Arthroscopy - bucket handle tear - what support?

A snowHead

Hi Guys,

My missus had a fall last year followed by a badminton injury & then a further injury due to a fall in the street the result of that combination was a bucket handle tear of the meniscus, which she has just had arthroscopy to fix, they have trimmed meniscus & flushed out the crap, they have informed her she has level 4 (highest you can get) arthritis in both knees, which seems a bit bizarre as she has no pain with either knee or any restricted movement! They also said she has only 20% of her ACL in the same knee the meniscus was damaged

She doesn't want to give up skiing & consultant indicated she should be fine to return to sport after 6 weeks, she's a couple of weeks in & so far rehab has gone well, walked out of the hospital after surgery, has been doing all recommended exercises & has had virtually no pain since the op

We won't be going until next season now as will be past season end by the time she's finished rehab, so plenty more time to strengthen the knee muscles but my question is this, should she wear a knee support & if so what type, we did ask the consultant but he simply said he was no expert on skiing, not much help!

I'd wondered about Ski Mojo, but she doesn't fancy the complexity of putting it on & complication of using loos on the slopes - also seems a bit like using a sledgehammer to crack a nut!She's 58, a good skier, we typically clock 45/50km a day nearly all on piste & any level/condition of run, no former injuries

Any advice welcome, I did do a search & found some stuff re knee injuries & arthroscopy, but nothing re what type of knee support (if any) is best for this type of injury

A snowHead

@Russbost, no pain, everything fixed, good rehab ...no support needed IMHO

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I have a grade 4 bucket tear (no operation) & Ski Mojo done nothing for me.
Knee still swelled up for a week & kept catching when trying to straighten my leg. Its settled back down now.
But I board & dont ski.

Any knee support would be more of a confidence gainer than anything (maybe compared to no knee support may actually hold your other half back because thinking about the risk of re-injury).

I do find a patella strap just bellow the knee helpful at times - Think your other half needs to try a few different options.

Anyway, snowHeads is much more fun if you do.

Following a hairline fracture (possibly - the xray wasn't too clear) I had a bit of difficulty with stability and proprioception, and a neoprene support helped a lot. I now - having arthritis in both knees and tending to get quite a bit of swelling by the end of the skiing day - wear neoprene supports on both knees, as they not only help with proprioception, but keep the swelling down as well. I also wear compression tights. None of this is for 'support' as such, but helpful nonetheless.

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Level 4 Arthritis, no pain.... Wow, not sure what to say apart from bash on. Supports do very little for knees with arthritis in my experience, apart from making the brain feel more comfortable. In view of the ACL damage she may want to look at a high end Donjoy brace,or similar

A mojo works well really for arthritis sufferers that have pain,

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

@Russbost, I have had operations on both knees and have been told that next time it is a new knee.

I just keep my knees warm and whilst I have a little restricted movement I can still ski everything I want to including bumps, off piste and some racing. I am also over 60 so no spring chicken Smile

After all it is free

Following ACL loss and MCL damage, I get some (mainly) outer jointline pain on boarding and skiing, which physio says may be meniscal, or OA, or wear and tear, or...? Also get easily tired muscles and have knees which obviously aren't what they once were. Anyhows, since first injury I have worn Boots own brand neoprene spring sided (spring, not hinge) wrap around supports; 2 velcro straps each at top & bottom (so 4 in total, cross strapped or parallel), very easily adjusted for fit and tightness and open at the back of knee; and £18 at present... https://www.boots.com/boots-advanced-adjustable-knee-support-10170862
I find that they give a very helpful level of general support without feeling as if they're bulky or in the way. Definitely increase my confidence on snow, knee wise. Could be purely psychological but I can feel the difference when I take them off at the end of the day and I think they reduce the pain which I suffer at present. My consultant was anti full brace, but I wouldn't ski without these.
Have tried some others, so far find these the best. Other skiers have recommended Mueller HG supports, and other makes are available too - it's just cost and where you can ideally examine and try them in person. I have struggled to find any physio or doctor where I live who can advise on bracing at all, sadly. Otherwise there's much more expensive Donjoy, Ossur, etc braces specifically designed for OA or ligament support (Google them plus look for local fitting centres); difficult to get ones for both at the same time, though Ossur do an ACL CTi Unloader, which is designed for one side OA plus ACL. But £500+++....

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I wore a neoporene sleeve type support for some years following a meniscus tear and my knees are quite old and often ache, I dont know if it made any difference but it gave me some "moral" support which is half the battle in my view. More recently I have been using a Mojo which makes it easier on the knees and is also some assistance in the increasing fatigue department (old persons issue). The Mojo is actually not too much faff once you have got used to it and I have seen several people try the device for the first time with a significant degree of sceticism and then agree that it has made a huge difference for them. Your wife might like to see if she can borrow a mojo to try it out.

snowHeads are a friendly bunch.

I have had both my meniscus virtually taken out and always use neoprene supports to give a bit of support and more importantly IMO warmth to the joint which allows tendons/ligaments etc to stretch rather than snap

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@Russbost, I don't want to speak out of turn given that I don't know the specifics of your wife's case, but there is not good evidence in favor of arthroscopic knee procedures for osteoarthritis (either with or without meniscal tears). See these links for the current NICE guidelines and a summary from the NHS.

There are exceptions to the general guideline, and it's possible that your wife came under those exceptions. In any case, it sounds like the procedure went well and she's doing better so that's great news.

Going forward, the most important thing to do is rigorous and consistent physiotherapy. This will take a lot of work on her part, but she's relatively young and that knee has a long way to go - find a really good physiotherapist or other physical exercise person - yoga, pilates, etc are all fine, the particular therapy matters much less than finding a knowledgable and hard-working practioner who will push you and support you. That kind of focused, hard training is a much better predictor of her outcome than whether or not you use a brace. (That said, do use a brace! They help.) Ideally fine someone who is familiar with the lateral knee forces present in skiing. That's worth paying privately for if you have to.

(Also, note that in that guideline I sent, the only benefits of surgery were short-term. All surgery, but especially orthopedic surgery, has a huge placebo effect that usually overwhelms the short term benefits. There is a great book on this by an Australian orthopedic surgeon named Ian Harris, well worth reading if you're interested in orthopedics!)

Add me to the "no support" group, although some folks end up needing a brace or sleeve more for their head/heart rather than their knee, and there's no harm in that. Hard to square their arthritis observation with her being asymptomatic but we'll take it, eh? I think knees speak pretty clearly to us, we just need to listen.

You know it makes sense.

Many thanks for the info guys, update is that she has had no further problems is busy with exercises for about 45 minutes a day & has been playing badminton as well as she ever did for the last 3 months or so. We were already booked away with friends & family for the end of Jan, but have just booked Cervinia for a pre Xmas break just the 2 of us, so there'll be no pressure & she can do as much or as little as she wants & see how it behaves.

She's got some basic sleeve type supports which I think will do more to keep the muscles warm rather than anything else, so we've gone down the "almost no support" route - might pick up some of those Boots ones as a backup if she feels she needs more support

She has been meticulous in doing all exercises recommended & gets no pain at all so fingers crossed - bl**dy great getting old innit! Crying or Very sad

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

@Grizzler,
Take it from me as an Msk physio, fellow skier and someone who has a degenerative lateral meniscus herself that the Ski Mojo is absolutely amazing. I learnt about it from acquaintance and initially thought it was a bit of a joke, but after skiing in February & March 2019 with an alternative brace (good one and not cheap) with pain every day, even with anti-inflammatory meds, I decided I needed to do something!

I 'test drove' a Mojo @ Chill Factore in Manchester for 2 hours. It sounds odd but felt like I was skiing from my armchair initially, so comfortable and took out all the ski chatter across the slope and moguls which really stirs up my knee pain. This armchair feeling disappeared quickly and I settled into the Mojo. Disengaging it a couple of times made me feel I gained 2 stone immediately - switched on again quickly Smile

Upshot - I bought one and not looked back during my skiing in December 19 in Obergurgl. No pain, no medication. Even had some spectacular falls and the Mojo seemed to protect my knees during them as I felt it wouldn't allow the joint to twist to breaking point... i.e that point where the ACL +/- meniscal injury occurs.
OK, a 'boggy knee' issue one night due to a long day, but an ice pack or 2 in the evening and I was up for another full day on the slopes.
I definitely say if you have knee issues then the Mojo is for you. Even my 24 Yr old daughter will be getting one for her holiday.

Try one out first at the various snow centres if you aren't convinced and let me know! See the Ski Mojo website for the sites that participate.

A snowHead

I love the Ski Mojo. I can reassure your wife that, as a woman, It’s not a faff to go to the loo on the mountain.
The first time putting it on is a faff but that is normal. After that it is super easy.
I picked up mine 2nd hand on here. Best ski purchase after my fitted boots. Neoprene knee supports offer nothing compared to a ski mojo.
It is possible, based on your description, she does not need it yet but might in future so I’d recommend keeping an eye out for a 2nd hand one and pick it up before she might need it. Then you are buying on your own terms and at your own pace.
Good luck with the recovery.

A snowHead

@Russbost, how did you get on during the pre-Xmas trip to Cervinia?

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

Mojo doesn't offer support, it offers assistance.

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Lots of good advice and positive reactions to the ski mojo, I’ve had one for 5 years after ex got hers because of ACL rupture. Got her back to skiing.
Only advice I’d give is make sure salopettes are roomy and don’t have a fleece type lining! It’s a pain when the Velcro hooks into the lining on the salopettes.
If you decided to buy from eBay make sure it’s a modern one as the version one kept on failing at the waist belt.

Anyway, snowHeads is much more fun if you do.

I'd agree on a size bigger for the salopettes or at least roomier at the knees.

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Yes...space across the knees is essential

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Arthroscopy - bucket handle tear - what support?

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