Meniscus terror - rehabability vs cutskis

[mcski]

According to dr google, it seems I have a meniscus tear. No idea how it happened, just got up one morning and ouch the knee did not like bending at all. It’s improved from a real hobble a couple weeks ago to the occasional dagger getting up if I have been sitting long w it bent. Pain point is inside crevice next to kneecap although depending on whether I’m climbing or descending stairs, the pain will sometime be at the top of the kneecap area. Weight pressure doesn’t seem to hurt. It’s more extending leg after a retraction into a bend. It’s definitely less hurty now, but I don’t see skiing or mtb any time soon tho which is distressing. Been holding off seeing a doc just to be told rest it after an expensive mri.

I try to avoid surgery unless really necessary. Is that realistic w this kind of tear?

[NW_SKIER]

I tore mine last December in a ski crash. Gimped my way through the rest of ski season stupidly, then did rehab most of the summer per doctor's recommendation. I had stability issues, pain exactly where you describe, and couldn't crouch down and get back up without heavily biasing my good leg.

If you aren't really, really bad, I wouldn't get it cut. From what I've been informed, that fast tracks you to arthritis and there's no real guarantee that you'll be 100 percent again anyways.

I healed up fine by late August and am pain free and uber stable again now. YMMV

Healing vibes dood.

[mcski]

Thx mang. That helps a lot.

[old goat]

I tore my medial meniscus 40 years ago--no mri's back then of course. It swelled up like a grapefruit. I coudn't bend it at all. I tore it in January, No surgery. I was XC touring by April but I had to sidehill so the bad leg was the downhill leg. By the summer I was back to normal. Now that knee is starting to give me trouble, whether it's from the old injury or something else I don't know.
As far as the wisdom of not seeing a doc--my non-expert opinion is that it's probably ok to wait, especially since there was no trauma and the knee sounds like it's stable.

[goathead]

same same
meniscus tear, swelled up for 6 weeks after marathon. remains stable and functional 10 years later

[L82thegate]

I've had three tears over maybe a 6 year span. An MRI was used to isolate pieces of floaty tissue and determine the degree of the problem. In all instances, a good (now retired) specialist used a tiny incision and a camera equipped nibbler/vacuum to clean them up. Limited use for a few weeks but able to tour conservatively within 1 1/2 months. You may have something more advanced, hope not but I haven't had anything amiss with my knees since then. Probably getting low on cartilage by now but that will be a different adventure I'm sure.

[Dantheman]

Been holding off seeing a doc just to be told rest it after an expensive mri.

That shit is the worst. IANAD, but AFAIK the consensus on meniscus issues seems to be that surgery is only worth it if there's instability or mechanical locking issues, which can usually be diagnosed with just a physical exam.

[bodywhomper]

i recommend a consultation with a physiatrist, especially one that skis and deals with sports medicine.

[schindlerpiste]

I tore mine playing basketball (HORSE). It was a flap tear, and that sucks. Had it shaved, and was told that arthritis was a part of the prognosis. Boy, was he right. It seems that if you are under 35 or so many Orthopods would rather surgically repair the tear than cut it away. Repair does not always work, and there is always the risk of a second surgery (meniscectomy). After a certain age, arthroscopic knee surgery is rarely performed.
The key is to keep your thighs strong. Strengthening the muscles around the knee may replace the need for surgery.

Regarding MRI, I think that they are good to a point because they show a tear, but surgery is either needed, or not, that can be ascertained by manipulation and it's not until the surgeon is inside looking around until he really sees what's going on.

[Bosco]

I had reconstruction on both knees and a few years back got a complex tear on the posterior horn of the medial meniscus. My MO on injuries such as this, which ain't likely to go away anytime soon, is to get them fixed ASAP and move on with life.

[old goat]

BTW---great thread title. Right up there with physical terrorists.

[schindlerpiste]

This summer, I visited a local PC Ortho, re: constant nagging pain in medial aspect of left knee. Previously, In 2004, I suffered a flap tear of the medial meniscus which was shaved (meniscectomy). I was told that it would become arthritic. The doc was right. The PC doc took an x-ray (no MRI) and it revealed that I was bone on bone. Because of my age, surgery would likely be counter productive. He recommended steroid and/or hyaluronic acid injections. The order was submitted to ins., but it was denied. (At the same time, I was going thru a bout wherein I had my gall bladder removed ...surgery, 2 CT scans, ultrasound, etc... which cost the ins. co about $35K). I think that this is why the order was denied. I was informed that each injection would cost over $1K and would provide only temporary relief. Although the pain is real, and constant, I elected to go the 600mg Ibuprofen when the pain gets really bad, and glucosamine everyday. Also, I use an Iceman machine just about everyday. Glucosamine offers absolutely no relief. I guess that I have to learn to live with the discomfort. I have a DonJoy brace, but find it way too constrictive. Recently, I purchased a Bauerfeind GenuTrain brace, and we will see how that goes.
One thing is for sure, I do not plan on cutting down activity (skiing, hiking), because the pain is real when just sitting on the couch or laying in bed. I didn't mountain bike once this year though.

[mcski]

Just happened on thisnold thread and realized it’s been a year and I should update it

The knee is pretty much back to normal now. Did a lot of mtb on it this summer with nary an issue. It did take some time. Never went to see a doc, but it took longer than I expected for the knee to turn the corner to steady improvement. For weeks, it seemed to be stagnant or improve a little and then stabby pains would return. I was getting pretty depressed with the situation by Jan or so and I was finally about to capitulate and go see a Dr. in fact, had a convo w a buddy about a reasonable mri priced provider and was going to call to set an appt the next day. And Shazam, the next day came and the knee felt much better so I let it ride. From that point, pain became less and less and issue and knee showed steady improvement. Started doing regular stairs and other pt type activities and did my first ride in March. I was pretty cautious but it managed fine and it’s been pretty good ever since.

I wore a brace intermittently but didn’t seem to help much

Very happy to have dodged a surgery and the knee is pretty back to normal.

[Buster Highmen]

The saga of another old man's knee.

CLINICAL HISTORY: MENISCAL INJURY, KNEE:: CHRONIC R KNEE PAIN OVER
THE PAST 1 YEAR IN ACTIVE INDIVIDUAL (SKIING, BIKING), PRIMARILY AT
ANTERIOR/MEDIAL KNEE; SUSPECTED MENISCUS OR CARTILAGE INJURY::
CHRONIC R KNEE PAIN OVER THE PAST 1 YEAR IN ACTIVE INDIVIDUAL
(SKIING, BIKIN...

COMPARISON: 9/19/2022

TECHNIQUE: Multiplanar, multisequence images of the right knee were
obtained without the administration of IV contrast.

CONTRAST: None

FINDINGS: Markedly limited evaluation secondary to significant
susceptibility artifact.

Bone: No acute fracture is distinctly evident. Tricompartmental
marginal osteophyte formation.

Joints: The joints are congruent. Small to moderate knee effusion.

Baker's cyst: Tiny Baker's cyst.

Medial meniscus: Suboptimally evaluated. The posterior horn root
insertion, posterior horn, and body appear attenuated. The free
margin of the posterior horn is blunted.

Lateral meniscus: Suboptimal evaluation. A tiny radial tear involves
the free margin of the body (image 17, series 8).

Cruciate ligaments: Not well evaluated secondary to significant
susceptibility artifact. Status post ACL reconstruction. The graft
appears to be situated normally posterior to Blumensaat line and
grossly intact. The proximal PCL is attenuated (images 12 through 16,
series 3). The PCL are otherwise appears grossly intact within the
significant limitations of this exam.

Collateral ligaments: The medial and lateral collateral ligamentous
complexes are grossly intact.

Popliteus muscle and tendon: Intermediate interstitial signal is
present within the popliteus tendon origin. The popliteus tendon and
muscle are otherwise intact.

Extensor mechanism: The quadriceps and patellar tendons are intact.
The medial and lateral patellar retinacular attachments are intact.

Articular cartilage: Suboptimally evaluated secondary to
susceptibility artifact. The central articular weightbearing
cartilage of the medial compartment is thinned and irregular with
suspected broad-based grade 2 and 3 chondral loss evident. The
patellar apex and medial patellar facet articular cartilage is
thinned and irregular with grade 2 chondral loss present. Suspected
grade 2 chondral loss of the central femoral trochlear articular
cartilage. No discrete focal chondral defect of the lateral
compartment articular cartilage.

Musculature: No asymmetric fatty muscular atrophy or evidence of
denervation.


I'm not bone on bone yet. Shit was awful over the summer, wore a knee brace and was in pretty consistent pain. Started some simple physical therapy/stretching and occasional icing and things got lots better. Now back to cycling the backroads around here for an hour or so 4+ times a week, no more knee braces with minor knee pings in the morning and some dull pain while sitting or lying down.

Bottom line: no surgery suggested, keep up the p.t. and if pain continues or worsens, get cortisone/steroid injection which should alleviate pain for 3+ months. I'm deferring the injection until January in hopes that it will assuage the pain through the beginning of April and EuroBBI2023.

[bodywhomper]

My physiatrist gives those soft tissue stimulating injections. Apparently, lots of success stories. I’ve heard that the science is fuzzy, but have not read into it myself.

All of my injuries have been addressed by PT and maintaining a baseline of strong stabilizing muscles. I often develop discomfort near my mcl and medial meniscus and I have found stretching/rollering my sartorius muscle provides nearly instant relief.

Due to slow recovery from my last injury, I had imaging done to determine is there were other issues not identified such as severe meniscus tear or unhealed hamstring tear. The MRI report was alarming, but the follow-up with the physiatrist was very re-assuring. I learned that I’d had multiple older damaging incidents with the ACL and all meniscus tears were very minor.

My PT rx now is leg blasters with additional adductor/abductor exercises, some mobility range exercises, and increasing activities that puts more stress on the knee, like trail running (this last item is a mental game of gaining confidence that I’m good to go). My last PT appt was more like a psych therapy appt about methods to improve mental confidence that I won’t re-injure myself again (I reinjured myself twice this summer because I wasn’t healed yet). The PT sees that everything is strong and stable. They’re aware that I tele ski, ski a lot, and work on my skis. I will likely wear a light compression knee brace/sock for most active stuff. I generally like how they feel.

[Buster Highmen]

Man, leg blasters makes my knee ache. Running makes it swell even more.

I'm just doing biking for now.

[bodywhomper]

You’re older then me. Unclear if the ache for you is related the eccentric nature of leg blasters or something else. I get achy, too, but it goes away. I also can get achy doing an intensive form of tai chi chuan. But swelling is bad in my book!

When I was recovering from a minor meniscus tear that was caused from atrophy related to a broken foot, my PT always has me spin for at least 10 minutes to warm thing up and get fluids going.

My physiatrist is very pro cycling for rehab. My PT for that minor meniscus injury was sort of pro cycling but not if it took away time focusing on strength training. She mildly chastise me when I started longer rides (finally didn’t hurt) and less time strengthening at gym or home. They didn’t always see eye to eye, but worked in the same office and discussed patient rx. Both are athletes and skiers: physiatrist grew up in Olympic valley, pt grew up in bishop.

When I was 20/21 (mid-90’s), i was trying to learn to tele in Sierra cement on skinny skis and I kept Brie hiring a knee by catching a tip. Had MRI, surgeon said it was meniscus and should get it trimmed (the strong trend at the time), surgeon ended up finding the meniscus in great shape but a torn and inflamed plica, which he trimmed off. I have vhs of the surgery. He was a top ortheo surgeon at Scripps in San Diego, worked on athletes. I was never shown that MRI or the radiologist report.

[zion zig zag]

Man, leg blasters makes my knee ache. Running makes it swell even more.

I'm just doing biking for now.

Just got an MRI today because my knee has been bothering me for a year. Radiologists report says grade 1 MCL sprain (meh?), and a radial tear of the posterior horn meniscus. He recommended a consult with a surgeon. This seems inline with what you have/had? How are you now? Any treatments at all?

[mcski]

Most of the reading I’ve done seems to indicate rest as first option. I took that course when I had meniscus locking issues a yr or so ago. Took a lot of patience but once it felt good enough for exercise it got strong pretty quickly and skied hard on it without problems all last season…

Until the last day when I took an slow mo awkward twisting fall and now have suspect acl tear. Unrelated to previous issue, but i guess my thing is avoid surgery is preferred in my book. Not sure I’ll pull that off this time, but I’m giving it a little time to see how much it improves. Huge so far. At least for everyday activities. Not sure how it will stand up to skiing yet tho

I’d give it some time for sure. The meniscus tear may not even present as an issue (locking/stabby pain) or go away on its own. Mine took about 2.5 months.

[zion zig zag]

Just got an MRI today because my knee has been bothering me for a year. Radiologists report says grade 1 MCL sprain (meh?), and a radial tear of the posterior horn meniscus. He recommended a consult with a surgeon. This seems inline with what you have/had? How are you now? Any treatments at all?

Back in this thread because I hit a hard mogul at decent speed in flat light the other day, at a strange angle. Boom, instant pain on the same knee that I got the MRI on back in August. I skied another lap with no increase in pain and then went home with some stiffness.

The next morning the knee was very stiff and sore and I limped severely to get around. Now, 4 days later after rest and ice, it’s still sore and stiff but I can walk decently. I’ve been riding the stationary bike on low resistance for 20ish minutes per day and that seems fine.

All that to ask, what is the recommended timeline that I stay off skis? I assume that touring in pow would be better than banging laps at the resort?

Edit: I should add that after a consultation with a surgeon back in August, he recommended no surgery at that time.

[Hopeless Sinner]

A dose of Synvisc provided immediate relief(w/in hours) for my "old man's knees" which include meniscus damage. Surgery is not the answer according to studies my dr quoted, no difference in the outcomes. Dr says he's been using this on skiers for 15 years, 2 shots per year.

https://www.synviscone.ca/en/synvisc...is-synvisc-one

[schindlerpiste]

Ihave osteoarthritis in my right knee and am 5 weeks post cortisone injection. I do squats, quad stretches and single leg balance on bozo ball with both legs. I stretch 4x/wk, ski 3-4x/wk, ice with Mr. Ice 4x/wk and sauna 3x/wk. I feel ok with constant dull pain, but continue to wear Bauerfeind GenuTtain Kniebandage. Being idle after initial period or rest is NOT your friend.
Exercises from a trusted PT:

[Peruvian]

I tore my meniscus up on the Muir Snowfield 25 years ago. I had to drive myself back to Seattle to get the Group Health. I had surgery the next day and was skiing low angle powder at Whistler 6 weeks later. I took glucosamine/chondritin for almost 10 years after based on the surgeon's recommendation and then realized it was voodoo medicine and just stopped one day. Never have had an issue.

[Barnballs]

Had meniscus surg last October ( free edge medial tear) after major swelling observed after a trail run, and didn't return to normal. Was diligent w/PT and home exercises, no run/tennis/ski/vball etc for 2.5 mo's. Skied easy late Jan and it felt great, then we had a foot early Feb and skied some chop. Not smart. Knee swelled up that night - bakers cyst, rupture etc.. Had a 2nd MRI in March - showed a chunk of cartilage missing. Back to PT, and had a MONOVISC shot 3 weeks ago. Feels stronger & no swelling (finally) after minor activities. Frustrating!! but hopefully back on track. The MRI reports couldn't be different...1st was barely 1/2 page, 2nd was almost 2 pages, full of unflattering words describing the inner workings of my left knee.

[rod9301]

You probably know this, but bakers cyst is caused by arthritis

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