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Cindysphinx
11-27-2009, 02:02 PM
OK, it's time to decide what to do about this knee.

Long story short. The MRI says incomplete lateral meniscus tear and arthritis. Physical exam says medial meniscus tear. Xrays say no arthritis. Several weeks of PT didn't resolve things. OS says he can't do anything more short of surgery. OS says it makes sense to do an exploratory arthroscopy: Go in, look around, clean it up. OS says I would be out 4-6 weeks.

As things stand, there is definitely something wrong with the knee. It doesn't hurt when I play doubles, but I am extremely slow. When I run, it starts hurting after about 5 minutes. No matter how much or how little I play (or ice or Advil), my knee is sore, especially after I've been sitting a while. I spend a lot of time trying to manage swelling.

I am really on the fence about this.

I had arthroscopic surgery on the other knee in 2005, but that decision was easy because that knee was so bad. Still, it took a year before the knee (and my fitness) was 100%. It's hard to believe the promises of 4-6 weeks this time around given what happened last time.

Still, if I go ahead and have the surgery now, then I could put my energies into rehab rather than putting my effort into (unsuccessful) attempts to manage things. I have heard that living with a bad meniscus raises your risk of arthritis. I am very worried that I have lost some strength in this leg, and that could set me up for a more serious injury (I already got a stress fracture and bone bruise, which I doubt would have happened on a healthy knee). I could miss Dec. and Jan., but I'd perhaps be ready to play in February. Then again, every surgery has risks, and I would hate myself if the surgery went bad and created more problems than it solved.

Or I could just soldier on and schedule the surgery after the 2010 adult season in June, so I'd have the entire summer to recover. And maybe by then the knee would have gotten better on its own. But if I wait that long, I will be a pile of wriggling Jello in terms of loss of overall fitness and strength, and that will take a long time to recover, assuming I can recover my fitness at all at my age.

Anybody got any bright ideas? Should I do this now (like, this week) or wait?

Ripper014
11-27-2009, 02:54 PM
No bright ideas but you can take this for what it is worth... tennis is winding down... with Christmas coming up... and 4-6 weeks will have you up and running by the new year.

What I find about injuries is that instinctively you will stress other parts of your body to take the pressure of the injured area. In the long run... you are at risk if injuring something else.

Though I hate the thought of surgery and have never had to go through it yet... I recommend getting things fixed before something seriously goes wrong.

Tennis is just tennis it is not life changing... losing your health is.

ollinger
11-27-2009, 03:54 PM
Problem here is that it's not clear whether arthritis, meniscus tear or both are causing the pain. 15-20% of meniscus surgeries produce no improvement in symptoms. Depending on what part of the meniscus is involved, it can either be sutured or just "cleaned up," the latter producing frequently less satisfying outcomes. You may want to find out exactly what the orthopod expects to be able to do.

Cindysphinx
11-27-2009, 04:49 PM
Problem here is that it's not clear whether arthritis, meniscus tear or both are causing the pain. 15-20% of meniscus surgeries produce no improvement in symptoms. Depending on what part of the meniscus is involved, it can either be sutured or just "cleaned up," the latter producing frequently less satisfying outcomes. You may want to find out exactly what the orthopod expects to be able to do.

He doesn't know what he will find when he gets in there. And he can't say until he knows what exactly is going on.

That's also kind of scary. This guy is a good surgeon. He operated on my daughter's knee earlier this year. In her case, no one could figure out what was wrong, and a different doc thought meniscus tear. He went in and found no tear, so he did nothing and closed her up. Problems persisted for another 18 months, despite a consultation with yet another OS.

So I took her to this new guy, and he decided it was a tracking problem and did a lateral release. When he came out of the operating room, he said he was certain he had fixed the problem. Six months later and she is pain-free and running.

I trust this guy's judgment, and his judgment is all I have to go on, unfortunately.

LeeD
11-27-2009, 04:54 PM
Sorry to hear about your knees.
I tore my lateral meniscus like late July this year, and I stopped playing for easily 2 months, first days back tentative and scared.
I'm a gardener, and had to BACK down all the stairs I needed to negotiate, could never walk facing down the steps until +3 weeks after injury.
Of course, I windsurfed 5 days a week, 2 hours a day, but that's a walk in the park for me (I often sail in 20+ mph winds keeping dry for 3 hours).
It healed, but not my sprained left ankle from Sept '08 or the back of my wrists, from 5 years ago.
Always get a third opinion. Fortunately for me, I know at least 5 orthopedic surgeons and a couple of sports medicine docs. Comes with the territory from surfing, motocross, waterski jumping, windsurfing, and tennis.

Cindysphinx
11-27-2009, 05:17 PM
I dunno. I don't see the point of a third opinion, or a second opinion. The test results are what they are. The physical exam is what it is (and contradicts the MRI completely).

There aren't many more tools left in the box. The only things we have left are an injection (pointless) and surgery.

Lee, how do you know you had a torn meniscus?

LeeD
11-27-2009, 05:33 PM
Oh, just two of my sports medicine docs looked me over, and one of the ortho's. OTOH, my buddy who's an Eroom doc also looked it over, and he said "REST thos"..... my other Eroom doc buddie said to have it looked at and monitored.
Having lived thru 4 collarbone breaks, 2 tib/fibs, 1 fib, over 17 ribs, 5 fingers, and over 7 dislocates and separated shoulders, I'd think I have an idea how to recoup from physical injuries.
Oh, I've raced over 40 road races (motorcycles) and over 300 motocross races.

Topaz
11-27-2009, 05:50 PM
No bright ideas but you can take this for what it is worth... tennis is winding down... with Christmas coming up... and 4-6 weeks will have you up and running by the new year.

What I find about injuries is that instinctively you will stress other parts of your body to take the pressure of the injured area. In the long run... you are at risk if injuring something else.

Though I hate the thought of surgery and have never had to go through it yet... I recommend getting things fixed before something seriously goes wrong.

Tennis is just tennis it is not life changing... losing your health is.

I would echo pretty much everything Ripper said...this is actually a pretty good time to have it...would you rather miss mixed or ladies doubles/singles/multiple leagues that start later on.

A woman in my clinic had knee surgery last year the day after Christmas. She was back on the court in February.

If you trust this guy (and it sounds like you do, with good reason) I would say let him go in and look around.

And, on a totally different note, I was doing some reading about nettle tea (looking for alternative remedies for my chronic inflammatory sinus problems), and it seems it is widely recommended for many things, among them arthritis. Here's some info, take out of it what you wish:

http://herbalmedicine.suite101.com/article.cfm/stinging_nettles

http://www.teabenefits.com/herbal-tea-benefits/nettle-tea-benefits.html

http://www.herbsorganic.co.za/pages/working%20on/Nettle/Nettle%20info.htm

Fedace
11-27-2009, 05:53 PM
I say STOP listening to people in the forum and listen to the advice that the best possible Orthopedic surgeon can give you. Find the one that specializes in Sports medicine as sub-specialty. I am sure you have good insurance. from what i can gather, you are middle class or above.....

Jim A
11-27-2009, 06:04 PM
Recovery is so quick nowadays on it, and better to avoid the arthritis.

I'm 39 and have no cartilage in one knee and tears in the other, I waited too long to get the first done and they wound up shaving down the kneecap and drilling holes in it to improve blood flow and stave off arthritis about 3 years ago. Regardless I was back on the ice in just 4 weeks or so...our captain got 'scoped a month before districts and while not 100% wasn't far off his game, he logged about 500 miles on the bike though to get ready

I'm waiting to find out on the other one but likely will get it done sooner than later as well in order to have a couple months to prep before the season starts in April/May, 10 sets over the past few days have pretty much sealed that conclusion.

Ripper014
11-27-2009, 07:55 PM
And, on a totally different note, I was doing some reading about nettle tea (looking for alternative remedies for my chronic inflammatory sinus problems), and it seems it is widely recommended for many things, among them arthritis.

Topaz... have you ever tried doing nasal flushes (sinus rinse) for your nasal problem? I occasionally have to deal with bad allergies over the spring and fall... but find if I do regular sinus rinses it seems to help a lot. Disgusting I know... but its not too bad once you have gone through it once... and know what to expect.

Ken Honecker
11-28-2009, 12:07 AM
I'm a hardcore, rub some dirt on it sort of a guy. For example when I strained a calf this fall I kept playing until the other guy called it a night realizing I wasn't going to let him win. I've always waited until after season to have stuff worked on. That said I'd try and get a concencess of whether waiting was very likely to lead to problems down the road. If the answer was yes I think I'd get it worked on right away and then rehab the crap out of it. You want to be able to get another 20-30 years out of that knee right?

Topaz
11-28-2009, 04:29 AM
Topaz... have you ever tried doing nasal flushes (sinus rinse) for your nasal problem? I occasionally have to deal with bad allergies over the spring and fall... but find if I do regular sinus rinses it seems to help a lot. Disgusting I know... but its not too bad once you have gone through it once... and know what to expect.

Yup, I do them regularly...started about 2 years ago with the recommendation of my doc. I think they've helped tremendously, but I still seem to get a sinus infection every year during the same time...and they are getting worse. This last one was probably the most painful one I've ever had. She (my doc) hasn't felt the need to send me to a specialist yet, so I was just researching some other possibilities. I also read that chronic sinusitis can be caused by a food allergy! I already keep a daily food log, so I'm going to look at that as well. Headed out to Whole Foods today to see if I can find some nettle tea. Even if it doesn't work the benefits seem very complete for lots of other things, too.

I found a *lot* of info on alternative remedies for arthritis as I was looking...very interesting (at least to me!).

chess9
11-28-2009, 01:03 PM
He doesn't know what he will find when he gets in there. And he can't say until he knows what exactly is going on.

That's also kind of scary. This guy is a good surgeon. He operated on my daughter's knee earlier this year. In her case, no one could figure out what was wrong, and a different doc thought meniscus tear. He went in and found no tear, so he did nothing and closed her up. Problems persisted for another 18 months, despite a consultation with yet another OS.

So I took her to this new guy, and he decided it was a tracking problem and did a lateral release. When he came out of the operating room, he said he was certain he had fixed the problem. Six months later and she is pain-free and running.

I trust this guy's judgment, and his judgment is all I have to go on, unfortunately.

I'd go with my instincts on this one too.

One of the guys at our club had his meniscus trimmed and was hitting balls against the ball machine three days later. I saw him hitting balls for an hour in a pick-up doubles match today. He wasn't running hard, but he was moving! It's about two weeks out now. I'm told trimming the meniscus is a minor bit of knee work. I haven't had mine done though. ;)

Also, as young as you are, you'll heal quickly. ;)

-Robert

crystal_clear
11-29-2009, 07:38 PM
I recommend getting things fixed before something seriously goes wrong.

Tennis is just tennis it is not life changing... losing your health is.

Agreed~ body is like a car. A small fix would save a big fix in the future. A car needs a regular oil change and maintenance to keep smooth running condition.

What about body? How many people take care of their bodies like taking care of their cars?

Cindysphinx
11-29-2009, 11:49 PM
I played a match tonight. The knee did what it always does: It behaved beautifully during the match. No pain, no problems. Three Advil.

And now I'm up in the middle of the night with my knee aching. And I know when I get up from my desk, it will take some time to straighten my leg because of Theatre Sign.

I still can't decide whether to just keep playing on it and let nature run its course, or intervene. I was poking around the internet, and research shows that a stable meniscus tear can be left alone. It seems so weird to get surgery for a bit of aching and swelling. But this has been going on since August and it is getting old. . . .

jrod
11-30-2009, 04:39 AM
I played a match tonight. The knee did what it always does: It behaved beautifully during the match. No pain, no problems. Three Advil.

And now I'm up in the middle of the night with my knee aching. And I know when I get up from my desk, it will take some time to straighten my leg because of Theatre Sign.

I still can't decide whether to just keep playing on it and let nature run its course, or intervene. I was poking around the internet, and research shows that a stable meniscus tear can be left alone. It seems so weird to get surgery for a bit of aching and swelling. But this has been going on since August and it is getting old. . . .

Problem is Cindy, you don't know exactly what is going on in there. Secondly, regardless as to whether or not you get cut you will likely have to stay off it for a decent spell to let it heal.

My sense is to have the Doc take a look and get a proper diagnosis. Given decent information I'm pretty sure you can make an intelligent decision. As it stands now, you are speculating along with everyone else.

Just my $0.02.

Cindysphinx
11-30-2009, 06:18 AM
OK, I put in a call to the scheduler for this doctor.

I just got back from my exercise class. One hour of lower body work (15-minute run, lunges, squats, sprints, backwards hills). Felt the occasional twinge and couldn't do the side-walking lunges, but I could do everything else perfectly. Whoever heard of getting surgery when you can do pretty much everything you want to do? This is so weird.

mike53
11-30-2009, 06:35 AM
Whoever heard of getting surgery when you can do pretty much everything you want to do?


Not saying yours is, but most elective cosmetic surgery would fall into this category. Everyone I know is getting everything they can get covered fixed right now because of their uncertainly over the pending legislation.

charliefedererer
11-30-2009, 11:44 AM
Good luck with the arthroscopic surgery.
Providing everything heals well, are you making plans to modify your multiple knee pounding activities to prevent future knee problems?

Cindysphinx
11-30-2009, 05:21 PM
Good luck with the arthroscopic surgery.
Providing everything heals well, are you making plans to modify your multiple knee pounding activities to prevent future knee problems?

No. I need to play tennis. I need to run. I'll keep doing it until I can't do it anymore.

No more singles, though. Both times I hurt a knee, it was in an effort to become a singles player.

I reached a decision today. I called and talked to the scheduler for this practice. She said I would need an EKG, blood work and complete physical. Getting this done would push me back well into December. Which means I'd miss a lot of the winter season.

Hearing that also reminded me that I had some issues under general anesthesia last time -- it's not good when your heart rate falls and they have to give you two doses of epi, is it?

So I'll live with it as long as I can. Gotta just suck it up, I figure.

Ripper014
11-30-2009, 06:17 PM
I played a match tonight. The knee did what it always does: It behaved beautifully during the match. No pain, no problems. Three Advil.

And now I'm up in the middle of the night with my knee aching. And I know when I get up from my desk, it will take some time to straighten my leg because of Theatre Sign.

I still can't decide whether to just keep playing on it and let nature run its course, or intervene. I was poking around the internet, and research shows that a stable meniscus tear can be left alone. It seems so weird to get surgery for a bit of aching and swelling. But this has been going on since August and it is getting old. . . .



Your body is a incredible machine with warning mechanisms in place... if you feel pain there is a reason for it... it is your body telling you something is wrong.

It is your choice to manage the threshold of pain you are willing to deal with... but I would rather sacrifice a short term loss for a long term gain, especially if it is something I will eventually have to deal with anyway.

jazzyfunkybluesy
11-30-2009, 06:19 PM
Why ask strangers ask your doctor Jesus.

Ripper014
11-30-2009, 06:19 PM
No. I need to play tennis. I need to run. I'll keep doing it until I can't do it anymore.

No more singles, though. Both times I hurt a knee, it was in an effort to become a singles player.

I reached a decision today. I called and talked to the scheduler for this practice. She said I would need an EKG, blood work and complete physical. Getting this done would push me back well into December. Which means I'd miss a lot of the winter season.

Hearing that also reminded me that I had some issues under general anesthesia last time -- it's not good when your heart rate falls and they have to give you two doses of epi, is it?

So I'll live with it as long as I can. Gotta just suck it up, I figure.


My biggest concern would be the possibility of doing any additional damage, plus I find it frustrating to be playing competitively at less than my best.

crystal_clear
11-30-2009, 08:16 PM
Your body is a incredible machine with warning mechanisms in place... if you feel pain there is a reason for it... it is your body telling you something is wrong.

It is your choice to manage the threshold of pain you are willing to deal with... but I would rather sacrifice a short term loss for a long term gain, especially if it is something I will eventually have to deal with anyway.

Agreed~ Long term tennis is more important than the temporary one.

jrod
12-01-2009, 03:18 AM
....I reached a decision today. I called and talked to the scheduler for this practice. She said I would need an EKG, blood work and complete physical. Getting this done would push me back well into December. Which means I'd miss a lot of the winter season.


Sorry but your estimates are a little exaggerated. Blood work takes 20 minutes tops (18 minutes of waiting and 2 minutes to draw blood). It takes less than a couple of days to run the labs.

The EKG takes a a few minutes and a complete physical takes about an hour. I did both of these things yesterday and my total time invested was 90 minutes (including drive time), NOT a whole season.

Hearing that also reminded me that I had some issues under general anesthesia last time -- it's not good when your heart rate falls and they have to give you two doses of epi, is it?

So I'll live with it as long as I can. Gotta just suck it up, I figure.

Sure does smell like denial. I sure hope your knee problem resolves itself on its own.

Cindysphinx
12-01-2009, 04:45 AM
My doc is scheduling physicals for January. I suppose I could try to find a new doc, but my health plan is very short on internists who will accept a new patient. I dithered too long.

JazzyFunkyblues:

Why ask strangers ask your doctor Jesus.

My doctor's name is not Jesus.

Anyway, it is helpful to knock a decision around with other people sometimes. The people here have a different take on this than my doctor. His bottom line is "Yeah, sure, go play tennis if you want. You aren't going to hurt anything. Come back when you get tired of dealing with it." That may be medically correct, but it doesn't grapple at all with the philosophical and lifestyle and risk assessment questions.

That's why I have you people! :)

jrod
12-01-2009, 05:04 AM
^^^ I agree with your doc's advice. He is essentially defering to you for final judgement on the matter. You are the only person who knows when something isn't right. Hopefully you are honest with yourself and don't risk further injuring yourself Cindy.

Years ago, when I was a runner, my knees started to tell me "enough". I intially ignored the signs but after another 6 months the pain while running became unbearable. A colleague of mine who I ran with also suffered identical symptoms. We both stopped running and sought medical advice at the same time (late 40's for me, early 50's for him).

My doctor outlined the possibilities and suggested remedies. His approach was one of extreme caution, with surgery being the very last remedy. I started with physical therapy. The guy I got was very good (tri-athelete ) and started me on a number of strengthening exercises. Before long I started to play tennis for the first time in years.

My colleague got different medical advice, even though our symptoms were similar. His doctor recommended surgery for what he thought was a tear in his miniscus. He had the surgery and took 6 months to recover. His knee is fine today yet he does not run any more.

The thing is, both of us knew when it was time to stop. We both knew when it was time to seek medical advice. Even though our symptoms were identical, the root causes were not. We both had successful outcomes and are both very active now.

Hoepfully you'll know when it is time and get sound medical advice. At the end of the day though, you are the best judge as to which course of action makes the most sense.

charliefedererer
12-01-2009, 06:44 AM
Clearly this is an area with no absolutes with regard to the best combinations of future activity. We want to be fit AND healthy, and enjoy the activities we have already come to enjoy.

I had some knee pain at the end of the tennis season/running season in November about 10 years ago. With cold weather approaching I took a couple of weeks off around Thanksgiving.
The knee felt great. I flew to a meeting in Houston, and couldn't resist going on about a 6 mile run on roads. The knee was achy again for about a week. So I swore off running on roads, and switched to running on soft playing fields, and doing more of the aerobic work on stair steppers/Nordic Track/bike/rowing. It kills me, but I decided I play too much on hard courts to do anything but occasional road running. It still feels like a great hardship to give up on the road running, but I'm lucky enough to live next door to a fabulous series of playing fields kept soft with sprinklers all summer. And now I love cross country skiing, which definitely has less pounding than running, but only do if the courts are covered with snow, and that's probably only a few weekends a year. And I swore off using NSAIDS (ibuprofen, naproxen)the way I used to use them for every ache and pain. The multiple pathways of the inflammatory system are way too powerful to suppress it with anything other than high dose prednisone. The suppression of the cyclooxygenase/prostaglandin pathway does occur, but it seemed to me that the micro-tears in tendons/ligaments/cartilage would elicit more than enough of an antiinflammatory response by all the other pathways so eventually collagen could be laid down to heal these small tears. But high doses of NSAIDS are a very effective pain reliever, and I began to worry that hiding the discomfort would numb my all-too-easily-numbible brain into thinking I was fine since I felt fine (I never know when to stop). I decided I wanted to be more like my Dad who played competitively until he was 79, and not need a knee replacement like my Mom (who played 5 times a week in her 60's) until her knee replacement at only 69.

It had occurred to me as I was splitting wood that there is two ways to do it. One is to get a very heavy sledge hammer and hit the wedge with one great blow. The other is to use a more manageble hammer and hit it repeatedly until the log was completely split in two. Just like there are two ways to split a meniscus, either with one great blow, or many smaller ones. I worry that the large avascular central area of the meniscus might never properly heal, even if perfectly surgically aligned, unlike the lateral well vascularized meniscus tears that almost always heal.

drak
12-01-2009, 06:52 AM
OK, it's time to decide what to do about this knee.

Long story short. The MRI says incomplete lateral meniscus tear and arthritis. Physical exam says medial meniscus tear. Xrays say no arthritis. Several weeks of PT didn't resolve things. OS says he can't do anything more short of surgery. OS says it makes sense to do an exploratory arthroscopy: Go in, look around, clean it up. OS says I would be out 4-6 weeks.

As things stand, there is definitely something wrong with the knee. It doesn't hurt when I play doubles, but I am extremely slow. When I run, it starts hurting after about 5 minutes. No matter how much or how little I play (or ice or Advil), my knee is sore, especially after I've been sitting a while. I spend a lot of time trying to manage swelling.

I am really on the fence about this.

I had arthroscopic surgery on the other knee in 2005, but that decision was easy because that knee was so bad. Still, it took a year before the knee (and my fitness) was 100%. It's hard to believe the promises of 4-6 weeks this time around given what happened last time.

Still, if I go ahead and have the surgery now, then I could put my energies into rehab rather than putting my effort into (unsuccessful) attempts to manage things. I have heard that living with a bad meniscus raises your risk of arthritis. I am very worried that I have lost some strength in this leg, and that could set me up for a more serious injury (I already got a stress fracture and bone bruise, which I doubt would have happened on a healthy knee). I could miss Dec. and Jan., but I'd perhaps be ready to play in February. Then again, every surgery has risks, and I would hate myself if the surgery went bad and created more problems than it solved.

Or I could just soldier on and schedule the surgery after the 2010 adult season in June, so I'd have the entire summer to recover. And maybe by then the knee would have gotten better on its own. But if I wait that long, I will be a pile of wriggling Jello in terms of loss of overall fitness and strength, and that will take a long time to recover, assuming I can recover my fitness at all at my age.

Anybody got any bright ideas? Should I do this now (like, this week) or wait?


Cindy I can only relate my 3 scope experiences (the past 13 years - I am 54 now) for relatively minor medial meniscus tears. In all 3 I recovered fully in 4-6 weeks, I was in good shape prior to surgery and did a solid rehab schedule. Even after my last scope surgery 2 yrs ago at age 52 I was playing hard and normal singles at 4.5 level in 5-6 weeks. Maybe your damage is worse, but my "scope" experiences have been very positive.

Drak

drak
12-01-2009, 06:59 AM
OK, I put in a call to the scheduler for this doctor.

I just got back from my exercise class. One hour of lower body work (15-minute run, lunges, squats, sprints, backwards hills). Felt the occasional twinge and couldn't do the side-walking lunges, but I could do everything else perfectly. Whoever heard of getting surgery when you can do pretty much everything you want to do? This is so weird.

all 3 of my cuts were by my choice because it was irritating but did not really effect my play. The doc said some non athletes might do nothing and be fine, I like to go full out and not have to deal with the after pain all the time, so I got cut all 3 times and they were minor tears, felt much better afterward so for me they worked. Only YOU can decide what you are willing to accept and risk.

Drak

drak
12-01-2009, 07:01 AM
No. I need to play tennis. I need to run. I'll keep doing it until I can't do it anymore.

No more singles, though. Both times I hurt a knee, it was in an effort to become a singles player.

I reached a decision today. I called and talked to the scheduler for this practice. She said I would need an EKG, blood work and complete physical. Getting this done would push me back well into December. Which means I'd miss a lot of the winter season.

Hearing that also reminded me that I had some issues under general anesthesia last time -- it's not good when your heart rate falls and they have to give you two doses of epi, is it?

So I'll live with it as long as I can. Gotta just suck it up, I figure.

Just get an epidural, I did that for 2 of my knees and watched both on the monitor above, it was cool - like a PBS special!

Drak

Cindysphinx
12-01-2009, 07:03 AM
It had occurred to me as I was splitting wood that there is two ways to do it. One is to get a very heavy sledge hammer and hit the wedge with one great blow. The other is to use a more manageble hammer and hit it repeatedly until the log was completely split in two. Just like there are two ways to split a meniscus, either with one great blow, or many smaller ones. I worry that the large avascular central area of the meniscus might never properly heal, even if perfectly surgically aligned, unlike the lateral well vascularized meniscus tears that almost always heal.

OK, you lost me there at the end.

I hear you on the issues of longevity. I haven't changed my running surface -- uneven surfaces make me very nervous -- but I've changed the distances and the way I run. An hour is my max. Most common is 30 minutes. I try to do a lot of hills and sprints when I do run, and I am likely to walk on the downhills.

See, I just don't find myself very effective on a tennis court if I don't supplement tennis with runs. I haven't run since August, and I am starting to look like Tim Conway from the old Carol Burnett show -- no extension, slow first step. Lobs get over me, I can't run them down. It is now easy to beat me with a middling drop shot. This is embarrassing.

I don't think swimming, cycling or eliptical is going to help me with what I need for tennis. Only hills and sprints do that.

And I hate hate hate gyms and everything in them. When I did PT, I absolutely dreaded the 5-minute warm-up on the bike. Where did I get this horrible aversion to bikes?

drak
12-01-2009, 07:04 AM
My doc is scheduling physicals for January. I suppose I could try to find a new doc, but my health plan is very short on internists who will accept a new patient. I dithered too long.

JazzyFunkyblues:



My doctor's name is not Jesus.

Anyway, it is helpful to knock a decision around with other people sometimes. The people here have a different take on this than my doctor. His bottom line is "Yeah, sure, go play tennis if you want. You aren't going to hurt anything. Come back when you get tired of dealing with it." That may be medically correct, but it doesn't grapple at all with the philosophical and lifestyle and risk assessment questions.

That's why I have you people! :)

I don't get that, I had no physicals or blood drawn for any of my knee scopes done by 3 different Docs, and even for my much bigger shoulder surgery last December I had none of this - weird if you ask me.

Cindysphinx
12-01-2009, 07:08 AM
I don't get that, I had no physicals or blood drawn for any of my knee scopes done by 3 different Docs, and even for my much bigger shoulder surgery last December I had none of this - weird if you ask me.

Yeah, it is weird. I kind of expected to call and pick a date and have that be it.

Last time (2005), the doc wanted a full cardio work-up. At the time, I had a cheap health insurance plan, so *my portion* of the cost of that work-up was over $500. I have a freak-of-nature vascular issue and some benign valve thing lots of middle-aged women get, so that (coupled with my absurdly low pulse rate) weirded him out.

Since it is now 2009, I'll bet the internist is going to want to do the cardio work-up again. Do they think I'm made of money?

sureshs
12-01-2009, 07:45 AM
I say STOP listening to people in the forum and listen to the advice that the best possible Orthopedic surgeon can give you. Find the one that specializes in Sports medicine as sub-specialty. I am sure you have good insurance. from what i can gather, you are middle class or above.....

Ollinger is a medical guy and gives good advice.

Ripper014
12-01-2009, 07:58 AM
Yeah, it is weird. I kind of expected to call and pick a date and have that be it.

Last time (2005), the doc wanted a full cardio work-up. At the time, I had a cheap health insurance plan, so *my portion* of the cost of that work-up was over $500. I have a freak-of-nature vascular issue and some benign valve thing lots of middle-aged women get, so that (coupled with my absurdly low pulse rate) weirded him out.

Since it is now 2009, I'll bet the internist is going to want to do the cardio work-up again. Do they think I'm made of money?

Time to move to Canada... have you looked at P90x ... it is a in home work out regiment that I really enjoy. It is as hard as you want to make it... and it is a total body workout that varies everyday. I have always hated home based workout schemes but this one actually has me doing it with enthusiasm.

drak
12-01-2009, 10:47 AM
Yeah, it is weird. I kind of expected to call and pick a date and have that be it.

Last time (2005), the doc wanted a full cardio work-up. At the time, I had a cheap health insurance plan, so *my portion* of the cost of that work-up was over $500. I have a freak-of-nature vascular issue and some benign valve thing lots of middle-aged women get, so that (coupled with my absurdly low pulse rate) weirded him out.

Since it is now 2009, I'll bet the internist is going to want to do the cardio work-up again. Do they think I'm made of money?

well it sounds like you have a few health "issues" so a better safe than sorry approach is prudent. Do consider an epidural from waist down as opposed to being knocked out thru anesthesia.

Cindysphinx
12-01-2009, 11:19 AM
well it sounds like you have a few health "issues" so a better safe than sorry approach is prudent. Do consider an epidural from waist down as opposed to being knocked out thru anesthesia.

That's interesting that your doc was willing to do an epidural. My first doc who did my surgery was adamantly against doing it that way. He says epidurals can be incomplete and patients can still move. If they move while the instruments are in there, there can be some bad outcomes. He had to talk me into the general, though, as I had really hoped to do the epidural.

I've had three epidurals for childbirth, and they totally rock!

Topaz
12-01-2009, 11:49 AM
OK, you lost me there at the end.

I

Vascular regions have a good blood supply and regenerate/heal well and quickly.

Avascular regions do not have a good blood supply, and therefore, not so great on the healing.

Also, RE workouts...at home weight workouts that will kick you in the rear = Cathe Friedrich and Jari Love.

Cindysphinx
12-01-2009, 01:34 PM
Yes, but what has that got to do with my meniscus, given that I don't know whether it is torn or where it is torn? I mean, is this an argument for waiting to see if I am lucky and tore a vascular region?

drak
12-01-2009, 01:46 PM
That's interesting that your doc was willing to do an epidural. My first doc who did my surgery was adamantly against doing it that way. He says epidurals can be incomplete and patients can still move. If they move while the instruments are in there, there can be some bad outcomes. He had to talk me into the general, though, as I had really hoped to do the epidural.

I've had three epidurals for childbirth, and they totally rock!

I've had two for knee surgeries and my docs said nothing about any movement risk.

Drak

jmjmkim
12-01-2009, 02:36 PM
Surgery should always be last choice

equinox
12-02-2009, 04:36 AM
Umm manage the injury better? Cut down on tennis sessions and give more yourself recovery time.

Cindysphinx
12-02-2009, 06:08 AM
Yeah, I'm doing that. I try not to play on consecutive days, and I've stopped doing my Wednesday long run.

It doesn't really help, though. I guess it might help prevent things from getting worse in the short term . . . .

charliefedererer
12-02-2009, 06:47 AM
Yes, but what has that got to do with my meniscus, given that I don't know whether it is torn or where it is torn? I mean, is this an argument for waiting to see if I am lucky and tore a vascular region?

You may be interested in the following as a background as to what is going on at the microscpic level at you knee:
Cartilage, like most tissues, does not have a potential for regenerating once there is an injury. The little micro tears are filled in by scar tissue. More serious through and through meniscal tears do have the potential to heal together without surgery if in close opposition and treated by extensive rest, but suturing them together should speed the recovery as there is no gap to be bridged by fibrous scar tissue, and the sutures limit movement. But it still takes 6-8 weeks for the fibrous scar to strengthen to the point of resisting meaningful force. As the fibrous scar tissue that binds the collagen fragments is laid down it resembles a spider's web (also made of protein). Pound for pound, a spider's web is stronger than steel. But as we all know, if we want to disrupt a spider's web, all we have to do is wiggle our finger to break it up. So too, early fibrous scar tissue's individual strands are strong, yet so thin they are easily disrupted by movement. But over time they they are continued to be laid down in the inflammatory process by fibrocytes that have migrated to the site of inflammation from out tiniest blood vessels, the capillaries. The fibrin fibers create a weave that is ever tighter and increasingly cross linked at the molecular level so that they are not just individual fibers but a healed three dimentional tissue that plugs the gap left by injured tissue that died, and adheres tightly to adjacent cartilage tissue.
But all this is predicated on there being a blood supply to nourish the fibrocytes as they lay down the fibrin strands.
In our menisci, there are lots of tiny capillaries that can supply the needed blood containing oxygen and nutrients to sustain the healing process. But these capillary beds exists almost exclusively at the periphery of the menisci. The large central area of menisci have very few capillaries, i.e. have a poor blood supply, or are "avascular". Thus, this central area does not have a good potential for healing, with or without surgery.

"The MRI says incomplete lateral meniscus tear and arthritis."
What this means is that you had a former meniscal tear there that has healed back together by the above process of scar formation by the laying down of fibrin in between the crack in your meniscus. This looks like it is solidly held together, but the scar in this filled in crack is not cartilage. Hence the use of the term "arthritis", or inflammation of the cartilage, even though in this case the inflammation has actually probably ceased, and a fairly stable scar tissue filler is in place. Your orthopedic surgeon does not think this is the current source of your pain as there is no tenderness when he puts pressure on this area.

"Physical exam says medial meniscus tear."
Apparently there is no defect on the usually sensative MRI, so thankfully at least it's unlikely that there is a large tear. But this is the area of tenderness on physical exam, so there may be a small tear there. Or maybe its an area of "bruise" with mutliple micro tears that won't be visible even on arthroscopy at the surface of the cartilage.

"Xrays say no arthritis."
Xrays are far less sensitive to say anything about the menisci. Indeed on plain x-rays the mensici are essentially "invisible". If an area of meniscus separates off, or dies from repeated trauma (known as "osteoarthritis" or
"degenerative joint disease") then the femur bone above directly contacts the tibia below, and the lack of joint space is a representation on xray that this has happened. The other evidence of arthritis on plain xray would have been deposits of calciium withing the cartilage areas, as calcium crystals sometimes abnormally deposits there as the scar tissue is formed in the healing of cartilage.

"Several weeks of PT didn't resolve things."
There are no specific PT activities, or activities of any kind, that can speed the rate of cartilage healing. Whoever finds one surely will win the Nobel Prize (hence the dubious claims from nutritional supplements, ultrasound, accupuncture, etc. If a way of doing so ever is discovered, it will really be the true "fountain of youth" freeing the world from most from joint and back problems, and it will not be kept a secret as the process will be worth trillions to the discoverer/manufacturer). The purpose of the PT was for you to keep the joint active, but without pressure, so your own body could heal while you otherwise kept off the knee. (And truth be told, it's not at all clear you, individually, actually needed this PT.)
The only way to speed up the healing of cartilage problems, short of suturing two areas of separation together or removing protruding fragments, is through time. The wondrous process of the inflammatory reaction that starts at site of injury with the initial movement of white blood cells into an area, with those white blood cells emitting chemical mediators that attact the accumulation of fibrocytes that lay down the fibrin strands and then for the crosslinking to occur takes a good month to have even 20% of the final tensile strength. As the crosslinking continues, the final strength of the scar tissue and its attatchments continues to increase, reaching 40% at two months and up to over 60% in six moths, with final strength increases actually going on for a year. Of course many things could ****** this "healing" process, including poor local blood supply and excessive movement/repeated trauma. And for micro and smaller tears the process moves along faster as the three dimentional space that has to be filled in is smaller.

"The OS says he can't do anything more short of surgery. OS says it makes sense to do an exploratory arthroscopy: Go in, look around, clean it up. OS says I would be out 4-6 weeks."
There may indeed be a small fragment of protruding cartilage, a small piece of "floating" cartilage in the joint space, or less likely, an actual small tear that needs suturing. I'm not an orthopedic surgeon, and I would have to rely on his experience to what the likelihood of finding something to fix would be.
The exploration itself is a worthy process as it is the most sensitive way to find out what's at the surface of the joint space or floating within it, even though the MRI was the most sensitive to actually evaluate the three dimentional aspect of the meniscus (although even the MRI gives a poor view of the multi microscopic injuries that might be present).
Certainly the 4-6 weeks would be the best chance for small and micro injuries in your cartilage to heal, even if they would have done so without the arthroscopy. And by eliminating the repeated small blows to the knee menisci, you would be decreasing the chance that a fault line would emerge connenecting the dots of the micro/small injuries that finally results in a large tear.

charliefedererer
12-02-2009, 06:54 AM
Double post. Sorry.

Cindysphinx
12-02-2009, 07:28 AM
Wow. Thank you, Charlie!

If I'm understanding this passage correctly -- and I may not be on account of all of those huge words -- a period of rest of 4-6 weeks (which I did beginning in September) should have helped. But if I continue resting, things might get better, but I'd have to rest for six months?

My current plan is to keep playing and running at reduced levels, essentially trying to take it easy. If things haven't improved by June, then I would probably do the surgery.

Does that sound consistent with the information you provided? Or should I think about resting from Dec. to Mid-January also?

Sorry to be so dense about this, but I don't do well with things involving science or math, and sometimes the only thing I hear in my head is a blank buzzing.

LeeD
12-02-2009, 08:01 AM
Wait a minute here....
You think you have a meniscus tear and you're RUNNING?
I couldn't even walk down steps facing forwards!
I needed the bannister to get up steps.
And for easily 2 weeks.
How can you say you have an injury when you can still run?
I can't run ONE mile with my 15 month old sprained left ankle.

Cindysphinx
12-02-2009, 08:28 AM
Wait a minute here....
You think you have a meniscus tear and you're RUNNING?
I couldn't even walk down steps facing forwards!
I needed the bannister to get up steps.
And for easily 2 weeks.
How can you say you have an injury when you can still run?
I can't run ONE mile with my 15 month old sprained left ankle.

That was the situation in 2005 with my other knee. Limped, couldn't straighten, had trouble with stairs and uneven terrain, couldn't run or play tennis (or walk very well). Turned out to be a complex tear, and he removed 15% of the meniscus and did a plica ressection.

The reason I think I have an injury now in the other knee is that the MRI said an incomplete lateral meniscus tear. I also have pain at the joint line on the medial side, which suggests a tear in the medial meniscus, although this might just be a teensy thing. That's why I think something is injured.

The problem I am having is precisely what you suggest: If the situation is grave enough to require surgery, then how come I can play tennis and run?

It manifests itself in theatre sign (pain upon straightening after I've been sitting a while) and twinges when I do certain leg exercises that require lateral movement. I can do standard lunges and squats all day long.

LeeD
12-02-2009, 08:41 AM
I thought you were a mature adult!
If you are hurting, don't do anything to hurt it!
REST, don't run, don't play tennis until it doesn't hurt.
And if it hurts after doing whatever, STOP doing it!
Rest is rest. Physical therapy is something else, and can be done while resting, but with advice from dock AND physical therapist.

Topaz
12-02-2009, 08:51 AM
Charlie...excellent explanation.

Cindysphinx
12-02-2009, 10:25 AM
I thought you were a mature adult!
If you are hurting, don't do anything to hurt it!
REST, don't run, don't play tennis until it doesn't hurt.
And if it hurts after doing whatever, STOP doing it!
Rest is rest. Physical therapy is something else, and can be done while resting, but with advice from dock AND physical therapist.

I am an old adult. I wouldn't say I'm mature. :)

I can't rest forever. I rested six weeks. I have to either keep playing (which the OS said was OK to do), adopt a sedentary lifestyle, find a new sport, or get surgery.

Topaz
12-02-2009, 10:36 AM
I am an old adult. I wouldn't say I'm mature. :)

I can't rest forever. I rested six weeks. I have to either keep playing (which the OS said was OK to do), adopt a sedentary lifestyle, find a new sport, or get surgery.

Ok, maybe I missed it, but what is keeping you from getting the surgery? Are any of those other options appealing to you in any way (I'm thinking a big, fat NO! :) )? Is it the recovery time you are worried about?

charliefedererer
12-02-2009, 10:45 AM
What every patient hates is the uncertainty in medicine, and the uncertainty the doctor lays before them as to what is actually the matter with them and how likely the problem will respond to treatment.

The doctor hates this too, but in his training and experience, comes to realize that in expressing an opinion about the cause of a condition, he really is telling you that out of a hundred similar patients, so many will turn out to have this, and so many that. The same with placing a statistical likelihood on the outcome from a procedure or treatment.

Of course the individual patient is not terribly impressed that the doctor is giving them only a percentage likelihood of what they have and how things will go. For any one patient, it is a binary outcome. Either the doctor was "right" or "wrong" in their diagnosis and similarly either "successful" or "not successful" in their treatment. It's hard for patients to appreciate the limited resolution of even high tech imaging equipment like the MRI. But many processes are only occurring at a microscopic level, with adding in the clinical symtoms only a partial clue to what is really going on. And patients could care less that physicians have in their mind's eye a very clear view of the several different potential problems going on right on right down to the molecular level. The bottom line for patients is whether they are going to get better, and how quickly is this going to happen. And our modern lifestyle is not suited to waiting the long time it takes for collagen (scar tissue) formation and crosslinking which is the basis of healing of most sports injuries.

Thus, sad to say, I can't tell you for sure if resting it further will result in improvement in your symptoms. The only way to find out for sure if rest would be of benefit would be to rest it and see what happens.

Now "rest" is a relative term for the knee. With every step we bear our entire body weight on the knee. If this was an injury of the abdominal muscle, we wouldn't try to balance ourselves on a post directly over the injured abdominal area thousands of times a day (like we do for the thousands of steps that we take on our knee). We just wouldn't consider it "rest" for our abdominal muscle injury. Likewise real "rest" for the knee would be non-weight bearing with crutches to see if it would heal optimally. Since this is so socially unacceptable, and the final outcome not a certainty, few doctors would ask you to really give your knee this type of rest. But it is that type of rest could really lets the fine fibrin strands undergo maximal crosslinking.
But again, if you do have a "bruise" area consisting of hundreds of microscoptic "tears" in the avascular central part of the meniscus, that area is going to take a lot longer to heal, and may seem to never heal, because there just is not enough oxygen and nutrients getting to the site.

All one can say with certainty, is that the odds of an area healing go up with rest. (I can see LeeD and some others are imploring you to rest as much as you implored Fedace to rest his plantar fasciitis plagued feet this summer.)

And I am very sure your orthopod hates the uncertainty of all I've just mentioned, as well as the chance that there are either loose fragments of cartilage floating around in your joint space, or a loose fragment at the joint surface, that he could get you better faster by doing the arthroscopy.

drak
12-02-2009, 11:39 AM
Wait a minute here....
You think you have a meniscus tear and you're RUNNING?
I couldn't even walk down steps facing forwards!
I needed the bannister to get up steps.
And for easily 2 weeks.
How can you say you have an injury when you can still run?
I can't run ONE mile with my 15 month old sprained left ankle.

There are various different kinds and degrees of meniscus tears, hard to compare.

drak
12-02-2009, 11:41 AM
That was the situation in 2005 with my other knee. Limped, couldn't straighten, had trouble with stairs and uneven terrain, couldn't run or play tennis (or walk very well). Turned out to be a complex tear, and he removed 15% of the meniscus and did a plica ressection.

The reason I think I have an injury now in the other knee is that the MRI said an incomplete lateral meniscus tear. I also have pain at the joint line on the medial side, which suggests a tear in the medial meniscus, although this might just be a teensy thing. That's why I think something is injured.

The problem I am having is precisely what you suggest: If the situation is grave enough to require surgery, then how come I can play tennis and run?

It manifests itself in theatre sign (pain upon straightening after I've been sitting a while) and twinges when I do certain leg exercises that require lateral movement. I can do standard lunges and squats all day long.

I could do everything with all my 3 relatively small medial meniscus tears, it came down to how much irritation I wanted to endure.

Cindysphinx
12-02-2009, 12:14 PM
How much rest? Six months? I mean, that's what's troubling me.

I had a stress fracture, I was told to rest for six weeks, I rested for six weeks, and it is healed. What didn't heal in six weeks is whatever is wrong now (which was also troubling me during the entire rest period).

What I have difficulty with is the idea of resting when I don't even know for sure what is wrong or whether rest will work. I don't know if there is a tear or where the tear is (vascular or avascular). I would feel like a total chump if I put the rackets down for six months and then found that the problems returned the minute I started playing again (in tennis skirts would have to be *one size larger*), when I could have had surgery and been back in action in 2 months.

Topaz, yeah. I don't want to take time off now; I'd rather do it next summer. But I am left with that nagging feeling that surgery should be a last resort, so why bother with it if I can run and play tennis? I mean, this ain't a pedicure. It's surgery.

Topaz
12-02-2009, 12:16 PM
Topaz, yeah. I don't want to take time off now; I'd rather do it next summer. But I am left with that nagging feeling that surgery should be a last resort, so why bother with it if I can run and play tennis? I mean, this ain't a pedicure. It's surgery.

The concern I have is that by then (next summer) it could be much worse, particularly if you continue to run and play tennis. Then that could require even more time off.

LeeD
12-02-2009, 01:58 PM
If you suspect something is wrong in the knee, stop running for sure.
You can still play recreational tennis and not competitively. It's your mind that keeps you from injury. Running is just too much stress.
Go swimming instead. I would do NEITHER. You don't need to run to live a life of tennis.

crystal_clear
12-02-2009, 06:45 PM
Hoepfully you'll know when it is time and get sound medical advice. At the end of the day though, you are the best judge as to which course of action makes the most sense.

When the judge is addictive to something, tennis in this case, he/she can’t make wise decision anymore. :D

Cindysphinx
12-02-2009, 07:04 PM
You know, I was mulling Charlie's post about the meniscus healing. Something's not right.

What concerns me is that everything I have heard/read says that there are two types of meniscus injuries: acute and degenerative. Degenerative means due to age, which is obviously my problem.

Because an older meniscus has less blood flow than a young meniscus, surgeons rarely if ever repair a meniscus in someone over 40, regardless of the location of the tear. This is because the chances that the repair will succeed are too small. And of course there is no way a surgeon will attempt a repair in the avascular portion in someone over 40.

Doesn't that suggest that a meniscus tear in someone over 40 doesn't heal no matter how much rest you get?

The various orthopedics surgeons I have seen over the years (four!) seemed to agree that treatment for a meniscus in someone my age is either surgery or lifestyle change (giving up weight-bearing exercise). None of them have ever suggested that the situation will change with rest.

That's why I had my original dilemma: To have surgery now or later. I didn't think "not at all" was a viable option if I want to keep playing tennis.

charliefedererer
12-02-2009, 08:28 PM
What concerns me is that everything I have heard/read says that there are two types of meniscus injuries: acute and degenerative. Degenerative means due to age, which is obviously my problem
Degenerative means due to multiple small traumas. A young person can have degenerative meniscus injuries if they are a skier, gymnast, figure skater, runner or tennis player.
Acute is due to one sudden blow.

Because an older meniscus has less blood flow than a young meniscus, surgeons rarely if ever repair a meniscus in someone over 40, regardless of the location of the tear. This is because the chances that the repair will succeed are too small.
Are you sure an older (over 40) meniscus has less blood flow than a young meniscus? Is it really true surgeons rarely if ever repair a meniscus in someone over 40? Have you asked your surgeon, and this is what he told you? What about the other problems that may be seen on arthroscopy and taken care of:
" Common treatments with knee arthroscopy include:
•Removal or repair of torn meniscal cartilage.
•Reconstruction of a torn cruciate ligament.
•Trimming of torn pieces of articular cartilage.
•Removal of loose fragments of bone or cartilage.
•Removal of inflamed synovial tissue."
-http://orthoinfo.aaos.org/topic.cfm?topic=a00299

Doesn't that suggest that a meniscus tear in someone over 40 doesn't heal no matter how much rest you get?
My understanding is that a minor miniscus tear in a well vascularized area will heal with rest. What does your doctor say?

The various orthopedics surgeons I have seen over the years (four!) seemed to agree that treatment for a meniscus in someone my age is either surgery or lifestyle change (giving up weight-bearing exercise). None of them have ever suggested that the situation will change with rest.
What you consider surgery, they consider a diagnostic arthroscopy, a fairly minor procedure to see if there is a problem, plus the ability improve the situation with a fairly minor procedure if a problem is seen. (To your orthopod "surgery" is something like a total knee replacement.)
They realize patients are eager for as quick a resolution to their problem as possible, particulary if they have a passion for athletic activities.

That's why I had my original dilemma: To have surgery now or later. I didn't think "not at all" was a viable option if I want to keep playing tennis.

There is a third option: rest. Ask your orthopedic surgeon if he has seen someone similar to you improve clinically if they really did rest. (Part of the problem with the rest option is a lot of patients don't really rest.)
I must admit I'm somewhat surprised you are not opting for early arthroscopy however, both for a diagnosis, and for the potential to resolve this problem as quickly as possible.

mawashi
12-02-2009, 09:51 PM
You know, I was mulling Charlie's post about the meniscus healing. Something's not right.

What concerns me is that everything I have heard/read says that there are two types of meniscus injuries: acute and degenerative. Degenerative means due to age, which is obviously my problem.

Because an older meniscus has less blood flow than a young meniscus, surgeons rarely if ever repair a meniscus in someone over 40, regardless of the location of the tear. This is because the chances that the repair will succeed are too small. And of course there is no way a surgeon will attempt a repair in the avascular portion in someone over 40.

Doesn't that suggest that a meniscus tear in someone over 40 doesn't heal no matter how much rest you get?

The various orthopedics surgeons I have seen over the years (four!) seemed to agree that treatment for a meniscus in someone my age is either surgery or lifestyle change (giving up weight-bearing exercise). None of them have ever suggested that the situation will change with rest.

That's why I had my original dilemma: To have surgery now or later. I didn't think "not at all" was a viable option if I want to keep playing tennis.

Cindysphinx,

I've gone through the opt for my medial meniscus tear on my left knee it's been 5 months n recovery is rather slow.

Personally if I knew I had to go for an opt I would rather it sooner than later. The meniscus is non vascular n won't regenerate so you risk the chance of further damage n a longer recovery if you delay it longer than necessary.

Good luck.

mawashi

Xisbum
12-03-2009, 06:24 AM
Know what you mean about the elipticals and stationary bikes; not quite the same workout as a good, steady run.

We're moving into a new office building next week, and it's much closer to the mall. I'm thinking seriously about trying some lunch runs on that soft dirt. If the knee holds up during a 2-hour tennis match on hard courts, it should handle 30-45 minutes on dirt, right? :confused:

Gotta get into decent playing shape to hold my own with all these young 4.0 whippersnappers, and the best way to do that is running.

Can't help you with your basic dilemma here, though. My knee works okay now, some 4 years post surgery, but I do feel it for 2 or 3 days after a good tennis outing. It's just something I've accepted as a fact of life. Not much help, I know, but you should do what's right for you, and it may be totally different from what's right for me.

I'm with you, whatever you chose - knee buds to the end! :)

chess9
12-03-2009, 06:38 AM
To throw more into the mix, CinCin, new treatments are coming out all the time. For instance, look at these clinical trials:

http://www.regeneron.com/monoclonal_antibodies.html

I suspect that some of these degenerative diseases will be colored GONE within 10-15 years, or a lot sooner. Also, some stem cell lines were released by the president yesterday, which will spur research into many diseases.

I expect to be running faster in 10 years than I am now because of the developments in lung treatments (I have asthma), CAD, heart disease, and joints.

Good luck, Cindy!

-Robert

charliefedererer
12-03-2009, 07:32 AM
To throw more into the mix, CinCin, new treatments are coming out all the time. For instance, look at these clinical trials:

http://www.regeneron.com/monoclonal_antibodies.html

I suspect that some of these degenerative diseases will be colored GONE within 10-15 years, or a lot sooner. Also, some stem cell lines were released by the president yesterday, which will spur research into many diseases.

I expect to be running faster in 10 years than I am now because of the developments in lung treatments (I have asthma), CAD, heart disease, and joints.

Good luck, Cindy!

-Robert

Great point about advances in medicine always seem to be coming out. But it's always hard to know about research. Advances may be only a few years away or many.
Modulation of the inflammatory response to sports injuries has the potential to end protracted bouts of things like tennis elbow and plantar fasciitis, but for degenerative joint disease it's not the inflammation that's the primary problem. The primary problem is the mechanical injury from taking your entire body weight and accelerating it by running and jumping and coming down on our knees and hips, with all that energy being absorbed by the cartilage. The inflammatory response is needed to heal all the microspic tears and fissures in the collagen matrix. And some degree of permanent mechanical compression of that matrix is going on as well.
It's "fairly easy" to grow chondrocytes, the living cells in cartilage, in tissue culture. The much more elusive goal has been for them to form the extracellular matrix that will have the architecture, strength, resiliancy and adhesion to replace damaged cartilage. And how are the conditions of embryonic development going to be simulated for weight bearing cartilage going to be developed in the lab or in situ in diseased adult joints? So stem cell therapy for damaged cartilage is probably still quite far off.
And will insurers approve incredibly expensive therapies so adults can continue to play games? Hopefully yes, but time will tell.

Xisbum
12-03-2009, 07:34 AM
To throw more into the mix, CinCin, new treatments are coming out all the time. For instance, look at these clinical trials:

http://www.regeneron.com/monoclonal_antibodies.html

I suspect that some of these degenerative diseases will be colored GONE within 10-15 years, or a lot sooner. Also, some stem cell lines were released by the president yesterday, which will spur research into many diseases.

I expect to be running faster in 10 years than I am now because of the developments in lung treatments (I have asthma), CAD, heart disease, and joints.

Good luck, Cindy!

-Robert

I like the way you think. I saw an article a few weeks back - sorry, no link - about research in Thailand using a person's own stem cells to regenerate arthritic cartilage. I'm keeping an eagle eye out for clinical trials in the U.S., cuz I want to be first in line to volunteer. :)

Hold on, knee, hold on.

Cindysphinx
12-03-2009, 12:30 PM
Doing this surgery would be difficult now. I see two possible problems.

First, this is the right knee. That would be the knee I use to drive. My kids need a lot of driving for after-school activities now; this will be less of a problem next summer. Don't even get me started on the houseguests who have just said they will arrive next Thursday -- the day I had tried to schedule the surgery.

Second, missing a few months as Mawashi says would be no big deal next May. It would be a very big deal right now. If I did the surgery now, I would probably try to play as early as possible, even if I wasn't really ready. That's an injury waiting to happen. If I wait until May, then I have until September to recover and I am less likely to rush back because there is no league tennis in the summer.

There are a lot of unknowns. But I think I need to wait.

I could pay a $25 co-pay and ask my doc what would happen if I rested for six weeks or six months. I think I will save the money and use it to treat myself to sushi, because I can guess his answer: "Cindy, I don't know for sure what is wrong with your knee, so I can't possibly know if rest will fix it."

Topaz
12-03-2009, 02:18 PM
^^^Oh, see, for us May is smack dab in the middle of the season, and that would be a decidedly *bad* time to be out. I think you guys wrap up a bit before us, though, right?

Cindysphinx
12-03-2009, 02:36 PM
We tend to start Adult season in mid-April. If I front-load my matches, I can play 4-5 times by the end of May, and then I can bail. If I hold off on surgery, I can play winter mixed, winter day ladies (which counts for rating) and winter combo, all of which end in March.

Mike Cottrill
10-20-2010, 07:44 AM
"Physical exam says medial meniscus tear."
Apparently there is no defect on the usually sensative MRI, so thankfully at least it's unlikely that there is a large tear. But this is the area of tenderness on physical exam, so there may be a small tear there. Or maybe its an area of "bruise" with mutliple micro tears that won't be visible even on arthroscopy at the surface of the cartilage.

HI Charlie,
Excellent information you have provided in this thread. I know this tread is pretty old, but I’m hoping you are still around.
My understanding years ago it was standard and accepted practice to perform a complete meniscectomy when the meniscus was damaged. Years later the orthopedic community discovered this was a bad practice. Many of those that had this done are now suffering with osteoarthritis, many recurring procedures to remove bone spurs and such and trying to postpone knee replacement. Today it appears the community considers arthroscopy a minor procedure with minimal risk with little discussion of thrombosis or onset osteoarthritis. Have there been any published studies/results that report the long term effects of performing arthroscopy or not arthroscopy with regards to osteoarthritis in the case you outlined above?

Thanks

charliefedererer
10-20-2010, 08:31 AM
It would be hard to really compare arthroscopy to no arthroscopy for the long term outcome of patients undergoing arthroscopy for meniscal tears.
There is the initial selection bias of those with more severe meniscal tears and those eager to return to their sport or function who would opt out of a study to be sure to undergo arthroscopy. The study group left could be criticised as patients with minor tears and relatively inactive.
Another big problem is there would have to be many years of follow up to get the final result, and it is hard (and expensive in study design) to keep patients coming back for follow up for the 10-50 years to determine if osteoarthritis occurs, and to what extent it does occur.
Also, meniscal tears imply a certain amount of injury to the knee, and it would be hard to group patients into classes of patients dependent on the amount of associated bone, cartilage and ligament damage. (Although major damage can be assessed clinically and on MRI, more subtle associated initial damage, which long term could lead to osteoarthritis, may be missed with current MRI imaging.)
And a study done over many years would have to include the varying activity levels of partipants, some who continue as "weekend warriors" and the many who become "couch potatoes".

Howerver you may find it interesting to read the results of the following study published in the New England Journal of Medicine. It compared patients already with osteoarthritis who do or do mot undergo arthroscopy with the goal of improving their pain or function: A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee (You can read the full study at http://www.nejm.org/doi/full/10.1056/NEJMoa013259#t=article)

"When medical therapy fails to relieve the pain of osteoarthritis of the knee, arthroscopic lavage or débridement is often recommended. More than 650,000such procedures are performed each year1 at a cost of roughly $5,000 each. In uncontrolled studies of knee arthroscopy for osteoarthritis, about half the patients report relief from pain.2-16 However, the physiological basis for the pain relief is unclear. There is no evidence that arthroscopy cures or arrests the osteoarthritis. Therefore, we conducted a randomized, placebo-controlled trial to assess the efficacy of arthroscopic surgery of the knee in relieving pain and improving function in patients with osteoarthritis. Both patients and assessors of outcome were blinded to the treatment assignments."

"Results
At no point did either of the intervention groups report less pain or better function than the placebo group. For example, mean (±SD) scores on the Knee-Specific Pain Scale (range, 0 to 100, with higher scores indicating more severe pain) were similar in the placebo, lavage, and débridement groups: 48.9±21.9, 54.8±19.8, and 51.7±22.4, respectively, at one year (P=0.14 for the comparison between placebo and lavage; P=0.51 for the comparison between placebo and débridement) and 51.6±23.7, 53.7±23.7, and 51.4±23.2, respectively, at two years (P=0.64 and P=0.96, respectively). Furthermore, the 95 percent confidence intervals for the differences between the placebo group and the intervention groups exclude any clinically meaningful difference."

"Discussion
This study provides strong evidence that arthroscopic lavage with or without débridement is not better than and appears to be equivalent to a placebo procedure in improving knee pain and self-reported function. Indeed, at some points during follow-up, objective function was significantly worse in the débridement group than in the placebo group.
Arthroscopy is the most commonly performed type of orthopedic surgery, and the knee is by far the most common joint on which it is performed.1 Numerous uncontrolled, retrospective case series have reported substantial pain relief after arthroscopic lavage or arthroscopic débridement for osteoarthritis of the knee.2-16 In the only previous double-blind, randomized, controlled trial of knee arthroscopy of which we are aware,34 patients with minimal osteoarthritis as assessed by radiography were assigned to undergo arthroscopic lavage with either 3000 ml of fluid (treatment) or 250 ml of fluid (control) and were followed for one year. Both the treatment and the control groups reported improvement in function at 12 months, and although the report interprets the study as having proved the efficacy of lavage, there was no statistically significant difference between the groups in terms of the primary outcome at any point during follow-up.

To explain the improvement that has been reported after these procedures, some have proposed that the fluid that is flushed through the knee during arthroscopy cleanses the knee of painful debris and inflammatory enzymes.4,6,9,15,16,34 Others have suggested that the improvement is due to the removal of flaps of articular cartilage, torn meniscal fragments, hypertrophied synovium, and loose debris.2-14 However, our study found that outcomes after arthroscopic treatment are no better than those after a placebo procedure. This lack of difference suggests that the improvement is not due to any intrinsic efficacy of the procedures. Although patients in the placebo groups of randomized trials frequently have improvement, it may be attributable to either the natural history of the condition or some independent effect of the placebo.

Because we found no evidence that lavage or débridement is superior to a placebo procedure, the question arises whether these arthroscopic procedures could have small but clinically important benefits that we missed because of our limited sample size. To evaluate this possibility, we determined the size of the clinical benefit that the trial was able to rule out, using the minimal important difference for each of our scales. Because estimates of minimal important differences based on different samples and different methods do not yield the same values, we used the midpoint of the range of available minimal important differences in order to test our hypothesis about the equivalence of the three procedures. For the great majority of comparisons, the 95 percent confidence intervals did not contain the minimal important difference, indicating that there was not a clinically important improvement that the study had simply failed to detect.

One surgeon performed all the procedures in this study. Consequently, his technical proficiency is critical to the generalizability of our findings. Our study surgeon is board-certified, is fellowship-trained in arthroscopy and sports medicine, and has been in practice for 10 years in an academic medical center. He is currently the orthopedic surgeon for a National Basketball Association team and was the physician for the men's and women's U.S. Olympic basketball teams in 1996.

The principal limitation of this study is that our participants may not be representative of all candidates for arthroscopic treatment of osteoarthritis of the knee. Almost all participants were men, because the study was conducted at a Veterans Affairs medical center. We do not know whether our findings may be generalized to women, although uncontrolled studies do not indicate that there are differences between the sexes in responses to arthroscopic procedures.8,10,13 A selection bias might have been introduced by the fact that 44 percent of the eligible patients declined to participate in the study. We believe this high rate of refusal to participate resulted from the fact that all patients knew they had a one-in-three chance of undergoing a placebo procedure. Patients who agreed to participate might have been so sure that an arthroscopic procedure would help that they were willing to take a one-in-three chance of undergoing the placebo procedure. Such patients might have had higher expectations of benefit or been more susceptible to a placebo effect than those who chose not to participate.

If the efficacy of arthroscopic lavage or débridement in patients with osteoarthritis of the knee is no greater than that of placebo surgery, the billions of dollars spent on such procedures annually might be put to better use. This study has also shown the great potential for a placebo effect with surgery, although it is unclear whether this effect is due solely to the natural history of the condition or whether there is some independent effect. Researchers should reconsider the best ways of testing the efficacy of surgical procedures performed purely for the improvement of symptoms. In the debate about placebo-controlled trials of surgery, the critical ethical considerations surround the choice of the placebo. Finally, health care researchers should not underestimate the placebo effect, regardless of its mechanism.35"

"Conclusions
In this controlled trial involving patients with osteoarthritis of the knee, the outcomes after arthroscopic lavage or arthroscopic débridement were no better than those after a placebo procedure."

I included the introduction and discussion sections to give TT readers a taste of what is included in the legitimate medical literature. It also provides an insight that physicians are concerned with the rising cost of health care, as well as to providing the best possible care for their patients.

I hope this helps.

Mike Cottrill
10-20-2010, 09:57 AM
Great read Charlie,

Just to clarify for the layman and correct me if I’m wrong,
1) This study assumes no damage to the meniscus (cause of pain)
2) This study did not include meniscus débridement (meniscus tissue/tear as cause of pain)

charliefedererer
10-20-2010, 10:29 AM
Actually in the debridement group, meniscal fragments were removed, and the meniscus was smoothed as much as possible. In what was supposed to be the "lavage [rinse the joint out with water] only" group, the orthopedic surgeon did not think it was ethical to leave a grossly deformed meniscus, as this would be against standard best medical practice.

It should be noted that there were three equal sized groups in the study. One group underwent only lavage of the knee, one underwent debridement, and the third "sham" surgery. The following quotes are from the paper http://www.nejm.org/doi/full/10.1056/NEJMoa013259#t=article :

"Lavage
After diagnostic arthroscopy in patients in the lavage group, the joint was lavaged with at least 10 liters of fluid. Anything that could be flushed out through arthroscopic cannulas was removed. Normally, no instruments were used to mechanically débride or remove tissue. However, if a mechanically important, unstable tear in the meniscus (e.g., a displaced “bucket-handle” tear) was encountered, the torn portion was removed and the remaining meniscus was smoothed to a firm, stable rim. (There is general agreement that it is inappropriate to leave this type of meniscal tear untreated.11,13,19,20) No other débridement was performed."

"Débridement
After diagnostic arthroscopy in patients in the débridement group, the joint was lavaged with at least 10 liters of fluid, rough articular cartilage was shaved (chondroplasty was performed), loose debris was removed, all torn or degenerated meniscal fragments were trimmed, and the remaining meniscus was smoothed to a firm and stable rim. No abrasion arthroplasty or microfracture was performed. Typically, bone spurs were not removed, but any spurs from the tibial spine area that blocked full extension were shaved smooth."

"Placebo Procedure
To preserve blinding in the event that patients in the placebo group did not have total amnesia, a standard arthroscopic débridement procedure was simulated. After the knee was prepped and draped, three 1-cm incisions were made in the skin. The surgeon asked for all instruments and manipulated the knee as if arthroscopy were being performed. Saline was splashed to simulate the sounds of lavage. No instrument entered the portals for arthroscopy. The patient was kept in the operating room for the amount of time required for a débridement. Patients spent the night after the procedure in the hospital and were cared for by nurses who were unaware of the treatment-group assignment."

"Postoperatively, there were two minor complications and no deaths. Incisional erythema developed in one patient, who was given antibiotics. In a second patient, calf swelling developed in the leg that had undergone surgery; venography was negative for thrombosis. In no case did a complication necessitate the breaking of the randomization code."

"Postoperative care was delivered according to a protocol specifying that all patients should receive the same walking aids, graduated exercise program, and analgesics. The use of analgesics after surgery was monitored; during the two-year follow-up period, the amount used was similar in the three groups."

The paper was printed in 2002. This highlights one of the other problems with a medical study, namely that the results are valid for the time period tested, but not necessarily for a long time into the future. The patients were treated in the period from 1995-1998, and of course the proposal for the had to be written up, the proposal submitted and accepted for a grant that would pay for it, the merits and risks reviewed by scientific and ethics panels, before the first patient could even be entered into the study. At that time neither the MRI imaging or the arthrosopy equipment was as sophisticated as it is today. Indeed, there is no mention of the paper that MRI was used to catagorize patients; the clinical [pain and functional] status of the patient was used to determine if they were eligible for the study.

(Also of mention is the difficulty of getting patients to agree to be in a study where they may recieve a "sham" procedure. How likely would you participate in a study where you were told you have a 1 in 3 chance of wasting your time in pre-op, op and post-op care, never mind the pain associated with incisions (no matter how small), and potential post-procedure complications? This is just another reason why true controlled surgical procedures are so rarely done.)

Mike Cottrill
10-20-2010, 01:48 PM
Thanks Charlie,
If there were meniscus procedures done and no improvement could it be concluded that would be a bigger finding? Taking into account this study only, if a MRI is negative or inclusive, it would seem the procedure should only be done after a given amount of time and rest.

charliefedererer
10-21-2010, 05:58 AM
=Mike Cottrill;5134631]Thanks Charlie,
If there were meniscus procedures done and no improvement could it be concluded that would be a bigger finding? The fact that meniscal procedures were done in the debridement and irrigation patients, but still no overall improvement in symptoms or function from the sham operation group, may indicate that meniscal shaving/removal gives less symptomatic relief than currently thought. But the study had too few (180) patients, and wasn't properly designed to really answer that question. It is also possible (maybe even probable) that patients with obvious meniscal tears on MRI were exluded from the study, so those tears found at arthroscopy were not as major as those for which most patients undergo repair/debridement/removal. Also, the average age of the patients in this study was about 55, and there is no indication how many of them were playing tennis, or indeed involved in any present or past sports. So one really needs to be careful speculating on the implications of a study outside of the questions the study was designed to answer.

Taking into account this study only, if a MRI is negative or inclusive, it would seem the procedure should only be done after a given amount of time and rest. The conclusion from this study was that patients with chronic knee pain or limitation of function from chronic knee osteoarthritis could not expect to benefit with arthroscopy with or without debridement of loose cartilage or removal of "floating" debris in the knee joint.
Again, this is generalization. Any one individual may have a specific problem that in the opinion of his orthopedic surgeon would benefit from an arthroscopic procedure.

Ken Honecker
10-22-2010, 12:24 AM
Oct 8th I had my knee scoped. Prior to going under the knife they took a MRI, found 2 tears in the menicus, and told me I "would greatly benefit from the procedure". The day after the operation my knee felt great, better than it had for months. Heck I could have played tennis on it. However since then it is swollen and sore. I do think it is getting about 1-2% better each day and if it hadn't felt so great right afterwards I'd probably be happy with that but now I'm not as pumped.
I guess 2 weeks after having a "signifigant tear" which had folded under itself removed I shouldn't expect my 53 year old body to be completely healed. I was wondering how long it took other people to lose the swelling and begain to reap the benifits of the procedure?

Cindysphinx
10-22-2010, 05:27 AM
Oct 8th I had my knee scoped. Prior to going under the knife they took a MRI, found 2 tears in the menicus, and told me I "would greatly benefit from the procedure". The day after the operation my knee felt great, better than it had for months. Heck I could have played tennis on it. However since then it is swollen and sore. I do think it is getting about 1-2% better each day and if it hadn't felt so great right afterwards I'd probably be happy with that but now I'm not as pumped.
I guess 2 weeks after having a "signifigant tear" which had folded under itself removed I shouldn't expect my 53 year old body to be completely healed. I was wondering how long it took other people to lose the swelling and begain to reap the benifits of the procedure?

Answer: A long time.

It's hard to remember how long it took for me to think my knee was 100% better. I remember I returned to tennis at perhaps 8 weeks but was still pretty gimpy.

Trouble was, the knee/muscles were still pretty weak. I developed poor kneecap tracking, and that took a lot of extra physical therapy (about 4 months post-op) to correct. I think it was over a year before I could resume tennis without constantly worrying about and babying my knee and could do a long run (1 hour).

It has now been about 1 year since I got the injury in my "good" knee that caused me to start this thread. That injury was a bone bruise, stress fracture and lateral meniscus tear.

I decided not to have the surgery, and I think that was the right decision. Things have gotten better very slowly. My limitations with the knee are that I feel it if I try to do a long run, so I have stopped doing my weekly long run. I also feel it when I try to do sprints, but I do them anyway. I feel that my foot speed has suffered, but there is nothing to be done for that.

Bottom line: I have reduced my Advil consumption to zero, so that means everything is dandy!

Ken Honecker
10-23-2010, 01:58 AM
Cindy you had your's stitched back together rather than part removed didn't you? It is my understanding that takes longer to heal. Me they just scooped some out. I'm not going through PT as my Doc agreeded that a person as willing as I to abuse myself on my own probably didn't need it. They gave me a silly little sheet of exercises to do which are pretty much isometric and might be helpful for an 80 year old or someone who had been babying the thing for a couple of years but heck I was squating 410 pounds and playing up to 3 hours of tennis on it all the while. I have a hard time seeing how my muscles could be weak after 3 hours in the clinic.

The MRI tech and also the handout they gave me post op talk about getting the leg fully extended. Which is so not me since I've never not been able to straighten it. It has now been 2 weeks and I am seriously thinking of hopping on the Bowflex and putting some really low weights on like maybe 20 pounds and doing a bunch of work.

I'm glad to hear yours has healed up. I gave mine a year from the first injury and about 7 months from the second and if anything it was slowly getting worse. It really bothered me going up stairs. It didn't so much hurt running but damn I was slow. In tennis I could charge the net nicely but my lateral movement was poor, probably because I wasn't getting a good push off. Pretty much every night I had to take pills and put mineral ice on it and still sometimes it took me a couple of hours to get to sleep because of the discomfort.

kelkat
02-07-2011, 05:05 AM
Charlie, you still around. I could use your input and others in the know. Here is my story. Sorry it is so long.

Activities:
I am an very active league tennis player, 51 years young. Before knee pain I would play tennis 8-12 hrs hours per week, usually in
2 hr increments. However there were times I would play 2 hrs, off for 1 hr and then back on for 2 hrs.

I worked out for 40 minutes a couple times a week on the elliptical trainer. I warm and stretch before and after each workout and
tennis match. My knee problem is caused me to take 2 months off, and now alters my tennis schedule, and has caused me to
cancel matches.

1st Ortho findings:
Pain started in mid Nov. Went to my neuro-muscular therapist 2x a week. After the first session, he wondered if I had a
meniscus tear so I made an appt with my orthopod that did wonders for my tennis elbow. He ordered an
MRI. Report came back with arthritis, and degenerative meniscus. No tears. Continued therapy and stayed off for 3 weeks
Felt 90% better. While playing tennis on Dec 1st I experienced a snap or pop with my first right lateral movement to the ball.
I felt pain and weakness in my right knee immediately.

Went back to Orthopod. He took xrays, and said that I probably just aggrevated it. I asked for another MRI because it felt
like an injury. Insurance approved a 2nd MRI even though my initial MRI was less than 4 weeks prior. This time I went to a
different facility for the MRI for a different read. Nothing different was found on the 2nd MRI. Dr briefly moved my knee around,
pressing on different spots, etc. I got a cortizone injection to ease the swelling.

Symptoms:
Pain started on the outside of the right knee joint. On a scale of 1-10 at it’s worst it was an 7-8.
After coritsone injection, no pain, no swelling. Continued therapy.
After1 month rest, played tennis. Pain is different., no longer is on right side of knee joint, pain is overall and feels swollen and very tight.
Swelling in and around the knee after playing tennis, and at the end of the day. Ice makes it feel better.
Little pain when doing elliptical.
Inexplicable muscle tightness in the left quadriceps and ITB. Stretching provides temporary relief. With use, tightness returns.
Walking down stairs hurts. I have to limp or favor the left leg in order avoid pain.
I have limited range of knee joint flexion, to about 90 degrees with pain.


2nd Ortho findings:
Made an appt with a different Orthopod.
He is also an Orthopod to the NY Islanders, and the Jets for whatever that is worth. He came highly recommended. I brought my2nd MRI (on disc)
gave him my history, except I didn’t give him the MRI report, and didn’t tell of initial findings. I wanted to see what he saw
with no influence of prior dx. He loaded the disc and went to a couple of specific views. He stopped at one frame view,
and went back and forth with the progression. He showed us a meniscus tear and it seemed pretty obvious to my
untrained eye., and my husbands.He also noted a small pot hole in my cartilage exposing bone (osteochondritis). Then he examined my
knee much more thoughly than the previous dr..... including doing the McMurray test, which sent me into orbit with pain.
My husband who was there said the sound of my knee cracking sounded like a bat hitting a ball during on a crisp April day
during spring training. That test confirmed the tear.

Options:
Dr asked how much court time do I want to keep playing. I said I would be thrilled with 3x a week on the court, all dbles.
Options are:
• Cortizone shot with a glue type agent that will bond, not heal tear. He is not a fan of this.
• A series of 3 Euflexxa injections. 7 weeks rehab time. Lasts anywhere from 4 - 12 months. Not permanent and will most
likely have to redo periodically.
• I asked about surgery. He said they can go in and sew up the tear and do a microfracture procedure to mend the small cartliage
pothole. 3 months on crutches and 3 month rehab.
• He recommends the Euflexxa route. Mainly because of the difficult rehab. I have two kids 10 and 13 with a 2 story house, etc.

Questions:
After the weekend to think, my questions for him are:
• Can they fix the meniscus and leave the pothole? Pothole is right above tear. Meniscus recovery is not nearly as long. No crutches.
What are the risks of leaving the pothole alone? With menisicus repaired, would I not get the bone on bone grinding?
•If pothole not fixed, is this encouraging more arthritis in the future?
• If I do the injections repeatedly, am I just prolonging the inevitable? Then needing surgery 3-4 years down the line when older?

Any thoughts are appreciated. This is very difficult decision. I’ve read articles on microfacture procedures, athletes who have had it -- the successes, and not so great results. I am thinking about going for one more opinion, basically to see if someone else can point out and confirm the tear.

Cindysphinx
02-07-2011, 10:58 AM
Cindy you had your's stitched back together rather than part removed didn't you?

Sorry, I just now saw this, Ken.

No, I didn't have a repair. They just cut and trimmed.

charliefedererer
02-07-2011, 06:43 PM
Charlie, you still around. I could use your input and others in the know. Here is my story. Sorry it is so long.

Activities:
I am an very active league tennis player, 51 years young. Before knee pain I would play tennis 8-12 hrs hours per week, usually in
2 hr increments. However there were times I would play 2 hrs, off for 1 hr and then back on for 2 hrs.

I worked out for 40 minutes a couple times a week on the elliptical trainer. I warm and stretch before and after each workout and
tennis match. My knee problem is caused me to take 2 months off, and now alters my tennis schedule, and has caused me to
cancel matches.

1st Ortho findings:
Pain started in mid Nov. Went to my neuro-muscular therapist 2x a week. After the first session, he wondered if I had a
meniscus tear so I made an appt with my orthopod that did wonders for my tennis elbow. He ordered an
MRI. Report came back with arthritis, and degenerative meniscus. No tears. Continued therapy and stayed off for 3 weeks
Felt 90% better. While playing tennis on Dec 1st I experienced a snap or pop with my first right lateral movement to the ball.
I felt pain and weakness in my right knee immediately.

Went back to Orthopod. He took xrays, and said that I probably just aggrevated it. I asked for another MRI because it felt
like an injury. Insurance approved a 2nd MRI even though my initial MRI was less than 4 weeks prior. This time I went to a
different facility for the MRI for a different read. Nothing different was found on the 2nd MRI. Dr briefly moved my knee around,
pressing on different spots, etc. I got a cortizone injection to ease the swelling.

Symptoms:
Pain started on the outside of the right knee joint. On a scale of 1-10 at it’s worst it was an 7-8.
After coritsone injection, no pain, no swelling. Continued therapy.
After1 month rest, played tennis. Pain is different., no longer is on right side of knee joint, pain is overall and feels swollen and very tight.
Swelling in and around the knee after playing tennis, and at the end of the day. Ice makes it feel better.
Little pain when doing elliptical.
Inexplicable muscle tightness in the left quadriceps and ITB. Stretching provides temporary relief. With use, tightness returns.
Walking down stairs hurts. I have to limp or favor the left leg in order avoid pain.
I have limited range of knee joint flexion, to about 90 degrees with pain.


2nd Ortho findings:
Made an appt with a different Orthopod.
He is also an Orthopod to the NY Islanders, and the Jets for whatever that is worth. He came highly recommended. I brought my2nd MRI (on disc)
gave him my history, except I didn’t give him the MRI report, and didn’t tell of initial findings. I wanted to see what he saw
with no influence of prior dx. He loaded the disc and went to a couple of specific views. He stopped at one frame view,
and went back and forth with the progression. He showed us a meniscus tear and it seemed pretty obvious to my
untrained eye., and my husbands.He also noted a small pot hole in my cartilage exposing bone (osteochondritis). Then he examined my
knee much more thoughly than the previous dr..... including doing the McMurray test, which sent me into orbit with pain.
My husband who was there said the sound of my knee cracking sounded like a bat hitting a ball during on a crisp April day
during spring training. That test confirmed the tear.

Options:
Dr asked how much court time do I want to keep playing. I said I would be thrilled with 3x a week on the court, all dbles.
Options are:
• Cortizone shot with a glue type agent that will bond, not heal tear. He is not a fan of this.
• A series of 3 Euflexxa injections. 7 weeks rehab time. Lasts anywhere from 4 - 12 months. Not permanent and will most
likely have to redo periodically.
• I asked about surgery. He said they can go in and sew up the tear and do a microfracture procedure to mend the small cartliage
pothole. 3 months on crutches and 3 month rehab.
• He recommends the Euflexxa route. Mainly because of the difficult rehab. I have two kids 10 and 13 with a 2 story house, etc.

Questions:
After the weekend to think, my questions for him are:
• Can they fix the meniscus and leave the pothole? Pothole is right above tear. Meniscus recovery is not nearly as long. No crutches.
What are the risks of leaving the pothole alone? With menisicus repaired, would I not get the bone on bone grinding?
•If pothole not fixed, is this encouraging more arthritis in the future?
• If I do the injections repeatedly, am I just prolonging the inevitable? Then needing surgery 3-4 years down the line when older?

Any thoughts are appreciated. This is very difficult decision. I’ve read articles on microfacture procedures, athletes who have had it -- the successes, and not so great results. I am thinking about going for one more opinion, basically to see if someone else can point out and confirm the tear.

I'm sorry to hear you are having such difficulty.

For the specific questions, you will have to ask your orthopod. For instance, an isolated repair of the meniscus tear may be doomed if the underlying cartilage defect ("pothole") is so deep and so shaped that the meniscus is just pushed down into the depression by the overlying bone in and tears again.

The problem is the uncertainty of the outcome even if you undergo the bigger procedure. Perhaps it would give you the best chance of a very good long term outcome. But there is a chance after going through the procedure and being laid up on crutches that you will be no better. You would have to ask your orthopedic surgeon what those odds are in someone in your age group, size and physical condition.

What is a certainty, is that if you undergo the bigger procedure is that you will be much worse off for months. Can you and your family really handle your being on crutches for months, followed by months of rehab?

There are no right or wrong answers here. You can only do the best you can do by making a decision you can based on probabilities, not certainties of outcome.

kelkat
02-08-2011, 06:38 PM
Thanks Charlie. Calling tomorrow with the questions I posted.
I think that I am leaning towards the injections for now.
And then go from there :)

Thanks again.