Medial meniscus tear and repair

A snowHead

I finally got around to going to the doctor about a niggling knee problem I've had since a ski fall in April 2017. I hadn't anticipated it was at all serious as the knee has never been unstable and was not even swollen at the time of the original accident. However, the MRI shows a tear to the medial meniscus that hasn't healed, and I've been advised surgery is required for a repair, ideally sooner rather than later. Whilst the surgeon was very pro repair, he did also spell out the limitations following surgery and basically told me to go away and work out when I could fit it in over the next 2-3 months with the least impact on my life in general. He said they would restrict the ROM with a brace for several weeks after the surgery, during which I would also be non-weight bearing. I think he said 6 weeks but I am now wondering if I am miss remembering this because it seems really long! He definitely said 8 weeks until I can cycle around town (my main mode of transport and way of getting to work), 4 months till I can run, 6 months till I can ski. Surgeon said for him it's a routine operation and he does around 100 per year, though he appreciates for me it is anything but routine. He also said that in his opinion physio (instead of surgery) would not help as I already have full ROM and my leg muscles are strong, and that's what physio would be targeting. Leaving it is not an option in the long term as it will get worse and there is already some evidence of secondary damage from leaving it untreated for the last 15 months. Surgeon works at a specialist sports clinic and is a knee specialist there.

Does anyone have any advice on recovering from a similar operation? I'm 36, fit and healthy and do a lot of sport. I'll do all the physio and follow instructions to the letter. It's a repair not a trim, which I understand has a much longer recovery time. I have a follow-up consultation in 10 days time to make a plan. I'd be very grateful for any suggestions of things I should ask about at this consultation.

I was a little bit in shock at the time of the consultation, which was in German (which I speak well enough, but not fluently) and I didn't take notes (aside from frantically messaging MaireadOConnor as soon as I left). We had been intensively planning a trip to Japan next January, which now seems rather risky as I would theoretically only just be able to ski by then. Any thoughts?!

Thanks very much for any advice.

A snowHead

I guess you have a tear in the outer part of the meniscus, hence a repair may be possible. Having had a couple of knee surgeries I would go for the repair as cutting out the damaged meniscus may lead to other issues, it won’t be painful and you probably won’t swell up much and may have 2-4 tiny incision holes around your knee. The issue is just that it takes the meniscus ages to heal as it has poor blood flow.

Well, the person's real but it's just a made up name, see?

I would be going for a second opinion, I think.

You need to Login to know who's really who.

@Gämsbock, I had what sounds like similar damage.

Do you have any more specific details of diagnosis and/or proposed surgery?

I had arthroscopy after a couple of years of physio.

Anyway, snowHeads is much more fun if you do.

@PeakyB, it's a horizontal tear to the medial meniscus with an associated cyst. The proposed surgery is to repair the tear, without removing any of the meniscus.

You'll need to Register first of course.

@Hurtle, what do you think I should be concerned about?

Then you can post your own questions or snow reports...

Not so much worried as to double-check that there isn't a non-surgical option.

After all it is free

Hmm...Mr P may be experiencing a similar problem, but so far that is just a GP’s initial assessment, and he will be going for a proper scan ASAP. His problem started towards the end of this ski season with occasional pain in knee, but it’s got worse over the last month or so (not helped by scrambling around as crew on a friend’s boat in a yacht race last week). Thankfully he has private health insurance, so wants to crack on with dealing with now. It sounds as if these sort of problems range in overall seriousness, and maybe yours is more significant (not meaning to offend, but I hope Mr P’s issue is not as bad as yours!!). It could be interesting to compare notes as to treatment. Would hate to think it could have a significant impact on our plans for next winter’s skiing.

Mr P is nearly 58 (not a number I can get my head around). He cycles to work if he can and has skied a lot this winter just gone, so he’s pretty fit too. He’s stopped cycling over the last couple of weeks and maybe our plans to hike, walk and cycle in northern Spain next month will have to be moderated somewhat!

@Gämsbock, I'm unqualified to advise, but can summarise my experience. I had damaged medial meniscus on right knee. It gave me problems for 10 years but not enough to prevent me from skiing, cycling, resistance training in gym, etc. After it worsened about 4 years ago I had a period of intensive specialist sports physio. That was sometimes very painful but after about 3 months the problem more or less went away. It is still OK to ski, cycle, gym resistance work but not to run on.

Left knee medial meniscus damage presented quite suddenly in Dec 2015, after completing a week skiing. Much more serious, with swelling, pain, difficulty walking and unable to ski or do much leg exercise. Investigations showed serious damage to meniscus, degradation of bone surface around (arthritis) and resulting 'Baker's cyst' at back of knee. Oct 2016 had arthroscopy, which basically removed meniscus and attempted to smooth the indentations in the bone surface. Walking normally (short distances) within about a month. Back to gym after 6 weeks, gentle at first but 10 weeks from op doing varied 1.5 hr workout. 5 months after op I managed 1 week skiing, reasonably hard, around EK. Last season I did 6 weeks skiing but had to ice and treat with ibuprofen gel each evening. The final week, EOSB, was challenging and painful, though still very enjoyable.

I hope that is some help. I tend to agree with @Hurtle, a non-surgical option, such as specialist physio, may be worth a try. It worked for the minor damage to my right knee....but keyhole surgery needed for the other. I hope to delay need for full replacement knee for at least another 2 years.

Good luck snowHead

I've been on daily light dose of Naproxen for over a year. My view is that the arthroscopy improved the knee significantly but is a temporary solution. I've probably overdone the stress on the knee since. @Hurtle,

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Repairs, of course, are more complex than trims - requiring non load-bearing etc etc. But intensive physio could also be an option and require less down-time.

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Thanks everyone for your advice. I have thought about it a lot and also spent several hours on Google and reading research papers, which has been a very useful exercise to get my head around the treatment options. Fortunately or unfortunately (depending on how you look at it!) I'm struggling to find anything that is controversial in his advice. I have found research that indicates that physio is as effective as a trim in older patients with degenerative tears, with endpoints focused on the ability to do everyday activities such as climbing stairs, and with the physio focused on improving mobility/leg strength. However I don't fit the criteria for this treatment pathway, as I'm relatively young, my tear is not degenerative and the rest of the knee is in excellent condition, a trim is not proposed, I don't have any issues climbing stairs(!), and my mobility/leg strength is already excellent. This is consistent with his advice that physio would not be useful in my case. The repair offers the opportunity to preserve my meniscus, which I am keen to do this if at all possible.

@Gämsbock, just wondered if your research revealed anything about tissue augmentation, to address this sort of problem?
Unless I was just dreaming, I think some new technique being tested in USA?

You know it makes sense.

Update on Mr P. It is a torn meniscus, but by the sound of things, at the lower end of the scale. The doc had to check the scan for signs of arthritis and says that there is little sign, which apparently helps. Booked in for keyhole surgery on 17th July. Surgeon says Mr P should be back on his bike (gently) after 4 weeks and full recovery 8-10 weeks. We do go on holiday on 26th July and so it looks at though it will have to be a sedate affair. We are staying along the northern coast and into the mountains of northern Spain. Any plans for serious activity will have to be shelved. However, it is far more important to get him sorted before next winter.

Otherwise you'll just go on seeing the one name:

@Gämsbock, I had an ACL reconstruction and medical meniscus repair and was load bearing after 2 weeks and back on the bike after 4 weeks with no ill effects. 8 weeks in now. The doc and physio just said listen to your body and don’t fall off!

A snowHead

A snowHead

Mr P had his op Tuesday last week. It must have been a low end injury compared with some described above, though the surgeon said it was a big tear. Keyhole surgery under general anaesthetic. Mr P walked out of hospital with no crutches or stick on the same day. He says the leg felt rather wobbly until the weekend. Now it feels better, but a bit stiff in the mornings. Stitches come out today and he has a consultation with the physio. So far so good!

Help!!

Medial meniscus tear and repair

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