss, so even the surgery isn't a guarantee.

Yeah - thanks for the story. I'm skeptical about getting a $1000 MRI which will then show some tearing (from what I've read almost everyone who's middle age and athletic has some tearing) and then he'll try to get me into surgery which will be thousands more out of pocket and from what i've read no better than physical therapy.

But I'm curious if anything I'm describing is sounding to them like Mensiscus or MCL or what. Why all the stiffening at rest/night without seemingly motion or positioning or load activated pain? Am I just getting arthritic?

[splat]

There's a nerve that runs off the medial side of your joint under the kneecap that will tweak a little rubbing your finger across it if it's meniscus. Maybe someone else could describe it better.

[tintin5]

You don't need an MRI to diagnose an MCL sprain. A valgus stress test of the knee should be enough. Get a second opinion. Go see a trainer/physio/chiro/anyone who is comfortable performing the test. Save $1000.

North is correct. Even if it's a meniscus, the majority of those injuries heal up without needing surgery. If it doesn't get better, then you can talk to a surgeon. If the meniscus tear is just degenerative, you're no better off getting surgery.

[straightlineorbust]

When I was younger I did my MCL playing soccer bad enough that I would collapse from pain if I kicked a ball incorrectly. It was a pretty bad sprain, and sat out around 3 months or so of soccer (was playing year round at the time). But in the end it recovered from just pt.

I'd highly recommend a second opinion, because obviously I'm not an MD, but as others have said always best to try pt first if you can avoid surgery.

[ScrewYou]

I had half of my right meniscus removed. The inside part of the knee. No issues whatsoever.

In fact, it feels better than my left knee

[Kinnikinnick]

Well it looks like I could be headed for a Meniscus surgery after all.

Lingering symptoms - able to do anything, but 1, 2, days later my knee is stiff as heck.

Finally got the MRI:

- Peripheral meniscocapsular injury posterior horn medial meniscus
- intact ligaments
- bakers cyst
- mild pes anserine bursitis

How do I pick a surgeon?

[bigdude2468]

Ask others who have had knee surgery. What you have is pretty minor, honestly any ortho surgeon could do this in their sleep. Plenty of skiers have Bakers cysts and bursitis without symptoms.

[splat]

heal without surgery when it is possible.

[auvgeek]

^^100% agree. I used to think surgery was a great way to fix stuff; now I avoid it unless absolutely necessary.

In rough order of what I'd try before having a surgery:

- getting 8+ hours of good sleep every night
- consistency and progressively getting stronger without pain (especially hip & posterior chain strength if you sit all day)
- acupuncture/dry needling, deep-tissue massage, foam rolling (prefer the lax ball), stretching, etc.
- only taking natural pain killers (tumeric, ginger, etc—NOT taking ibuprofen or acetaminophen)
- eating "cleanly" (i.e., minimizing processed foods, lots of natural fats, lots of leafy greens + raw veggies)
- taking supplements (vitamin D, omega 3, & magnesium are especially important)
- natural injections (PRP, stem cells, etc)

If not, I would give all of those a shot for a good 6 months before getting surgery for a connective-tissue problem, except for an obvious case where it won't heal like a fully torn & displaced ligament. YMMV and all that, but you can always have the surgery later but you can't undo it once it's done.

[Kinnikinnick]

Yeah thanks guys - getting a 2nd opinion this week.

The main thing pushing me towards a surgery is that it just never heals. Going on 7-8 months since the initial injury. I take it easy then get on a bike or hike or just daily activities and it feels mostly OK but then the next day I feel jacked up. Limping around stiff as heck.

Not sure why the original Dr didn't push me towards some physical therapy as a 1st step, so maybe give that a shot.

The other thing is ski season is coming up. If I get the surgery by the end of Oct, I could be skiing solidly again by February. If I wait until December or Jan, then I'll be missing most if not all of the winter season.

[auvgeek]

Not sure why the original Dr didn't push me towards some physical therapy as a 1st step, so maybe give that a shot.

I would definitely do some PT before surgery. Most good surgeons won't operate until you've done enough PT. Here's a good article to get you started: https://www.t-nation.com/training/18...letproof-knees

The other thing is ski season is coming up. If I get the surgery by the end of Oct, I could be skiing solidly again by February. If I wait until December or Jan, then I'll be missing most if not all of the winter season.

As much as it sucks, consider how you'll feel in 5 - 10 years not necessarily how much you want to ski this season. If you're looking for a quick fix, at least consider PRP or stem cells before surgery.

Here are two scholarly (peer-reviewed, NEJ) articles on the efficacy of meniscus surgery. I'll let you read them and draw your own conclusions.

http://www.nejm.org/doi/full/10.1056/NEJMoa1305189
http://www.nejm.org/doi/full/10.1056/NEJMoa1301408

[AlpiNord]

Yeah thanks guys - getting a 2nd opinion this week.

The main thing pushing me towards a surgery is that it just never heals. Going on 7-8 months since the initial injury. I take it easy then get on a bike or hike or just daily activities and it feels mostly OK but then the next day I feel jacked up. Limping around stiff as heck.

Not sure why the original Dr didn't push me towards some physical therapy as a 1st step, so maybe give that a shot.

The other thing is ski season is coming up. If I get the surgery by the end of Oct, I could be skiing solidly again by February. If I wait until December or Jan, then I'll be missing most if not all of the winter season.

I had my meniscus trimmed last fall after trying to avoid it due to a car wreck 6 months earlier. The knee kept feeling like it was giving out. Down climbing sucked as did the swelling after activities. After a very minor trim, the knee has generally been back to post surgery ACL normal which was excellent. I was 'back in the saddle' in a few weeks. There are occassional periods of minor swelling and stiffness depending on activity. Last season's skiing & touring was pretty much trouble free.

I think the little flap that was torn and loose acted like a little wedge in the joint on occassions. This pressure created the issues I had. I'm not sure therapy could have fixed this problem.

Good luck if you do and definitely go easy the first week or two. Let it heal properly.

[Kinnikinnick]

Here are two scholarly (peer-reviewed, NEJ) articles on the efficacy of meniscus surgery. I'll let you read them and draw your own conclusions.

http://www.nejm.org/doi/full/10.1056/NEJMoa1305189
http://www.nejm.org/doi/full/10.1056/NEJMoa1301408

Yeah, thanks. I have read about some of these studies. The only difference, potentially, from some of the studies is that mine isn't a "degenerative tear" but the result of direct action - ie I had a specific twisting dynamic applied at the time of injury so some experts seem to say that in these cases the surgeries could help more than degenerative tears.

But yeah - I think I need to start PT.

I had my meniscus trimmed last fall after trying to avoid it due to a car wreck 6 months earlier. The knee kept feeling like it was giving out. Down climbing sucked as did the swelling after activities. After a very minor trim, the knee has generally been back to post surgery ACL normal which was excellent. I was 'back in the saddle' in a few weeks. There are occassional periods of minor swelling and stiffness depending on activity. Last season's skiing & touring was pretty much trouble free.

I think the little flap that was torn and loose acted like a little wedge in the joint on occassions. This pressure created the issues I had. I'm not sure therapy could have fixed this problem.

Good luck if you do and definitely go easy the first week or two. Let it heal properly.

This seems similar to mine. Actually what he's proposing to try is to try to sew up the tear. The surgeon compared mine to a hang-nail. If you don't get it trimmed or sewn up then it'll just become worse and possibly need more meniscus removal later.

[owwee]

This seems similar to mine. Actually what he's proposing to try is to try to sew up the tear. The surgeon compared mine to a hang-nail. If you don't get it trimmed or sewn up then it'll just become worse and possibly need more meniscus removal later.

I had a meniscus tear 7 years ago in my left knee. Want to share my experience since it has some aspects in common with yours. First, realize there are 3 kinds of tears: degenerative, partial, and complete/full. Forget degenerative tears; it's not what you have, as you said. Partial or complete/full just differentiates whether the tear is all the way through (meaning 2 or more separate pieces of meniscus now) or not. Menisci suck! They don't heal because they have no blood flow. It's like a fingernail, except that it doesn't grow out new material like a fingernail does. If your fingernail gets a hangnail, it's not gonna reattach ever on its own.

I would definitely get two or more surgeons' opinions. It's amazing how different their attitudes are from one to another! I would always go with the surgeon who seems competent but has the least desire to operate and intervene in things. I saw one surgeon who said, yeah, come on in, we'll operate and you'll be out of here in no time and fine again. I do these all day long; no big deal. I did *not* go with her. I went with the guy who gave me a detailed plan/explanation about what he would do: go in to look, see the situation, and either remove the least required to get rid of loose material, or if possible suture it back together. (Note: even with a perfect MRI, no one can really know what the tissue situation is like until they get in there with the scope.)

The outer few millimeters of the meniscus tissue have *some* very little amount of blood flow. And so if the tear is only in this outer part, it can be sutured together and *hopefully* will heal. However, once the tear goes through this outer layer into the dead part, "repair" (as it's called) becomes much more unlikely to be successful. Repair also apparently has to be attempted relatively recently after an injury. My doctor told me as I went into surgery he would most likely try to remove the torn part (partial menisectomy) than repair. Why? Well, in addition to most often not being feasible, repair is a *BYTCH* for recovery (more on that later). The reason to undertake a repair is that, depending on the severity and the situation, a repair can have a much better outcome in the long-term than a partial menisectomy because you are able to preserve more of the body's original tissue. A partial menisectomy, on the other hand, is nearly a walk in / walk out procedure, and it's true it's like getting your haircut... surgeons do this all day, day in, day out. That does not mean however that you are spared from the increased long term risks of having had the surgery... osteoarthritis / knee pain later in life.

So, yes, avoid surgery at all costs if you can. If you are just having inflammation / pain after activity, and the tear is only partial or degenerative, by all means, do not operate unless you have tried a full course of PT, which can take 6 - 12 months to gauge if it is effective or not. Studies show these outcomes can be as good or better than partial menisectomy. This does not sound like it applies to your situation however. If you are having locking or physical obstruction from a severed piece of the meniscus, PT is not going to be able to help fix this underlying structural defect. I delayed surgery for many months, but it was clear that no matter how many good days I had in a row, eventually this thing would slip out and start the whole inflammation/pain cycle over again.

Now, despite my surgeon anticipating a small partial menisectomy, when he got in there, he discovered that it was the *large* piece that was unstable, not the small piece! A menisectomy would have resulted in removing the majority of my meniscus, and he assessed that a suture/repair was feasible and did that. He had told me pre-op to expect a few days of recovery for a partial menisectomy versus months in the unlikely case of a repair. So imagine my shock coming out of anesthesia to learn I had a repair. Let me tell you, rehab SUCKED. I was in PT long enough to see two cycles of senior citizen hip replacement patients who were in and out in half the time I was. The first part was 4 weeks (or maybe 6? I can't recall now) with a locked brace, non-weight-bearing on crutches. The only exception was each day when I would unlock the brace to do a few knee flexion stretches. After this period, my leg was atrophied like a toothpick and then began the 4 months of rehabilitation to regain strength and movement. Note, I understand from reading that there are some disagreements on the post-op protocols and some doctors do not use this long non-weight-bearing period after surgery. In any case, you'll follow what your doctor outlines, whatever procedure you end up having done, and opinions seem to vary. (If you want to learn about how medical care is actually performed mostly on superstition and hunch and not actual evidence and statistics like you would think, google the "freakonomics bad medicine" 3-part podcast series.)

So 4-6 months after surgery, I was walking normally again finally, still rebuilding some atrophied leg muscles, but mostly back to normal life. Except that this whole process and the strain it put on my other knee revealed a pre-existing partial tear I had suffered in another accident without realizing it. My right knee was inflamed/swollen/painful, not enjoying life. And I went back to my surgeon, and he did an MRI and diagnosed a partial tear, meaning the tear only went about halfway through. It was really hampering my life, and I wanted to fix it with surgery, but bless him, he really resisted me and said to take it patiently and try PT. Many months of PT and patience and that knee is happy as a clam and loving life. And I'm glad I avoided surgery.

I would strongly recommend you think of the *long-term* in your life and not this year's ski season. I had a few f***ed up and suboptimal ski seasons in there while I dealt with my own knee issues. But I've now developed a love of my knees and learned that by doing a healthy regimen of knee exercises (mainly squats/dips and balance work), I can get out on the hill and charge like a teenager still. But if I neglect this training, my knees feel like I'm a 70 year old man. (I won't tell you my actual age here, ha ha, but it's between these two endpoints!) Any surgery is going to increase your risk of knee issues later in life, but sometimes surgery is unavoidable to resolve a mechanical defect in this son-of-a-bytch body part called the meniscus.

Another note, I saw a snake oil salesman surgeon about my second knee at one point who promised me he knew this amazing research and could repair this meniscus even though it had a deep tear and that he would do it all without me having a long, hard rehab, and he would straighten and align my knee cap while he was in there, and my knee would be better than before the injury. It was very tempting, but boy am I glad I took the patient PT route and avoided it. In retrospect, I think he was preying on the fear and doubt you have when you are sick or hurt and promising too-good-to-be-true things. I shudder to think of what might have happened if I'd let him operate on me!

Disclaimer: This advice is from the hours and hours of research and reading I did over those two years of treatment and many doctors visits with various practitioners. Opinions vary widely! There is no "established truth" in this field. There just isn't enough reliable data yet and the "state-of-the-art" still has much to learn. No doubt, facts and opinion have evolved in the 7 years since I started my odyssey. So take it conservatively, find a doctor who you trust, and follow his advice.

[Kinnikinnick]

Thanks for the detailed story.

Sounds very close to my situation.

The surgeon that I've already seen is talking a similar long non-weight bearing and rehab. He gave it a 50/50 that the repair would even work longer term, so its sounds like I may be onto the meniscetomy anyways.

Have a 2nd opinion later this week so see if there is any difference.

Started PT too, so perhaps that might help things out.