Meniscus tear, again. Surgery? Meniscus tear, again. Surgery?

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Thread: Meniscus tear, again. Surgery?

  1. #1
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    Default Meniscus tear, again. Surgery?

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    Hi Rip,
    Last year I have torn the meniscus squatting, and this time I have torn it by falling.
    I went to an obstacle race of 5km without any running training, but with lots of strength and swimming, so I was in a very good shape, generally (bad decision - I know).
    Anyway, I fell from one of the obstacles, that was obviously an accident, I fell really bad twisting my knee. It was really high, was sliding from about 6.5 meters.

    I happen to coach an orthoped which is considered the best in my country in the knee joint, he is very well known (I coach him in swimming), so I have consulted with him and got an MRI really quickly. It was done exactly 2 weeks after the injury, while it usually take here at least 8 weeks, if you manage to get it at all. At the MRI they have seen the tear from last year, at the medial meniscus, and said it is stable.
    On the current tear, which is in the lateral meniscus, they said: "complex lateral meniscus tear, involving the anterior horn and the body".

    No specifics about red / white zone, or the size of the tear, or which exactly kind of tears the complex tear involve. No ACL / PCL damage.
    Absolutely no pain at the medial side of the knee, it heald up "100%" since last year. Pain only at the lateral side of the knee.
    The orthoped said I need a surgery, arthroscopic, and that it's likely to worsen the situation if I will keep training on it without surgery, which may force me to a surgery later, on a bigger tear.


    The symptoms last year were not as bad as now. About 2 weeks after the injury I could compete in underwater hockey. Pain consisted for about 2 more months but I could squat carefully even heavy weights. It heald up really good.
    This time, now, I'm 3.5 weeks after the accident, and today I squatted 50kg, with a nagging pain, and any rotation still hurt quite bad. At the day of the injury I could not step on the leg.
    The symptoms today are way lower than the day of the injury and it gets better with time. I keep adding 5kg to the squat every session, 3 times a week, but I don't press over 70kg at the moment out of fear for the knee.
    It took about 3-4 days, but now I have a full range of motion regarding flexion and extension as long as there is not loading on the knee. Extreme extension hurt, but I can lock the knee. If it's pushed to hyper extension the injury hurt (also the bones, obviously). Lateral rotation of the shin ("knees caving out") hurt, especially when the knee is flexed.

    My legs were quite strong when the injury happend, I was resetting the squat due to a back injury (probably annular tear) but I was squatting 155kg the day before the race, on the way back to 195kg for fives.

    I'm a stronger than average, competitive athlete, 25 years old, 87kg / 191lb BW, 1.72m / 5'8", so the healing of the meniscus shall be better than average, I guess. I hope.

    My questions are:
    1. Considering the MRI results, is there any way to predict how well this tear will heal up on it's own?

    2. The surgery will probably be a menisctomy, but if it will be possible he will stitch the tear and not take that part out of the knee. His surgery skills are one of the best in the world, so if it will be done it will be done by him, and it will be done the best way it can be done in 2017. At the moment I'm not into the surgery. What needs to happen so I will definately need it in your opinion? Do you think I shall do it now?



    My plan is to keep squatting light and swimming easy with pushing the wall really carefully, and see how it feels in the upcoming month. If you have any other recommendation I will be very happy to know.



    Thank you very much in advance, really appreciate your help! :-)

  2. #2
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    We can't consider the MRI results if you don't post them. The details of the tear.

  3. #3
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    Quote Originally Posted by Mark Rippetoe View Post
    We can't consider the MRI results if you don't post them. The details of the tear.
    The results translation: "complex lateral meniscus tear, involving the anterior horn and the body". The doctor that saw the scan (not the orthoped I coach) have also rejected any damage to the ACL, PCL, pattelo-femoral joint, quadriceps and patellar tendon, colateral ligaments.
    Only a meniscus tear has been mentioned in the results of the MRI company itself.

    I can add the MRI itself, I have a copy. It's 80mb. Do you mean I shall post the scan itself?
    I have no other results, at all.

  4. #4
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    If this were my knee, I would not have any surgery.

  5. #5
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    Nor would I. Meniscus debridements have no better outcomes than treating with physical therapy. Physical therapy is typically bullshit, so you can extrapolate the benefit from squatting and deadlifting.

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    Quote Originally Posted by Theban93 View Post
    Food for thought: I had chronic shoulder issues. They refused me surgery for years. Until they misdiagnosed a partial tear of the supraspinatus tendon via MRI. Even the surgeon confirmed it. I really needed the surgery very fucking much (impingement and bursitits), but not for my completely intact supraspinatus. So imagine my surprise, waking up from anesthesia, being told that.
    Well, I think in my case the diagnosis is correct, since the symptoms and actual movement that made the injury are on the same path as the diagnosis. But sure shit can happen, and I'm sorry for your shoulder, it probably have been terrible \:

    Quote Originally Posted by Will Morris View Post
    Nor would I. Meniscus debridements have no better outcomes than treating with physical therapy. Physical therapy is typically bullshit, so you can extrapolate the benefit from squatting and deadlifting.
    Quote Originally Posted by Mark Rippetoe View Post
    If this were my knee, I would not have any surgery.
    That's the same thing I thought. Two more issues,

    1. What do you guys think of a repair surgery? so he will not get the injured part out, but will stitch it. It's not 100% possible but I can consult with him specifically about that. If it will be possible, would you consider the surgery? (it's still arthroscopy)

    2. If I won't do any surgery (might very well happend), do you think I'm going to be able to squat heavy weights again? Will I be able to perform powerful explosive movements without pain?
    In my sport there is not that much of a rotation of the knee, but when you change direction it's not 100% neutral position at the knee. Also at the squat sometimes with heavy weights the knee is not 100% neutral.
    Will I be able to perform freely?




    Thank you very much again (-:

  7. #7
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    Quote Originally Posted by TalEphrat View Post
    Well, I think in my case the diagnosis is correct, since the symptoms and actual movement that made the injury are on the same path as the diagnosis. But sure shit can happen, and I'm sorry for your shoulder, it probably have been terrible \:



    That's the same thing I thought. Two more issues,

    1. What do you guys think of a repair surgery? so he will not get the injured part out, but will stitch it. It's not 100% possible but I can consult with him specifically about that. If it will be possible, would you consider the surgery? (it's still arthroscopy)

    2. If I won't do any surgery (might very well happend), do you think I'm going to be able to squat heavy weights again? Will I be able to perform powerful explosive movements without pain?
    In my sport there is not that much of a rotation of the knee, but when you change direction it's not 100% neutral position at the knee. Also at the squat sometimes with heavy weights the knee is not 100% neutral.
    Will I be able to perform freely?




    Thank you very much again (-:
    You really don't get to choose whether you have a repair, or not. It all depends on the tear, the location of the tear, the depth of the tear, whether it contacts the articular surface, etc. Lots of people with shitty knees squat heavy all the time. In fact, there is a dude that wrote a really popular book about strength training that has shitty knees.

  8. #8
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    Quote Originally Posted by Will Morris View Post
    In fact, there is a dude that wrote a really popular book about strength training that has shitty knees.
    You're not talking about this dude, are you?



    (Sorry, Rip, I couldn't help it)

  9. #9
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    Thank you very much!
    Surgery will not be done.

    Will do my best to rehab it using the barbell. Thank you very much, again, that's not obvious at all (-:


    Cheers!

  10. #10
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    Quote Originally Posted by Will Morris View Post
    Meniscus debridements have no better outcomes than treating with physical therapy.
    Hi Will.

    I think it's important to read the study you're citing very carefully. There were a LOT of exclusion criteria. One of them was pain that can be directly explained by the actual results of the imaging. That means that the study you're referring to would not have included such patients within the study group.

    Patients like me. I had meniscal debridement done arthroscopically and my excruciating pain for almost a year improved by about 80% from the time I woke up from my surgery.

    In general, of course you're correct that much of orthopedic surgery is BS and not performed with an adequate evidence basis.

    Interestingly, for many months after MY surgery I couldn't get back to hundred percent with my knee. I reluctantly accepted that I would probably have to quit surfing because I just couldn't pop up on my board. My surgeon said that under no circumstances should I undertake a strength training program that involved squatting. Fortunately, Paul Horn talked me into it and I did get to 100% within two weeks of working with him after suffering significant residual pain for months.

    We'll never know if I could've gotten there without surgery in the first place. However, I seriously doubt that with the pain I was experiencing before surgery, I would've been able to tough it through even a broom handle squat.

    I saw Paul because I read some book by a guy with shitty knees.

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