how to regain full use of knee (without surgery) after meniscus tear

Posted by rbon1 @rbon1, May 22, 2019

Hello: I am a 70 year young male in generally good health. 3 months ago while playing pickle ball (BTW a great game that I really enjoy), I made a twisting movement and my knee stiffened up on me. Long story short, a post injury MRI showed a complex degenerative tear involving body and posterior horn of the medial meniscus. No prior knee issues or surgery and all ligaments in knee are fine with only a little osteoarthritis. Following the injury I had 3 months of PT concentrating on strengthening quads and hips and trying to regain full ROM of knee. After 1.5 months, I reached a plateau from which I have been unable to make progress. No issue sleeping. I can walk just fine and even hike but when hiking downhill I favor the affected knee. Indoor cycling feels really good with no pain at all in my knee. When I use the knee in question, pain is quite minor (but I have been unable to resume pickle ball). Orthopedic surgeon (who does 20 knee surgeries every week) suggests meniscotomy to trim meniscus or suggests steroid injection. My internist advises not to rush to surgery and suggests I consider steroid injection with more PT. I am generally with him–reluctant to have elective surgery or to inject stuff into my knee. But I like the idea of more PT. Would love to hear about how anyone similarly situated dealt with this and about your results. Many thanks

Hello @rbon1, welcome to Connect. I'd like to invite @ew100, @randyvaughan, @ellerbracke, and @ees1 to this discussion as they have all discussed dealing with meniscus tears and how they have dealt with them via different treatments. It sounds like you and your internist are on the same page. Has your internist suggested working with your PT to potentially alter your routine to get over the plateau or what the potential plateau may be in relation to?

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Thank you Justin. I would very much welcome hearing from anyone who was in a similar situation and wishes to share their experiences/learning.

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@JustinMcClanahan

Hello @rbon1, welcome to Connect. I'd like to invite @ew100, @randyvaughan, @ellerbracke, and @ees1 to this discussion as they have all discussed dealing with meniscus tears and how they have dealt with them via different treatments. It sounds like you and your internist are on the same page. Has your internist suggested working with your PT to potentially alter your routine to get over the plateau or what the potential plateau may be in relation to?

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@JustinMcClanahan Justin and @rebon1 I think this is what's going on with my knee a meniscus tear had X-Ray on both knees @rbon1 was yours painful? mine is and stiff in morning

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Can’t speak to specifics re. meniscus tear. Had major knee problems, diagnosed as combination of meniscus tear, arthritis of tibia, some under kneecap, and assorted debris in knee. Did arthroscopic “clean-out”. PLEASE do not do this. I learned that arthroscopic surgery limited to soft tissue usually works quite well, once you get to cartilage, you might as well throw in the hat and look to stem cell treatment or knee replacement (both down the road, of course, depending on how bad things are). Wish I would have had a better grasp of things when my knee troubles started. I ended up with unsuccessful arthro surgery of knee, followed by TKR 11 months (and lots of pain, exercises, shots, frustration) later. OK now 8 months post TKR. Try to avoid, though. Not your own knee, no matter how good the quality of the metal one is.

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@ellerbracke This is timely for me as my one has been hurting me for weeks ,had x,Ray's waiting for results

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@ellerbracke

Can’t speak to specifics re. meniscus tear. Had major knee problems, diagnosed as combination of meniscus tear, arthritis of tibia, some under kneecap, and assorted debris in knee. Did arthroscopic “clean-out”. PLEASE do not do this. I learned that arthroscopic surgery limited to soft tissue usually works quite well, once you get to cartilage, you might as well throw in the hat and look to stem cell treatment or knee replacement (both down the road, of course, depending on how bad things are). Wish I would have had a better grasp of things when my knee troubles started. I ended up with unsuccessful arthro surgery of knee, followed by TKR 11 months (and lots of pain, exercises, shots, frustration) later. OK now 8 months post TKR. Try to avoid, though. Not your own knee, no matter how good the quality of the metal one is.

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Thank you so much for your response. It is indeed challenging for a senior person with a new knee injury to make the "right" treatment decision.

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@rbon1 : I wanted to add one more comment. My brother also had a meniscus tear and some inflammation on the bones in his knee. TKR was brought up, he declined. Went to work with a physical therapist who specializes in sports injuries, and added acupuncture sessions with a practitioner of traditional chinese medicine. I took 6 months of treatments and exercises, but now his knee is perfectly fine (confirmed by X-rays and MRI).

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Thank you so much for sharing your experience and that of your brother.

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@ellerbracke

@rbon1 : I wanted to add one more comment. My brother also had a meniscus tear and some inflammation on the bones in his knee. TKR was brought up, he declined. Went to work with a physical therapist who specializes in sports injuries, and added acupuncture sessions with a practitioner of traditional chinese medicine. I took 6 months of treatments and exercises, but now his knee is perfectly fine (confirmed by X-rays and MRI).

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@ellerbracke Thanks for information on your brother I think I'm going to look into this Turned out xray showed just arthritis but pain goes down leg also

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@lioness

@ellerbracke Thanks for information on your brother I think I'm going to look into this Turned out xray showed just arthritis but pain goes down leg also

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@lioness “just” arthritis can be pretty limiting, depending on your lifestyle. I was not (yet) bone on bone, but I had to 1-step every time I faced stairs, and it hurt every time I walked for exercise, or got up out of a chair, or a car, and the tipping point for me was when I went on a very gently hike with one of my grandsons and his family and simply could not handle a slight downhill without hanging on to shrubs, trees, someone’s arm…….or I would have to have backed down the trail. That was after the arthroscopic surgery, and before I heard about stem cells. So TKR it was.
Regarding my brother, contrary to what I expected (he lives in a small city in Austria), there is a whole lot of un-traditional, experimental, holistic treatments available there, much more readily than in my adopted home (40 yrs. +) in SC. Not sure where you are located, but perhaps you also have more options, or at least, you know to ask about alternatives, which I did not (and you may already know anyway without my 2 cents.)

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@ellerbracke

@lioness “just” arthritis can be pretty limiting, depending on your lifestyle. I was not (yet) bone on bone, but I had to 1-step every time I faced stairs, and it hurt every time I walked for exercise, or got up out of a chair, or a car, and the tipping point for me was when I went on a very gently hike with one of my grandsons and his family and simply could not handle a slight downhill without hanging on to shrubs, trees, someone’s arm…….or I would have to have backed down the trail. That was after the arthroscopic surgery, and before I heard about stem cells. So TKR it was.
Regarding my brother, contrary to what I expected (he lives in a small city in Austria), there is a whole lot of un-traditional, experimental, holistic treatments available there, much more readily than in my adopted home (40 yrs. +) in SC. Not sure where you are located, but perhaps you also have more options, or at least, you know to ask about alternatives, which I did not (and you may already know anyway without my 2 cents.)

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@ellerbracke I live in Cali. But have studied holistic since the 70,s A gentleman here is 93 still working as a crossing guard he had what I have he just won't let physical things get him down He pushes against weight 10 lps I am starting to do same at 1lb but hurts just moving it .Dr. recommended a shot don't want to do that if I can help it At 77 I exercise everyday

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Hi @rbon1 and welcome to Connect. I had two meniscus surgeries, quite a while ago. Since then I have read that they are not done nearly as frequently, that PT can very often solve the problem better than surgery can. I presume there are still times when surgery is the best option, but back when I had my two they were very common.
I would tend to agree with you, more PT could help. I would not rule out an injection though, that can help also. If at any point in time you do consider surgery I would definitely seek a second opinion.
Good luck with this, I hope you find a satisfactory resolution. Please let us know how you are doing.
JK

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rbon1,
Fourteen years ago, I was (58 yo) training for a half marathon and L knee suddenly swelled like a melon. Long and short, my physician said "get a knee replacement (cartilage was gone, bone-on-bone) and you may be able to continue jogging (not running) or…give it up and live with it" (deal with the underlying arthritis later, in other words). I gave up running completely. Did some PT, without definitive results.

Took glucosamine (see how long ago this was?) and I thought I had achieved some kind of standoff. About 4-5 years after my diagnosis, I tried racquetball and was surprised I had recovered enough to stay with players my age. Even stopped the glucosamine completely, but that's another story. Been playing 3x/week until the present, but now I have to take nsaids. My wife has also been happy I can travel and accompany her on walking tours with the inevitable stairs. And since I race and prep my car myself, I am still limber enough to crawl under and perform major repair on my vehicles. All this time I was aware my R knee was compensating and would eventually run out of cartilage, too. And now I have to pay the piper and have an appointment with my doctor to schedule TKR.

My complaints: increasing difficulty going down stairs (BTW, USA is the most ADA-compliant country, hands down) and knees so noisy loose our spaniel grimaces everytime I get down on the floor to play with her. My apprehensions (other than surgery-related complications): reduced leg ROM and flexibility getting in and out of low cars with race seats; and stair performance no better than what it is, now. What tipped the balance? I bought my current car from a track buddy who underwent TKR with no problems. He's back to an open-wheel racer with a tighter cockpit. I'll take a chance on stairs.

The takeaway: it's been 14 good years with conscious joint management and adjustment of expectations. I read that the TKR age window is 50 – 80, which gets me (and you) farther away from the average with every passing day. I have given activity details to give a better understanding of the recovery and extended level of general activity possible; even with arthritic, or otherwise injured, joints. I am merely sharing, not recommending, since everyone's different and only you know when you will be ready and what relief direction you may choose. I am totally confident that if you decide to put off invasive intervention by more than a couple of years, new and better technology not may, but will, be available. So keep that in mind as well.

Best of luck to you! HTH

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Thank you so much for sharing your experiences and best of luck with your TKR (if you decide to go that route)!

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@mister2

rbon1,
Fourteen years ago, I was (58 yo) training for a half marathon and L knee suddenly swelled like a melon. Long and short, my physician said "get a knee replacement (cartilage was gone, bone-on-bone) and you may be able to continue jogging (not running) or…give it up and live with it" (deal with the underlying arthritis later, in other words). I gave up running completely. Did some PT, without definitive results.

Took glucosamine (see how long ago this was?) and I thought I had achieved some kind of standoff. About 4-5 years after my diagnosis, I tried racquetball and was surprised I had recovered enough to stay with players my age. Even stopped the glucosamine completely, but that's another story. Been playing 3x/week until the present, but now I have to take nsaids. My wife has also been happy I can travel and accompany her on walking tours with the inevitable stairs. And since I race and prep my car myself, I am still limber enough to crawl under and perform major repair on my vehicles. All this time I was aware my R knee was compensating and would eventually run out of cartilage, too. And now I have to pay the piper and have an appointment with my doctor to schedule TKR.

My complaints: increasing difficulty going down stairs (BTW, USA is the most ADA-compliant country, hands down) and knees so noisy loose our spaniel grimaces everytime I get down on the floor to play with her. My apprehensions (other than surgery-related complications): reduced leg ROM and flexibility getting in and out of low cars with race seats; and stair performance no better than what it is, now. What tipped the balance? I bought my current car from a track buddy who underwent TKR with no problems. He's back to an open-wheel racer with a tighter cockpit. I'll take a chance on stairs.

The takeaway: it's been 14 good years with conscious joint management and adjustment of expectations. I read that the TKR age window is 50 – 80, which gets me (and you) farther away from the average with every passing day. I have given activity details to give a better understanding of the recovery and extended level of general activity possible; even with arthritic, or otherwise injured, joints. I am merely sharing, not recommending, since everyone's different and only you know when you will be ready and what relief direction you may choose. I am totally confident that if you decide to put off invasive intervention by more than a couple of years, new and better technology not may, but will, be available. So keep that in mind as well.

Best of luck to you! HTH

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@mister2 : Thank you for a very straightforward, and detailed description of your knee history. I am both amazed and happy that you were able to postpone serious surgery for over a decade, what with your active lifestyle. I may – or may not – have jumped the gun, but after unsuccessful arthroscopic surgery for torn cartilage, torn meniscus, advanced arthritis on tibia, and under knee cap, in spite of really compliant rehab the pain continued whenever I tried to do normal things…. like walking down stairs, walking down inclines, walking – period, stopping abruptly, getting up from a chair, simply sitting or standing any length of time. Basically, pain out of proportion to visible cause. Lived with that for about 11 months.
My TKR was successful as far as normal pain, normal scarring, and above normal recovery of flexibility, but it still is an artificial joint, with limitations. Some days I kick myself for having decided to have it done, but then today I went back to a famous local destination – Biltmore House in Asheville, NC. Summer home (Castle) of the Vanderbilt family. Last visited September ‘18, just a week before knee surgery, since they had a stunning exhibit of Chihuly glass sculptures interspersed in the gardens and the mansion. On about 5 different levels. And it just about wore me to the core to get down the steps to each new attraction. Went back for brunch at a restaurant there today, took some of the same paths, and no pain, walking steps or inclines. So even with my regrets of not being quite the same any more, I do see the benefits. If that makes sense. BTW, brunch was to celebrate my 70th.

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