Printable View
With that type of tear, you're best option is physical therapy…surgery 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 fasterQuote:
Originally Posted by Elkhound Odin
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.
Sounds like a tough call.
I felt mine was tough call too. Going into the surgery I wasn’t 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 didn’t 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?
Sent from my iPhone using TGR Forums
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.Quote:
Originally Posted by Elkhound Odin
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.
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."
Interesting. Thanks for the link.
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.
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.
Bump
16 months out if meniscus repair and I’m 98%. Hard chattery snow causes some discomfort but I’m doing everything I want to without the stiffness and pain that I had before. I should have gone in sooner and had the repair.
Sent from my iPhone using TGR Forums
US banned adipose procedure of getting stem cells from abdomen fat like I had done. Which is too fukking bad.Quote:
Originally Posted by auvgeek
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.
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.Quote:
Originally Posted by Kinnikinnick
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. :mad:
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 trial’s 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.
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. I’ve 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, I’m in a break from PT due to insurance issues, but I’m continuing the PT stuff at home. I’ve also started spinning on an exercise bike thing.
I visited my physiatrist in late May. He observed signs that I’m still recovering from when I badly broke my pinky toe in Jan 2018, and that I’m 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 I’m not mostly improved at that time.
Here's an interesting one for you guys:
Back in the spring after a big day on the bike in St. George, I woke up the next day with a sore right knee. Nothing too bad, so I didn't pay much attention to it: I figured it might have been caused by having my saddle too high, extending my knee too much on the pedal stroke. I took it easy on the knee for a few weeks and the minor pain went away.
Fast forward to this summer, when I took my dogs for a 5-mile run around the neighborhood. Nothing happened on the run itself- no odd twists, steps, or anything- but I woke up the next day and could barely move my right leg. It wasn't locked or anything, I had full flexibility and control but the inside and bottom part of my knee hurt like hell. It was fairly swollen, but not so much you'd notice if you looked at both knees and didn't know. Like a dumb-ass, I didn't do anything about except take it easy for a while since I thought it was related to my spring incident and would go away on its own.
Well, it didn't. From early August until last month, it was a hindrance and bothered me most days. Riding my mountain bike didn't really hurt much, but I could feel it was unstable and weak. I'd say the pain level on most days was maybe 2-3 out of 10, so I wasn't all that concerned. Then about a month ago, out of nowhere, it started hurting like hell when I took my dogs for a walk. It would pop and click- sometimes every step I took, but mostly just on occasion. My knee would throb later at night and after activities. So I finally went to the ortho. Based on some basic tests in his office, he diagnosed it as a medial meniscus tear in my right knee, and it was confirmed by an MRI the following week: that diagnosis came back as a complex bucket handle tear plus an ACL and MCL sprain.
So... I went back to the ortho after the MRI and he immediately recommended surgery, but he also couldn't tell me whether the meniscus would need to be trimmed (partial menisectomy) or sutured together (full menisectomy) until he got in there. I ride my bike for a living, and there's no way I could be off the bike for 4-6 months recovering from the full menisectomy. So right after that visit, I decided to wait until after New Years and get a second opinion. But something strange happened right after that visit (about three weeks ago)- my knee started feeling better. It hasn't popped or clicked since then, and there's virtually no pain: a 99% improvement in how it felt less than a month ago. I've started lifting weights and doing mobility exercises to rehab on my own, and I've been able to do quite a bit considering. I can do lateral lunges and full squats with no pain. One of my clients is an orthopedic surgeon (he specializes in something else, so he was only willing to give me a high-level recommendation) and he said always consider surgery as a last option... which is my current path. But I'd also be interested in having another MRI done at some point in the next few months to see if there's any kind of healing going on. I just don't want to pay another $450 to find out.
Don’t have surgery if you’re not having pain. No need to repeat the mri either, unless you start having trouble again somewhere down the road. There are plenty of people with meniscus damage that don’t know it or have symptoms.Quote:
Originally Posted by smmokan
Just to be clear, meniscus repair is not a total meniscectomy. Total meniscectomy means completely removing it. That’s bad. You don’t want that.
aren't the current thoughts about efficacy with meniscus surgery more of an issue in the long-term wear and tear of the joint?... depending on the severity of the injury.
smmokan, your self-rehab is similar to the current rehab that i'm in. stregthening to stabilize the joint with a side of alignment. there are several areas of my bad leg that have atrophied, but i have a clear (nonsurgical/invasive) treatment plan, have had noticeable improvements, am skiing(!), have a supportive household (and friends), and am maintaining a pretty good attitude about it all.
for me, it's been a learning experience about PTs, which has been a bit of a bummer because it set me back during the end of summer and early fall and, emotionally, it made me feel pretty bad.
Bottom line, it's good news you are not having pain or symptoms. :) That may not be that strange actually. Check out this post from several months ago with the most recent medical studies comparing surgery or not (below).Quote:
Originally Posted by smmokan
A couple other notes:
1) Partial meniscectomy, full meniscectomy, and meniscal REPAIR are **three** different surgical procedures.
2) A second MRI wouldn't be useful to see healing because, once torn, a meniscus will always shows "signal" on an MRI. And second, the resolution of symptoms is NOT associated with a healing of the tear (in almost all common situations). The resolution of symptoms is more due to the body accommodating the injury and the absence of further inflammation. A meniscus is "dead" tissue (like a fingernail) and doesn't heal once torn (beyond the vascular perimeter).
-----
https://www.tetongravity.com/forums/...74#post5686374
Quote:
Originally Posted by owwee
Sorry for the distant bump, but I’m curious of course how the people in this thread, with a torn meniscus, made out? Surgery or not, any long term advice? Of course I’ve got an acute complex menicscal tear in the red zone on the mri, and trying to avoid surgery. Thanks so much!
I hadn’t seen this thread and started my own last year. My verdict was no surgery needed. It took about 2 months to get pain resolved and another two or so for PT and recover. YMMV
My meniscus tear seems to be mostly healed in year three. Pt and no MRI or surgery. It swelled like a biatch at first but didn't have problems with locking fwiw. Still do the glute pt stuff as part of general workout routine. Get a few phantom pains from time to time but not limiting me from anything I want to do. I'd try not to cut if at all possible as I believe it heals itself over (long) time and the cut makes knee replacement more likely in long run. Just my 2 cents
Sent from my Pixel 7 using Tapatalk
Looking for recs of intense eccentric (short/long head) hamstring strengthening exercises that I can do at home.
My mcl tear (no meniscus injury) is apparently healed well, but I “strained” my shorthead hamstring during the injury. Injury occurred in late March. At that time, I could hit lap bell to bell at least 2 days in a row, all tele, and not feel sore/fatigued; so I felt strong. The hamstring is still a problem.
At full extension with slight twist (maybe hyper extension), I’m loosing knee stability and pulling that muscles. The motion while skiing is when “boosting”/springing over an obstacle or a terrain variation. I think I can alter my tele skiing mechanics to avoid that motion. I’m also now wearing a mild knee brace with hinges alu stays that inhibits full and hyper extension.
My PT believes that I need to focus on addition strengthening of those muscles. I have an appt with her next week, but am concerned that she won’t give enough. I’ve been following her previous recommendations and adding leg blasters (5 sets, 3x per week), but am still having this problems.
Got an answer for home strengthening the bicep femoris hamstring (especially the short head hamstring) from one of the ski hill physicians - Nordic hamstring exercises (15-20 reps) and backwards pedaling on the stationary bike with resistance.
Looking for recommendations for simple stayed knee braces that keep the knee from fully extending. Not sure my current stayed knee brace is doing enough in that regard.
check out donjoy, I have had the non-pleasure of purchasing their products very recently but have read/heard good reviews.
this is the site I purchased from, guy called me 3 mins after hitting the purchase button to say he was out of one item but upgraded to the next level at NC, good service.
https://www.donjoyperformance.com/
edit: forgot link to site
Swiss ball trifectaQuote:
Originally Posted by bodywhomper
Unless your meniscus is torn at the meniscal synovial junction it will never heal on it own and will usually only heal with a repair. How do you know you had a tear if you didn’t get an MRI? MRI or scope are the only definitive diagnosis for meniscus tear. Clinical diagnosis can only suggest a meniscus tearQuote:
Originally Posted by kokomas
Sent from my iPhone using TGR Forums
Thanks. I’m already doing this, but one foot at a time on the ball. Perhaps I’m not doing it enough (not enough sets?). I do this on the off days from doing leg blasters.Quote:
Originally Posted by eskido
Thanks!!Quote:
Originally Posted by hawkgt
Thanks mcski and to others for the info. Will carry on and hopefully get some expert input soon from a surgeon. Hope everyone heals up!