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Rehab on meniscus surgery

post #1 of 26
Thread Starter 
Hello, I recently had meniscus surgery about 2 months ago. Knee hurts some times but I can manage my self. Taking into account that I'm leaving to Chile (Valle Nevado) on the 20'th of July, Is there any special excersice that I should do?

If so please let me know
post #2 of 26
CAll your ortho and ask his/her opinion. If it's 2 months afterwards and you did rehab or at least worked to strenghten the leg muscles, it really shouldn't be hurting.
post #3 of 26
Did you have a meniscal repair or debridement? There's a big difference in terms of post-op management/recovery/activity.
post #4 of 26
Quote:
Originally Posted by jdistefa View Post
Did you have a meniscal repair or debridement? There's a big difference in terms of post-op management/recovery/activity.
Could you please explain further? I am having a small medial tear cleaned up on July 16th.
post #5 of 26
Debridement = cutting/trimming damaged/torn meniscus back to good stable tissue.

Repair = sewing/tacking/anchoring a peripheral tear (close to the knee capsule where good blood supply is)

Most meniscal tears are > 3mm from the peripheral margin which reduces the chance for a repair to heal (due to limited blood supply).

Most adults tend to have ragged and/or complex/multiplane mensical tears that really can't be 'repaired' but simply have to be debrided.

Hope that helps.
post #6 of 26
to add: the vast majority or surgeons out there will cut rather than repair. You need to ask the surgeon if your tear is located in an area where there is blood flow and if they can perform that kind of repair. It's much better down the line if you can repair.
post #7 of 26
Quote:
Originally Posted by Finndog View Post
to add: the vast majority or surgeons out there will cut rather than repair. You need to ask the surgeon if your tear is located in an area where there is blood flow and if they can perform that kind of repair. It's much better down the line if you can repair.
At my age i think cut is the only option.

I was most interested in the post-op particularly rehab protocol.

I have an old tear that is at least 15 years old that has been completely asyptomatic. the current state of affairs is a new small tear. During a recent tennis outing (I play 2 to 3 times a week) just walked over to pick up a ball & I got a very, very minor little twinge on the medial side of my patella down almost like on my tabial plateau. didn't give it a 2nd thought. Played the rest of the afternoon but woke up the next day with some fluid and a bit of pain. Waited a week, had an MRI and then the surgery scheduled.

I am really not worried about the surgeon. He study at the Steadman-Hawkins clinic, repaired my older boys ACL, numerous and I mean numerous CMAC racers & racer's parents knees includng X-US ski team members and he also worked on the wife of CMAC's head coach (who is one hell of a ski racer herself)and also a couple of US Ski team members.

He says I should be back playing tennis 2 weeks post op???
post #8 of 26
Quote:
Originally Posted by Finndog View Post
to add: the vast majority or surgeons out there will cut rather than repair. You need to ask the surgeon if your tear is located in an area where there is blood flow and if they can perform that kind of repair. It's much better down the line if you can repair.
Most surgeons will cut rather than repair simply because a repair is not possible. Even if the repair is in an area with good blood flow, the failure rate (not related to surgical technique) is moderate. Menisci simply don't heal well.

Re. Atomicman's query, yes you will probably be back playing tennis within a few weeks. The question is... should you?
post #9 of 26
I can tell you through my research prior to my surgery that few doctors in the NJ/NY area had any experience with the repair. Most are simply going in and cleaning out;even if it's in a good area with ample blood flow. If you are lucky enough to live in an area like CO or UT, you have a better chance of finding surgeons who are used to treating patients who have athletic lifestyles. That's not the case around here. Took a 3 doctors to find one to treat my sports hernia that I am dealing with now. All just said it will heal on it's own. Hmm, 9 months now???
post #10 of 26
It really doesn't matter if you have an "athletic lifestyle" or not, it's all a question of where your tear is, how old it is, how old you are, and what type of tear it is (shear/transverse, radial, bucket handle, parrot beak, simple/complex, macerated, etc).

Your meniscus doesn't know that you're an athlete .

Here's an angiogram of a meniscus that may help to clarify the healing - or lack of - issue (F = femur, T = tibia):
525x525px-LL-vbattach3529.jpg
post #11 of 26
"J", you would be suprised to see the different attitude in doctors! Night and day. If you don't tell them you aren't a couch potato and expect more, you won't get it. I don't know if yo are doctor or not but you haven't seen it from the patient's POV, but I could get several of my fellow skiers who have encountered the same problems. Unless you are very specific and do your research first, your arent' likely to get a doctor to offer the more difficult or involved proceedures. If your tear is simple and easy for them to get in and out, that's what they are going to do. My current surgeon, who is doing this surgery and I just had this same discussion. He is an avid skier and biker and freely admitted the problem out there. He attributed part of it to insurance companies but he difinitely admitted it. If yo have surgery and it requires more time or involvement, the insurance companies are not going to pay them to do it; just the basic and what is reasonable and customary. PS- Repair wasn't an option for me but the whole procedure took him 1/2; if he when longer, it all comes out of his take. Go to a rehab center and it gets even more evident. They have protocols for those who just want to get by and protocols for athletic people. The approaches are very different. Maybe it's just around here but unfortunately, I have had several surgeries so I kinda know the game pretty well now.

Sorry for the late edit: Also, would a doctor perform the same procedure to rebuild a knee if the rehab or process was more involved and costly for a 50 something over weight couch potato who never exercises or is non-active vs. a 20 something college athelete?
post #12 of 26
Finndog,

Sorry your experience has been difficult. I've seen it from both a patient and physician perspective, but I'm also in Canada where the medical culture is somewhat different.

It's good to have common ground with your treating physician, but - of course - none of that changes the underlying anatomical, age, injury, treatment, and healing realities that I discussed .
post #13 of 26
I agree whole-heartedly that it shouldn't but it absolutely does. My good friend flew from upstate NY to Chicago to have his arm operated on because he wanted a sports specialist to do the surgery using a more sound and advance method. There are a number of specialty clinics popping up now that specialize in treating only sports related injuries. The difference with these clinics is they are selling sport specific surgery techniques and rehab.
post #14 of 26
Just as a general rule of thumb... The best predictors of surgical outcome, short of gross errors, are as follows (in order of importance):

1) Patient factors (age, chronic illness, diabetes, smoking, tissue quality)
2) Patient compliance (motivation/coping/adherence to post-op program/instructions/rehab)
3) Surgeon (skill, experience, decision making, caring/personality)
4) Surgical technique

Going to a specialized clinic may improve some of the criteria in 3) & 4), but until one compares matched cohort outcome data over the long term, it's all sales & marketing IMO.

However, the perception of quality/expertise is an important part of healing/belief/placebo effect (whatever label you want to put on it), so that can't be discounted .
post #15 of 26
so having surgeons and PTs who specialize in specific sports training and or procedures won't offer you an advantage? So Tiger woods going out to Utah for his ACL surgery was marketing? So I will have the same outcome going to a local non-specialist doctor for ACL surgery as going to a dr who performs nothing but ACL procedures and trains and studies the latest techniques and has the most advanced tools and equipement? This makes no sense to me. How is this possible?
post #16 of 26
Finndog,

I'm not arguing with you, ok? You clearly have a very strong belief system.

I'm just suggesting a few things to think about.... The answers to most of your questions are in the list on my previous post .
post #17 of 26
Hey Jdistefa, I've got this can of worms I'm having trouble with. Think you can get it open for me?



This is why I and, as far as I can tell, the other docs on Epic are pretty careful about offering medical advice, especially to people whose MRIs we haven't seen and who we haven't physically examined. Second guessing our medical colleagues who have examined their patients is ethically problematic at best.

On the occasions when I do respond to medical questions, I make sure I can back up everything I post with citations. That way, I'm not providing advice, but merely offering sources of information, which lay people can read and think about on their own. The down side to this is that it is terribly time consuming writing a referenced post; and by the time I've finished it, I could have written a review article for actual publication.

Speaking of which, regarding your comment about periprosthetic fractures on the knee replacement thread. If you have cases of periprosthetic fracture associated with skiing, you should write them up and publish them, as I could find only two case reports of this in the literature. And don't say you don't have time - if you have time to waste here, you have time to write a short clinical note to your favorite orthopedic journal.

Cheers!
post #18 of 26
Quote:
Originally Posted by Acrophobia View Post
Hey Jdistefa, I've got this can of worms I'm having trouble with. Think you can get it open for me?



This is why I and, as far as I can tell, the other docs on Epic are pretty careful about offering medical advice, especially to people whose MRIs we haven't seen and who we haven't physically examined. Second guessing our medical colleagues who have examined their patients is ethically problematic at best.

On the occasions when I do respond to medical questions, I make sure I can back up everything I post with citations. That way, I'm not providing advice, but merely offering sources of information, which lay people can read and think about on their own. The down side to this is that it is terribly time consuming writing a referenced post; and by the time I've finished it, I could have written a review article for actual publication.

Speaking of which, regarding your comment about periprosthetic fractures on the knee replacement thread. If you have cases of periprosthetic fracture associated with skiing, you should write them up and publish them, as I could find only two case reports of this in the literature. And don't say you don't have time - if you have time to waste here, you have time to write a short clinical note to your favorite orthopedic journal.

Cheers!
Just so I'm being very clear here - are you implying that I'm being unethical?

I just reviewed my posts, and sorry if I'm misreading, but I thought I was offering some useful background information without the intent to comment on specific case management.

You and I both know that case reports don't represent the incidence/prevalence of disease. Periprosthetic fractures are a rare but serious problem, and I thought a cautionary note to provoke reflection was reasonable. Some of the newer titanium implants that have similar elastic properties to bone help to alleviate much of the risk, but you can't get around the fact that metal in bone acts as a stress riser.

Am I supposed to be writing referenced posts? I thought the spirit of this place was to make a reasonable contribution. If you've been reading this section of the forum, you'll note that I post rarely, and only when I think I can offer something useful.

If I've violated some policy on this forum, please let me know. As you've noted, time is scarce and I would be happy to retreat to lurking .
post #19 of 26
Quote:
Originally Posted by jdistefa View Post
Re. Atomicman's query, yes you will probably be back playing tennis within a few weeks. The question is... should you?
I believe the comment bolded above may have prompted Acrophobia's response.
post #20 of 26
Quote:
Originally Posted by Atomicman View Post
I believe the comment bolded above may have prompted Acrophobia's response.
The question (a reasonable one) was for the patient/poster, not in any way intended to conflict with the particular surgeon's comments.
post #21 of 26
Quote:
Originally Posted by jdistefa View Post
The question (a reasonable one) was for the patient/poster, not in any way intended to conflict with the particular surgeon's comments.
I guess my question is then, the surgeon said 2 weeks having examined my knee and MRI and the shape iI in and having known me for about 7 years and you , questioning should i return to tennis in a few weeks. what makes you question this?
post #22 of 26
Quote:
Originally Posted by Atomicman View Post
I guess my question is then, the surgeon said 2 weeks having examined my knee and MRI and the shape iI in and having known me for about 7 years and you , questioning should i return to tennis in a few weeks. what makes you question this?
Sigh... just experience.

It is not unusual for a meniscal tear to progress, despite being debrided back to apparently stable tissue. Think of it like a t-shirt: Tough to get a rip started, but once you have a lead point, awfully easy.

The chances of this happening are dependent on the type of tear, meniscal quality, patient age, coexisting arthritis, and activity. Plant and pivot sports are tough on menisci - that's just a fact of life.

My question was an admittedly poor attempt (in retrospect I should have explained my intent better) to highlight the general principle of activity modification as part of the healing (and reducing re-injury risk) process.

This is a tough room.
post #23 of 26
I'm not accusing you of anything, jdistefa, just pointing out that it's wise to be careful about offering medical advice on the internet. If you offer advice that is incorrect based on details you didn't have at the time (like a complete medical history, a physical exam, and an MRI), you can potentially cause someone a great deal of distress. That is the "ethically problematic" issue.

In order to avoid the appearance of offering advice, or contradicting other people's doctors, I personally cite references when I discuss medical issues, but obviously that isn't a requirement. It is good practice, however. I wind up learning a lot when I look up references!

And yes, the literature does not adequately reflect what happens in real life, which is why people with cases need to write them up. Seriously, do you have a case series of skiers with periprosthetic fracture? Because if you do, just write up the narrative, scrounge up their films and publish it. Heck, I'll even write the background and conclusions if you don't have time. In writing up a response to the Knee Thread (I haven't posted it yet - these things take time), I realized I'm halfway to a review article, so if you've got a case or two - bingo! Another cha-ching on our publication lists.

Anyway, just to be clear, I'm not attacking you. I look forward to your continued contributions to Epic.
post #24 of 26
Quote:
Originally Posted by Acrophobia View Post
Anyway, just to be clear, I'm not attacking you. I look forward to your continued contributions to Epic.
Thx for your advice.

Yes, we have quite an interesting case series of ski related bone explosions, metal and non-metal related.... Part of the s/e of having a hospital in an area that sees 1.2 million skier visits a year. I'm afraid publishing is going to have to wait for another life .

My contributions to Epic outside of the bootfitting area are stopping tonight - what started as an intent to be helpful has turned into an unpleasant experience at best.
post #25 of 26
Quote:
Originally Posted by jdistefa View Post

My contributions to Epic outside of the bootfitting area are stopping tonight - what started as an intent to be helpful has turned into an unpleasant experience at best.
I hope you reconsider. I learn something or are motivated to learn more from many of your posts.
post #26 of 26
Quote:
Originally Posted by jdistefa View Post
Sigh... just experience.

It is not unusual for a meniscal tear to progress, despite being debrided back to apparently stable tissue. Think of it like a t-shirt: Tough to get a rip started, but once you have a lead point, awfully easy.

The chances of this happening are dependent on the type of tear, meniscal quality, patient age, coexisting arthritis, and activity. Plant and pivot sports are tough on menisci - that's just a fact of life.

My question was an admittedly poor attempt (in retrospect I should have explained my intent better) to highlight the general principle of activity modification as part of the healing (and reducing re-injury risk) process.

This is a tough room.
That makes much more sense now.

The symptoms i am currently experiencing are almost zero! In fact I have not had and never have had any popping, clicking or giving out. Currently, I feel like I could easily play tennis at a bit of a subdued level. I wouldn't really want to chase any tough shots. That would make me kinda nervous. But, yesterday I mowed the lawn with no incident or pain. I do understand even professional lawn mowing isn't a plant and pivot endeavor!

when he examined my knee very little pain, just more nervous about some of the twisting tests!

My current symptoms are more thaqt it just doesn't feel quite right. Minimal pain if any and it is very sporadic and a very slight sporadic stiffness, I think there may be some fluid in my knee but not much. No current swelling.

So, I am not going to do anything put my knee at risk for ski season. i love tennis but given the choice I will take skiing anyday.
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