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non surgical treatment for meniscus tear (Read 4849 times)

casual runner


    I injured my knee in early March on a month long camping trip. It swelled up and became moderately sore and tender. I reduced my activity a little but did not stop walking and hiking. I took 2 short runs and decided that was not a good idea so I stopped running.Since i was camping and moving around from place to place frequently, and my insurance did not cover me in the states I was in, I was not able to do proper Rest Ice Compression Elevation or get a proper diagnosis until I came home last week. But I knew from the sounds that I probably tore a meniscus.

     

    I had an MRI and am told I have a tear in my left lateral meniscus. Doc wants to remove 25% of it. I want to avoid surgery if I can. So I'm soliciting success/failure stories from people who have had tears and chose not to have surgery. I'm 51, male, not overweight, and not a heavy runner-only 3-4 miles 2-3 times a week and that's only when I'm disciplined.But I do walk 5-6 miles daily without fail, and I hike and do short backpacking trips.

     

    I've been doing RICE religiously now for 3 days and the swelling and pain (and noise) has gone way down, but there is still some tenderness. I can probably do this for another 2-3 days before going crazy from inactivity. I may have my answer at that point, but I'd like to hear from anyone else who tried to avoid surgery. I have an excellent surgeon and I'm sure surgery would be successful but I still want to avoid it for reasons I wont go into.

      (Without knowing the specifics of your case disclaimer)

       

      About 8 years ago I had a nicked meniscus and opted out of surgery. The joint specialist who looked at it described it as akin to a hangnail: painful if stressed, and curable by either 1) trimming it (that would have been surgery) or 2) leaving it alone and letting it heal itself.

       

      He said that letting it heal itself would take longer. As it only caused me occasional pain, I chose that. And my knee hasn't bothered me in several years.

       

      I chose not to have surgery because I have an old-school notion that knee surgery has barely evolved since the Code of Hammurabi. Silly, I know.

       I like running alone.

      casual runner


        Well mine is more than a nick I think-they called it a complex tear. But it didnt look very big on the MRI, not that I could really see it. I'm not sure the doctor could even see it, but the radiologists sure did.

         

        Mine has caused me much swelling and soreness, but partly because I didnt stay off it and I could really do RICE properly on my trip. Plus I was afraid ton take anti-inflammatoriies because of stomach trouble over the last few months (though not in the last few weeks). Now it feels much better after 3 days of RICE, and I've been able to handle low doses of ibuprofen (2-3 tabs a day).

         

        I'm going to get a 2nd opinion on Tuesday so maybe that will help clarify my options. The big  problem is I MUST have 2 good knees for a work project for several weeks in June.I will make most of my year's income on that one project, s if I cant work I'm screwed.  If conservative treatment isnt going to work I need to have the surgery asap so I can recover in time.

          Not a completely relevant case, so take it for what its worth.

           

          In 2005 I tore my ACL and damaged the meniscus.  The meniscus tore in a way that created a flap, that folded over and caused binding issues in the knee.  When I had the ACL repaired, I _think_ all they did was to fold the flap back where it was supposed to be.   I don't think they removed anything.  I've had no problems since then, through 3 years of sprint work and coming up on 2000 miles after that.  

           

          Again, I don't completely remember what was done to the meniscus while they were in there fixing the ACL, but a sample of 1 is statistically significant, right?


          an amazing likeness

            For my meniscus damage, I was offered the option of "repair it now", or "wait until the knee locks up and you'll be back". The info shared was the damaged meniscus would not be further damaged by time and/or using the leg -- but that the damaged meniscus would displace the knee into unusal alignments and would put stress on the 3 cruciate ligaments.

             

            I opted for the surgery. Recovery took 4 - 6 weeks to getback to laying down base miles.  But I had other issues happening as well, so can't predict how much of that was purely meniscus repair.

            Choosing my words carefully has never been my strength I've been known to be vague and often pointless

            casual runner


              I had an MRI and am told I have a tear in my left lateral meniscus. Doc wants to remove 25% of it. 

               

               

              Interesting what a second opinion can do. I got my second opinion today and it could hardly have been more different than the first, and I didn't tell them what the first opinion was. The first doctor was rushed, and hardly examined me at all except for noting the fluid buildup. This doctor took all the time in the world to examine both legs and explain things and he thought it would be completely unnecessary to have surgery now.  He thought I had a minor possible/probable tear in the red (healable) zone of the medial meniscus and conservative treatment was the way to go, while the other doctor only mentioned one in the lateral meniscus and advised me to get surgery done.  Guess I'll find out if one was right and one was wrong, but I'm much more pleased with the second opinion.

              casual runner


                Had a talk with a friend who had the same problem a few years back. turns out his ortho doctor is the same one as my second opinion doctor. Smile

                It sounds like his symptoms and MRI were pretty similar to mine. He chose not to have surgery-he asked the doctor if he (the doctor) would have surgery if this was him, and the doctor said no. So he wore a knee brace for strenuous activities like skiing -one of the heavy duty jointed types-and eventually all his symptoms went away though it sounds like it was a very slow process. Now he is symptom free and hasn't used the brace in years. And he abuses his joints much worse than I do. But he did cut back his running quite a bit. Sorry about that part. Wink


                Man in Tights

                  Hi I had a tear in my left medial meniscus.

                  I asked my surgeon who also happened to be a good family friend why not let it just be. 

                  He said minor tears usually ground themselves away and often didn't need surgical intervention.

                  I needed to have 20% of my meniscus removed.  So surgery was a must if I wanted to be running again. This involved lopping off the damaged portion and cleaning the synovial fluid which had torn bits of cartilage floating around. 

                  Since it was performed using arthroscopy it was quite clean and efficient. Yeah there is a long post operative rehab once had to go through to get the leg fit again. But it was worth it.

                  A few month later I was back running again.

                   

                  The danger of running with a damaged meniscus is further wear and tear to a point when surgery becomes imperative. And in the process damage other muscles as well since.

                    I had a surprise removal of 50% (by cross sectional measure, not by volume) of my lateral meniscus as part of a ACL surgery in 2009.  This really really bummed me out because in my case the MRI did not indicate a meniscus tear before surgery but the tear was discovered during surgery. 

                     

                    My personal, non-medical-professional opinion:  keep all your meniscus that you possibly can.  I subsequently have MRI-indicated articular cartilage damage in the same compartment where the mensiscectomy was performed and one of the top cartilage docs in the country told me that this damage was, and I quote, "because you have no meniscus."  So, I am going in for knee surgery in two days with super doc, and I will know in about 48 hours what my running future will really look like.  There are so many things I would do differently if I could go back in time 2-1/2 years, but at the top of the list are (a) do not play basketball and (b) instruct my OS NOT to remove meniscus.  It's hard to know if he called the right audible at the time of surgery, but in some ways, if the articular cartilage damage turns out to be real and serious, then it's hard to fathom how the outcome from removing part of the meniscus could have possibly been worse.

                     

                    Best to you and blessings,

                    - Joe

                    We are fragile creatures on collision with our judgment day.

                    casual runner


                      Hi I had a tear in my left medial meniscus.

                      I asked my surgeon who also happened to be a good family friend why not let it just be. 

                      He said minor tears usually ground themselves away and often didn't need surgical intervention.

                      I needed to have 20% of my meniscus removed.  So surgery was a must if I wanted to be running again. This involved lopping off the damaged portion and cleaning the synovial fluid which had torn bits of cartilage floating around. 

                      Since it was performed using arthroscopy it was quite clean and efficient. Yeah there is a long post operative rehab once had to go through to get the leg fit again. But it was worth it.

                      A few month later I was back running again.

                       

                      The danger of running with a damaged meniscus is further wear and tear to a point when surgery becomes imperative. And in the process damage other muscles as well since.

                       

                       Running again in a few months is the advantage and temptation of getting the surgery done. I know others who have done it and feel the same way. So far anyway.I know someone else who had the surgery last year, and is now having pain again. I haven't talked to him lately but I haven't seen him running either.

                       

                      "The danger of running with a damaged meniscus is further wear and tear to a point when surgery becomes imperative".

                       

                      This seems logical. You don't want to run with a badly damaged anything. Running would not be a part of a conservative treatment program, at least at first. I will update where I am at below.

                      casual runner


                        I had a surprise removal of 50% (by cross sectional measure, not by volume) of my lateral meniscus as part of a ACL surgery in 2009.  This really really bummed me out because in my case the MRI did not indicate a meniscus tear before surgery but the tear was discovered during surgery. 

                         

                        My personal, non-medical-professional opinion:  keep all your meniscus that you possibly can.  I subsequently have MRI-indicated articular cartilage damage in the same compartment where the mensiscectomy was performed and one of the top cartilage docs in the country told me that this damage was, and I quote, "because you have no meniscus."  So, I am going in for knee surgery in two days with super doc, and I will know in about 48 hours what my running future will really look like.  There are so many things I would do differently if I could go back in time 2-1/2 years, but at the top of the list are (a) do not play basketball and (b) instruct my OS NOT to remove meniscus.  It's hard to know if he called the right audible at the time of surgery, but in some ways, if the articular cartilage damage turns out to be real and serious, then it's hard to fathom how the outcome from removing part of the meniscus could have possibly been worse.

                         

                        Best to you and blessings,

                         

                         

                        You don't say how old you are, but many/most people of middle age have tears of the meniscus. They shouldn't remove any unless you had symptoms because many of those tears are asymptomatic. You probably know this by now. Many people don't. I've been reading recent studies showing how MRI is overused and misinterpreted in meniscus injuries.

                         

                        I'm still trying to keep all the meniscus I can. I'm still hopeful this is the right decision long term, but it hasn't been an easy one. My knee is definitely nowhere near 100%. I've done some short runs but don't feel ready to push it. I had a cortisone shot in May and August. Its a good thing I'm a "casual runner", because a more hardcore runner would not be able to wait this long. I can ride as much as I want, but even longer walks of more than several miles give me a little trouble. I'll know in a month or so if it is improving or not, because the cortisone should start wearing off soon if it is working at all-I didn't notice any improvement until a month after the August shot, so that might have been real improvment and not the shot.

                         

                        Anyway I plan to give it at least a year, and I'll take more shots if I have to, and then re-evaluate my options. I'm definitely doing way better than I was in early June, when I could barely walk, but I'm also not where I want to be. Hopefully my patience pays off...