Torn meniscus surgery - yea or nay

[FastEddieB]

About a month back my left knee started twinging just below the lower inside corner of my kneecap, accompanied by minor swelling. This also happened about 5 months ago, and was then resolved by a cortisone shot and rest. But this time, over about 2 weeks it progressed to the point I could not put any weight on it, needing crutches to get around, and sleeping was problematic because it was hard to find a position where it didn’t hurt. Saw an orthopedist who gave me what I think was another cortisone injection which had little or no immediate effect this time. Most days I need 1 to 2 oxycodone over the course of the day take the edge off. It’s improved about 50% over the last week but I still require a cane most of the time.

Anyway, had an MRI on Monday. It shows a generally healthy knee for a 70-year-old, other than some wear, but said a “Parrot beak type tear is present within the medial meniscus at the junction of body and posterior horn.” There’s also mention of some cartilage “fraying” and “loss”, though my doctor says that age-typical. Arthroscopic surgery to repair things is being presented as an option. It’s apparently pretty minor and routine, and often produces good results. But the doctor also says these things can resolve themselves over time, and there’s no rush to commit to surgery.

Just throwing this out there to solicit what has or hasn’t worked for others - any feedback is appreciated.

Thanks in advance.

 

[Bell206]

any feedback is appreciated.

If quality of life issue highly recommend the surgery. Have been nursing a torn MCL/meniscus in left knee for 6 months. The mechanical stability in that knee is decreasing so as soon as essential surgery is allowed will be getting that cleared up to regain the stability. Unfortunately, have had LCL repaired, ACL replaced/meniscus removed in right knee over the years all via arthroscopic. No daily pills needed (yet) other than an Advil for my arthritis after a full day. Main thing is follow through with PT or whatever to the letter to regain flexibility and stability. Good luck.

 

[jsstevens]

My wife has been diagnosed with a more complicated tear. Our GP said she’d need surgery but the orthopedist offered a range of options starting with PT and proceeding up through surgery. So far she’s doing PT and it’s much better.

 

[BrianNC]

I've had my left knee meniscus repaired twice. Worked for me. I couldn't imagine not having it. Knee is basically good and strong now.

 

[rk911]

Bro-In-Law had the surgery and glad he did. One of my wife's friends opted for gel injections instead and is not doing fine. I have a "minor-to-moderate" tear (doc unable to be more precise without opening me up). one cortisone shot, touted as a one-and-done lasted just 4-5 weeks. a second shot (not cortisone and really a series of shots all done at the same visit...don't recall the name) almost 18-mos ago and 99% of my pain is gone. every now and then it'll remind me that it's there (<1 on a 10 scale) but I can walk, climb stairs, sleep, etc. but I don't run with the dog (which is how I got into this pickle in the first place). so for now surgery for me is not just on the back burner it's not even in the kitchen. but we're all different. only you can decide. second medical opinions are always valuable especially when it comes to surgery. I wish you the best and the wisdom to make the right decision for you.

 

[AKiss20]

I did my ACL, Meniscus, and MCL skiing about 10 years ago. Got the surgery (hamstring for the ACL) and was skiing the next season (granted I was 19). Works fine to this day. Sometimes if I do a weird move climbing I can tweak it a bit but it’s pretty rare. Interestingly for a few years after my surgery I could tell when the weather was changing from a faint pain in my knee, probably due to changing air pressure. Doesn’t happen anymore though.

 

[PaulS]

I had my meniscus repaired about 4 years ago, two tears, not big tears, I think one was a saddle tear, the other was a nick, but my knee would "slide" and hurt for a day or two, especially walking down hill. After the MRI doc said get the surgery done. Of course many friends told me I'd be crippled afterward if I did it. Problem was it was impacting my life negatively, I couldn't bicycle and couldn't walk far so I had it done. There was more damage than the mri revealed, the tear was wearing my knee cartilage. Anyway, he cleaned it up, and I walked out after I woke up. It went well, I had a slight complication, they put a tourniquet on your leg for the operation (laparoscopic) to stop bleeding while they're in there, I got muscle spasms ( thigh) from that for about 3 weeks, that's not usual. Once that stopped, the PT got my knee and thigh built back up. I was back to riding my bike in about 8 weeks, took about a year to feel completely normal, but it was a marked improvement from day one. You sound like you are being impacted by it, I put up with it for about 6 months before I got it diagnosed. It would feel better, then 'twinge' again and take day or two to stop hurting. I would do it again if I needed to. I recommend getting it done.

 

[Doug Reid]

I have had both knees repaired due to torn meniscus, and then later both total knee replacements. My advice would be to investigate how much, if any, bone to bone contact is going to be present post surgery. The recovery time for a meniscus surgery is not much different from a total knee replacement. I handle pain pretty well and never took pain meds prior to surgery...I did take NSAID meds. I am recovering now from shoulder surgery...it never seems to end .

 

[Half Fast]

Yes, it will likely heal on its own, given time. But c’mon, Eddie - at your age can you afford to wait?

I had arthroscopic surgery on my left knee following a motorcycle crash a few years ago. Went well, surgery was no big deal, but as I recall it took several weeks to be 70% of normal. Then the last 30% took about a year. I still have some stiffness once in a while, but I can walk and climb as well as ever.

 

[n2230b]

Don’t forget, try to loose some weight!
The load on the knees grows exponentially with added weight.
Easier said than done but improvement in symptoms likely, unless your BMI
is already below 26 .

 

[JCranford]

I had the MCL on my left knee repairs a few years ago. Its been 100% ever since. Now the right knee is giving me fits...

 

[MacFly]

Your age and the location of the tear strongly suggests a very low likelihood that that tear will heal, and that likelihood is even more decreased if you're getting steroid injections. The arthroscopic operation to fix the problem is very straightforward with very quick recovery and excellent results. Cartilage loss does hasten the onset of degenerative arthritis which in turn can ultimately lead to a knee replacement, but that will likely take years. If you were 30 with a torn meniscus, that would be something to consider. At age 70, maybe less of a consideration.

Your choice now is based on how much this recurrent inflammation and other symptoms from the torn cartilage limits your life. If you're going to have pain that requires crutches and oxycodone every 5 months, and injections don't help....well, I know what I'd do.

 

[upstateny]

Been there, done that. Totally worthwhile. Day of procedure, two crutches. Next day, one. Next day nothing. Works great! Back to tennis after a few months.

The funny part was at the follow-up appt. The doctor is showing my pictures of before and after taken inside the knee. I asked him, "Other than putting you kids through college, what does the meniscus do?" He got quite a chuckle out of that.

 

[455 Bravo Uniform]

You only need right rudder, donworryboutit.

Seriously though, it sounds like you’re down for the count, and injections haven’t been working. Fix the knee sooner to prevent deterioration of other body parts that aren’t getting used as much as a result, including your cardiovascular health.

 

[NHWannabe]

About a month back my left knee started twinging just below the lower inside corner of my kneecap, accompanied by minor swelling. This also happened about 5 months ago, and was then resolved by a cortisone shot and rest. But this time, over about 2 weeks it progressed to the point I could not put any weight on it, needing crutches to get around, and sleeping was problematic because it was hard to find a position where it didn’t hurt. Saw an orthopedist who gave me what I think was another cortisone injection which had little or no immediate effect this time. Most days I need 1 to 2 oxycodone over the course of the day take the edge off. It’s improved about 50% over the last week but I still require a cane most of the time.

Anyway, had an MRI on Monday. It shows a generally healthy knee for a 70-year-old, other than some wear, but said a “Parrot beak type tear is present within the medial meniscus at the junction of body and posterior horn.” There’s also mention of some cartilage “fraying” and “loss”, though my doctor says that age-typical. Arthroscopic surgery to repair things is being presented as an option. It’s apparently pretty minor and routine, and often produces good results. But the doctor also says these things can resolve themselves over time, and there’s no rush to commit to surgery.

Just throwing this out there to solicit what has or hasn’t worked for others - any feedback is appreciated.

Thanks in advance.

You've asked the right questions.

Other questions you should ask any time you go for an operation.

Where will the procedure be done? - standalone outpatient is always better for elective surgery.
What is the surgeons revision rate for this procedure?
What is the facility's re-admission rate.
What is the facility's infection rate.
What is the post-surgery rehab - there are many online PT services which can save you significant money.

Questions everyone should ask for medical procedures.
Do I really need this test/procedure?
What are the risks/side effects?
Are there simpler, safer options?
What happens if I don't do anything?
How much does it cost? Will insurance pay for it?

Always get a second opinion

 

[midlifeflyer]

I've had both done at different times.

 

[Daleandee]

Tore my left meniscus years ago crawling around under a 18 story hotel building (was part of my job at that time). That was years ago and it has been 100% since the doc did the repair. It was pretty quick surgery and it was usable in a couple of weeks. A bit longer until full recovery. Not a big deal at that time but I was in my late 40's so not sure how it would go for me now.

 

[MacFly]

Tore my left meniscus years ago crawling around under a 18 story hotel building (was part of my job at that time). That was years ago and it has been 100% since the doc did the repair. It was pretty quick surgery and it was usable in a couple of weeks. A bit longer until full recovery. Not a big deal at that time but I was in my late 40's so not sure how it would go for me now.

Yup. I had the meniscectomy for torn cartilage in 1987, had the knee replacement in 2010. Pretty much the way it works.

 

[AKBill]

Had arthroscopic surgery to repair the meniscus in my left knee. That was 2 years ago age 60. I think I was back to work in 6 weeks. My job is physically demanding, on my feet from 4am to 6:30pm, work underground maintaining equipment.

It took about a year for the knee to feel 100%, improvement in quality of life started 1 week after surgery and greatly improved by the 3 week mark.

 

[FastEddieB]

Big thanks to everyone who responded, even if I don't reference you below.

As an update, by yesterday I'd say I was 75% recovered, getting around pretty well without the cane, just limping but able to take steps normally rather than one at a time. But I'm paying today for overdoing it yesterday.

I'm almost certainly going to get the ball rolling on Monday, setting up the surgery and the two medical clearances I'll need.

To Bell206 and all those who recommended surgery for quality of life or gave reports of their experiences: knowing now there's something structurally wrong with my knee, even after this episode resolves I think I can expect recurrence every 4 to 8 months - maybe more often if the damage is allowed to progress. And each episode is unpredictable and about 3-4 weeks of being pretty severely limited in activities and in a fair amount of pain. Not a pleasant prospect.

To rk911 and NHWannabe: I emailed a copy of my MRI report to a retired orthopedic surgeon I've flown with. He said surgery was "very reasonable", but I'd probably get a good result. But "not essential". He said that with the early arthritis the report described (which he said was normal at 70), recovery might be "somewhat less predictable". Overall he said it depended on my lifestyle and how significantly these episodes affected it.

To n2230B: At 6'1" and 184 lbs. my BMI is 24.3, and so is in the "normal" range. 180 lbs is my personal goal weight.

To Half Fast: Don't be smug! You're not THAT far behind!

 

[Half Fast]

Overall he said it depended on my lifestyle and how significantly these episodes affected it.

Your lifestyle involves sport bikes, dirt bikes, and climbing in and out of that Sky Arrow. Glad you decided to get this done; I think you'll be glad you did.

To Half Fast: Don't be smug! You're not THAT far behind!

LOL! Much too true!

 

[3393RP]

Your age and the location of the tear strongly suggests a very low likelihood that that tear will heal, and that likelihood is even more decreased if you're getting steroid injections. The arthroscopic operation to fix the problem is very straightforward with very quick recovery and excellent results. Cartilage loss does hasten the onset of degenerative arthritis which in turn can ultimately lead to a knee replacement, but that will likely take years. If you were 30 with a torn meniscus, that would be something to consider. At age 70, maybe less of a consideration.

Your choice now is based on how much this recurrent inflammation and other symptoms from the torn cartilage limits your life. If you're going to have pain that requires crutches and oxycodone every 5 months, and injections don't help....well, I know what I'd do.

This is good advice, and without going into a litany of pain and suffering, I know a little about bad knees.

It won't heal by itself, and arthroscopy will fix it with little pain and inconvenience. Do the surgery, follow your physical therapist's instructions, and you'll be back at it in no time.

 

[Shepherd]

I put it off for a very painful year.
I walked in with a cane, and a couple of hours later I walked out on my own 2 feet and have had no pain since.

 

[MacFly]

I put it off for a very painful year.
I walked in with a cane, and a couple of hours later I walked out on my own 2 feet and have had no pain since.

I would observe that I feel the same about total knee replacement, although the process was a bit more involved. I spent a very painful 3-4 years, activities curtailed. I had bilateral unicompartmental knee replacements and 30 days later was waterskiing and mountain biking (no running, however). That was about 10 years ago, I still mountain or road bike 20-40 miles/week.

 

[FastEddieB]

Thanks for the recent posts.

Over the last 3 days my knee pain has largely resolved, I'd say 80% to 90% better. No cane needed, but still limping. Part of the limping is my left calf cramping from "walking funny" for weeks. But still doing much better.

That said, surgery scheduled for June 2. I just can't see going through this at random, and likely decreasing, intervals for the rest of my life. And I'm really eager to get back on my bike, though I'll listen to the doctor for when that will be possible.

I'll let you know how the operation goes...

 

[PaulS]

A bike was actually part of the physical therapy to build the muscles back up. I hope it goes well for you Eddie.

 

[Doug Reid]

FYI, supplements like turmeric, tart cherry extract, ginger root, etc. can help keep inflammation under control...that will keep swelling down an relieve pain . It has been my experience rather large doses are needed to actually feel results. Good luck...keep us posted.

 

[FastEddieB]

Update:

The deed is done. Had to be at the hospital 6:30 AM yesterday, with the actual surgery a few hours later. I’ve had IV’s be problematic before, but I do best insisting they use my wrist rather than my elbow, so it was just a little prick (insert joke here).

I’m a little fuzzy on how I got from the recovery room to the car for Karen to drive me back to our N GA home. I sort of remember getting dressed on my own, but zero recollection of what Karen said was a wheelchair ride to the car. Due to the COVID 19 situation, Karen could not come into the hospital and waited in the car.

As an aside, one of the things I’m most grateful for in this life is modern anesthetics and pain meds. I recall the the anesthetics I got in the 1980’s for lithotripsy were quite miserable - now they’re a walk in the park, with virtually no side effects beyond the little memory gaps while recovering.

For pain meds, I took one oxycodone at 3P yesterday and another at about 11:30PM. I didn’t need the latter, but they suggested it as the “block” in my thigh would likely be wearing off around 3A. I hate taking codeine at night - I’m one of those folks where it causes insomnia, as it did last night. Today, I’m hoping a couple Tylenol might be all I need - there’s no pain at all in the joint where it was before, just a mild pain/itching at the inner incision point.

Again, thanks for all the advice and encouragement. We’ll be headed back to the TN home in a couple hours, and I don’t expect the 2 hour drive, with Nurse Karen driving - to be any problem at all. I’ll continue to update as things progress.

 

[PaulS]

Way to go Eddie, one day at a time, be an "A" student for physical therapy.

 

[Half Fast]

Glad all went well, Eddie. Best wishes for a quick recovery! Let me know if you need someone to come exercise your bikes and plane while you're incapacitated.

 

[Bill]

Heal well, Eddie, and put your best foot forward in PT!

 

[JuggyJet]

Hi FastEddieB,

How are you recovering? I did mine a day after yours on June 3rd. I did not need any painkillers after the surgery. I was able to walk normally two days after the procedure, but my doctor told me not to run (slow, but I am a runner) for five weeks. My knee still feels a bit tender, and when I take a long walk, I sometimes get a bit of pinching pain resulting in a sudden stop. Are you experiencing anything like that after your surgery? I would appreciate it if you would share your post surgery experience.

 

[FastEddieB]

My knee has been basically devoid of pain within the joint, literally since the day of the operation. Minor twinges and pulling around the incision sites as they heal, but nothing requiring medication. Felt strange at first to flex my knee beyond a certain point - again, no pain but more “pulling”. They told me to take it easy and not overdue it. So far, I’m back on the tractor, doing light yard work and have puttered around on my little Yamaha. Flew yesterday for the first time in a while, and flying down to Blairsville, GA this morning to meet and fly with a POA member if all goes well.

My follow-up is next Wednesday and I hope to get cleared to begin cycling again. I’ll report back in after that.

One weird thing. Even the day of the surgery I could go up steps just fine. But for a couple of days I had to go down steps one at a time. It felt weirdly like my left knee might give out if I took step normally. My theory is I was so used to pain in the joint, that I was interpreting the lack of pain as numbness. It’s 100% fine now, but again, it felt a little weird for a couple of days.

 

[JuggyJet]

It’s 100% fine now, but again, it felt a little weird for a couple of days.

Thanks for sharing the info. Congratulations on your 100% recovery! Happy Flying!

 

[MacFly]

Hi FastEddieB,

I was able to walk normally two days after the procedure, but my doctor told me not to run (slow, but I am a runner) for five weeks.

I had an arthroscopic partial meniscectomy almost 40 years ago. It was great, and my experience mirrors what’s been mentioned in this thread. My orthopedic surgeon at that time told me that from then on...the more I ran over the succeeding years, the sooner I’d need a knee replacement. When I had my knee replacement 25 years later, my orthopedic surgeon at the Mayo Clinic told me that there’s nothing that will wear out a damaged knee faster than running. Even now, with both knees replaced, I water ski, snow ski, or bike almost daily. But I haven’t run a step in more than 10 years.

 

[JuggyJet]

my orthopedic surgeon at the Mayo Clinic told me that there’s nothing that will wear out a damaged knee faster than running.

Hi MacFly,

Thank you very much for your reply. I just did a quick google search on running after the arthroscope...I must admit that I am feeling a bit down now. Only reason I decided to go through with the procedure was so that I could return to running (even happy with just "jogging" at this point) ASAP. I need to read up more but it does make sense that even after a successful procedure, the biomechanics of the knee are no longer the same.... I have a lot of other non-running activities I enjoy so I do not want end up with a full knee replacement for sure. But, I appreciate your turning my attention toward the subject.

 

[MacFly]

Sorry to bear bad news. It’s something I strongly recommend your discuss with your orthopedic surgeon. I strongly recommend a Fellowship-trained joint specialist rather than a general orthopedist.

The osteoarthritis that is the root cause of a knee replacement is based on lack of cartilage. In some cases, the cartilage cushion, or part of it (usually the parts on the inside of the knee) wears thin as we age and goes away. In other cases it wears thin as we age and tears, and in some other cases even when younger, the cartilage is traumatically torn. End result is the same...bone-on-bone -> arthritis. Then...the next step is knee replacement when the ongoing pain of the arthritis is greater than the hassle of getting a knee replacement. No matter what age.

If the cartilage is damaged and the torn fragment is removed...as what you had (and I had)...it’s great (for awhile) because the inflammation from the tear goes away, and so does the pain. But now the knee cartilage that’s left is more susceptible to damage, and the medial loading that is caused by high-impact activity like running will accelerate the damage, might lead to more tears, will make what cartilage is left go away faster, and will accelerate osteoarthritis.

Full disclosure...I am a surgeon, but not an orthopedic surgeon. Because I’ve been there, now have bilateral total knee replacements, it’s something that I’ve studied and discussed extensively, however.

 

[JuggyJet]

Hi FastEddieB,

It was not my intent to hijack your thread. But, because of your thread, I am getting some excellent advice from fellow members here. So, please excuse me, and thank you for your thread at the same time.

Hi MacFly,

It turned out to be a very difficult day for me today. After reading your advice, and some articles from my google search, I realized that getting back to distance running is getting distant if I want to keep my knees healthy in the “long run”. Boy, writing this is hard now... I always thought I was going to be able to run forever. Bummer. But again, I am very appreciative of your kind professional advice based on your own experience and expert knowledge in the field of medicine. I am sure reading this thread today increased the longevity of my knees by a couple of decades. For now, I will learn to enjoy taking a long walk and may be some hiking. Thank you again, Doc MacFly!

 

[MacFly]

FWIW, after my knee replacements, I took up biking, both road biking and mountain biking. No impact, very aerobic, challenging, and you do build an impressive set of quads. And the quadriceps are the fundamental basis of knee health.

 

[JuggyJet]

FWIW, after my knee replacements, I took up biking, both road biking and mountain biking. No impact, very aerobic, challenging, and you do build an impressive set of quads. And the quadriceps are the fundamental basis of knee health.

Runners and cyclists often do not get along on the road; I never liked them (had numerous bad experiences on the road). But now, I cannot believe I am actually going to take a look into biking (not those fast moving road biking though, it does not seem that safe around here on NYC area roads; I may be able to keep my knees but get run over by a bus ).