Meniscus Question

When I had my ACL surgery - my Dr. found that my lateral meniscus was also torn but it had started to heal itself, so he didn't operate on it.....

Now I can't do a lot of stuff activity/PT-wise to allow it to heal....

When can one assume that it's healed enough to start doing activity?? Like weighted closed-chain exercises (squats, leg press, etc), more walking (ie longer distances), etc etc.......

My Dr. isnt' being real forthcoming on this - he's leaving it up to my PT and they are wanting to see what the Dr. says....*sigh*

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Originally Posted by jenscats5

When I had my ACL surgery - my Dr. found that my lateral meniscus was also torn but it had started to heal itself, so he didn't operate on it.....

Now I can't do a lot of stuff activity/PT-wise to allow it to heal....

When can one assume that it's healed enough to start doing activity?? Like weighted closed-chain exercises (squats, leg press, etc), more walking (ie longer distances), etc etc.......

My Dr. isnt' being real forthcoming on this - he's leaving it up to my PT and they are wanting to see what the Dr. says....*sigh*

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Ummm...where was the tear? The further towards the rear of the meniscus, the less you can bend and bear weight. The max it will ever heal on its own is 3 mo. In my case, I am not allowed to bear *any* weight with the leg bent beyond 45 degrees.

How severe is the tear? If it's "healing itself" it probably wasn't too bad.

If you push it with the meniscus, you will cause damage. The meniscus has no nerves, so you won't really feel the damage, either.

The good news is that you don't really *need* a meniscus for activity/skiing...but without it, (i.e., if they later have to do a (partial) removal if it doesn't heal properly and you injure it again) you are a prime candidate for early onset of arthritis.

My advice: Find out if it is an anterior/posterior injury, and -- esp if posterior -- be *very* cautious.

(I'm speaking as someone who had a meniscus repair just under 3 months ago. It is a very tough thing for those 3 months, and afterwards it is challenging because you lose strength and can't get right back into it...but if you play it right, you'll heal 100%.)

Correct me if I'm wrong but I thought the menisci couldn't heal on it's own because it's avascular. I think I read somewhere that there is a tiny portion of the meniscus that connects to the knee lining and this area does have blood vessels and if there's a small tear there, that area can heal on it's own. Is this where your tear is?

And upallnight, agreed on the recovery time for the meniscus repair. Had mine done beginning of March, six weeks of PT and it still wasn't fully healed. Went for the ACL reconstruction on 6/14 and because of it still healing and the compensation of no ACL the repair already had some wear and tear. Doc fixed it up tho.

Jen, next time you go to PT, call your Doc on your cell and give the phone to your PT guy and say "O.K., talk." ;)

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Originally Posted by Skibumtress

Correct me if I'm wrong but I thought the menisci couldn't heal on it's own because it's avascular. I think I read somewhere that there is a tiny portion of the meniscus that connects to the knee lining and this area does have blood vessels and if there's a small tear there, that area can heal on it's own. Is this where your tear is?

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agreed on that. blood flow in the meniscus is poor, which is why any healing (if it will even occur) takes a long time.

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Originally Posted by Skibumtress

And upallnight, agreed on the recovery time for the meniscus repair. Had mine done beginning of March, six weeks of PT and it still wasn't fully healed. Went for the ACL reconstruction on 6/14 and because of it still healing and the compensation of no ACL the repair already had some wear and tear. Doc fixed it up tho.

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i'm at 3 mo, and i sure hope that the repair doesn't already have wear and tear...but something in my gut tells me things aren't quite right.

what is most disconcerting is that my doc said, short of surgery, there is no way to determine if the repair worked. you only know if it tears again and you have to go in. that -- combined with the knowledge that pain during PT does not necessarily mean you re-injured the meniscus, just as no pain during PT does not mean that you did not re-injure it -- is super-frustrating for me.

i work extremely hard at PT every day, but we don't know if it's working or not. the PT is to regain strength and mobility, but the meniscus just needs the 3 mo to heal as good as it ever will.

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Originally Posted by Skibumtress

Jen, next time you go to PT, call your Doc on your cell and give the phone to your PT guy and say "O.K., talk." ;)

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i recommend this. i'm bringing my phys therapist to my next appointment with the surgeon, so we can all discuss what is going on, why it is happening, and what the options are.

if the repair is not going to heal, i want to get going on plan B ASAP.

good luck to you, jenscat. please keep us posted.

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Originally Posted by upallnight

i recommend this. i'm bringing my phys therapist to my next appointment with the surgeon, so we can all discuss what is going on, why it is happening, and what the options are.

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I know the Doctors and Physical Therapists are "busy people," but it amazes me that there isn't some sort of communication that goes on between these two about their patients. Again, I know they're "busy people" and although the surgeries may be the same, the injuries and individuals are all very different.
At my first PT appointment this time around, the scrip for PT was faxed in (mind you about seven hours before I arrived)... PT gal looked at it and it said "protocall." PT person said we can't take something that just says "protocall." I said, well how about calling my Doctor, he's still at the office...... they hesitated for a bit (I assume she did not want to call)... I said "can I borrow your phone?" Called the doc, and handed the phone to the PT gal.

My injury occured on 2/1, so it's now (just about) 5 months from the original injury & I assume that I injured the meniscus at the same time I tore my ACL.....now my Dr. said when he went in for the ACL repair - he saw that the meniscus was healing.....I have a friend who's dad is a Physician's asst. & he said that meniscus doesn't usually show up on a MRI, so it's not worth getting another one at this point.....

I'll have to find out where the tear is.....I guess I'm just wondering when it's *assumed* that the healing is done.....

That's one thing I like about my PT office. It's down the hall from my ortho - when they have a question, my PT walks over and asks my ortho in person. Problem solved.

But yeah, if they're not communicating, I'd get them on the phone at least.



And I'd agree a MRI is a waste for a meniscus tear. Sometimes they show up on an MRI and aren't there, other times they don't show and are... I think with meniscus stuff you just have to go on feel. Once you've reached the point where it should have healed, you go back to normal activity... and if it's locking and catching, you have to have it scoped again. :(

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Originally Posted by Skibumtress

I know the Doctors and Physical Therapists are "busy people," but it amazes me that there isn't some sort of communication that goes on between these two about their patients. Again, I know they're "busy people" and although the surgeries may be the same, the injuries and individuals are all very different.
At my first PT appointment this time around, the scrip for PT was faxed in (mind you about seven hours before I arrived)... PT gal looked at it and it said "protocall." PT person said we can't take something that just says "protocall." I said, well how about calling my Doctor, he's still at the office...... they hesitated for a bit (I assume she did not want to call)... I said "can I borrow your phone?" Called the doc, and handed the phone to the PT gal.

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"Protocall"? Yeah...I can see why they wouldn't want to accept a piece of paper with something that's not even a word! ;-)

My 'scrip said something like MMR (medial meniscus repair) with some other info/shorthand...but it was enough for the PT to know the basics and how to get started.

Over the past few months, the doc & PT have communicated by fax, phone and through me...but I'm getting all of us together in one room.

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Originally Posted by jenscats5

My injury occured on 2/1, so it's now (just about) 5 months from the original injury & I assume that I injured the meniscus at the same time I tore my ACL.....now my Dr. said when he went in for the ACL repair - he saw that the meniscus was healing.....I have a friend who's dad is a Physician's asst. & he said that meniscus doesn't usually show up on a MRI, so it's not worth getting another one at this point.....

I'll have to find out where the tear is.....I guess I'm just wondering when it's *assumed* that the healing is done.....

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My doc has told me that an MRI can show certain things (including the buckethandle tear that I had), but it really won't give enough detail to tell whether the meniscus has "healed". For that, they would need to go in and poke around, and that's not something they normally do.

3 months is the time it takes for maximal healing of soft tissue (healing, not strength recovery); after 3 months, you should be clear to do whatever activities you can and start regaining strength in the full range.

The time may be less than 3 mo, but that is subject to the detail of your particular tear. In other words, you may be able to get away with moving through a great range in less than 3 mo, but the tear will likely still be healing until 3 mo, as I understand it.

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Originally Posted by Skibumtress

And upallnight, agreed on the recovery time for the meniscus repair. Had mine done beginning of March, six weeks of PT and it still wasn't fully healed. Went for the ACL reconstruction on 6/14 and because of it still healing and the compensation of no ACL the repair already had some wear and tear. Doc fixed it up tho.

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Just curious...Is it common to operate and, say, do the repair...but then wait 3 months to do the ACL? I know nothing of ACL operations but am wondering whether that is common practice and why.

Is this done so the meniscus heals and then is "out of the way" for the ACL repair?

When one has an ACL repair, does the action you need to take immediately after surgery put the meniscus repair (more delicate) at risk?

Why would not having an ACL cause additional wear on the meniscus? Were you in a protective phase for that 3 month period? I'm under the impression that the particular PT I have is designed (supposed) to not come anywhere near the repair site (i.e., that's why i can't do any weight-bearing with the leg bent more than 45*).

Thanks, and good healing to all.

Most of the time I find Quest Diagnostics to be helpful.

http://www.questdiagnostics.com/kbas.../te7366/dp.htm

I had a meniscus repair done in conjunction with an ACL about 6 years ago. There's really no reason I'm aware of not to do them together, its' just going to suck regardless with the rehab limitations for the meniscus repair.

That site is great, Skibumtress. WIsh I had seen it before going under the knife (not that I would have made a different decision, but it would have been helpful).

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Originally Posted by altagirl

I had a meniscus repair done in conjunction with an ACL about 6 years ago. There's really no reason I'm aware of not to do them together, its' just going to suck regardless with the rehab limitations for the meniscus repair.

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Gotcha... So why would the above poster do them separately, esp if "lack of ACL" cause "additional wear and tear on the repair"? Seems to add additional risk and longer total recovery, but maybe there's a good reason for it.

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Originally Posted by upallnight

Just curious...Is it common to operate and, say, do the repair...but then wait 3 months to do the ACL? I know nothing of ACL operations but am wondering whether that is common practice and why.

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Nope, not common practice that I know of. It's mentioned in another thread that I started a while back. Originally diagnosed with a meniscus tear, two fractures and an "intermediate-high grade" ACL tear. From what my first doc saw with the MRI, the ACL would be a no problem to snip and trim a little because of the position of the tear. Don't know if this is a state or federal law but in NJ you have to sign off on the particular surgery. At the time ACL reconstruction didn't seem necessary because of where the tear was so I didn't sign off on ACL reconstruction. During surgery when Doc got in there, my ACL was totally ruptured so he took it out. The MRI didn't pick this up because the ACL was exactly where it should be but it was just "floating" there. So, it was back to the drawing board on 6/14 (day of ACL reconstruction surgery).
And I actually switched Docs. Reasons being: 1) My original Doc is not in my network and a second surgery would have been pricey; 2) I had to convince him that I needed ACL reconstruction. Even though he knew I was very physically active, he thought I could live without (now keep in mind, his speciality is "knee replacement"). My Doc who did the ACL reconstruction said I was the perfect candidate. So needless to say, it's been a long haul.

typically a meniscus tear, if it is going to heal, will heal within about 2-3 months. But since you have had ACL surgery they may just be treating this the same as a meniscal repair or even more conservatively. Most meniscal repairs will be limited on how much flexion they can do and the types of activity they can do for up to 4 months.

I an guessing that if the tear had already started to heal that it was on the small side and in an area of decent blood supply. Not all of the meniscus has good blood supply.

My suggestion would be to ask your ortho very direct questions, if he won't answer you or you don't fully understand his explainations then ask your therapist to talk to your ortho.