I recently got a minor tear in my lateral meniscus in my right knee. I've been doing a lot of research on meniscus tears/treatment recently. I have been wearing a hinged knee brace for the last two days now and it still hurts and clicks just as much. Oddly there is still no visible swelling. Also, I have good insurance that will cover 80-90% of the operation if I decide to have it done.
I am a 20 year old male. The sports I participate in include; water skiing, wake boarding, golfing and working out (lifting weights, jogging on the treadmill, and bike riding). I plan on going back to all these sports next year.
I've done some research but can't really find exact answers on if a meniscus repair would be a good idea or not. The doctor didn't help much either...typical. Don't hesitate to give me your advice, I will consider your advice/experience it's not like I'm trying to have people vote on if I go get surgery or not. lol
What it really comes down to:
How long should I wait wearing this brace to see if my meniscus can heal itself?
Would i get arthritis from not repairing it since I'm still relatively young (20)?
Would I still be able to do the sports activities I like without the surgery, if I use a knee brace?
Does it really take 4-6 weeks with crutches and a brace after meniscus repair surgery?
Also if anyone has any personal experience with a meniscus injury and had or didn't have surgery on it feel free to share with me what you did to recover from your injury, and if it was a good decision or not. Also is the surgery worth it or not?
First off, you have to make the distinction between a meniscal repair and a meniscal debridement (removing or shaving down the torn portion). They are not the same procedure. The more common one is a meniscal debridement.
Very few meniscal tears can actually be repaired. For a repair to be done, the meniscal tear must be in what is called the red zone. The meniscus is a cartilage structure, that has essentially no blood supply (avascular). Each of the menisci in the knee, only have a few blood vessels, just at the peripheral attachment, where they connect to the joint capsule. This is less than a third of the width of the meniscus. The outer zone is the red zone and the inner most is called the white zone (no blood vessels at all).
So, if the meniscus is torn off the capsule, or is torn within the red zone, then it might heal with a repair. If the tear is at the junction of the red and white zones (called a red-white tear), it might also heal, but not very commonly. If the tear is in the white zone, then it has no healing potential, and a repair will not even be attempted.
So, the first thing you need to know is where the tear is actually located.
As to the brace, hinged braces, or the high speed ACL braces, are basically for instability problems, where there is abnormal movement of the joint, due to a ligament injury. They really do not do anything for meniscal problems, except to remind the patient to take it easy on the knee. The neoprene sleeves may actually make a knee with a meniscal tear feel better than the hinged braces (which can rub and slide with activity). But, it is actually a patient preference type of thing.
The surgeries for the meniscus, as stated before, are very different. For the typical meniscal tear, in the white zone, the surgeon does an arthroscopic debridement. Here, the torn portion of the meniscus is removed and the remaining edge of the meniscus is smoothed down with a meniscal shaver. As long as the outer third rim of the cartilage is retained, the function of the meniscus is preserved. The main function of the meniscus is to deepen the tibial plateau for the articulation with the femoral condyles. This provides quite a bit of stability to the joint. Secondary function is to provide cushioning to the joint.
After a meniscal debridement, the patient is allowed to weight bear as tolerated and is instructed to work on range of motion exercises. The ROM helps to smooth out the remaining rim of cartilage. The patient can advance activity as tolerated and can return to sports as soon as their ROM and strength are regained.
A meniscal repair is very different. It can still usually be done through the 'scope. Occasionally, a small incision is made to help with the suturing of the meniscus, depending upon the technique the surgeon employs.
In these cases, the meniscal tear edges are roughened up a little with the chondrotome (an arthroscopic instrument). Then the tear is repaired using any one of several different techniques. There are techniques in which the sutures are placed from inside to outside or vice versa. There are little "darts" that can be used to hold the edges together. It is really a choice of the surgeons based on the way the tear is oriented and his/her experience and preferences.
Then, the surgeon will usually place a clot of blood in the repaired section. This is done to help bring in the cells needed to jump start the repair process.
The post-op protocol for a repair is much different from the debridement. In a repair, the patient is not allowed to do ROM freely. The surgeon does not want the patient doing any activity which might pinch or catch the meniscus and disrupt the sutures before the cartilage has time to heal.
So, in general (as each surgeon has his/her own protocol), the patient is placed in a post-op ROM brace and it is locked out in full extension (some surgeons just use a knee immobilizer instead of the more expensive ROM brace). The patient is usually allowed to partially weight bear, with the knee in full extension. In some protocols, the patient is allowed to do supervised ROM exercises in physical therapy only.
Then after about 6 weeks or so, the activity is gradually advanced. The brace is unlocked or removed and the patient begins active ROM exercises. Weight bearing is gradually advanced. Once full ROM has been regained, then the patient can start doing strengthening activities. Sport specific activities, such as cutting, pivoting, jumping, kicking, etc are only allowed after the patient has regained full ROM and strength.
So, as you can see, that the two procedures and rehab are very different.
If you have a minor (very small) tear in the red zone, the surgeon may be hoping that it will repair itself, if not stressed too much. If the tear is in the white zone, some people are not too bothered by small tears that do not flip into the joint, and just live with the tear.
It is quite common for meniscal tears to not swell. If the tear is acute, and in the red zone, then there may be some bleeding into the joint. But, tears in the white zone have no blood vessels to injury, so they don't cause an effusion. Even chronic tear of the meniscus usually do not set up any inflammatory response, so they don't cause swelling. If there is articular cartilage degeneration associated with the meniscal tear, then the patient may have some inflammatory swelling.
What you really need to find out, is what type of meniscal injury you have. If it is in the red zone, then a repair is probably a good idea if your knee pain does not get better on its own. But, be prepared for a bit of a trial in the rehabilitation department.
If it is in the white zone, then it is a matter of how much you want to put up with. If the discomfort is enough to interfere with your lifestyle, then you can try a debridement. The rehab is pretty easy and most patients get back to activities fairly quickly.
But, remember, there are no guarantees in surgery. Even if the surgery is picture perfect and the rehab goes great, some patients will still have some knee pain. But, most patients are better after the surgery, even with the discomfort.
Speak with your surgeon. Discuss your options. Then decide how much this affects your lifestyle and if you want to go through the whole surgery and rehab.