torn meniscus, surgery or no surgery?

[buddy]

Hoping someone here is a real doctor...

Had a meniscus issue 20 years ago, and had it snipped. Thought it was becoming a problem again as my knee was popping and cracking with almost any movement for almost 2 years. Didn't prevent me from much, and didn't cause any particular pain.

Then it stopped doing that about 2 months ago. Went to the ortho, they took xrays and did an mri. Based on that, they recommended doing a shot or trying pt. I opted for pt, and went the other day for the first appointment. The therapist discussed what he saw in my records and pictures, and it sounded to me like the biggest issue was a lot of arthritis in the knee.

My question to the learned minds here... is meniscus surgery even done if there is a lot of arthritis? Or do they just go straight to a knee replacement? Can gel nsaids (like Voltarin?) be helpful? I'm ok with the pt so far, as he's given me stuff that will be helpful strengthening muscles to help relieve that pain, and various other pain (IT band stuff).

Thanks to all but Fishy and Dove.

How about doing the shot and PT! The shot should provide some lubrication and allow PT to go more smoothly and with less discomfort. They currently offer hyaluronidase shots or stem cell injections. Not a cure, but a temporary fix.

 

[History Geek]

ACL replacement in my right knee in 1997 when I was 33. This meant it was going to become arthritic more quickly, especially since I am a former offensive lineman that lived most of my adult life between 225-250 pounds. But I still ran 5Ks/played pick-up hoops/skiied, etc. I tore the meniscus running on a treadmill in 2020 when I was 56. Pain wasn't bad once it healed but the tear would catch going downstairs. Couldn't live with that so I had it trimmed. Arthritic fraying was also cleaned out. Felt better than it did pre-surgery. Tore it again in 2022 skiing. More clicking so I had it trimmed/cleaned out again. Rehab 3x a week for 6 weeks each time. Without that part of my menicus, I'm bone on bone there, so my running days are over. But I now bike regularly (always in the saddle -- no standing) and can ski with a cartilage sleeve with side supports. Bottom line -- you can still be active with some minor adjustments. I'd get the surgery.

 

[Chin Diesel]

Hoping someone here is a real doctor...

Had a meniscus issue 20 years ago, and had it snipped. Thought it was becoming a problem again as my knee was popping and cracking with almost any movement for almost 2 years. Didn't prevent me from much, and didn't cause any particular pain.

Then it stopped doing that about 2 months ago. Went to the ortho, they took xrays and did an mri. Based on that, they recommended doing a shot or trying pt. I opted for pt, and went the other day for the first appointment. The therapist discussed what he saw in my records and pictures, and it sounded to me like the biggest issue was a lot of arthritis in the knee.

My question to the learned minds here... is meniscus surgery even done if there is a lot of arthritis? Or do they just go straight to a knee replacement? Can gel nsaids (like Voltarin?) be helpful? I'm ok with the pt so far, as he's given me stuff that will be helpful strengthening muscles to help relieve that pain, and various other pain (IT band stuff).

Thanks to all but Fishy and Dove.

As I sitting in waiting room for a pre-surgery appt for my foot......

Voltarin has worked great for arthritis in my hands and feet. If there are underlying conditions causing additional swelling, it won't help with them but it does keep the arthritic inflammation down.

 

[DrZzzz]

It all depends on your symptoms and how active you are or want to be. I tore my right ACL rolling in BJJ about 15 years ago. My weight was not on my knee when it tore. So I tore my ACL with no damage to my meniscus. I did not have my ACL repaired. I chose to give up BJJ and things like basketball.

15 years later my knee is pain free. Any explosive cutting movements are out of the question, as well as jumping. However I was able to run on a treadmill (straight ahead) no problem.

That ended when I had a partial ACL tear on the left side. This time I damaged the meniscus. The part of the ACL that tore rolled into a ball. I couldn’t walk without a limp.

Interestingly, the MRI showed a full ACL tear. When the surgeon went in and took pictures it was a partial tear showing said “ball” impeding my movement. He removed the torn meniscus as well.

And my left knee is shot. The meniscus matters more than anything. It stabilizes the knee (your knee is NEVER 100% as stable increasing odds of reinjury) and is a shock absorber (you lose some shock absorbtion, increasing odds of reinjury). You can do a lot with a torn ACL if you don’t damage the meniscus. They usually go hand in hand (if you tear the ACL).

Having said that if a torn meniscus is causing problems in your lifestyle, you may need surgery. Then accept that you are at increased risk for arthritis. You may also need to give up certain activities (basketball, jiu jitsu) whether you have surgery or not. Hope that helps.

 

[uconnfan68]

Thanks for the advice and replies.

New PT person, and we did more strengthening exercises after heat, then biofreeze handrubbed in. She told me that a new knee was the next step based on my age and level of arthritis. She’s a serious runner and she’s been here for a while. I believe what she’s telling me. She wants me to develop certain neglected muscles above and below the knee to help with stability. That’s what I’ll be trying. She advocates for biofreeze before nsaid gels. It’s not like I’m a serious athlete at 74. I play golf a few times a week (and take a cart), do yardwork/mowing, and work inside (mainly laundry, up and down 2 flights, won’t let my wife do it, too fragile). I’m ok if it doesn’t get significantly worse. At least I understand a lot more about the situation.

 

[Giddyup5]

Didn’t realize this subforum existed.

Here’s the deal.

If you had a weight bearing xray (meaning you were standing while they took it) it will show how much arthritis you have. If it’s grade 2 ( out of 4) or less then an arthroscopic meniscetomy is absolutely worth having.


If it’s grade 4 then surgery will not help. I would consider living with it while getting injections for pains, nsaids, and wait for your knee replacement.

If grade 3 then debatable. For example, if you have tried nsaids, pt, cortisone injections and none have helped I would consider surgery. One of the main reasons is because surgery is such a low risk procedure. You will be asleep for 20-30 minutes. There isn’t much downside for most people.