Advice For 22 Year Old Returning From Meniscus Surgery (For a 2nd Time)

[robok9]

Preface: I know doctor's advice is better than people on a forum. I'm simply looking for supplementary anecdotal advice

January 2019: I had nagging knee pain for about 4-5 months then it got bad one day after playing. MRI later showed that I tore my meniscus.

February 2020: Partial Meniscectomy. Doc said 6-7 weeks till tennis with no formal rehab needed because "you're young and this was minor. Just ease into it at 6 weeks and you'll be fine." In hindsight this makes it sound like he's a bad doctor after the next part but he works for a professional basketball team, and he's highly rated in the area.

June 2020: Due to lockdowns, I pretty much had no physical activity because of staying indoors so much. Then at the proper time, I started playing tennis again. Played about 10 times pain free and then noticed my knee started to feel 'funny.' Played tennis another time and BOOM super swollen afterward. Later I found out I tore the meniscus again.

August 2020: Take 2. Partial Meniscectomy. A little bit of cartilage issues in there too. This time doc said 4 months without tennis to be safe and gave me some rehab to do for strengthening.

November 2020: I'm approaching the 4 month mark and am dying to play again. I've been doing all the strengthening and my knee is mostly back to where it should be strength wise, but it still feels off. With the first surgery after 5 weeks I felt 100% ready to go play, but this time it seems to be going slower (but I can't tell if it's in my head). Normal everyday stuff like going up stairs doesn't hurt which is a good sign, but often I feel a sort of hitch in my knee or a little discomfort (not pain). I know every surgery heals differently, but I'm sorta paranoid about hurting it again.

Anybody have any advice for easing back into tennis?

Also if you haven't noticed... this timeline pretty closely follows Federer's knee issues in 2016, so this means I've got a chance to win the 2021 AO!

 

[S&V-not_dead_yet]

Preface: I know doctor's advice is better than people on a forum. I'm simply looking for supplementary anecdotal advice

January 2019: I had nagging knee pain for about 4-5 months then it got bad one day after playing. MRI later showed that I tore my meniscus.

February 2020: Partial Meniscectomy. Doc said 6-7 weeks till tennis with no formal rehab needed because "you're young and this was minor. Just ease into it at 6 weeks and you'll be fine." In hindsight this makes it sound like he's a bad doctor after the next part but he works for a professional basketball team, and he's highly rated in the area.

June 2020: Due to lockdowns, I pretty much had no physical activity because of staying indoors so much. Then at the proper time, I started playing tennis again. Played about 10 times pain free and then noticed my knee started to feel 'funny.' Played tennis another time and BOOM super swollen afterward. Later I found out I tore the meniscus again.

August 2020: Take 2. Partial Meniscectomy. A little bit of cartilage issues in there too. This time doc said 4 months without tennis to be safe and gave me some rehab to do for strengthening.

November 2020: I'm approaching the 4 month mark and am dying to play again. I've been doing all the strengthening and my knee is mostly back to where it should be strength wise, but it still feels off. With the first surgery after 5 weeks I felt 100% ready to go play, but this time it seems to be going slower (but I can't tell if it's in my head). Normal everyday stuff like going up stairs doesn't hurt which is a good sign, but often I feel a sort of hitch in my knee or a little discomfort (not pain). I know every surgery heals differently, but I'm sorta paranoid about hurting it again.

Anybody have any advice for easing back into tennis?

Also if you haven't noticed... this timeline pretty closely follows Federer's knee issues in 2016, so this means I've got a chance to win the 2021 AO!

Was it the same doc?

Did he explain how either tear occurred [ie something you did or a structural weakness or something else]?

I assume it was the same knee?

Two identical injuries in the same area has me leaning towards a "structural weakness".

Any similar instances in the family?

Did he recommend a knee brace when you first start playing again? I come from a volleyball background and I've seen some players with major knee braces. Of course, you don't want them to become a crutch [no pun intended]; ideally, you can rehab back to 100%.

Good luck in Melbourne!

Disclaimer: I'm no doctor, nor do I play one on TV, nor did I stay at a Holiday Inn Express recently.

 

[ollinger]

Doubles. Meniscus pieces removed twice from the same knee generally means there isn't much left in there to prevent bone-on-bone contact. No amount of strengthening will change that reality.

 

[Harry_Wild]

Do a strong over all conditioning course similar to what a pro athlete does before going into the season. In other words, copy Rafael Nadal conditioning routine and you will be fine. 5 sets on clay, in the beginning of the 5 set, you can mimic Rafa and jump up and down in place like 6-7 times before the 1st game of the 5th set. Your opponent probably at that point, just want get off the court!

 

[Turbo-87]

I'm sure that was tongue in cheek.

 

[Mongolmike]

Forget tennis. Tennis is so 1980's.

Pickleball young man. Pickleball is the future! In fact, you don't even need a meniscus to play!

 

[yossarian]

Do a strong over all conditioning course similar to what a pro athlete does before going into the season. In other words, copy Rafael Nadal conditioning routine and you will be fine. 5 sets on clay, in the beginning of the 5 set, you can mimic Rafa and jump up and down in place like 6-7 times before the 1st game of the 5th set. Your opponent probably at that point, just want get off the court!

do not do this

 

[BenWolfeTennis&Fitness]

I feel your pain! I think that you might want to consider doing some knee strengthening exercises. I made a video on rehabbing knees (

) that might help. I also have some mobility exercises that I know are specifically tailored to preventing knee injuries. I myself have done a lot to protect the knee (I'm 6'4" and not getting any younger haha!) so know a lot about it. Hopefully that's a good start. Let me know if you want more details on myofascial release exercises or mobility training.

 

[yossarian]

I feel your pain! I think that you might want to consider doing some knee strengthening exercises. I made a video on rehabbing knees (

) that might help. I also have some mobility exercises that I know are specifically tailored to preventing knee injuries. I myself have done a lot to protect the knee (I'm 6'4" and not getting any younger haha!) so know a lot about it. Hopefully that's a good start. Let me know if you want more details on myofascial release exercises or mobility training.

1. you cannot preferentially target the VMO. that is a myth

2. you definitely want to control the eccentric portion of every exercise better

3. your right knee definitely collapsed into valgus on one of those squats. again you want to really make sure you're controlling the eccentric portion of it and attempting to only tap the bench rather than rest on it

 

[BenWolfeTennis&Fitness]

Here is a peer reviewed scholarly article that shows you can . https://www.jstage.jst.go.jp/article/jpts/27/9/27_jpts-2015-381/_pdf. I also have worked with elite trainers that have helped me with my knee issues and it was very helpful.

 

[BenWolfeTennis&Fitness]

Also I mentioned in the video that my right leg is weaker than my left, meaning I'm working on it haha. Definitely not perfect and that's the point of doing them!

 

[yossarian]

Here is a peer reviewed scholarly article that shows you can . https://www.jstage.jst.go.jp/article/jpts/27/9/27_jpts-2015-381/_pdf. I also have worked with elite trainers that have helped me with my knee issues and it was very helpful.

interesting. I question the feasibility of this approach (limited ROM and super slow training with a biofeedback device) and the clinical significance of the findings, though. And the overwhelming majority of literature says that you cannot isolate the VMO from the rest of the quad and that attempting to do so brings about no real benefit

 

[BenWolfeTennis&Fitness]

Always good to question! It's pretty amazing how our bodies behave and how one thing works for one and not another person. Enjoyed the exchange of ideas with you, thanks for your time!

 

[tlm]

Preface: I know doctor's advice is better than people on a forum. I'm simply looking for supplementary anecdotal advice

January 2019: I had nagging knee pain for about 4-5 months then it got bad one day after playing. MRI later showed that I tore my meniscus.

February 2020: Partial Meniscectomy. Doc said 6-7 weeks till tennis with no formal rehab needed because "you're young and this was minor. Just ease into it at 6 weeks and you'll be fine." In hindsight this makes it sound like he's a bad doctor after the next part but he works for a professional basketball team, and he's highly rated in the area.

June 2020: Due to lockdowns, I pretty much had no physical activity because of staying indoors so much. Then at the proper time, I started playing tennis again. Played about 10 times pain free and then noticed my knee started to feel 'funny.' Played tennis another time and BOOM super swollen afterward. Later I found out I tore the meniscus again.

August 2020: Take 2. Partial Meniscectomy. A little bit of cartilage issues in there too. This time doc said 4 months without tennis to be safe and gave me some rehab to do for strengthening.

November 2020: I'm approaching the 4 month mark and am dying to play again. I've been doing all the strengthening and my knee is mostly back to where it should be strength wise, but it still feels off. With the first surgery after 5 weeks I felt 100% ready to go play, but this time it seems to be going slower (but I can't tell if it's in my head). Normal everyday stuff like going up stairs doesn't hurt which is a good sign, but often I feel a sort of hitch in my knee or a little discomfort (not pain). I know every surgery heals differently, but I'm sorta paranoid about hurting it again.

Anybody have any advice for easing back into tennis?

Also if you haven't noticed... this timeline pretty closely follows Federer's knee issues in 2016, so this means I've got a chance to win the 2021 AO!

A few guys I know have had the same surgery and I’m always surprised that the doctors tell them they can go back to tennis in 6 weeks. I think these doctors know a lot more about performing surgery than what it takes to be ready for the rigors of tennis. When you have a knee injury you have been off the court and most likely off your feet as much as possible for too long to maintain your leg strength.

Regardless of your age muscle atrophy happens quickly so you have obviously lost some leg strength. These doctors really make me wonder of what the hell they are telling their patients. I would suggest a minimum of 8-10 weeks with some very gradual strength training and stationary bike riding. Then I would start doing body weight squats and then move to some light weighted squats. If have a knee injury I am going to strengthen my legs more than they were before the injury.

When doing rehab strengthening everything is controlled and mostly straight forward movements that gradually increase the resistance. Once you have regained your leg strength and can run with no pain now you are ready to start easing back into tennis.

 

[tlm]

I feel your pain! I think that you might want to consider doing some knee strengthening exercises. I made a video on rehabbing knees (

) that might help. I also have some mobility exercises that I know are specifically tailored to preventing knee injuries. I myself have done a lot to protect the knee (I'm 6'4" and not getting any younger haha!) so know a lot about it. Hopefully that's a good start. Let me know if you want more details on myofascial release exercises or mobility training.

This looks like a very good program. A few years back I was getting some knee pain in my left leg and it was not going away so the research I did made me think I have a slight tear or arthritis in that knee. I was weight training then but just upper body work thinking that my legs were getting enough work from tennis.

That was a mistake because yes your legs get some strengthening from tennis but it is not even and balanced training and some of it is very stressful. So I did some research and I found that muscle imbalance causes a lot of injuries, so I started doing leg work like squats and calf raises and within weeks pain went away. I’ve continued with leg strength training and no more knee problems even with playing tennis 5 days a week.

 

[socallefty]

Everyone’s experience is different as it depends on the extent of the injury and also the quality of the surgery - there are above-average, average and below-average surgeons just like there is a curve of competence in every profession. Surgeons can have their good days and bad days also. I used to have to watch a lot of open-heart valve surgeries for my job years ago and you could clearly see the difference in skill levels between different surgeons and even the difference in the quality of what they did on different days.

In my case, I had a meniscectomy on my right knee last year in October and I did strenuous rehab daily with a physical trainer which started one week after the surgery. My doctor said that tennis would likely take 6 weeks, but I could play earlier if I felt that my knee was ready. I started drills and playing doubles exactly 4 weeks after surgery and singles matches a week later - even played a USTA league doubles match 31 days after surgery. I wore a hinged heavy-duty brace from Athledict for many months after though just to be safe. I was also icing the knee multiple times a day and definitely after playing.

After I started to play again 4-5 times a week, my knee started getting sore again and so, I had a hyuluronic acid (single dose of Durolane) shot in March five months after the surgery. Since then, I’ve been playing daily again (70% singles) and have played more than 300 times this year. I have not even needed to ice my knee since April and I just wear a thin fabric sleeve to keep my knee warm when I play. Now I wish that I had tried the HA injection first without doing the surgery as it seems way better than cortisone shots.

My surgeon told me that for younger patients, they try to repair the meniscus more often by suturing the tear rather than just cutting out the torn part and in this case, rehab can be longer by about two weeks. He said that in those cases, patients usually start tennis only after 2 months. But, he emphasized that the recovery time always depends on the quality and regularity of the physical training (PT) that is done by the patient after surgery and the sooner they start it, the better it is. I have a friend who shocked me by starting to play tennis just two months after a full hip replacement and singles after another month. He was also very diligent about the physical therapy and he is starting to play tennis 3-4 times a week again and thinking of starting ice hockey also.

Rest is not good after surgery as it makes all the muscles that support the knee weak. If you do physical therapy diligently and strengthen all those muscles, there is less load on your knee and there is more chance that you will recover fast. It looks like your surgeon made an error in telling you that you didn’t need to do physical therapy to rehab your leg muscles and it might be why you re-injured it. Muscles atrophy with rest and even a week of bed rest causes a lot of atrophy - so, starting PT as soon as you can tolerate the pain is crucial.

 

[BenWolfeTennis&Fitness]

This looks like a very good program. A few years back I was getting some knee pain in my left leg and it was not going away so the research I did made me think I have a slight tear or arthritis in that knee. I was weight training then but just upper body work thinking that my legs were getting enough work from tennis.

That was a mistake because yes your legs get some strengthening from tennis but it is not even and balanced training and some of it is very stressful. So I did some research and I found that muscle imbalance cases a lot of injuries, so I started doing leg work like squats and calf raises and within weeks pain went away. I’ve continued with leg strength training and no more knee problems even with playing tennis 5 days a week.

That's great you're feeling good on the court! I think of the gym as a way to enjoy the tennis more . I think we are on the same boat. Happy hitting!

 

[tlm]

That's great you're feeling good on the court! I think of the gym as a way to enjoy the tennis more . I think we are on the same boat. Happy hitting!

That’s good that you don’t mind the gym work. I believe that if people want to play tennis into old age that working out is the key.

 

[FairFrank]

Forget tennis. Tennis is so 1980's.

Pickleball young man. Pickleball is the future! In fact, you don't even need a meniscus to play!

Agree, probably here is the way to check it out.
Wish you the best @robok9

 

[ktx]

My experience: 2 partial meniscectomies in my mid-20s, about 1-year apart. My 2nd ortho said (this is HIGHLY paraphrased) sometimes the first surgery does not clean out all the "debris" and a second, more aggressive look is needed. I did a LOT of physical therapy - 6 mos before surgery and 6 weeks afterwards. Overuse/too much running still aggravates my knee and I have a Baker's cyst that will fill up, but luckily the stability is pretty good. I still have some weakness and notice valgus on some exercises, but all of that PT stuck with me and I notice when my knee isn't tracking properly. Get into PT ASAP - yes you are young, but these types of injuries can stay with you. I am now 40- my knee is permanently, slightly swollen, but I can play tennis 4-5 week on hardcourts with little to no pain. Good luck!

 

[robok9]

Lot of great info here!

Really appreciate all of your input

 

[TennisReborn]

I've had two meniscus surgeries on my left knee, and one on my right. I ended up also having microfracture surgery on my right knee due to a condyle flap tear.

Recovery is a slow process, and in my case, I tore my left side again after the first surgery, and then the right.

I've just started playing again after a long time away.

This time, I got a personal trainer and did 9 months of leg work and general exercise before stepping on to a court.

So far my knees now feel good on the court.

I guess my anecdotal advice would be: if you can afford it, get a good personal trainer, explain your injuries, and build up leg strength, balance and general fitness before hitting the courts again. Under the guidance of a good PT, I've done a lot of squats, lunges, deadlifts, etc, and my legs are more developed now than they've ever been before. I'm really hoping this will protect my knees a bit. Good luck!

 

[tlm]

I've had two meniscus surgeries on my left knee, and one on my right. I ended up also having microfracture surgery on my right knee due to a condyle flap tear.

Recovery is a slow process, and in my case, I tore my left side again after the first surgery, and then the right.

I've just started playing again after a long time away.

This time, I got a personal trainer and did 9 months of leg work and general exercise before stepping on to a court.

So far my knees now feel good on the court.

I guess my anecdotal advice would be: if you can afford it, get a good personal trainer, explain your injuries, and build up leg strength, balance and general fitness before hitting the courts again. Under the guidance of a good PT, I've done a lot of squats, lunges, deadlifts, etc, and my legs are more developed now than they've ever been before. I'm really hoping this will protect my knees a bit. Good luck!

This is excellent advise. I’m sorry but these doctors saying you can go back to tennis in six weeks are full of crap. Sure you might get away with it but why take the chance? You lose muscle fast when injured so if you are smart you will build your leg strength up to more than what it was before the injury before playing tennis. It’s common sense the more muscle strength the less strain on the joints.

 

[Harry_Wild]

It’s common sense the more muscle strength the less strain on the joints.

Totally agree! I got a lot of flak on my post for suggesting this very thing!

 

[tlm]

Totally agree! I got a lot of flak on my post for suggesting this very thing!

Anyone that doesn’t believe that more muscle strength protects the joint should not be listened to.

 

[mcs1970]

I had an ACL surgery a year ago and still cannot do one legged hops. Muscle atrophy and loss of leg strength is a real thing. Hamstring is very weak after the graft. I went from boasting how even at 50 I could beat a lot of 30 year olds in a sprint to really struggling to get any sort of acceleration. Plus doc saying I should be much farther along was making me feel worse.

This thread gives me a lot of hope to be patient and continue working to regain my strength first and worry about tennis later.

 

[dr325i]

I had the meniscus scope October 2019. The Doctor and PA advised tennis could be possible as soon as 8 weeks after but with appropriate therapy.
A week after the scope I started my therapy -- daily 30-60 minutes of trainer prescribed and guided exercises at their facility. It lasted about 6 weeks until 2 months after the procedure I was able to step on the court. Far far far from real playing, but more of very cautious and small steps.
It improved over time, however, never to the point when I could totally "forget" about it.
I learned to live with Kinesio tape and shaved knee and learned to play with additional taping (kind of like Nadal used to do) under the knee cap. I still feel discomfort and weakness, and limitations with that knee. Once it warms up, it does feel "better", however, after it cools down, it feels weaker than I'd like it to.

Then, bout 3 weeks ago, I've had another episode of pain and "popping" sounds and feeling like I had just pre-surgery last October. I assume, 50 years of age and 40+ years of tennis (30 years of extra weight on top of it) did not do any good on my knee(s)...

I am thinking about the injection (gel/cortisone/whatever!) before going for the second round surgery.

By the way, after the surgery last October, the Doctor mentioned that he believes I will need a full knee replacement within next 3 years...

 

[Shroud]

I tore mine but it was in the part that got blood flow so the doc said that it might heal but if it didn't then he would have to go to work. It healed. But he gave me exercises that just didn't make things right. Exercises with a towel and resistance. I turned to the internet and found a guy who had had surgery but it was not right after that. Or that it was now bone on bone mostly. He basically said that he fixed it by doing bicycles. Like laying on your back and bicycling. he was reporting like 3 sets of an HOUR each eventually. I thought that was nuts...who has time. Anyhow I ditched the towel and just did bicycles working up to 3 sets of 4-5 minutes IIRC. That seemed to target the knee joint and I have been fine since and playing tennis. Though occasionally I would have some pain and it was always when I stopped the bicycling and or gained weight. So my personal take away is that if I want to keep playing tennis I need to at minimum do the bicycles.

Other leg strength stuff is good but the bicycles are like zero impact and seem to target the knee joint specifically.

Also the dude talked about the Prose method for running and that helping a ton.

There was some talk of jumping. Sure at some point if you can but that has to be the worst thing for the meniscus I think. At least for me. And standing with the knee locked...

 

[Dartagnan64]

The meniscus helps with cushioning and alignment of the tibia and femur at the knee joint. With parts of it removed there will be less of both those things. It's not "bone on bone" because the cartilage if the joint is still intact.

I'd suggest a knee sleeve with a patellar cushion like the genu train from bauerfiend. Will provide passive stability to help with the alignment issues. The compression will provide some circulation and healing benefits. It's not going to add cushioning unfortunately. But better alignment and patellar motion can help at least prevent some wear and repeat injury.

The genutrain has several models depending on how much support you need. When I had patellar tendinitis I just used the regular Genu Train and it helped a lot. For a meniscus you might want a bit more side bar support.

And I did a lot of single leg incline squats to strengthen the quadriceps