Second Knee Op in 18 months.

Discussion in 'Health & Fitness' started by Red Sunset, Sep 2, 2012.

  1. Red Sunset

    Red Sunset Rookie

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    Hi There.
    I'm 32 years old and am headed for my second knee op in 18 months.
    Last time I tore the meniscus in my right knee. Now I've got a complex meniscus tear of the OTHER knee.
    Has anybody had any experience coming back from these sorts of cartilage tears? Both time I did it running backwards for an overhead.

    I'm a little overweight, so this is probably going to be my first solution.
    I'm a 4.0 - 4.5 rated player and played a lot when I was younger, then had quite a long lay off, and then got back in to it again.

    Should I give up on tennis for my knee's sake?
     
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  2. ollinger

    ollinger Legend

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    You may have seen in some newpapers or magazines reports of a pretty good study recently published on this topic. Conclusion was that if you have any evidence of arthritis in the knee, a meniscus procedure is worthless. And if you have arthritis there, you're likely headed for a knee replacement procedure down the road so, if that's the case, you'd likely be better off doing something other than tennis.
     
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  3. Red Sunset

    Red Sunset Rookie

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    Thanks for replying Ollinger. I don't think I have any arthritis. At least, MRI report didn't say anything about it. I think it's just straight cartilage damge.
     
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  4. Chas Tennis

    Chas Tennis Hall of Fame

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    posture?

    There have been several threads in the last year discussing posture and its relation to knee and foot problems. I believe that this is very important for many people and is important for me.

    Hopefully, you do not have advanced arthritis. Some indication of cartilage condition is the knee cartilage spacing on an X-Ray taken specially to show it. Ask your Dr to discuss this spacing.

    If you have had MRIs request the written reports that the specialist who examined the images wrote. It lists the injury and is literally also a checklist of the other conditions of your knee. Some issues may not be discussed very much by your Dr. I ask for the MRI report at the lab when I get the MRI but your Dr will also have a copy. Search the terms to get an idea of your knee condition and discuss with your Dr.

    One important aspect is that the knee and foot receive much of their alignment from muscles in the hip, pelvis and butt areas. These muscles tend to get tight or weak and affect the knee and foot.

    My first meniscus tear was in 1999. I gave it 4 months to heal and it didn't. Surgery was successful. It was injured when I had gone back for an overhead late in the match and was tired. The second meniscus tear of the other knee was in 2011, I rested for 3 months, started back very slowly (4-6 weeks) and had PT for posture issues identified by a sports medicine specialist. Both knees feel good now and do not affect my tennis.

    Search terms including TW forums: Trendelenburg, posture gluteus medius,
    Chas Tennis posture, piriformis stretch, Posture Guy knee,

    http://en.wikipedia.org/wiki/Trendelenburg's_sign

    A few recent TW threads:
    http://tt.tennis-warehouse.com/showthread.php?t=435344&highlight=knee+posture+Chas+Tennis
    http://tt.tennis-warehouse.com/showthread.php?t=401903&highlight=knee+posture+Chas+Tennis
    http://tt.tennis-warehouse.com/showthread.php?t=414073
    http://tt.tennis-warehouse.com/showthread.php?t=413973&highlight=posture+guy+knee+foot+orthodics

    There's
    1) getting older
    2) misusing your body as with lack of conditioning, risky posture, bad technique.
    3) failure to allow healing.

    My goal is to understand #2 and #3.
     
    Last edited: Sep 3, 2012
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  5. Red Sunset

    Red Sunset Rookie

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    Thanks heaps Chas. I got a copy of the MRI report, and appart from significant knee effusion, it says the rest is all ok. Interesting that going back for a smash seems to be a common way of tearing the meniscus. I've joined a gym to do "pre-hab" and make sure my quads, calves, etc are strong. I'm also going to start doing beginner Pilates to improve my flexibility overall. It's great to hear that your injuries don't effect your tennis now. I'd hate to have to give it up at 32!
     
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  6. TCF

    TCF Hall of Fame

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    ====================================================
     
    Last edited: Oct 25, 2012
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  7. Ashley D

    Ashley D Rookie

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    Thanks for the post TCF. I'm heading for knee surgery soon too. Sorry you've had so many knee issues, but it's very encouraging for me to hear that you have fully recovered. I'm hoping to have surgery in about 6 weeks and then be back on court early next year.
     
    Last edited: Sep 2, 2012
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  8. TCF

    TCF Hall of Fame

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    ====================================================
     
    Last edited: Oct 25, 2012
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  9. usta2050

    usta2050 Rookie

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    I think you should give up hard court tennis if your knee hurts a lot and further damages can cause disability when you are older like 60+.
     
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  10. usta2050

    usta2050 Rookie

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    For 3), I try to play every 2 to 3 days instead of everyday. and stretch a lot everyday. also, people told me core strength is very important to the knee.
     
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  11. charliefedererer

    charliefedererer Legend

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    As long as there is no evidence of articular cartilage damage on MRI (or at your arthroscopy), you may not be at high risk for degenerative osteoarthritis.



    [​IMG]

    [​IMG]


    Weight loss is critical if you expect to continue playing tennis. Degenerative osteoarthritis is not usually caused by a single injury. It usually is the result of small micro traumas over time.
    Lose weight and there is less force on your articular cartilage every time you step or jump.


    Jumping around on the court with small spit steps may actually be good for your your knees!
    Huh?!!!
    When you go down into a split step, you are using your leg muscles to absorb the shock.
    Something I've noticed: those who are overweight don't split step and hop around the court, absorbing the force with their legs. They land with one thud on their knees, and don't let their body weight fall over a distance.
    Tommy Haas practicing at 2009 LA tennis http://www.youtube.com/watch?v=u6avhDgY1l8


    The squat is actually a great exercise to protect your knee. It is a closed chain exercise, so there is no "lever action" eccentrically pulling on your knee like a leg extension.
    Squats strengthen every leg muscle, plus your core muscles, plus the muscles that connect the legs to the core.
    Walking lunges are a great way to take the strength gained from lunges and make it into usable strength for better movement and to better absorb shock at the knee.
     
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  12. Chas Tennis

    Chas Tennis Hall of Fame

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    CF, do you have some illustrations showing how the meniscus cartilage and the articulate cartilage work together?

    The articulate cartilage is fixed on the bone ends, more part of the bone. The meniscus cartilage is in between them, sort of tied down at its ends. The meniscus is freer to move around within the knee joint and that's probably one reason that the meniscus injury is the most common knee injury.

    I had 30-40% (surgeon's estimate) of my right meniscus removed 12 years ago. I'm not young, have played a lot of tennis and the knee feels fine. I asked my Dr, also the surgeon, how much of the meniscus could be removed and still have it function, he said 85%. I have never accepted that.
     
    Last edited: Sep 7, 2012
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  13. usta2050

    usta2050 Rookie

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    wow, thank you for the excellent tips!

    i also try to stretch in between games to loosen my calves. the looser I am the more smaller steps I can do.
     
    Last edited: Sep 8, 2012
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  14. Red Sunset

    Red Sunset Rookie

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    Thanks for all the advice guys. I think weight loss is my main focus. I'm at least 12kgs heavier than when I was "in my prime" which must be putting pressure on my knees. I don't think it's anything degenerative. The cartlidge tears have both been linked to specific incidents on the court. Both involved me running backwards. I've joined a gym and am doing non weight bearing cardio, as well as gentle weights to strengthen my quads, calfs and hamstrings. Hopefully a gym program and weight loss will mean I can keep playing.
     
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  15. usta2050

    usta2050 Rookie

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    do you play singles or doubles?

    it sounds like you need to do pilates to strength your core too.
     
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  16. Red Sunset

    Red Sunset Rookie

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    Since I came back from the first knee op, I've played exclusively doubles. Which is good in some ways, but bad because my natural preference is to serve and volley in doubles. Yeah, the gym I joined has beginner's Pilates, so I think I'll sign up for some classes post op.
     
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  17. usta2050

    usta2050 Rookie

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    when i started doing leg raises on these stands, it made me realise how a human body is connected. thus, the importance of a strong core to keep everything together.

    playing doubles is safer but it also doesn't work out your muscles as much as singles would.

    this is what i think, if you had knee issues and play doubles only, you actually need to do more exercises to compensate for the lack of workout in doubles.



    [​IMG]
     
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  18. UCSF2012

    UCSF2012 Hall of Fame

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    Don't give up tennis, but you'll have to put it off for the time being.

    You got it. You have to lose weight. Too much load/weight on the joints, and your body can't handle it. Don't stay static while you're recovering from surgery (except for immediately after, of course). Upper body weight training is good. When your surgeon gives you the okay, start an aquatics program. Strenthens the muscles under reduced load. Swimming is good too (use a foam pillow to float the legs, while you use your upper body to thrust). Tons of fitness things you can do with a bum knee, until you are healthy enough to increase load on land.

    Once you're back in tennis, PRACTICE running in all directions: forward, side shuffle, back sprint, and diagonally. That keeps all stability muscles in check
     
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  19. Red Sunset

    Red Sunset Rookie

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    Thanks UCFS. Yeah, not going to rush back this time. Going to lose the weight and stick with the gym until I feel really fit and strong. Then will hit the courts again.
     
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  20. charliefedererer

    charliefedererer Legend

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    Healthy menisci sitting on top of the articular cartilage of the lower leg bone (tibia).
    [​IMG]


    Meniscus tear.
    [​IMG]


    Meniscal tears vary widely in their severity.
    [​IMG]


    Meniscal tears near the periphery can be sutured/repaired because the blood supply in this area is good enough to expect healing to occur. Other tears result in removal of the loose fragments of the meniscus because the blood supply is just not good enough to expect any healing will occur.

    [​IMG]

    Clearly the meniscus does serve a function to help align the bi-lobed end of the upper leg bone (femur) in the shallow two cavities on the surface of the lower leg bone (tibial plateau).

    I don't know how much of a remaining meniscus is needed to provide function - I would guess that it would depend where the removed segments are to say if the remaining portion of the meniscus is doing much good.

    It would seem that having strong leg muscles (perhaps by doing squats) would contribute to knee stability to help compensate for any stability loss from removed portions of the meniscus.


    Chas: Do you run with the barefoot posture of keeping your torso right over your legs, or do you have a pronounced heel strike? (The reason I ask is that it is probably better for your meniscal and articluar cartiage health to minimize the heel strike.)
     
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  21. Chas Tennis

    Chas Tennis Hall of Fame

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    I don't know. For most of my life my tennis shoes would wear heavily on the rear & outside (lateral) sides of the heels. The feet were both supinating.

    However, a few years ago (5 years?) that changed so that I noticed the heels of my shoes both wore much more evenly, about normally. I tend to be heavy on my feet and my wife has occasionally commented on my gait. She just now said that I 'put my heels down too heavily on the floor', probably the issue that you mention.

    Do you have some links on this posture issue, which muscles might be weak or tight, etc?

    Last year I got some physical therapy to correct weak gluteus medius muscles, piriformis tightness and also to stretch tight rectus femorus muscles. I've posted on those posture issues often. These exercises and stretches made my walking feel much better, smoother, etc. I saw posture improvements in the way that my pelvis was tilted - back now about an inch at the top - from the rectus femorus stretch. See Anterior Pelvis Tilt
    http://en.wikipedia.org/wiki/Pelvic_tilt
    Just learned - This reference adds that some of the other muscles I corrected in PT, the gluteus medius & gluteus minimus, could also cause Anterior Pelvic Tilt. http://posturecorrection101.com/nyc...r-imbalances/anterior-pelvic-tilt-correction/


    [​IMG]

    Earlier this year my knees were giving me some pain after tennis. I worried that arthritis was starting to cause the pain as my Dr warned me when we discussed it. But now my knees have both smoothed out again and feel fine.

    Squats - I left the squats out of my exercises after I injured my knee in 1999. I also read in Scientific Stretching that a sign of a tight Soleus is difficulty in squatting. I'm tall and feel that my balance is awkward when I body-weight squat to 90°. Limited ROM for the Soleus? Knees have limited ROM also.

    I realize that I'm on thin ice and a show-stopping injury could occur at any time, especially on the court, but I've seen some improvements lately and believe in the importance of the posture issues.
     
    Last edited: Sep 9, 2012
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  22. Red Sunset

    Red Sunset Rookie

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    Thanks for all the images Charliefederer. My MRI stated I have a complex tear with radial components. It also says something about "probably discoid". Last time it was a flap tear that had folded under. I guess this one sounds worse.
     
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  23. charliefedererer

    charliefedererer Legend

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    Posture Guy (who posts here fairly frequently) has recommended Pain Free and The Egoscue Method of Health Through Motion: Revolutionary Program That Lets You Rediscover the Body's Power to Rejuvenate It.
    The first is an easier read, but the second gives a deeper analysis of how muscle imbalances can cause problems far away from the underlying problem.
    Some might consider the Egoscue method as "alternative medicine", but undoubtedly many suffer from knee and leg problems that have their root in postural problems.


    Recently I specifically asked Posture Guy if squatting with a postural problem could lead to injuries. He replied yes, and that he had worked with patients to first correct their postural problems before moving ahead with squatting or other lifting.
     
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  24. backttennis

    backttennis New User

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    I got 3 meniscus tears from running 23 years ago and had 3 operations; a successful repair and two partial removals. I gave up running, but tennis singles has never bothered my knees, and I run a lot on the court. My knees don't bother me at all.

    After surgery, I went to therapy, and I still weight train doing the same exercises they taught me on machines at the gym to keep my quadriceps strong. Doctors and therapists told me to avoid squats, as they compress and spread out the meniscus with your full weight on it, and this can easily spread any small tears.
     
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  25. charliefedererer

    charliefedererer Legend

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    People should pay attention to their doctor's advice. There may be specific reasons why a physician directs someone with a meniscus tear not to squat.

    But, I found this orthopedic surgeon's rehab program post meniscus repair, and he recommends starting body squats not before week 6. http://www.drlintner.com/rehab-protocols/knee-rehab-protocols/meniscal-repair/

    By week 12, here is his regimen:
    "Initiate lateral movements and sports cord: lunges – forward, backward, or side step with sports cord, lat step-ups with sports cord, step over hurdles.
    Jogging
    Plyometric program – bilateral progressing to unilateral
    Plyos can include squat jumps, tuck jumps, box jumps, depth jumps, 180 jumps, cone jumps, broad jumps, scissor hops
    Leg circuit: squats, lunges, scissor jumps on step, squat jumps
    Power skipping
    Bounding in place and for distance
    Quick feet on step – forward and side-to-side – use sports cord
    Progress lateral movements – shuffles with sports cord; slide board
    Ladder drills"



    No shock here, Mark Rippetoe is pro squat for those with a history of meniscus injury:
    "Well, I have several tears in my meniscus, none of which occurred while squatting. Furthermore, deep squats do not bother either my torn meniscus or my absent ACL. In my 30 years of doing this, I have never observed a single example of deep squats tearing a meniscus. Ever. I've seen it happen once or twice on cleans and snatches that got in a bad position, but never squats or deadlifts. As for actual data, I don't have that, but I do know that she doesn't either. I do, however, have experience and logic on my side, while she has merely her preconceived perceptions and conventional wisdom. Maybe there are people with input on this question..."
    - http://startingstrength.com/resources/forum/showthread.php?t=7749&page=1



    Here are some other discussions on doing squats with prior meniscus injury:

    deep squats and meniscus http://board.crossfit.com/archive/index.php/t-29424.html

    Full Squats for Meniscus Tear? http://tnation.t-nation.com/free_on...ce_bodybuilding/full_squats_for_meniscus_tear
     
    Last edited: Sep 9, 2012
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  26. Cindysphinx

    Cindysphinx G.O.A.T.

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    I had arthroscopic surgery for a medial meniscus tear in 2005. Nowadays, the only way I can remember which knee it was is by looking for the scar. I would say my knees are 100%.

    It was a long road, though. I think it was 9 months to a year before I felt really good about the knee. The key for me was (and still is) a ton of squats and lunges. If I don't do my squats/lunges and get lazy, my knees will start to get sore after I run or play tennis.

    So yes, you can come back and do very well if you do your PT and get your legs strong. And maintain a healthy weight.
     
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  27. Chas Tennis

    Chas Tennis Hall of Fame

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    Video + Healing or Remodeling?

    There are videos on Youtube that do a great job of explaining the structure of each joint.

    Here is one on the knee and especially the meniscii -

    http://www.youtube.com/watch?v=ucVRGTFw7K0&list=PL71B520150FFAEB90&index=29&feature=plpp_video

    One thing I always have to question is the issue of healing and blood flow. As described in this video only "2%" of the meniscus has blood flow. Also, there is a statement that new meniscus cartilage does not form after the early twenties.

    The earlier CF replies show meniscus injuries and many obviously are located outside the 2% of the cartilage volume with blood flow near the outer edge.

    My tear of the lateral meniscus at the posterior root (not certain that is in the outer 2%) improved greatly and seems to have healed or remodeled in some way. ? Seems inconsistent with 'no blood flow, no healing'. ? What is actually happening? Statistics?

    Anyone have information on healing as distinguished from some kind of remodeling that might bear on how the knee functions or feels?
     
    Last edited: Sep 10, 2012
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  28. backttennis

    backttennis New User

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    Dr. Lintner's rehab

    Weeks 12-36

    ◦ ◦Jogging
    ◦Plyometric program – bilateral progressing to unilateral
    ◦Plyos can include squat jumps, tuck jumps, box jumps, depth jumps, 180 jumps, cone jumps, broad jumps, scissor hops
    ◦Leg circuit: squats, lunges, scissor jumps on step, squat jumps
    ◦Power skipping
    ◦Bounding in place and for distance

    This doctor's regimen sounded "okay" - but not ideal - to me until I got to this part. At 3 months post op, he has patients jogging, jumping, bounding, and power skipping. This is stuff I would not even do today; it's too high impact and there are plenty of other ways to strengthen leg muscles that aren't.

    I started jogging at 3 months post op on a soft surface and had to go right back in for another menicus tear caused by the jogging. I avoid anything high impact, particularly anything involving heel strike, since my tears were in the medial posterior compartment. Where your tear is located and what caused it will have some bearing on the best rehab for you and what you must avoid doing afterwards.
     
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