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  1. #76
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    Kinnikinnick
    Are you in the Denver area? Who was your surgeon?

    I suffered severe right knee pain from running on flat dirt road in May. Saw an ortho doc a couple weeks after and he said I had chondromalacia (fancy word for degeneration). Told me to give up running (after 39 years of it). Range of motion is now normal. But, I can still feel things aren't right with the knee. I get that running is out, but I can't walk the dog more than a couple mile on flat ground. Got an MRI that showed a meniscus tear. Saw a different ortho doc last week. He described the tear as cables ripped apart and said it could not be repaired. He offered nothing more than a cortisone shot for pain relief if I wanted. Maybe "minor" surgery to trim part of the meniscus that is bulging out. I see the original ortho doc this week for his opinion. Looking for a third set of eyes.

    Any of you other guys that researched stem cell have any info/opinion specifically for meniscus tears?

  2. #77
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    Hey EO,
    I just PMíd you.

    Dr McCarty CU Sports Medicine is who I used.

    I had two differing opinions on the viability of my repair too.

    One said it wonít work and just have a trim (and expect the 20 year clock for a total knee replacement start). Dr McCarty thought I should try PT and then a steroid shot and then finally a scope with possible repair. He ended up doing a ďinside - out repairĒ .

    I think that that the reality is that they canít tell that great one way or another until they are inside with the scope. So Iíd advise you to try PT 1st and then go with the doc who you feel the best about given your research.

    Some people seem to have success with the stem cell injections too, so if paying out of pocket is an option, you could try that.

    Good luck


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  3. #78
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    Quote Originally Posted by Elkhound Odin View Post
    Any of you other guys that researched stem cell have any info/opinion specifically for meniscus tears?
    I don't know anything about meniscus specifically, but my wife has a pretty significant talar defect in her ankle (two separate ground falls while climbing, one bouldering, one leading), which seems very similar to the ankle's version of a meniscus. Before her stem-cell injection almost exactly one year ago, she wasn't able to walk 3 miles on flat, even ground. It was a slow progression -- she continued with PT from July till November. When she first went skiing iin November, she could only do 2 runs on the bunny slope at Loveland Valley. She overdid it at Christmas in WA, kept at the PT, was able to ski about every other day in Chamonix for two weeks in April, and now she's been skiing both weekend days and doing stuff like Tuning Forks on Torreys after work (refreeze) last month because she wanted to ski more than just weekends. She still has pain sometimes, still hasn't been able to run properly yet, and she wishes she could do big 30 mi, 10k vf days like she used to, but it's SO much better than it was a year ago.

    Since you're in the Denver area, Dr. Karli at the Steadman Clinic in Vail is the one who did her stem-cell injection. https://www.thesteadmanclinic.com/ou.../david-c-karli
    We also looked into the Centeno-Shultz Renegexx clinic, but they were about double the price for a stem-cell injection, IIRC. We kind of insisted on trying a stem cell injection before surgery. The Steadman clinic docs didn't really think it would work given the time since the original injury and that we weren't doing it as part of a surgery. But we're so glad we insisted. And the technology is only improving, and if she needs another one in 5 years, at least they didn't cut out any viable tissue with a surgery.
    Last edited by auvgeek; 07-10-2018 at 12:47 PM.
    "Alpine rock and steep, deep powder are what I seek, and I will always find solace there." - Bean Bowers

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  4. #79
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    Auvgeek, What was the procedure for the stem cell, and how much was it? (if you don;t mind me asking)

  5. #80
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    They drill into the pelvic crest from the back and extract raw bone marrow aspirate, leave the room to process it, come back about 10 min later and inject the processed stem cells into the desired area under ultrasound guidance. We chose to forego topical anesthesics because we read some journal articles saying lidocaine and other topical anesthesics can kill viable stem cells. The injections were painful and uncomfortable, especially from the pressure of having that much volume injected into a small joint space. She was a trooper about it. Note that the US doesn't allow cultured stem cells (yet), so they have to drill into you pelvic bone every time you want an injection, no more than once a year (only really an issue if you have multiple injuries you want addressed at the same time).

    I think it was $2500. We're by no means rich and it was a stretch for us, but it was worth it.
    "Alpine rock and steep, deep powder are what I seek, and I will always find solace there." - Bean Bowers

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  6. #81
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    Quote Originally Posted by Kinnikinnick View Post
    I think that that the reality is that they canít tell that great one way or another until they are inside with the scope.
    this is very true, what they saw from my MRI was somewhat different from what they saw with the scope

  7. #82
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    Quote Originally Posted by Elkhound Odin View Post
    He described the tear as cables ripped apart and said it could not be repaired.
    With that type of tear, you're best option is physical therapyÖsurgery isn't going to do much unless your knee is locking, all they'll do is trim out parts of your meniscus which puts you on the road to Osteoarthritis faster

  8. #83
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    I went for three different consults.
    consult 1: recommends no surgery. can't repair. Surgery for clean up only if function/pain get worse.
    consult 2: surgery possible for clean up to deal with pain. can't repair
    consult 3: surgery possible for clean up. Possible repair by tacking the tear down to the bone. But, recovery is long and outcome not 100%.

    asked what happens if I don't do anything since I have function and pain is tolerable, they said eventually I'll need knee replacement. Consult 2 & 3 said clean up might extend knee life. But, then they provide an anecdotal case where the person didn't do anything and they have been fine for 6-7 years. Consult 3 offered an option for a brace to relieve the strain, but left that based on how my knee is functioning.

    asked all 3 about PT, they said, meh. It won't really do anything to fix the problem

    asked about stem cell & PRP, they said don't bother, won't do anything. Sure, they said I could find a snake oil saleman pitching miracles, but I'd be wasting my money.

    All three told me to stop running. Don't do any repetitive high impact activities like that or heavy lifting. Hike in moderation. Get on a bike, go swimming. Skiing is OK, but don't hammer the bumps all day long.

    Right now, my knee works. It swells up after walking, but so does my other knee. I've got to the point I have to accept I'm old I guess.

  9. #84
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    meniscus or MCL tear/experiences.

    Sounds like a tough call.

    I felt mine was tough call too. Going into the surgery I wasnít sure whether I was getting trim or the repair. I asked him to try the repair if it looked viable but it was his call in the end based on what he saw.

    I opted for the surgery in general bc it just didnít get better with extended rest or PT. I wanted to be able to go on long hikes/skis without the days of stiffness and limping around. My hip was starting to hurt from limping.

    I think that that is your decision point -can you do your activities enough to be happy with as it is?





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  10. #85
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    Quote Originally Posted by Elkhound Odin View Post
    asked about stem cell & PRP, they said don't bother, won't do anything. Sure, they said I could find a snake oil saleman pitching miracles, but I'd be wasting my money.
    That's what two of the three orthos told my wife about her ankle and stem cells, also. The other one said it only works in conjunction with a surgery.

    I wonder how those same orthos feel about the recent peer review studies claiming surgery is statistically no better than PT for meniscus tears.

    The key question is what percentage of the patients that they've personally seen try it are the same or worse? The ortho we saw who argued the hardest against the stem cell approach would not give a straight answer to that question -- I asked if he'd seen any who'd tried it and came to him after and he decided it was time to leave the room. And of course, there aren't any real peer reviewed studies of the efficacy of stem cells yet. (And with the current political climate, who knows if they'll ever get funded.)

    Look, I'm not saying stem cell injections are the end all be all of sports injuries. It might not help you at all. BUT we just don't know enough yet, and it's pretty low risk compared to a surgery where they might cut out something useful and actually make it worse.
    "Alpine rock and steep, deep powder are what I seek, and I will always find solace there." - Bean Bowers

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  11. #86
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    the truth is usually somewhere in the middle. For example, the doc is correct in that PT will not FIX a torn meniscus- but it will train you to strengthen the muscles and put less stress on the joint, which results in less pain. OTOH, surgical transplantation to regions with low blood flow may or may not work.


    Fyi- there was a May 2018 study that may eventually be the way of the future- "Engineered Healing of Avascular Meniscus Tears by Stem Cell Recruitment."
    (may be free.. https://www.nature.com/articles/s41598-018-26545-8.pdf)

    "Meniscus injuries are extremely common with approximately one million patients undergoing surgical treatment annually in the U.S. alone. Upon injury, the outer zone of the meniscus can be repaired and expected to functionally heal but tears in the inner avascular region are unlikely to heal. To date,no regenerative therapy has been proven successful for consistently promoting healing in inner-zonemeniscus tears. Here, we show that controlled applications of connective tissue growth factor (CTGF)and transforming growth factor beta 3 (TGFβ3) can induce seamless healing of avascular meniscus tears by inducing recruitment and step-wise differentiation of synovial mesenchymal stem/progenitor cells(syMSCs). A short-term release of CTGF, a selected chemotactic and profibrogenic cue, successfully recruited syMSCs into the incision site and formed an integrated fbrous matrix. Sustain-released TGFβ3 then led to a remodeling of the intermediate fibrous matrix into fibrocartilaginous matrix, fully integrating incised meniscal tissues with improved functional properties. Our data may represent a novel clinically relevant strategy to improve healing of avascular meniscus tears by recruiting endogenous stem/progenitor cells."
    Move upside and let the man go through...

  12. #87
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    Interesting. Thanks for the link.
    "Alpine rock and steep, deep powder are what I seek, and I will always find solace there." - Bean Bowers

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  13. #88
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    Grade 3 MCL tear yesterday after a freak accident. Knee is super swollen and I'm utilizing RICE. Hoping to be back in 6 weeks on so. Has anyone used Tumeric? Looking to cut back on Ibuprf.

  14. #89
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    Bummer, dude! Yeah, my wife has used tumeric. She likes fish oil better. And diet is super important for overall inflammation, too. Keto, paleo, vegan, whatever as long as you're mainly eating veggies, grass fed beef or wild-caught fish, and cutting out processed foods you're probably doing pretty well.
    "Alpine rock and steep, deep powder are what I seek, and I will always find solace there." - Bean Bowers

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  15. #90
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    Bump

    16 months out if meniscus repair and Iím 98%. Hard chattery snow causes some discomfort but Iím doing everything I want to without the stiffness and pain that I had before. I should have gone in sooner and had the repair.


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    Quote Originally Posted by Benny Profane View Post
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  16. #91
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    Quote Originally Posted by auvgeek View Post
    They drill into the pelvic crest from the back and extract raw bone marrow aspirate, leave the room to process it, come back about 10 min later and inject the processed stem cells into the desired area under ultrasound guidance. We chose to forego topical anesthesics because we read some journal articles saying lidocaine and other topical anesthesics can kill viable stem cells. The injections were painful and uncomfortable, especially from the pressure of having that much volume injected into a small joint space. She was a trooper about it. Note that the US doesn't allow cultured stem cells (yet), so they have to drill into you pelvic bone every time you want an injection, no more than once a year (only really an issue if you have multiple injuries you want addressed at the same time).

    I think it was $2500. We're by no means rich and it was a stretch for us, but it was worth it.
    US banned adipose procedure of getting stem cells from abdomen fat like I had done. Which is too fukking bad.

  17. #92
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    I don't know anything about stem cells or PRP but if you're going to research the subject go to Pubmed, which is the site of the National Library of Medicine to do your search. You will have to wade through a lot of very technical irrelevant articles to find useful ones. Find review articles if you can. You will usually be able to read an abstract for free but pay for the whole article. I think the last one I paid for was about $30. (Doctors, nurses et al will usually have free access through their hospital library so if you know someone . . . ).

    Wikipedia is also a good place to start. The medical articles are usually authoritative. The wiki on stem cells has a very short section on orthopedic use with a good reference--no 48, that would be a good place to start. Search pubmed for that article and there should be a link to the full text.

  18. #93
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    Summary of current state of the medical research

    Quote Originally Posted by Kinnikinnick View Post
    Bump

    16 months out if meniscus repair and Iím 98%. Hard chattery snow causes some discomfort but Iím doing everything I want to without the stiffness and pain that I had before. I should have gone in sooner and had the repair.


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    Very great to hear your update kinnikinnick and that you're healing up well. Repair rehab take a looong time, but can work out well in my personal experience also.

    I'm bumping this to add a new experience... I had a new tear from a trivial househould accident. Same left medial meniscus that had repair surgery 8 years earlier.

    MRI confirmed a small tear, luckily unrelated to the previous injury and surgical repair. But the symptoms (pain and limitation of activity) were significant. I was super bummed but did a fresh research of the current medical knowledge. Opted for PT, and after about 4 months, I felt as good as I ever did with that knee including skiing and short jogs (which is all the running I ever do.)

    Dropping some links here that should outline the current "best medical advice."
    TL;DR, it can be summarized as follows, as my delightfully conservative orthopedic surgeon said:

    "The study comparing PT and surgery showed that after two years, the two groups ended up in about the same place. But about 25% in the PT group crossed over and had surgery after PT (because they were too impacted by symptoms). And they ended up in the same place after two years. So try 6-8 weeks of PT, and if you don't need surgery, that's great. But if your symptoms are still bothersome, you should get the surgery so you can get on with your life, and it should be an equally good outcome."

    Most relevant research articles:

    ----------

    October 2, 2018
    Effect of Early Surgery vs Physical Therapy on Knee Function Among Patients With Nonobstructive Meniscal Tears. The ESCAPE Randomized Clinical Trial
    https://jamanetwork.com/journals/jam...rticle/2705186

    Objective: To assess whether PT is noninferior to arthroscopic partial meniscectomy (APM) for improving patient-reported knee function in patients with meniscal tears.

    Findings: In this noninferiority randomized clinical trial that included 321 patients, knee function that was measured by a self-administered questionnaire improved by 20.4 points in the physical therapy group vs 26.2 points in the early surgery group over a follow-up period of 24 months. The difference between the 2 treatment groups did not exceed the noninferiority margin of 8 points.

    Conclusions and Relevance: Among patients with nonobstructive meniscal tears, PT was noninferior to APM for improving patient-reported knee function over a 24-month follow-up period. Based on these results, PT may be considered an alternative to surgery for patients with nonobstructive meniscal tears.

    ----------

    20 July 2016
    Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up
    https://www.bmj.com/content/354/bmj.i3740

    Objective: To determine if exercise therapy is superior to arthroscopic partial meniscectomy for knee function in middle aged patients with degenerative meniscal tears.

    Results: No clinically relevant difference was found between the two groups in change in KOOS4 at two years.

    Conclusion: The observed difference in treatment effect was minute after two years of follow-up, and the trialís inferential uncertainty was sufficiently small to exclude clinically relevant differences. Exercise therapy showed positive effects over surgery in improving thigh muscle strength, at least in the short term. Our results should encourage clinicians and middle aged patients with degenerative meniscal tear and no definitive radiographic evidence of osteoarthritis to consider supervised exercise therapy as a treatment option.

    ----------

    2014 Jul 18
    Treatment of meniscal tears: An evidence based approach
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4095015/

    This study includes classification of meniscal tears with pictures of each.

    Abstract: Treatment options for meniscal tears fall into three broad categories; non-operative, meniscectomy or meniscal repair. Selecting the most appropriate treatment for a given patient involves both patient factors (e.g., age, co-morbidities and compliance) and tear characteristics (e.g., location of tear/age/reducibility of tear). There is evidence suggesting that degenerative tears in older patients without mechanical symptoms can be effectively treated non-operatively with a structured physical therapy programme as a first line. Even if these patients later require meniscectomy they will still achieve similar functional outcomes than if they had initially been treated surgically. Partial meniscectomy is suitable for symptomatic tears not amenable to repair, and can still preserve meniscal function especially when the peripheral meniscal rim is intact. Meniscal repair shows 80% success at 2 years and is more suitable in younger patients with reducible tears that are peripheral (e.g., nearer the capsular attachment) and horizontal or longitudinal in nature. However, careful patient selection and repair technique is required with good compliance to post-operative rehabilitation, which often consists of bracing and non-weight bearing for 4-6 wk.

    ----------

    2013 Jul;23(5):589-93. doi: 10.1007/s00590-012-1028-6. Epub 2012 Jun 30.
    Traumatic and non-traumatic isolated horizontal meniscal tears of the knee in patients less than 40 years of age.
    https://www.ncbi.nlm.nih.gov/pubmed/...?dopt=Abstract

    Purpose: The aim of this study is to analyze the characteristics of isolated horizontal meniscal tears in young patients and compared traumatic and non-traumatic isolated horizontal meniscal tear without other type of meniscal tear.

    Conclusions: Isolated horizontal meniscal tears in young patients predominantly involved non-dominant knees and medial meniscus. Anterior aspect of medial meniscus was more frequently involved in traumatic group. Meniscal cysts were more frequently showed in non-traumatic group.

    ----------

    First published May 18, 2017. Online issue publication January 12, 2018
    Arthroscopic partial meniscectomy versus placebo surgery for a degenerative meniscus tear: a 2-year follow-up of the randomised controlled trial
    https://ard.bmj.com/content/77/2/188

    Objective: To assess if arthroscopic partial meniscectomy (APM) is superior to placebo surgery in the treatment of patients with degenerative tear of the medial meniscus.

    Results: In the intention-to-treat analysis, there were no significant between-group differences in the mean changes from baseline to 24 months in WOMET score.

    Conclusions: In this 2-year follow-up of patients without knee osteoarthritis but with symptoms of a degenerative medial meniscus tear, the outcomes after APM were no better than those after placebo surgery. No evidence could be found to support the prevailing ideas that patients with presence of mechanical symptoms or certain meniscus tear characteristics or those who have failed initial conservative treatment are more likely to benefit from APM.

  19. #94
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    Aug 2006
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    My PT believe I have a medical meniscus tear in my left knee. My GP, who is a DO, did not detect a meniscus issue when I first saw him in mid-April. Iíve been doing PT since early May. My issue arose in mid-March.

    No catastrophic incident for me, which is confusing to me. It literally started with pings of mild pain when standing in from a the chair at my dinner table. Then hurt a lot when in a ski toured. Then hurt several days later when trying to go on a short trail run. Then lots of swelling after working on my property, which involved picking up large logs off the ground.

    There has been no imaging.

    Currently, Iím in a break from PT due to insurance issues, but Iím continuing the PT stuff at home. Iíve also started spinning on an exercise bike thing.

    I visited my physiatrist in late May. He observed signs that Iím still recovering from when I badly broke my pinky toe in Jan 2018, and that Iím generally weak (and have weakened more since stopping most activities between March and May) in strength and mobility related to knee stability. My PTs concurred with the physiatrists and their continua focus on mobility, especially on my lower leg and at my pelvis has helped a lot. I also brought in some older shoes of mine, which demonstrated that I was not much of a pronator prior to breaking my toe.

    My physiatrist suggested visiting a procedure on platelet injections later this summer if Iím not mostly improved at that time.

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