Alternatives to surgery for meniscus tear

**letterk** · 10-27-2010, 11:43 AM

I tore my meniscus in two places this summer playing basketball (I play about twice a week year round). Normally, these don't heal and require surgery. However, while my doc says the tears are fixable, he doesn't really know until he gets in there. If not fixable, the options are to live with the pain or remove the damaged portion entirely. Removal means much greater chance for future joint problems.

I can't live with the pain as it's completely shut me down (and I'm getting soft in the middle). So right now I have surgery being scheduled in about 2 months. I've been doing some research on alternatives and while there seems to be a number of promising options, they are lacking in clinical data. Prolotherapy, Regenexx, etc... Anyone have real experience with these types of treatments?

**Go West Young Man** · 10-27-2010, 11:59 AM

Not exactly the same situation, but I tore up my shoulder last year playing hockey. It was painful and annoying, and both docs I saw told me that at my age (38 at the time) and with my activity levels I shouldn't be surprised when things start to fall apart. They said it was't serious or structural, I could easily live with for the rest of my life and it would never worsen, but my motion and activities would be restricted by the pain. OTOH, surgery would necessitate a painful year-long recovery process.

I did the cortisone shots, I did the physio, RICE, everything possible to avoid surgery, but finally sucked it up and had it taken care of. Moral of the story, a couple years later it still aches a bit (I'm sure I'll get arthritis in there) but I'm back playing hockey, baseball, biking, everything I did before with no restrictions or pain.

It sounds like you're too young to just give up and live with it, so I hope you manage to find the right combination of treatments that work for you.

**letterk** · 10-27-2010, 12:03 PM

Not that many years behind you. Couple months away from 35. But yes, I still think I'm too young to give up on those things. My wife will say otherwise...

I guess if the surgery had a higher success rate I'd feel better about it. It's the high chance of the need for removal that has me looking at other options.

**syzygy** · 10-27-2010, 12:09 PM

Some areas of the meniscus (outer) have some blood supply so there are only options if this is the affected area. If it's a classic tear towards the middle or a bucket handle tear (outer lip horizontal tear) then they normally have to remove the offending piece. I had a meniscal tear in my right knee from motorcycle trials that required surgery and removal and I haven't had any issues with it whatsoever - feels the same as it ever did. I also have an asymptomatic tear in my left knee and so far no issues and it's been two years. I am a pretty active guy so its likely I'll experience issues later in life due to fatigue but so far so good, and I'm 41.

**mdevine** · 10-27-2010, 12:56 PM

Originally Posted by syzygy

Some areas of the meniscus (outer) have some blood supply so there are only options if this is the affected area. If it's a classic tear towards the middle or a bucket handle tear (outer lip horizontal tear) then they normally have to remove the offending piece. I had a meniscal tear in my right knee from motorcycle trials that required surgery and removal and I haven't had any issues with it whatsoever - feels the same as it ever did. I also have an asymptomatic tear in my left knee and so far no issues and it's been two years. I am a pretty active guy so its likely I'll experience issues later in life due to fatigue but so far so good, and I'm 41.

+1.
Unfortunately, these injuries don't heal themselves because of the poor blood supply to the meniscus. I have seen patients delay surgery and extend the tear further while awaiting it. On a personal level, I had both medial menisci repaired over a one year period after sports related injuries (in my late 30s) and have not had a bit of trouble since the arthroscopic surgeries. The surgeries these days tend to spare the bulk of the meniscus and this results in much less trouble with arthritis down the road. Good luck.

**letterk** · 10-27-2010, 01:06 PM

The main reason I'm delaying it because of travel. My schedule doesn't allow for 3+ months of recover until next year. I'm being very careful not to insure it further. Which is why I'm getting soft in the middle.

**instpasr** · 10-27-2010, 01:07 PM

Better to get surgery sooner than later. I had the same injury and put it off and now regret it as I could have been pain free sooner.

**mdevine** · 10-27-2010, 01:13 PM

My recovery time was much less than three months. I missed one week of work (which is mostly sedentary) and about one month of golf. I've seen football players back from this surgery in under a month.

**Bullwinkle** · 10-27-2010, 01:56 PM

60yo wife had this surgery over the summer and she was not out of comission anywhere close to 3 months.. in and out same day for surgery, back to see the doc same day the following week. Then just common sense.

**jones2289** · 10-27-2010, 02:32 PM

I had the same problem about three years ago. I was told by the surgeon that he wouldn't know if it was repairable until he got in there. It ended up that he couldn't repair it, and ended up removing about half of the meniscus.

In the case that it is removed, your recovery period will be dramatically shorter than if it is repaired, as I'm sure the doctor told you. However, you're definitely correct in saying that you could be out for 3+ months, as this is what I was told as well. The surgeon said that in the event of a repair, I would have been on crutches for at least six weeks, followed by physical therapy and limited activity until the repair was fully healed.

I hope that you can find a feasible and effective alternative to the surgery, and wish you the best. I don't have any suggestions, but just wanted to throw in my two cents since there seem to be dissenting opions on the duration of recovery.

**ouch** · 10-27-2010, 05:30 PM

Torn meniscus? My specialty! That's what knocked me for a loop last summer ('09).

My doc (an offensive lineman from Harvard who doesn't take insurance- how's that for credentials?) describes the meniscus as a deck of cards. He was able to salvage about half of mine.

It was a major PITA, but I'd recommend it unhesitatingly, especially for an in shape young whippersnapper such as yourself. Fifteen months after the surgery, I have no ill effects whatsoever, and have not lost a bit of mobility. You would probably spring back in no time. I was back at full speed about six weeks after the operation.

**letterk** · 10-28-2010, 08:32 AM

I've found the recovery is higly dependent on the surgeon and the techniques used. For instance, my wife had hip surgery to repair a torn labrum early this year. Most surgeons just remove the tear, but her's repaired it. Better long term prognosis, but drastically different recovery. Instead of 2-3 months, it was closer to 8. It's actually a more painful and a longer recovery than complete hip replacement! But the chances of her having problems later are next to nothing.

My surgeon (same facility), when doing a repair not removal, does microfracture on the side of the joint for blood flow. It's the microfracture that lenthens the recovery, but also improves the outcome. I've been told crutches for less than a week, then a brace to keep my leg straight for a month, then 3+ months of therapy. A friend of mine just had this done with the same doc and he was told 3-6 months. He's been on crutches for about 3 weeks now.

My doc is the sports doctor for a number of local universities and is a extremely well known and respected surgeon. Everyone with knee issues sees him, so I'm confident he'll do a good job. But surgery is surgery.

**letterk** · 10-28-2010, 08:34 AM

Originally Posted by ouch

Torn meniscus? My specialty! That's what knocked me for a loop last summer ('09).

My doc (an offensive lineman from Harvard who doesn't take insurance- how's that for credentials?) describes the meniscus as a deck of cards. He was able to salvage about half of mine.

It was a major PITA, but I'd recommend it unhesitatingly, especially for an in shape young whippersnapper such as yourself. Fifteen months after the surgery, I have no ill effects whatsoever, and have not lost a bit of mobility. You would probably spring back in no time. I was back at full speed about six weeks after the operation.

Did you have it repaired or removed?

**ouch** · 10-28-2010, 11:32 AM

Half was removed.

**instpasr** · 10-28-2010, 12:05 PM

With my knee problem I had a small meniscus tear and a rather large osteo chondial defect that we did micro fracture on. The tear is good the OCD Im Still having problems with, there are more options available now then when I had mine done 9 years ago. My doc used to be a team doc for the Steelers and I've operated with him several times so I was comfortable with him. The down side to my micro fracture was that I was on crutches for 6 weeks because of the area involved.

**TimmyBoston** · 10-29-2010, 11:06 PM

John, I've never had a meniscus tear, but I had a bad multiple ligament and tendon tear in my thumb. I spent a year in a combination of toughing it out, in physical therapy and meeting with surgeons. None of the it did any good. The surgeons all said they might be able to fix it, but I'd never play football again or any other sport. Finally, I got an appointment with one of the top hand surgeons in the country. (I share the same name as a famous college basketball coach's son, he thought I was the coach's son and fit me right in the next day. The look on his face when he walked into the examining room was priceless.) He looked at my hand for thirty seconds, told me he could fix it no problem. I got the surgery and I was back on the field starting the next season. I know surgery sucks, believe me I know, I've had tons of them, but with the right surgeon it can work wonders. If you've got a great surgeon, I'd get the operation, but if you aren't comfortable with your surgeon, keep looking. I hope this helps and hope you're healed up soon. I look forward to you kicking my ace in B-ball at the next BBQ.

**ouch** · 10-30-2010, 07:29 AM

Tim, does your father throw chairs?

**TimmyBoston** · 10-30-2010, 08:18 PM

Originally Posted by ouch

Tim, does your father throw chairs?

Whose doesn't?

**riooso** · 10-30-2010, 08:49 PM

I tore mine pretty badly when I was 17 in 1968. My doctor couldn't do much with it at the time. Fast forward about 25 years. The nerves that hurt were pulverized by this time and the end of all both my bones had worn out a bit. I had powered through the pain and ruined my knee. I finally got it worked on in 93 and it was a life changing event......

Get it fixed.

Richard

**mook** · 11-09-2010, 04:30 AM

My turn too chip in chaps, im 30 blew my knee out playing rugby in Cape town back in 1999 just strapped it up and was back playing after about 4 weeks fast forward to 2003 and im playing for Cardiff University and the knee blows again strapped it and carried on. I went in for arthroscopic knee surgery back in May this year Surgeon confirmed that the first injury probably tore my ACL the second one made sure as there was no sign of it anywhere in the knee. I was experiencing a slight pain up the back of my hamstring and had a rel issue with a sensitive kneecap. The surgery cleaned and flushed out all the gristle that was left and ive been pain free since. My advice was if i intended to continue at any sort of high level rugby i would need to have a full ACL reconstruction and deal with the 12 months physio with a high chance of regaining the full strength in the knee joint again or i could hang up the boots and call it a day and find a less high impact sport to enjoy. The key assesment was that at 30 even with the surgery my best days were probably behind me the assesment that the knee itself would be fine without the cruciate made the decision for me the boots were hung up and i started swimming and hiking as an alternative to the crash bang wallop of rugby.

The choice to be made is if you need to perform at that high level get the surgery do your time in physio and remember no one made you do it. if you are ready to lessen the intensity then look at a day to day management of it