Second Knee Op in 18 months.

[Red Sunset]

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?

[ollinger]

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.

[Red Sunset]

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.

[Chas Tennis]

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%27s_sign

A few recent TW threads:
http://tt.tennis-warehouse.com/showt...re+Chas+Tennis
http://tt.tennis-warehouse.com/showt...re+Chas+Tennis
http://tt.tennis-warehouse.com/showthread.php?t=414073
http://tt.tennis-warehouse.com/showt...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.

[Red Sunset]

Originally Posted by Chas Tennis

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 you knee. Some issues may not be discussed very much by your Dr. I ask at the MRI 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.

I gave my first meniscus tear in 1999 4 months to heal and it didn't. Surgery was successful. I had gone back for an overhead when 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%27s_sign

I'll edit this thread to add a few of the recent TW links.

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

My goal is to understand #2 and #3.

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!

[TCF]

================================================== ==

[Ashley D]

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.

[TCF]

================================================== ==

[usta2050]

Originally Posted by Red Sunset

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?

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+.

[usta2050]

Originally Posted by Chas Tennis

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%27s_sign

A few recent TW threads:
http://tt.tennis-warehouse.com/showt...re+Chas+Tennis
http://tt.tennis-warehouse.com/showt...re+Chas+Tennis
http://tt.tennis-warehouse.com/showthread.php?t=414073
http://tt.tennis-warehouse.com/showt...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.

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.

[charliefedererer]

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.








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.

[Chas Tennis]

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.

[usta2050]

Originally Posted by charliefedererer

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.








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.

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.

[Red Sunset]

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.

[usta2050]

do you play singles or doubles?

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

[Red Sunset]

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.

[usta2050]

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.

[UCSF2012]

Originally Posted by Red Sunset

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?

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

[Red Sunset]

Originally Posted by UCSF2012

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

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.

[charliefedererer]

Originally Posted by Chas Tennis

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.

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



Meniscus tear.



Meniscal tears vary widely in their severity.



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.



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.)