Meniscus tear,concerns over surgery?

Had MRI about a month ago and got a meniscus tear and a cyst because I’ve left it so long.Got appointment with consultant in around a month.Little concerned about having the surgery done so just wondering if anyone has had some surgery and how it was after.

I think it must have been around 12-15 years ago I tore it,and I’ve seen a few physios who gave me exercises to do but nothing really worked and it’s only after the MRI that I now know it’s a meniscus tear.I didn’t pursue trying to get it sorted over those years as it doesn’t really affect me biking which is my main hobby.I enjoy hiking and running but after one hard days hike towards the end of the route my right knee starts hurting to the point I’m hobbling for last few hours.Running I can only manage about 20minutes before it gets painful.I miss running and it’s also stopping me doing harder longer walks,multi day hikes ECT so I do want it sorting if possible.I saw another physio in December as because of how crap weather has been thought get it sorted and start jogging again to keep fitness up.He did mention meniscus and gave me a exercise plan which was about a 40mins of stretching a day.This made it worse so I went to GP and pushed for a scan.If theres a good chance surgeries will sort it ill go for it,but im concerned of it making it worse.Biking is the only sport i can do comfortably at the minute so if surgery screws me up for that I’ll be properly gutted.

Cheers

IANAE (orthopaedic surgeon) but my understanding is this:

• a torn meniscus is usually a sign of early osteoarthritis (the wear and repair type).
• as such, in the majority of cases having them trimmed is of little benefit to long term outcome. There was an excellent study that showed this a few years back.
• there are a few edge cases (professional athlete losing £££s per week of inactivity with a limited professional lifespan or a bucket handle tear causing a locked knee) where having an intervention is beneficial.

OP is the surgeon offering you this procedure privately or on the NHS?

I had a meniscus tear years ago, consultant said just wait and it will repair itself. Took about 9 months, but it did just go away.

Had two meniscus repairs on same knee, both occasions due to other more major trauma to the knee, and meniscus repair while they were in there sorting out other stuff (one was bucket handle blocking mobility so needed sorting)

You really need to see a consultant who can tell you what is going on and what the options and prognosis look like

Had one repaired via keyhole surgery a few years ago. My knee initially swelled up so was sent for MRI which confirmed a tear. The pain did subside for a while until I accidentally put too much force through it and I then walked with a constant limp. The surgery was like flicking a switch and I felt like a fraud when they gave me crutches to leave the hospital. I’ve had no issues since with my 50 year old hardworking knees. I know I’m only a sample of one, but the study that suggests operations aren’t worth it overall would have left me limping forever.

I’ve got one in each knee. Been a miserable couple of years, but they do seem to be clearing up with physio.

I actually did my first bike ride in ages yesterday as I’ve got to build the muscles back up.

IM(recent)E – long post but hope it’s useful.

I’ve just had my follow up after MRI, following a ‘traumatic incident’ in Nov 22 where I went to run across a busy road to make a gap in traffic and my knee went ‘bang’

Yes, NHS/Tory cuts (I might have missed a letter there) that is correct, 18 months to finally get a diagnosis and treatment plan.

I have lost almost all the meniscus on the inside (medial) part of the knee and also have a cyst behind the patella and it’s degenerative arthritis that is also present on the other (but I haven’t had the tear on that side). So the knee joint is kind of collapsing on the inside, wearing the joint faster and causing bone on bone pain.

The solution is a knee replacement (partial or total) but I’m not recommended for it because I’m too young (55) and it’ll not last my expected lifespan and then will need doing again. So recommended to get by as best I can for another 5-10 years after which it becomes viable. In the same timeframe the technology will improve – surgeon said success rates currently are way behind hip replacements, such that 50% only of operations are a ‘success’ in that symptoms, etc., go away. About 30% according to him are no different to how things were, and 19% the outcome is worse. And 1%, the patient wishes they’d never met the surgeon, it’s that poor.

On trimming the meniscus – as Kramer says, he said the current thinking is to avoid unless it actually is causing the knee to lock or collapse. Most of the pain comes from the bone on bone impingement (my x-rays show significant ‘beaking’ – maybe peaking? – which is what AIUI makes me a replacement candidate in the future) and so steroid injections may help but you only get a few of them before they stop being effective. Instead he has recommend

1/ exercises to build up muscles to support it (already being done, have had physio while waiting)

2/ give up thoughts of running and in particular wanting to get back to sports like football that require fast stop/change direction movements – he said those days are gone. I told him of a friend who (a bit older) had a knee replacement and is now back bowling medium pace in senior cricket and he said that if his surgeon finds out he’ll be livid.

3/ stop being a fat **** (NB had to give up 2x weekly bootcamps i did and got fat since…..def not my fault) 

4/ they are going to try me with an unloader brace – eg: https://www.ossur.com/en-gb/bracing-and-supports/knee/unloader-one-x that supports and puts more back onto the bit where the meniscus is still present. I’ve been measured and it’s on order and then they’ll have me in to show me how to fit and use, but you can buy privately apparently.

IANAE so not sure if it’s in any way suitable / similar to my condition, but may be worth reading and asking the question.

TL;DR – probably right to be concerned about surgery but might not be on the table anyway.

Oh, one more thing – when i said that pain was bad on walking (like you said, end of a walk and after) and that I wake several times a night as knee gets fixed in position – surgeon said paracetamol is one of the best known effective and and safe medicines out there, that you can get for <20p a day bought OTC. In terms he said don’t be a martyr; try to keep to 6 per day rather than the 8 max dosage, take regularly to stay on top of the pain rather than when pain comes, normal activity won’t significantly make it worse so use the P to enable me to have decent quality of life while accepting some stuff is now in my past. I’m now regularly taking 500mg 4x per day and upping to 2x in the morning if I expect an active day and then again maybe 2x as needed through that day.

My knee sounds similar to the OPs but a touch worse. I have about a 10km, 500m descent, walking range and no real ability to run. But I’m fine on the bike. NHS physio assessed me and considered my non operable. I’m not locking or collapsing so in his opinion there is nothing to be gained and obviously some risks. I don’t believe he was staying the NHS can’t afford to help.

So currently I’m just getting on with what i can do. Which to be fair is quire alot. When it first shared it was horrible and ordinary stuff was uncomfortable, just so glad most days I’d never know i had a problem. I could afford to go private but so far I’m not tempted. I’d hate to be worse off.

Had 5 due to sports mainly. My right knee now has severe osteoarthritis – new knee next.

Cycling has never been affected.

The morphine injection when you wake up is fun.

For those who are unaware, the advice wrt degenerative arthritis has changed significantly recently.

We used to tell people to avoid painful activity, now we tell people to take painkillers and get on and do the things that they want to do. We also tell them that more pain doesn’t mean more damage, in fact it can be a good sign because it means that you are keeping the joint function going.

My bugbear is people who don’t take painkillers despite being advised to do so because they “don’t want to mask the pain”. It’s a common belief, and on the surface it makes sense, but actually it’s doing them harm.

My bugbear is people who don’t take painkillers despite being advised to do so because they “don’t want to mask the pain”. It’s a common belief, and on the surface it makes sense, but actually it’s doing them harm.

My dislike comes from playing through pain when I played sport – and taking painkillers to mask the injuries which I think did then cause further damage. But as my two main sports i was in a solitary role – GK and WK – if you give up a spot then it’s hard to get back, no side needs two WKs.

But yes – surgeon said get on the paracetamol and get on with life.

Thanks for advice as given me lots more to think about and ask consultant.👍👍

I’m with theotherjonv on this. I’ve been told by medical professionals to take ibuprofen to quell the swelling when I walk but rarely take anything as I worry about creating a dependency.

You can’t become dependent on paracetamol or ibuprofen.

Ibuprofen is anti inflammatory. But can cause stomach and other problems

Paracetamol isn’t anti inflammatory but in the correct does has less side effects

Actually ibuprofen isn’t anti-inflammatory, the class of drugs are only known as “anti-inflammatories” because that was how they were mistakenly thought to work when they were invented.

To reiterate Kramer, if it is not locking try conservative management.

As an adult, your meniscus is not “repaired”. It has minimal blood supply and therefore minimal healing capacity. It is trimmed to a stable base. For me, I would like to keep as much of me as possible, tears can settle down and become asymptomatic (but not always).

Always remember you cannot undo surgery……

As an asthmatic I have been told not to take ibuprofen. Not sure why.So I stick to Paracetamol.

@monkeycmonkeydo – yeah, Ibuprofen and similar can make asthma control more difficult, especially if it’s not great (ie using blue inhaler regularly) in the first place.

Isn’t it great having an on line doctor to answer questions and clear up our misconceptions. I’d always assumed ibuprofen was anti inflammatory, so you live and learn.

https://www.nhs.uk/conditions/nsaids/

Common questions about ibuprofen for adults
How does ibuprofen work?
Ibuprofen is a type of medicine called a non-steroidal anti-inflammatory drug (NSAID). It works by reducing hormones that cause pain and swelling in the body.

When you apply ibuprofen to your skin, it works in the same way as when you take it as tablets, capsules, granules or liquid, but it only works in the area you’ve applied it to.
When will I feel better?

@theotherjonv

The wording on that website is vague to the point of being misleading I think.

RIcE are what reduce swelling and inflammation.

playing through pain when I played sport – and taking painkillers to mask the injuries which I think did then cause further damage.

Yes it likely did.

I can see how people get confused. Masking symptoms from acute injury isn’t a good idea (unless  you’re a professional with a limited career timespan etc etc), see also people who try and “push through” relatively minor self limiting illness and make things worse.

You need to click through links but the language isn’t ambiguous at all:

https://www.nhs.uk/medicines/ibuprofen-for-adults/common-questions-about-ibuprofen-for-adults/

“Ibuprofen is a type of medicine called a non-steroidal anti-inflammatory drug (NSAID)”

It might work differently to other NSAIDs but it does reduce inflammation, and it’s not a steroid…..

“It works by reducing hormones that cause pain and swelling in the body”

That said – version control on the internet isn’t great, maybe it has changed but that site should be reliable.

Anyway, whether it is or isn’t it a NSAID, it is a pain killer so should be a ‘good’ choice for helping manage degenerative knee and allowing people to get on with life, BUT does have more issues with long term use and hence isn’t. Back to the really useful advice about knee-knack

@theotherjonv

Yes they are NSAIDs. However the whole class “NSAID” is probably a misnomer as they don’t really reduce inflammation.

On the back of this I’ll be lobbing my ibuprofen and get paracetamol, tastes better anyway.

However the whole class “NSAID” is probably a misnomer as they don’t really reduce inflammation.

So they’re the politicians of the pharmaceutical world then 😉

Serious question then (and having said not to derail the thread, but I think this is a branch rather than a tangent) – do different classes of painkiller work better on different types of pain. I’ve always thought ibuprofen was better for muscle and soft tissue type pain and paracetamol for headache type, but is that semi-placebo because of past use and expectation. And indeed I’ve had too many days of 3’s and 3’s (double dosing with the 6hr interval split so P at 6-12-18 and IB at 9-15-21) to be entirely happy with now.

@theotherjonv paracetamol doesn’t work so well for a minority of people. If it works for you, it’s far safer than ibuprofen, although not completely risk free.

If you are safe to take Ibuprofen at a decent dose, then it does seem to be more effective for back pain. However it can cause heart attacks, stomach ulcers and renal failure, as well as making asthma worse, so if taking it regularly it’s worth talking to <ahem> your GP.

My understanding of meniscal tears (as a vet…!) is that if they cause significant pain and there is a bucket handle type tear then arthroscopic trimming of the tear will result in rapid improvement. The cartilage will not heal on its’ own so the best you can hope for without surgery is that fibrocartilage will form that will stabilise it, but this is the beginning of an ongoing degenerative process in the knee.
Bottom line if it’s a decent sized tear and causing significant pain then I would go for surgery – it’s minor (arthroscopic) and with rapid recovery times.

As an additional thought, worth asking your consultatn about potential for a sutured repair of the tear rather than trim/removal. Not sure of the situations used, but maybe an option that is worth exploring.