# torn meniscus- what to ask?



## howdyhowdyhowdy (Jan 26, 2004)

Got an initial diagnoses of torn meniscus from orthopedic surgeon, MRI to confirm next week. What kind of questions should I be asking i.e. surgical options, if any (specific type of tear unknown at this point), recovery times (return-to-work scenarios, etc).

What would be the effects of no surgery? I have most likely been living with this for about 12 years, and it has rarely bothered me until recently when I could barely walk for 2 days. I suspect I have the same issue in my other knee but it has never caused a problem besides popping when I squat down really low.

Thanks


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## turbogrover (Dec 4, 2005)

I had a torn meniscus on Thanksgiving day 2009. Couldnt walk on it, and eventually had surgery 8 days later. I was walking again after four days, and back to work eight days after surgery. I did a couple days of rehab therapy, but found that I was better off without it, and did my own rehab at my own pace. I was fully 100% recovered by 3 1/2 months and racing mtb and runnng. 
My suggestion is to research a good surgeon in your area. Makes a big difference how much he knows about doing the procedure. Ive had other friends tell me they never recovered from the surgery, and still have chronic knee pain. 
I dont think its just hit or miss. I think its also the competency of the surgeon, and his ability to properly assess the damage and make a good diagnosis.


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## Bob12676 (Sep 10, 2008)

My guess is that, if you have had mild symptoms over the last 12 years and it has recently gotten worse, the tear has grown in size. I have had 4 meniscus surgeries, the first in 2002 was a run of the mill small tear that required minimal recovery and had no lasting after effects. The problem is, that with even a small amount of tissue removed, the remaining tissue is put under a greater load and is more likely to be tear again. My second and third surgeries were 6 months apart in 2006-7 and were due to new tears that started where the small amount of meniscus had been removed in the first surgery. The second surgery did no good and never healed right which is why the third was done. Unfortunately the third attempt didn't help either and after another 8 months I was back on the table for a meniscus transplant, in which my remaining meniscus was removed completely and replaced with a cadaver meniscus. The transplant surgery sucked, it took 3 weeks to get off crutches, 3 months of PT and a year before it was completely healed. Now the knee feels better than it has in a decade. Transplants are becoming much more common and depending on the size and shape of your tear might be the best option. I think the rule they commonly use is weather or not you retain 50% or less of your anterior or posterier meniscus (there are two meniscus in each knee). Some times the surgeon will not know how much tissue he/she will need to remove untill the process is under way, but I would definetly ask. The transplant is kind of new and you may need to consult with a surgeon who has experiance doing them to get an honest assesment (most surgeons are kind of arrogant and if they don't know much about a specific surgical option they may have a weighted opinion of it) . Either way, good luck.


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## 1SPD (Apr 25, 2010)

I had a torn meniscus and surgery about 4 years ago now. So far all is good. Every once in a while it bothers me but not while riding at all. It gets a little sore going down stairs some times and I can't do squats like I used to or jump as high (can't play basketball that well anyway). It gets sore if I go running. I think that is because I don't run much to start with and when I do go, I try to bang out like 2-3 miles right off the bat.

The doctors first shot some Xrays and gave me a Cortisone shot. Things felt better initially of course, but then I was in my car parked and twisted around to get something out of the back seat. Internally, I heard a nasty pop sound and it hurt like hell. I was back in the office some 45 minutes later and got an MRI 2 days after that. I ended up with a micro tear in my mcl and a torn meniscus. I was told that it appeared to be a degenerative tear judging by the way the tear looked in all the films. That means it slowly tore, started to heal, tore a little more, healed again....He said that this was probably a result of my jumping out of air planes in the Army (hard landings) as well as going too heavy on squats in the gym. When they did surgery, they actually pulled out a piece of my meniscus that was floating around in the joint and wedging itself under my patella (very painful).

My scars are damn near invisible at this point. I was told that recovery would be 8-10 weeks. I was walking about 2 days post surgery (limping) and actually went snowboarding 8 weeks to the day! Not the brightest decision but all went well. I then started getting sore shortly after that after doing various activities so I had to slow back down. I think I ended up getting one more corti injection post surgery about 3 months after because some scar tissue had formed and began rubbing internally a little bit. I have been fine since and that was at least 3 years ago now. 

I pretty much know my limits and what I can/can't do. I have no problems riding my bike what so ever though. In fact, he even suggested that I get on a spin bike a few times a week during my physical theropy/recovery time.


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## member13 (Jun 4, 2009)

It is important to understand how your surgeon is going to"repair" your torn meniscus. Often times the surgen cuts away a prortion of the torn meniscus and you are up and walking within a day of the operation. Depending on the size of the damage and where it is, they might actual suture the torn meniscus, which will require a few months on crutches and lots of rehab. 

Cutting too much of the meniscus can lead to bone on bone wear and major joint problems later in life, such as arthritis and a knee replacement. 

Also the meniscus is cartilage and it is non-vascular (ie no arteries or veins) so suturing it back together does not always work and the repair takes a long time to heal.

I had a major meniscus tear and did the suture repair. It was very painful and lots of recovery time, but worth it ,as my knee has no issues and it has been 6 years.

Good luck- also find a good surgeon.


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## dru (Sep 4, 2006)

*tough call*

This is mostly to Stripes and somewhat to Howdy.

Been there done that.

Howdy, your situation is way less serious than Stripes. I'm not sure if I'd even get that tear cleaned up-a hard call to make.

Anyways......

I've got about 10% of my meniscus left on the inside side, and have had the patellar graft ACL transplant. My surgury is almost 20 years old now, so I have some experience.

#1: removing the meniscus will bring on arthritis.

How long is up in the air. I did a lot of sports after my surgery including running, mtb, boxing, and karate and I was very close to full-on arthritis 8 years ago because of it. Once I stopped running the swelling took almost 2 years to come out of my knee. I was leaving the boxing club limping after every workout, and gobbled ibuprofen for more than a year.

Biking seemed to calm everything down, although I did have a few scary moments a few years back where I got pain when cranking hard on the pedals. Very occasionally I'll get a jolt in the knee if I hit an obstacle hard with the pedal on the bad knee side weighted.

As for day to day life, any kind of jarring movement causes instant pain. I need to be very careful to avoid any kind of impact or I get pain. Running more than 20 or 30 steps brings pain. Thank god I am fine walking and mowing the lawn.

#2: The gold standard for the ACL transplant is still the patellar tendon. It hurts like hell though.

You could go fo the hamstring graft or cadaver parts though. With the latter are you committed to taking antirejection drugs for the rest of your life? If so you will be living with a compromised immune system.

#3: Stitching up a torn meniscus often fails. This is why it was so common to just cut it out like was done to me. As well, as you age the likelihood of successfully sutureing the meniscus goes down.

#4: if you are a big guy you are looking at some pain later on in your life. I'm only 175~180 lbs which is the #1 reason I'm not crippled yet. If you are overweight lose the weight now.

#5: Meniscus transplants are new. If I was more sure about them I'd get one tomorrow. I really wish there was an artificial option. Again, if you go the cadaver route, do you need to take drugs long term?

Good luck, you have a lot to think about.

Drew


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## dru (Sep 4, 2006)

*@stripes*

@ Stripes 
I was checking about on the net and it sounds like allografts like menisci and ligaments don't reject for the most part. The science has got around the body's response by freezing the donor tissue first.

I don't know how many times you've dislocated your knee because of your torn ACL, and it is hard to know how much damage you've done to the menisci. In my case I had dislocated it 5 times before I got the transplant so the inside meniscus was torn really bad.

If you only have minor tearing the may choose not to transplant the meniscus at all.

As for the ACL why the aversion to autograft? If you went the hamstring route you will have exactly 1 more scar than an allograft. That scar is about 1/4" long. If you went patellar, the scar is big, but they stitch it up very nicely for girls. It runs right up the middle of the kneecap and is ~4" long. For guys they just use staples! Sexist surgeons eh?

I hate to say this, but sports like Aikido are not good for the knees. I know a lot of martial artists who are middle aged with these issues. Your age alone is puts you more and more at risk for shredding things. I'm 47 btw, and truthfully I consider myself very lucky to have the level of health and fitness I do, even if that is just bombing trails and putting on miles.

Drew


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## bbbr (Nov 6, 2005)

in my case, i had a repair to my lateral meniscus that failed. One year later I had the chunk of meniscus that was flapping around removed, leaving 3-5% behind and the promise of a fake knee (the surface of the tibial plateau was cracking and degenerating already). I opted against a transplant as the success rate wasn't high enough for me at the time and the surgeon would remove what little lateral meniscus i had left to install the "new" one. If the transplant failed, I would be left with no lateral meniscus and an accelerated date with the fake knee.

That was in 2007 and i haven't had too many problems with arthritis (i had a plica band removed from the same knee in 09 and there weren't any significant changes from the 07 operation). Loosing 30+ pounds and riding more have both helped slow the destruction to a minimal rate. If the pain in the knee goes up again, I'll revisit the transplant option or look around at what else is available to slow the destruction back down to an minimal rate.


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## dru (Sep 4, 2006)

@Stripes. Aikido would be very good for learning how to land. 

My karate club was really sucky for ground fighting and even throws but we did a million breakfalls. I've done front breakfalls onto concrete from standing on a chair. Diving rolls over 5 or 6 people, that kind of stuff was part of the torture and routine. I'm really thinking it helped me avoid injury. 

I broke a collarbone in '84 and haven't broken a bone except my hand since. I roadraced motorcycles briefly in 1990 and have crashed 17 times on pavement. I cant count how many times I've gone over the bars on the bike. I always avoid serious injury. Maybe I am just lucky.

I'm not saying don't do martial arts. If you want to do Aikido, do it. Just understand that it is a sport where joint injuries are more common than not. 

As for snowboarding, I'm curious myself. I skied for 15 years or so when I was a kid and really miss it. I am %100 positive I'd re-injure my knee because of the cartilage damage so no skiing for me. I'm thinking that snowboarding may spread the impact loads to both knees like it does for biking. Who knows?

Drew


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## dru (Sep 4, 2006)

@bbbr, that sucks doesn't it? 

I'm constantly waiting for the bomb to drop. Quite a few guys I work with are hobbling along with bad knees. I hate seeing them in pain. 

When is it my turn?

I don't know what I'll do. The surgeon had told me, all those years ago that I'd get arthritis and need more surgery by 50. I'm 47 now.

Drew


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## bbbr (Nov 6, 2005)

The waiting game sucks, especially at 33...

I'm gonna keep riding till the knee collapses and i start popping Advil like candy again. My PT and Knee Surgeon are amazed I'm not in worse shape yet given what the knee has been through and what i enjoy doing beyond biking. Over the last couple of years I've been section hiking the Long Trail in Vermont, gotten over halfway through the NH 48 4000's and climbing the Rockpile (Mt Washington) in the summer and winter a few times a year for the last 10 years. I'm not willing to let the knee get in my way too much.


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## dru (Sep 4, 2006)

Yes, you have to enjoy your life still. I love the mountains, which I've only ever been to a few times. Nothing beats that. 

Drew


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## tpc1 (Jun 29, 2010)

I tore mine about 4 years ago, I went in for surgery, up and about in a week with limited use, or at least being careful. and was in great shape by 2 months. And havent had any problems since. But like someone said above and you already knew get to the best orthopedic to have it done and you will be fine. To many hack surgeons out there. Good luck


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## bbbr (Nov 6, 2005)

Dru-

Got to keep working, moving and having fun; keeps you alive and vigorous. My cousins grandfather just passed away from cancer at the age of 93, he was running his farm (cutting wood with his chainsaw, feeding the sheep and so on) right up till the end. The man never allowed a problem to get in his way or keep him from doing what he enjoyed.


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## dru (Sep 4, 2006)

So what are they going to do? ACL transplant? What cartilage damage are you refering to? The meniscus is cartilage, so are you talking about it, or damage to the surface of the femur and/or tibia?

As far as I know, they will only remove the torn chunks of the meniscus to retore functionality, otherwise the tear will flip over and you'll instantly know something is wrong!

Best of luck with it all!

P.S. I was talking to the wife about corpse parts (meniscus trans.) for my knee. I really almost don't want to know what is going on inside.

Drew


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