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Surgery recommendations for meniscal tear
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Surgery recommendations for meniscal tear - December 28, 2006 11:44:00 PM
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JSPT
Posts: 289
Joined: April 19, 2005
From: Michigan
Status: offline
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I injured my R knee about 6 months ago and would like some opinions about surgical options.
Symptoms: Only present after running or when the tibia is externally rotated on the femur (stupid branches), or with squatting past about 120 degrees. No pain with cutting or normal ADL's.
-No mechanism of injury. Symptoms began insidiously the day after a normal run of about 3 miles.
-Pain is located over the R MCL and just anterior and lateral to this point around the tibial plateau
-The knee very rarely locks, but has on occasion with hyper-extension; never during ADL's.
MRI Findings:
Compatible with a tear of the apex of free edge of the body of the medial meniscus resulting in foreshortening of the meniscus. The fragment cannot be identified and may be floating freely in the knee joint.
In addition, the body of the medial meniscus is displaced somewhat outside the joint space.
I have an appt. with an orthopod in a month. I have exhausted my PT options, and it feels fine except for with the above activities.
Anybody have a similar problem? Thoughts on benefits of waiting another 6 months?
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JS
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Re: Surgery recommendations for meniscal tear - December 29, 2006 10:23:00 AM
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Shill
Posts: 1107
Joined: February 13, 2003
From: Madison WI USA
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Wait it out. I currently have a left knee that wont let me squat beyond about 135-140. I have had it before, it completely went away, in all activities, though I think mine has more to do with posterior aspects of my lateral meniscus. There is probably no risk involved with waiting. The question is, how will your patience fare? IF you are no better in 6 months of CONSISTENT activities at and near the limit of your discomfort, you then make yourself a much better candidate for surgery. Flex your knee under less load than bodyweight, and do it a few times daily, gradually progressing the compressive force over the 6 months. See if this provides a stimulus for healing. Its never been studied, but you can be your own little case study.
If you have surgery, make it clear you want as little meniscus removed as is necessary. We all assume they know this is what we want, but it doesnt hurt to say it out loud.
Thats all. Happy New Year.
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Steve Hill PT
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Re: Surgery recommendations for meniscal tear - December 29, 2006 8:49:00 PM
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JSPT
Posts: 289
Joined: April 19, 2005
From: Michigan
Status: offline
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Thanks Shill. That's exactly the type of opinion I wanted. I only wonder about the floater.
I was kneeling on a Theraball showing a patient how to balance yesterday. When my tibia was translated posterior, it felt like the chunk moved outside the joint space. Immediately when I got off, I lost some extension and it hurt like a b****.
I had another PT do some long-axis traction on the tibia, felt it move, and the knee immediately regained extension and there was no pain.
Won't those symptoms remain, even if the tear does heal? Isn't the only way to stop the floater from interfering with the knee mechanism to remove it?
_____________________________
JS
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Re: Surgery recommendations for meniscal tear - December 30, 2006 1:16:00 AM
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jma
Posts: 2432
Joined: August 24, 2000
From: NY
Status: offline
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If surgery is performed, one would like to make sure that the floater and any other fragments that wasn't picked up will be removed and not wind up in areas that may cause more damage to the knee. Agree with Shills post as well.
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