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non surgical treatment of meniscal tears

 

   


cayenne

Nov 27, 08 8:30

Post #1 of 17 (10531 views)
non surgical treatment of meniscal tears Quote | Reply

I have a relatively mild tear in my left knee and it is really acting up lately. I have a mary mid-Feb and am wondering how to proceed with the training while it is frequently painful to walk. Any non-surgical ideas? I have the ice/ Aleve thing going already. Doing a good strength training regime. Is cutting back to one long run/one short run and lots of cycling/swimming a good route?
Thanks in advance.


Martin Zollinger

Nov 27, 08 10:13

Post #2 of 17 (10518 views)
Re: non surgical treatment of meniscal tears [cayenne] [In reply to] Quote | Reply

Graston and Active Release technique both have meniscus protocols.
The efficacy though??
However if you are looking for something to try, graston.com activerelease.com both have links to local providers.
Martin


dirtrunr

Nov 27, 08 19:49

Post #3 of 17 (10481 views)
Re: non surgical treatment of meniscal tears [cayenne] [In reply to] Quote | Reply

Hate to go negative here, but I'd reconsider your priorities. Yes, you may be able to suffer (and I mean suffer) thru your Feb marathon, but at what cost? If it's continually painful, it needs to be fixed. Surgically. There are no techniques or protocols that will fix this besides arthroscopic surgery. It's a relatively minor surgery and the rehab is very easy, but you need to seriously reconsinder doing this marathon. IF you do decide to run, you'll more than likely have significant pain all through your training cycle, compensate for it through altered mechanics which will cause other problems, and end up worse off than if you had just re-scheduled the marathon.

In my opinion, get the surgery, rest and rehab yourself for the next 6 weeks, and start base building for an excellent 2009 season. Good luck!

(if this sounds very negative, I'm very sorry, but you really have only one option with this especially since you're having frequent pain with just walking)


Steve_B

Nov 28, 08 6:52

Post #4 of 17 (10446 views)
Re: non surgical treatment of meniscal tears [dirtrunr] [In reply to] Quote | Reply

I have to agree with the caution of dirtrunr......but will also add that for me, non-surgical rest and rehab worked.

In March '06 I tore my right medial meniscus. It is uncertain how this happened, maybe just a misstep/slippage on a treadmill. But as I was 57 at the time, my doctor thought it might've just be degenerative. When the MRI was finally taken, it showed the tear to be longitudinal, that is, kind of from end to end down the middle of the meniscus. My doctor was pretty quick in saying that especially at my age surgery was too risky in that it would just speed up the onset of arthritis due to the fact that too much of the meniscus would need to be removed in order to repair it (addition by subtraction?); simple "scoping" wouldn't work. He left it up to me and encouraged me to talk with an orthopedic surgeon, who made the same assessment.

So, I spent the '06 season doing aquabikes, and literally only ran during those events, from the water to t-zone and from the end of the bike to wherever we aqbkers had to finish. (My doctor thought that these short, race-specific efforts would not do much harm, given that the healing process was so far along at that point.) That was my '06 season - 7 aqbks - but just sucking it all up and not running solved my meniscus problems. My '07 and '08 seasons were both long and aggressive, and I'm hopeful that the thing is permanently healed -- but the possibility of a degenerative problem is always in the midpoint of my mind!

Unless the marathon is the only thing you care about for most of '09, I would look to pass on it this time around. The pain and discomfort are really minor issues compared to the damage you could do over a much longer period of time. My '06 experience was miserable, as I love running and it killed me to be at those aqbks and stop competing after the bike. (For all of them, I left almost immediately; even if I had won something, I didn't stick around for the awards.) However, that too did pass, and I've made it back to the "bright" side of things. TAKE YOUR TIME WITH THIS!!!


Steve_B

Nov 28, 08 7:07

Post #5 of 17 (10437 views)
Re: non surgical treatment of meniscal tears [cayenne] [In reply to] Quote | Reply

A few more thoughts:

1. I did a lot of physio, at my doctor's recommendation, and I'm certain that helped the healing process.

2. Lots of swimming and biking were fine for me, as was cross-country skiing. And as for the biking part, one of the unseen benefits of the aqbks was that I learned what it feels like to really push it in a race. Do you know how hard you can ride in a race when you don't have to worry about saving something for the run? Well, I didn't, but coming back to running after learning some new things about my cycling limits meant that I just had to find some middle ground between running and more intense cycling. (For many years I held back on the bike just so that I could best capitalize on my strength, which was running.) The short story here is that cycling has now emerged as my strength, but that I'm still running well off the bike.

3. Be VERY gentle about your strength training on the affected leg. Keep the weight way down, and minimize range-of-motion.

4. You don't mention a doctor; is one on the scene? Between when my doctor suspected a torn meniscus and the MRI confirmed it, I asked him about 2 months out from Columbia if he thought I could still do it. He looked at my incredulously and made some sympathetically sarcastic remark to the effect that I'd lost my mind. Have you received a medical suggestion about doing the marathon?

Best of luck with all of this, cayenne, and I apologize for being such a noodge about it!


cayenne

Nov 28, 08 7:34

Post #6 of 17 (10429 views)
Re: non surgical treatment of meniscal tears [stevebradley] [In reply to] Quote | Reply

Thanks so much for the information. It is so funny that running slowly doesn't hurt that bad! I am in the medical profession so at times I am my worst enemy because I can "test" myself without the MD which is not always good! Had the same thing go on in my other knee and it resolved with weight loss and general good conditioning. I am no spring chicken(50) and I suspect it is degenerative as well. I have used my joints over the years.
No, this is not an A race, just to stay motivated through the winter. "A" race is next Nov and a couple smaller ones in the spring/fall.
I will try a short run today and then see how long it takes to recover. May have to postpone the race.
Thanks again.
C


Keyser_Soze

Nov 28, 08 7:57

Post #7 of 17 (10421 views)
Re: non surgical treatment of meniscal tears [cayenne] [In reply to] Quote | Reply

Mild tear? If you want it fixed - now is the time to fix it...not 4 months into 2009 when you don't "want" to have it fixed.

BTW - I just went 9 months of "dealing with it" on a "mild tear"...and am now 8 days post op...Hoping for a great 2009!

If it is not a tear...then is may get better on its own.


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Dr. J

Nov 28, 08 8:12

Post #8 of 17 (10414 views)
Re: non surgical treatment of meniscal tears [cayenne] [In reply to] Quote | Reply

Alright...I will bite. I always cringe when I see a medical question, a lot of misinformation posted, and consider posting.

But, here it goes. There is no good non-operative treatment for meniscal tears. Consider your meniscus to be a "shock absorber" for the knee. If its ability to function is diminshed (it has to be partially or totally removed), then the forces subjected upon the articular cartilage are increased. This increase in forces results in acceleration of degenerative changes in the knee (arthritis).

So, why then have surgery? Because if the torn meniscus is causing mechanical symptoms (locking or catching), this micro-instability causes little "scuffs" or dings in the cartilage, which seems to be worse than shaving the torn portion away, leaving more smooth motion.

Today, we avoid complete meniscectomy except in the most severe cases. This would lead to certain degenerative arthritis.

In some cases in adults, the tear can be repaired if it is in the right region (the peripheral or outside portion of the meniscus). I nearly always attempt a repair in children/adolescents as their healing potential is greater.

The longer one waits after a tear, the more likely increasing damage occurs following the initial injury. The micro instability can cause continued articular cartilage damage, worsening or additional tears.

The diagnosis can commonly be made by MRI, but only confirmed by looking at and probing it during arthroscopy.

Hope this is helpful.
J
Jeff Shilt
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twitter @MdotDoc


Martin Zollinger

Nov 29, 08 7:43

Post #9 of 17 (10351 views)
Re: non surgical treatment of meniscal tears [Dr. J] [In reply to] Quote | Reply

Hi,

X2, great piece of information-a true tear should be fixed, as the efficacy of any 'conservative' treatments has not been proven.

The only thing the op missed was who and how this "tear" was diagnosed. Maybe the op can clarify if there is a MRI to confirm, or if this was done on clinical suspicion, or on an self internet diagnosis.


cayenne

Nov 29, 08 8:58

Post #10 of 17 (10342 views)
Re: non surgical treatment of meniscal tears [Dr. J] [In reply to] Quote | Reply

Dr. J,
My concern for having surgery is everyone I have seen or know has been on a slippery slope to a TKR after arthoscopy at my age(50). It also seems,here, that a lot of "extra stuff" gets done during the procedure that tends to slow healing down, like patellar debridement. No, I don't have MRI confirmation but some of the manual tests are just as reliable. Not to diagnose the location or type, but at least the deficiet.
A lot of the ortho docs in this region don't go for a MRI until months later anyway. Any suggestions? I will get to a good sports med doc, I just don't want to be told to forget running, tris etc. I have come too far these past 2 years to quit now.
Thanks,
Cayenne


Dr. J

Nov 29, 08 10:04

Post #11 of 17 (10328 views)
Re: non surgical treatment of meniscal tears [cayenne] [In reply to] Quote | Reply

Cayenne:

Better to have the information and make an educated decision than to base your decision on suspicion. The information, whether you choose to act on it or not, will alone not hasten degenerative changes. Whatever the underlying cause, make the diagnosis and move forward with adequate information.

I respectfully disagree that clinical exam is equal to MRI in diagnosis. Furthermore, if a meniscal tear is not the underlying cause of your symptoms, you will move forward in your rehabilitation with greater mental ease knowing you aren't doing anything that causes greater damage, if indeed it is negative.

J
Jeff Shilt
__________________________
www.mdotdoc@blogspot.com
twitter @MdotDoc


cayenne

Nov 29, 08 14:46

Post #12 of 17 (10299 views)
Re: non surgical treatment of meniscal tears [Dr. J] [In reply to] Quote | Reply

Very good points. Thanks.While it may take a couple weeks to get in,what would you recommend in the way of training? Just got off the trainer for only 75 min and got several "zingers" through out the workout. It seems running is least painful in that my knee only goes through partial ROM. I will step up my workouts in the pool:)
Thanks for your input.
C


Martin Zollinger

Nov 29, 08 16:32

Post #13 of 17 (10280 views)
Re: non surgical treatment of meniscal tears [cayenne] [In reply to] Quote | Reply

Hey,

I guessed by the wording of your initial post that you did not have definitive evidence of a tear.

MRI ASAP, Without it you are pretty much guessing, the specificity and sensitivity of most ortho tests are not as high as you would like. You may use a combination of ortho tests to try and increase your odds of an accurate diagnosis, however, MRI=gold standard

You may find your knee is structurally fine.......


wickedcheezit

Nov 30, 08 9:45

Post #14 of 17 (10232 views)
Re: non surgical treatment of meniscal tears [cayenne] [In reply to] Quote | Reply

Hi, I am just back to running following a menisectomy (partial) for a medial tear. Originally symptomatic on left, then had pain in right with surgery on right.
I seem to be having a harder time getting back to running than some but I am finally starting to get there. I still have some pain on the left but not much (though I won't be suprised to have to have the repair on that too).

I could not have a MRI, but wished that I could have; it would have answered many of my questions sooner. I had to go through lots of PT and biking and swimming only for nearly 6 months before surgery was declared the only option left.

If you can have a MRI you definitely should. It will answer alot of questions for you. The location of the tear will tell you much about if it is even slightly possible to have it heal on its own.
I kept trying to work out on mine and I think it resulted in a much bigger tear than probably was there in the beginning.

See a specialist and get an MRI


mmrocker13

Dec 1, 08 7:39

Post #15 of 17 (10195 views)
Re: non surgical treatment of meniscal tears [Dr. J] [In reply to] Quote | Reply

My own personal experience matches this. After diagnosis of my most recent tear, I continued to run up until my surgery date (about 3 months). I caused substantial articular cartilige damage (and made the tear worse)--basically creating hamburger in my joint space. I ended up having a microfracture to try and repair it. Which failed. So I am now missing my meniscus (I've had multiple surgeries) AND a good portion of my articular cartilige and am bone on bone. I am 32, and I regret that decision to run on that tear pretty much every day.

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Dr. J

Jan 25, 09 21:10

Post #16 of 17 (10076 views)
Re: non surgical treatment of meniscal tears [cayenne] [In reply to] Quote | Reply

What was the verdict of your MRI?

How are you doing now?
Jeff Shilt
__________________________
www.mdotdoc@blogspot.com
twitter @MdotDoc


cayenne

Jan 26, 09 3:38

Post #17 of 17 (10045 views)
Re: non surgical treatment of meniscal tears [Dr. J] [In reply to] Quote | Reply

Hi,
Thanks for the responce! My MRI showed 2 chondral defects...I would have rather had a meniscal tear! Since I am 50, the consensus is I am too old for microfracture but the Synvisc injection have been recommended. Haven't done that yet. I have doubled my glucosamine/Aleve and have been increasing the strength training, cut back on the running voulme and have been kinesiotaping my knee when I do run. I wrap my knee when I ride. It seems to be helping quite a bit. My knee still is painful/clicks etc but nothing I can't stand and doesn't seem to be dangerous ie "giving out".
Sucks to get old!
Got a 1/2 IM in May so hopefully I can hang on, lose some more weight and continue to improve.
Thanks for asking!
C

   
 
 
 



Current-aided swims
Do swims aided by a current, such as the NYC Tri and the past weekend's IM Chattanooga, diminish the achievement? Or are they just a local geographic expression of multisport?
Diminish the achievement
Just the local geography