Meniscus Surgery: Bad Idea?

[adventure]

I've seen several threads here about people who have had meniscus surgery.

I think meniscus repair surgery is a great idea, when possible, since this surgery allows the meniscus to heal.

However, the majority of meniscus surgeries involve removal of some portion of the meniscus. This reduces the amount of protection your knee has.

What is the rationale for REMOVING ANY portion of the meniscus at all?

From the threads I've seen here, meniscectomy seems to lead to rather poor results.

There seems to be every reason to KEEP the remaining meniscus in place, even if torn/damaged, and almost none for removing any portion of it, aside from a doctor being able to charge the insurance company tens of thousands of dollars for a useless, and possibly counter-productive procedure.

 

[Say Chi Sin Lo]

Removal of cartilage serves to preserve the rest of joint. The torn piece(s) can catch and irritate other surfaces of the joint. You're not helping initial injury, but you're removing the pieces that can compromise the rest of the joint.

Besides, surgeons know when to do a debridment and when to leave things be.

 

[Frank Silbermann]

It all depends on the injury. Imagine you have a cellophane potato chip bag with a tear in it. That tear will spread and deepen unless you cut out a piece to round the end of the tear. Sometimes you can do that with a meniscus tear to prevent the tear from progressing.

Generally, the part of the meniscus where that happens (the thin flat inner part tearing from the center) is the part that cannot be surgically repaired, only trimmed. If the doctor says you need surgery, it's not certain that it will ever clear up without surgery.

The part which can be surgically repaired (the thick outer part) is not the part you can afford to lose or trim.

If you do have a meniscus problem, however your resolve it, you're more likely to get another tear. Since you already got the first tear doing what you do, continuing as before will guarantee it. Therefore, you're a fool to continue playing tennis without continuing regular physical therapy (at home, not necessarily at the doctor's office) for the rest of your playing career.

 

[Chas Tennis]

I've seen several threads here about people who have had meniscus surgery.

I think meniscus repair surgery is a great idea, when possible, since this surgery allows the meniscus to heal.

However, the majority of meniscus surgeries involve removal of some portion of the meniscus. This reduces the amount of protection your knee has.

What is the rationale for REMOVING ANY portion of the meniscus at all?

From the threads I've seen here, meniscectomy seems to lead to rather poor results.

There seems to be every reason to KEEP the remaining meniscus in place, even if torn/damaged, and almost none for removing any portion of it, aside from a doctor being able to charge the insurance company tens of thousands of dollars for a useless, and possibly counter-productive procedure.

Video on Arthoscopic Knee Surgery, Meniscectomy vs Repair
http://www.youtube.com/watch?v=kB98kPLOcBM

Repair looks like a very complex procedure requiring a highly skilled surgeon. The surgeon would have to determine whether a repair is feasible after looking inside the knee.

I believe that the success rate of partial meniscetomy is very good.

Have you found any information on the outcomes of meniscus repairs?

Meniscus injuries that are accompanied also by osteoarthritis should be considered separately.

I had an estimated 30-40% of my medial meniscus removed 13 years ago. I have played a lot of tennis and my knee does well. I have a video of my knee operation. Mostly I could only see what looked like a robot dinosaur head munching cotton candy - I could identify no clear meniscus structure.

A second issue needs consideration on arthroscopic knee surgery, the incidence of complications. Of the maybe 8-10 players that I know who have had arthroscopic knee surgery, 3 had blood clot complications. One was serious and another very serious.

 

[ollinger]

Recent medical literature is clear on one point: meniscus surgery where there are X-ray findings of arthritis in the joint is completely pointless.

 

[Chas Tennis]

Suppose the knee is locked with the meniscus injury, etc.?

Does that include situations where the meniscus is out of place and perhaps locking the knee?

Regarding knee surgery with "unstable" meniscus injury -

See reply by Dr Fleisig
http://asmiforum.proboards.com/index.cgi?board=knee&action=display&thread=1909

http://tt.tennis-warehouse.com/showthread.php?t=451384

I don't think the case was made one way or the other in the thread above regarding meniscus injuries and osteoarthritis. There certainly are situations where the meniscus must be dealt with, arthritis or not.

 

[Cindysphinx]

I've seen several threads here about people who have had meniscus surgery.

I think meniscus repair surgery is a great idea, when possible, since this surgery allows the meniscus to heal.

However, the majority of meniscus surgeries involve removal of some portion of the meniscus. This reduces the amount of protection your knee has.

What is the rationale for REMOVING ANY portion of the meniscus at all?

From the threads I've seen here, meniscectomy seems to lead to rather poor results.

There seems to be every reason to KEEP the remaining meniscus in place, even if torn/damaged, and almost none for removing any portion of it, aside from a doctor being able to charge the insurance company tens of thousands of dollars for a useless, and possibly counter-productive procedure.

I had about 15% of my meniscus removed in 2005. No problems now, good results.

Before surgery, my knee was locked with an eight degree deficit, and I am glad it could be fixed.

 

[anantak2k]

This right here is the perfect analogy. I had a tear on my right meniscus for a few years. Went to physical therapy for the longest time, rested it a lot. But it was constant, chronic, minor knee pain with inflammation every time I played tennis.

1 year after the arthroscopic surgery where they rounded up the tear to prevent further tearing, my knees were back to 100%.
5-6 years later now, its still great. No more knee pain at all. I am really happy about the results and glad I went through with the surgery.

It all depends on the injury. Imagine you have a cellophane potato chip bag with a tear in it. That tear will spread and deepen unless you cut out a piece to round the end of the tear. Sometimes you can do that with a meniscus tear to prevent the tear from progressing.

Generally, the part of the meniscus where that happens (the thin flat inner part tearing from the center) is the part that cannot be surgically repaired, only trimmed. If the doctor says you need surgery, it's not certain that it will ever clear up without surgery.

The part which can be surgically repaired (the thick outer part) is not the part you can afford to lose or trim.

If you do have a meniscus problem, however your resolve it, you're more likely to get another tear. Since you already got the first tear doing what you do, continuing as before will guarantee it. Therefore, you're a fool to continue playing tennis without continuing regular physical therapy (at home, not necessarily at the doctor's office) for the rest of your playing career.

 

[DirtBaller4]

I had meniscus surgery also. My understanding was that they just remove the torn or damaged parts.

I could not fully extend my leg before I got surgery, so it wasn't really an option to go without. The surgery only took one hour. I was playing tennis one month later and skiing 4 months later.

That was 2007, my knee still get sore, but ice and knee braces help a lot.

If you need it, don't fear it. Just get a second opinion and go with the best surgeon you can find. Talk to a close friend who has had it done and ask them who did their surgery.

I used they guy who did my dad's knee surgery.

 

[adventure]

Lots of great feedback, thanks everyone! If I ever need this surgery, I'll look for the best surgeon I can find and follow PT religiously.