Osteotomy may be a good choice for you.

I had one in an effort to put off knee replacement....but I'm a lot older than you at 52 but had surgery at 50. At your age keeping your knee as long as possible should be the goal.

Thanks everyone for sharing your experiences and good advice. I have been to the ortho. doc and to PT and they both feel that my knee might be ok with the tear. The doc said it looks like there is a tear that is just lying there flat. He did not agree that there is a flap for sure on the MRI. He thinks that it looks like a thickening but not necessarily a flap. He said I could be feeling and presenting good because of the cortisone shot. He told me to push the knee between now and the first of the year and see how it goes. If its bad then it will be surgery. Both the PT and the doc think its possible I irritated something that was already there.
Ive been biking on the trainer and swimming all pretty easy with no pain. Slight ache when I push it more. Ive now run a few times up to 4 miles. No pain running this am 4 miles. Im icing after the workouts. No drugs.
Am I wasting time not having the surgery? I dont want to lose my whole season when it could be avoided. But I dont really want to lose 50% of my meniscus either.
I am doing the rehab PT exercises. Some days I think oh great its good and other days I think its not. Sometimes it feels so weird walking on it like its ot right. Im still walking so carefully. and its still uncomfortable sleeping - not pain but not comfortable.

Has anyone had the collagen meniscal implant done? My ortho tells me my right medial meniscus as a horizontal tear, probably not repairable. I suppose the good news was that wasn't what was bothering my running; it seems I have a good old-fashioned case of runner's knee. Direct pressure to the inside of my knee at the office produced no pain - so really the ortho told me not to worry about it. But I will, nonetheless...

So I started researching, as I'm not overly fond of the idea of having it removed - seems that a good precursor to arthritis if the shock-absorbing meniscus is just removed. I found that there are two things done to replace them these days: dead-guy parts and this collagen structural implant. The collagen implant seems to have a weird history with the FDA, and the company that makes it is now based in Germany - it seems the surgery is more available overseas.

I'm not opposed to the idea of travel medicine if the prognosis is better. Has anyone here had one of these?

ben

Yes if its not bothering you leave it in there. thats my understanding. A friend of mine had the implants done and it got infected. The best outcomes seem to not be surgery. But if you have to you have to.
I will worry about mine too! I hope that I start to worry less over time and maybe its good to worry now. Find a good PT.

Thanks.

I really don't want to give up triathlons. I love them more than any other form of racing I've done, and they're family-friendly to boot. I start PT tomorrow; one of the nice things about living near a big city (Philly) is the number of options available. My ortho doctor (a cyclist) recommended this place.

The infection thing with the implant is worrisome, but I suppose I'll cross that bridge if I come to it. I just don't like the idea of removal, so I guess I'll keep digging for information to arm myself. Maybe not an immediate concern, but it might be in the future.

Good luck with your injury, and I hope your season comes together!

ben

Good luck! PT should help. I guess if its not to big a tear and its really painful and clicking locking then surgery for removal is the best option. clicking and locking is rubbing on the bone and that is bad so at that point I don't think you have much of a choice. I know a lot of people that have had it done and are fine. my problem is that its big! I total get the tri thing. I love it too and can not imagine my life without it.
let me know how it goes. I'd be interested to hear. I will do the same.

I saw my Dr this morning because the knee is not behaving at all the last few weeks. It's getting tough to ride the trainer without significant pain during and after the ride. I received a cortisone injection to try and get some of the swelling down. The medial and lateral plica are both inflammed and swollen. They catch when I walk which is a little disconcerting.

I'm in the process of seeking a couple of other opinions but I trust my Dr when he told me I have a couple of choices - 1) Grin and bare it with ice, ibrupofen and limited activity or, 2) Look into the osteotomy and a possible meniscal transplant. I'm taking 2400 mg advil per day so I don't think grin and bare it is a long term option. My quad has started to atrophy due to limited activity the last 6 weeks, too. I won't do a meniscal transplant as it seems like the outcomes are only good if you give up running completely after the surgery.

Long story, but what was your recovery? My Dr said 8 weeks until the fracture heals but he'd release me to full activity at that point. He said the muscles will need rehab/recovery for probably 6 months but the fracture healing is the key. He said it's about 75-80% success rate and it might buy me 7-10 years.

Thoughts?

What were you doing in the race that led to your injury?

sorry it's bothering you so much. That is a LOT of advil!!!

I'm in PT now, but more for the "runner's knee" than the meniscus issues. They hurt on both sides (now that I can assign THAT random knee pain to something) - but I had just always assigned a certain amount of knee pain to just be old & a few pounds heavier than I should be. I think that with the catch thing, you'll need to do surgery at some point. I can't imagine that bit banging around in there is doing you any favors.

Thanks too for the info on the dead-guy parts. I'd been looking into that a bit since I'm (a hypochondriac) concerned that mine will require surgery at some point, but I didn't know that they'd require me to give up running either.

good luck!

I had surgery 12/11 and 6/12 my bone was not fully healed which is somewhat expected since I had plate put in one for HTO and one for TTO.

It took a full year to have my leg not to feel off and a bit of discomfort.

Looked up in my blog

I was given permission to walk at 8 weeks; 3 days post surgery. I had been on crutches with foot touching but not any weight since surgery.

Saw my Ortho for 10 week post op visit....72 days since surgery

• I'm doing remarkably well
• Takes fully year to recovery
• Recovery depends on getting muscle back & I'm doing well with that
• I can do any non weight bearing activity, ice after workouts
• Avoid cutting or anything that will torque my knee....up and down and forward is good
• My Proprioception will be better than last 2 years once healed but not as good as pre injury
• 50% of folks have hardware/plate removed can be done around 9 months depending on healing; day surgery and no need for crutches use same incision
• Scar on thigh has keloid due to tension but was closed same as shin incision
• Try cortisone on keloid
• Need to get new cycling and run/walk orthotics since alignment is different
• No alleve for another month
• Got a copy of my surgical report
• chatted about my impatience with recovery, he said I'm a driven endurance athlete missing my endorphins but am on front end of recovery.

I hope to get 8-10 years. Look and read the studies which I found interesting.

My recovery we hampered by the underlying issue that caused some/part of my knee issues flared up 3-5 months post op and I'm still dealing with it but overall I'm glad I had the surgery. Return to my pre surgery health and training hasn't happened as I had hoped. I have signed up for some races this year for a goal but not sure I'll be able to do them.

Want to know more PM me.

Reviving this thread because I have a medial meniscus hole or tear. Not sure which yet.

Backstory: Strength training and was doing box step-ups and when I came back down I locked my knee instead of letting it flex to absorb the impact. Unfortunately I also had weights in my hands so that added extra pounds. Sharp pain for a couple days, rested, two weeks later I ran a half marathon. Some pains at mile 10-11 but nothing serious. Took two weeks off completely because I was lazy. Ran a 12k and felt fine. Another 10 days off because I was really kicking back. Ran on Dec 29th and my knee locked and was so painful I couldn't run. Was 2 miles from home and had to walk. Really painful. My entire leg was on fire by the time I got home.

Saw a sports med doc that next Monday and he was able to generate a lot of pain with seemingly little movement. He said conservative treatment is PT for a couple weeks to see if it feels better or go right for the MRI.

I chose PT because my deductible just kicked in, of course. My knee feels better but not perfect. Now I'm wondering at what point do I throw in the towel and get the MRI? I've worked with my PT on and off for 10+ years for random things. He agreed that PT first was the right approach since I'll need it regardless of what the MRI says.

The only activity I'm doing is swimming with a pull buoy. Tried the recumbent bike and my knee hurt so I stopped.

Should I give in and get the MRI or doing a couple more weeks of PT? I'll talk to my PT as well next week but I'm always interested in multiple POV.

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Jen

"In order to keep a true perspective on one's importance, everyone should have a dog that worships him and a cat that will ignore him." - Dereke Bruce

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Easy for me to say get an MRI 'cause down here mine only cost $190 but it is better to know what is going on than put it off.I know you don't want to get surgery but you may need it so go see what is wrong.I've had two knee surgeries and my knee is just fine ,now if they could have sucked away all the pudge while they were at it I'd be back running as well as ever. ;-)


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Not Kathy, but if I had been a candidate for transplant, I would have considered it...not concurrent to my DFO, but following it.

If your articular cartilage damage is minor, I'd try the transplant first.

Have you tried a prescription unloader? My Advice would be to try that first for awhile. If it gives you relief, then look into surgery.

I had a DFO, and while different slightly from an HTO, (femur, and longer recovery protocol), I would do it again in a heartbeat, even with the complications. It is, though, a last resort.

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mmm-mmm-Momo Charms
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Jen, a good sports med Ortho can diagnosis most knee issues w/o an MRI. Did you see a sports med ortho or a different sports med type doc?

If you end up getting an MRI, costs can vary greatly even being in your network. I had two MRIs in the same year one was $4000 as in network approved cost and the nother one $400.....10x as much. University teaching hospitals I found were the most expensive and free standing independent facility was the least expensive.

Great advice - thanks. I saw my doc again a couple of weeks ago and he did a cortisone injection to try and get some swelling out of the joint. That helped a bit and has let me get back on the bike and in the pool. I tried some very light jogging the other day and that was absolutely out of the question.

I have a prescription unloader and I started using at again at all times. I had only been using it if I tried to run. I now use it while on the bike and any other workouts where I'm putting any sort of load on my knee. It seems to help so I'll keep with it.

My plan right now is to continue to bike and swim, see if I can get a couple of sprint races is this summer, and look for surgery in the fall. I might as well be recovering as the weather gets cold. I spent a couple of summers ago recovering from an ACL and that was miserable. I'll have to wait and see how things progress as I pickup up the biking this spring.

I will say, having had a bunch of other procedures done prior to the DFO, cartilage/soft tissue stuff is (IMO) a harder recovery than the bone surgery was. It was a longish recovery, but pretty straightforward. Surgery was January of 2010, in bed until aprilish (<--not typical), crutches thru May, then cane. First easy ride outdoors in July. Was able to ride again with no restrictions by fall of that year. Started back VERY slowly in Marchish 2011 run/walking.

For me, the most painful thing wasn't the DFO itself--it was the second femur break that happened after...which also made the recovery even longer (doubled it, basically, and put me on a few months of bed rest). All that aside, still, it was worth it, and, like I said, fairly straightforward.

It was crazy--having spent most of my life with arthritis/knee pain, I didn't realize how bad it actually hurt until it didn't hurt anymore. :D

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mmm-mmm-Momo Charms
Handmade beverage charms, jewelry, and miscellanea
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We know there is a tear of some kind but we don't know the extent of it. Partial, full, flap, etc. The results would give us a better idea whether surgery is necessary. His specialty is sports meds with extensive background in knee injuries. He diagnosed it quickly but did say we'd need more info before determining surgery.

I know MRIs vary widely in cost. My insurance has a cost estimator that gives me an idea but I'd follow up with each location to confirm before I head in there.

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Jen

"In order to keep a true perspective on one's importance, everyone should have a dog that worships him and a cat that will ignore him." - Dereke Bruce

Update: Right knee done; went under the knife last Friday. Off crutches on Saturday, hobbling around fine since then. Knee is the size of a grapefruit under/around kneecap and hurts at the incision points. The rest of it just kind of aches a little bit, but no worse than it had before the surgery. Doc prescribed Vicodin, but I haven't touched it or even Advil. It really doesn't hurt any worse than I've felt after events.

I've been told by my doc to do NOTHING for two weeks. No upper body strength training, no swimming, no nothing. It's going to be a long two weeks...

At this point the left knee hurts more than the right, at least at the very inside where the medial meniscus seems to show itself. I've been loading up the left knee to compensate for not using my right much, but I've not exactly been a stellar patient either. I haven't really been sitting still much (it sucks) and we've got enough snow yesterday to require some shoveling. My self-diagnosis is that the left knee is as damaged as the right one was - but for now I'm going to let the left alone and compare the two. I've a prescription for an MRI in the left knee, but I'm just sitting on it for now.

One of the nurses at the hospital asked if I was an athlete; after saying yes he said "Welcome to the knee pain club" - he was a basketball player who had already had both knees done. I'm hoping for a better outcome than that! I'm thinking of following the "Couch to 5K" program or something like that to get my run mileage back up, once I get the go-ahead to run again. At this point though, I'm not planning on doing any more running than I "need" to.

So, what did you end up having done? Clean out or clip or repair?

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mmm-mmm-Momo Charms
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I believe the doc cut out about 30% of the medial meniscus; to clear the horizontal degenerative tear. I asked what he did when I came out of anesthesia, but I was still a bit fuzzy.

I think he left the meaty part behind (the non load bearing part).

From an engineer's point of view, I'm hoping that some portion of it might refill if I'm nice to it. I guess medical research is not in my favor here, but the design doesn't seem to make sense without the ability to regenerate. The sharp inside edge of the meniscus seems designed to be refilled from the meaty part as it wears. I think if it's torn then the tear becomes self-replicating - it creates a stress riser - like a tear in a roll of tape: as you remove more tape, the tear propagates along with the tape being peeled off - but if you start at a clean edge the tear won't be there as it refills.

One can hope, I guess.

Have had two medial tears in right knee with the latter resulting in complete removal. One at age of 16 and another at 23. Fortunately, found a good doc to do a meniscal transplant at 24.

Biggest advice(s):

1 - Find the best PT you can.

2 - Work on support muscles - especially glute med and core (not your abs). Most time the injury doesn't occur or re-occur because the knee or meniscus is weak but what isn't functioning properly elsewhere.

Well, it's always good to have hope, but no...medical science doesn't really back you up on that one :D

I'm surprised your doc said no anything for two weeks--mine had me doing ROM stuff as soon as I was alert enough to do so for most of my clips, and light spinning with no resistance (or torque from clipping in and out) also. I could swim as soon as my incisions were healed, or if I covered them with tegaderm.

Definitely get in to PT right away, though...it helps a lot. :-)

You'll be back to things just fine, I'm sure--you can get by without a good amount of it (or all of it, if you have to). You are smart in taking it easy, though--no sense rushing.

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mmm-mmm-Momo Charms
Handmade beverage charms, jewelry, and miscellanea
http://momocharms.wordpress.com

when they took 60% of my medial posterior horn at age 58, i was doing recumbent biking within 3 days very easy. biking and swimming in about 3 to 4 weeks as i was conservative. i did start running after 6 weeks and i neglected my pt ie doing total knee extensions and making sure the vmo (although hard to isolate when weightlifting) was stronger and firing properly. i should have done more pt. so the consequence was i favored my right knee and the left knee developed PFS. as i said earlier on this thread the left knee showed degenerative tears but being 64 the doc said quit racing, do yoga that taking more meniscus out i'll get more OA, which i was experiencing already. so i did stem cell and prp and the left knee which i could barely bend beyond say 30 degrees is close to 98%. i am waiting for warmer weather and more pt on this leg before running in earnest, but i have tested the knee a time or two by running easy for half a mile and it seems so so much better and no day after complications.

so be careful that your good leg compensates too much for your bad leg. and think about stem cell/prp and run that by your doctor if you good leg goes bad.

good luck. if any consequence i was racing well after the first sugery but at my age if i slacked off on the pt i would soon pay for it. build in time for working on the legs ie foam rolling, trigger point, massage, proper warmup and cool down and keep weight off.

So my update is this. I did not have surgery. I have been doing rehab instead. There was fear of hurting my left knee due to favoring it so I have been using the spin scan on the trainer to be sure I dont pedal uneven. I am running a higher cadence and doing drills to get my cadence high for periods of time up to 100. I did some drills getting off my left foot faster to get more pressure on my right and off my left. My left knee had started hurting but now is feeling good.
I am doing my strength work and foam rolling as ordered. I am now up to 15-24 hour weeks of s/b/r. I ran 47 miles last week with a 21 mile long run and got in 287 on the bike the week before. Slight soreness at times but not while training. Its feeling good. Im walking normal. The funny thing was it felt better to run then walk for a while.
Im still very careful with anything that is not straight up back and forth. I dont plan on doing anything different that way maybe forever. I guess time will tell but I do not want to take any risk. As of right now it looks like I will have a racing season this year. Oh ya and I raced a 5k last week that was about 30 seconds off my pr.

I'm going to schedule the MRI. I'm not in acute pain but I still can't fully straighten my knee and haven't dared run on it. Ugh.

I hope your recovery goes smoothly. I'm sick of sitting around. As soon as I smell spring in the air I will go nuts so if I'm going to have surgery I should do it now.

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Jen

"In order to keep a true perspective on one's importance, everyone should have a dog that worships him and a cat that will ignore him." - Dereke Bruce