# Knee problem: extruded meniscus ?



## natzx7 (May 30, 2007)

Anyone else been through this? I have been diagnosed with an extruded meniscus with a possibility of microfracture. Seems like they can othroscopically repair my meniscus with limited recovery time, but if I have a microfracture of the joint I'd be off my feet for 6-8 weeks after repair. That's really not an option as I have to work. Anyone else had their meniscus repaired? How long before you could ride? ( or work, I guess ) I have a very active job and I'm always crawling around in tight spots , heavy lifting etc. Trying to decide to pull the trigger on the meniscus job or hobble around until winter which is slow season with the possibility of doing further damage. I hate watching my bike collect dust :madman:. I should add I'm 42 yrs, 5'8 150 lbs, good shape.


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## rugger (Jul 26, 2006)

i just had meniscus surgery. Had 60% of the meniscus removed and the knee cap shaved where it was all chewed up. Was walking without assistance 2 hours after surgery. On spin bike with no resistance on day 4. 
Week 1 - 3 was on elliptical or spin bike 3 times a week with little resistance.
Week 4 - 6 slowly started ramping up resistance.
week 6 - 8 i got on the road bike for easy rides and started light lifting. Leg extensions and squats.
Week 8 doc turned me loose and i rode mtb that night and felt no pain. Little sore from lack of riding but my fitness was fine and knee felt okay.


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## natzx7 (May 30, 2007)

Thanks for the reply. That's about what I was hoping for. Guess now would be the time to do it, sounds like I can still work and its going to be awful hot for riding here in FL over the summer.


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## kinsler (Sep 13, 2011)

The recovery is very different between a meniscal repair and a meniscal debridement (partial removal). Repairs typically require weight bearing and activity restrictions to allow healing and protect the repair. Meniscal tears do better with early surgery. You don't want your meniscal removed- it increases the forces the cartilage on the ends of your bone (up to 300% if the entire meniscus is removed). That will lead to early arthritis.


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## natzx7 (May 30, 2007)

Thanks for the advice. I will ask my orthopedic surgeon why he wants to remove the extruded portion and not repair it.


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## hanklr (Oct 16, 2009)

natzx7 said:


> Thanks for the advice. I will ask my orthopedic surgeon why he wants to remove the extruded portion and not repair it.


It will be three weeks since my meniscus surgery on 5/23. I had 30% removed. The answer is real simple, most repairs to the meniscus don't heal well. It's the lack of blood supply that causes docs to not even try a repair, especially in the white zone. You would just have to have another surgery to clean it out. And, don't listen to people when they say removal can or will cause early arthritis. There is no real medical evidence to support this. People that get arthritis after having the surgery might have gotten it anyway, even without the surgery.

I read one of the posts below where the person had much more then me removed, and i wish i could say i was at that point, but i'm not. I'll be going to my third pt session and i still can't walk normal yet. If you ask me now if i would have it done all over again, i would say probably not. I'm hoping that will change six months from now, but we'll see. I tore mine moving a treadmill a little over two years ago. Moved the treadmill to another room to use it more. It was a real kick in the head, to say the least. So, as you can tell, i gave not having the surgery a good shot.

Prior to the surgery I had lots of pain bending and going upstairs. I would ride, but would have trouble riding two days in a row, cause of the pain. My surgery went well, no extra scar tissue or anything. Surgery was quick, under an hour. I wasn't given crutches or a brace or anything. I'm currently having trouble bending it though. My pt person says i'm a little behind in walking, but she said it typical can take a month or so, to get to that point.

My advice to you is to ask your doc all the questions, do some google searches, and give it plenty of time. After some time, if you decide you can't deal with the current pain, then make a decision.


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## kinsler (Sep 13, 2011)

hanklr said:


> It will be three weeks since my meniscus surgery on 5/23. I had 30% removed. The answer is real simple, most repairs to the meniscus don't heal well. It's the lack of blood supply that causes docs to not even try a repair, especially in the white zone. You would just have to have another surgery to clean it out. And, don't listen to people when they say removal can or will cause early arthritis. There is no real medical evidence to support this. People that get arthritis after having the surgery might have gotten it anyway, even without the surgery.
> 
> I read one of the posts below where the person had much more then me removed, and i wish i could say i was at that point, but i'm not. I'll be going to my third pt session and i still can't walk normal yet. If you ask me now if i would have it done all over again, i would say probably not. I'm hoping that will change six months from now, but we'll see. I tore mine moving a treadmill a little over two years ago. Moved the treadmill to another room to use it more. It was a real kick in the head, to say the least. So, as you can tell, i gave not having the surgery a good shot.
> 
> ...


It is true that the meniscus has a poor blood supply and that certain tears don't heal, but saying most repairs don't heal isn't really true. The blood supply to the meniscus comes in from the periphery (the joint capsule) and only penetrates 25-30% of the outer portion of the meniscus. Most surgeons would attempt to repair any tear that is in the "red-red" (definitely vascular) or "red-white" (on the edge of vascular) zone, if the pattern is amendable to it. Success rates vary between 65-70% healing if the tear is in isolation or 85-90% if someone is having their ACL reconstructed at the time. Taking out a meniscus will cause arthritis. Removing the meniscus increases the forces that the articular cartilage (i.e. cartilage on the ends of the bone) sees by upwards of 300%. That's why surgeons stopped performing total meniscetomies (removing the entire meniscus). It is also why we attempt to repair the meniscus. In fact the meniscus is so important that in young patients who have had almost their entire meniscus remove we will attempt to perform a meniscal transplant.

I tend to refer patients to boneinfo.org for information- this website is from the American Academy of Orthopaedic Surgeons and is a good resource. Using google to search for medical information is asking for trouble...


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## natzx7 (May 30, 2007)

I have not really been having any pain for about 3 weeks. I have been as conservative with my knee, trying to be conscious of it, and not jumping on it or doing any squats or jogging. I have been doing about 20 min a day of moderate arc trainer work, and still riding hard on the weekends. I know I should probably be being a little less aggressive with it ( my wife is a physical therapist and I listen to most of her advice lol ) but it's felt ok so I'm hoping I might be alright without a repair or partial removal.


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## hanklr (Oct 16, 2009)

natzx7 said:


> I have not really been having any pain for about 3 weeks. I have been as conservative with my knee, trying to be conscious of it, and not jumping on it or doing any squats or jogging. I have been doing about 20 min a day of moderate arc trainer work, and still riding hard on the weekends. I know I should probably be being a little less aggressive with it ( my wife is a physical therapist and I listen to most of her advice lol ) but it's felt ok so I'm hoping I might be alright without a repair or partial removal.


Yeah, just wait it out. *Wait till it reaches the point where the pain pretty much tells you that you might need something done. *Hopefully it doesn't get to that point for you.

I stand by what I said. *Do lots of searching online, google or otherwise, to read stories of people that had it done. *Ask your doc lots of questions. *And don't listen about the arthritis issue that some talk about.

Good luck*


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## bikerjohn64 (Feb 12, 2012)

I'm with waiting it out in this one too. Don't do anything you can't undo. 

I've been without a PCL since the mid 80's and am now 47 with sever arthritis to the point of practically bone-on-bone issue. Looking at a knee replacement in my mid 50's doc says. 

I re-injured my medial (inner) meniscus skiing(stupid-i know) in March and just saw my orthopedic surgeon. 

I thought I could perhaps have it "cleaned out" again but basically was told that there's not much to clean out :-(

If you are riding ok and walking ok with your knee; go with that for as long as you can. The other option I can suggest is having a "lube" injected into the knee. 

I have had great result with a product called Synvisc. It relieved the pain for about 8 months for me. Time for another shot. 

Anyhow; go slow since the operation can go well but there's no saying how YOUR body will react from the procedure. Everyone is different. 

Good luck; hopefully you can make it last.


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## natzx7 (May 30, 2007)

Well, I guess I'll dig up this old thread for an update. I just tried to be really conscious of my left knee and " saved " it for my weekend rides. I just babied it and quit the leg press with big weight. I stuck to low impact higher rep workouts and tried to not get so crouched up at work. 3 months later and I'm riding as strong/ stronger than ever! I'm glad I didn't opt for surgery. 
*knocks on wood*


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## bycyclist (Oct 13, 2008)

Just had mine repaired earlier today. Everyone is individual regarding the context of their injury and recovery times. I was still riding my SS yesterday, getting in one last ride pre-surgery.

My ortho doc and I are very hopeful that due to the nature of the tear/fray,I'll be back on trail in 4-5 weeks.


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## natzx7 (May 30, 2007)

Hope you have a quick recovery, bycyclist.


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## bycyclist (Oct 13, 2008)

Thanks - so far very quick! 10 days post op and rode my SS yesterday for 1.5hrs on an easier trail! Starting to feel good again


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## natzx7 (May 30, 2007)

Great news, glad you're back in the saddle. :thumbsup:


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