$200 Bounty: Meniscus Torn. What to do?
Hello,
I learned this week that I have a torn meniscus. I am looking for general knowledge and feedback about the subject and my situation.
I am giving out a bounty for comments that are valuable to me. I will follow the same procedure as in my last bounty post (https://steemit.com/bounty/@knircky/wanted-how-to-bring-value-into-the-steemit-ecosystem-usd200-sbd-bounty)
*Please read this post and provide feedback on how to deal with my injury. Ideally you should have some experience or knowledge and let me know how you qualify. The best comments will receive $200 bounty.
70% of that payout will be decided by me and the rest by the amount of votes the comment generates in SBD. If anyone wants to support this idea by adding to this bounty send SBD or STEEM to my account with the comment "bounty". I will add this to the bounty and let you decide how to distribute your part of the bounty. The bounty will be paid out some time after two weeks from now on Tuesday Dec-1. Please also read my original post how bounties could work: https://steemit.com/steemit/@knircky/the-potential-of-bounties-an-improvement-proposal-for-steem-to-double-its-value
Remark: Your comment must be valuable to me and about the subject in general in order for me to pay out the bounty. If there are no comments that do pertain to my situation and meniscus injuries I will not pay out. You can see that I failed to make such a statement in my last bounty post and paid the bounty even though I did not feel that I received valuable feedback. This time I will be more critical and expect some effort and expertise to go into the post in order for me to pay up*
Background
I am 39 years old and have been active when I was young but stopped working out when in college. In college I played basketball in the college team (Germany so nothing glorious) and ever since have practically done no sport. So basically just gotten fat over the last 15 years. Some of my friends asked me about a year ago to play basketball with them and I have been playing basketball practically weekly since. I also joined a Gym about 5 months ago and have been exercising 2-3 times every week including basketball. I am about 100 lb overweight and weigh 280 lb with a height of 6 feet 3' or 193 cm.
How I got injured
There is no particular event that I know of that led to the injury or anything that I can remember. What has been happening over the last couple of months is simply pain in my knees and legs after exercise, particularly after basketball. This is usually noticeable the next morning when I get out of bed. the same thing also happens when i go to the gym where i have a trainer that makes me do all kinds of exercise that involve legs and weights. (thrive)
The first time I noticed issues was in February of this year, I went to Penn medicin, took X-Rays but the Dr., who was a knee specialist said he could not see anything wrong with the knee. He suggested an MRI and said he would request it from my insurance. The pain went away and I simply did not follow up.
Diagnosis
Over time my pain in the knee came back and became stronger and stronger, so I decided to go to Penn medicine again. This time I was adamant to get an MRI. Before getting the MRI a knee and sport specialist analyzed my knee and thought it did not look very bad and that I was ok to play basketball and work out. So I did play basketball last week and was just very careful not to hurt my knee. I went to the gym the day after. The next day I noticed my knee started to hurt quite a bit to the effect that I can not walk without limping or sit with my knee bent.
The result came back this week. My knee looks pretty much like the picture below, except that the tore is about 1/3 as visible
Another thing that came up in the MRI was that the bone on the side of the knee that is torn shows irritation and signs of aging according to the MRI report. The Dr. indicated that is likely a result of the issue of the torn meniscus and as such should be removed.
He suggested surgery.
Some questions
I have never been in surgery and as such I had some questions. Something that was weird to me is that the Dr. and his assistants were very detailed when reviewing the MRI and my injury but whenever we spoke about the surgery I felt they were very evasive and it seemed like I was being sold.
There were also some things that were inconsistent about the statements that were made
- I was told that I would be able to walk 2-3 days after the surgery w/o cruches
- I was told I should take off work for 2 week
- I was told I can travel after 1 week (fly)
- I was also told that I would start physical therapy 1 week after the surgery
- I was told there is really no time pressure to when to do the surgery
When I spoke with others and did some research online it looks more like the recovery period is 4-6 weeks, so all this seems a bit strange.
I have no clue about any of this, I am a computer scientist and know nothing about biology my questions were probably not the best.
Situation and Surgery Schedule
I have travel planned in November, December and January. In January I need to fly to EU (i live in Philadelphia) for work and I was going to go home to Germany over NYE for a week. I am an Expat and like to visit my family at least once a year.
Another option was to schedule the surgery mid December, but I am worried that I won't be able to travel to Eu in January in that case and I am not allowed to take any days off in December for work.
As such I have scheduled my surgery January 20. directly after my business trip to Rome. Penn said that this made perfect sense.
What I am looking for
I am looking for general advice and background info to my situation and if the decisions I made are decent or sub-optimal.
I really want to go home and on the business trip, however if it is bad for my knee I am happy to cancel my business trip and stay home over the holidays.
There is however risk and loss of value if I do not go on the business trip, so if it does not make a major difference like the Dr. says, I prefere that option overall. December is also a very busy time for work to the effect that I am not allowed to take any PTO, so having surgery that month is best to avoid if at all possible.
Aside from the specifics I am also looking for general background and information about this sort of injury and how I should deal with it.
Thank you for taking the time and looking into this for me.
I am a physician and a previous pro volleyball player with 6 knee surgeries involving meniscus tears/ repairs and Acl replacement.
I keep this very short. Look at your MRI report as the simple peripheral tears of the meniscus where blood supply is adequate may heal over months with rehab and lifestyle modifications. If the tear is complex and central where blood supply is poor then you need intervention with procedures. I highly recommend you to look in to blood cells injections in to the joint to promote healing of the tear. There are ortho centers that do that. Takes less than half hour office visit and you are done to continue with your day. Blood cells have ability to heal minor tears with fibrocartilage production. You may need injection once a week for a few weeks in a row and each time you will feel some improvement. For some surgery is avoided with healing of tears. My knee is arthritic and I keep a very active life despite my aweful looking mri and xrays with blood injections in to my right knee.
If you decide on surgery please make sure you do your search for the best ortho at a center with good records. It is an easy procedure with potential bad out come in a hand of a surgeon that is not meticulous or in a center that allows residents in training do the surgery with supervision.
Best of luck to you!
Treatment
If the injury is minor and the pain and other symptoms go away, the doctor will recommend an exercise program to strengthen the muscles. The exercises are performed for meniscal problems initially under the supervision of a doctor or therapist. The therapist will ensure that the patient does the exercises properly without risk of a new injury. The following exercises are designed to build up the thigh muscles and increase flexibility:
Warming up the joint by riding a bike, stretching exercises and then lift the leg
Foot expansion of upright posture (can be placed a little weight on the ankle for this exercise)
In prone, execute lifting movements of the foot
Exercises in the pool, including fast paced water chest, lifting each leg 90 back against the wall of the basin.
If the tear is extensive, the doctor may perform surgery or arthroscopy to assess lesion severity and repair. The doctor can suture the meniscus at relatively young patients, if the lesion is in an well vascularized area and ligaments are intact. Most young athletes can perform vigorous sports activities after meniscus repair.
Elderly patients or if the tear is in an area poorly vascularized, the doctor will resect a small portion of the meniscus, to smooth the surface. In some cases, the doctor will resect the entire meniscus. However, degenerative rheumatism, such as osteoarthritis, shows a higher risk of development if the meniscus is removed entirely. Doctors researchers investigating a procedure whereby the meniscus is replaced with a meniscus from a cadaver (allograft). A graft meniscus is fragile and can break easily and shrink. Researchers have tried with artificial meniscus replacement, but the procedure also had less successful than allograft.
Rehabilitation after surgery to repair the meniscus lasts several weeks and postoperative activity is more restricted than for total resection of the meniscus. However, the exercises increase healing. Whatever type of surgery, rehabilitation include walking, flexion and extension exercises for knee and thigh muscle strengthening exercises. The best results of treatment for meniscal injury are obtained in patients without changes and without damage of the articular cartilage anterior and intact cruciate ligament.
@knirky: I ruptured my meniscus (left knee internal) in 1984 I was 22 then, I was playing football and I just heard it snap, I thought my knee was broken.
I was really worried but a Dr told me it was the meniscus and all I could do was have it removed. I didn't like the idea so once the pain ceased I just didn't think about it, but apparently the tear was big because every now and then when I made a sudden move my knee would just lock up and I couldn't pass a certain level with it, I would have to give it a sudden jerk (which was very painful, (if you saw Lethal Weapon 2 were Gibson gets out of a straight jacket by disjointing his shoulder you get an idea of what it was like) sometimes I'd take 6 or 8 shots of whiskey just to get the courage to make the move.
But eventually I decided I wanted it removed and had all the tests done, but a friend of mine who had one removed told me you didn't quite end up the same, he said it felt like one leg was longer than the other one. So I didn't remove, and continued having my knee lock every once in a while, but the last time it was so severe it really hurt when I fixed it and I think I tore right through the meniscus because that was about 11 years ago and it hasn't locked anymore even though it does feel kind of weird but no pain.
You have to decide if you want it fixed, remember I live in a third world country, medicine isn't up to the standards you have in Germany so maybe your experience could be much better than what I could expect here, I don't know what modern options you have.
I do know that I was told the recuperation time would be about 6 weeks.
Hey knircky,
I have torn the meniscus in both of my knees over the past 8 years, with the right medial tear being far more serious than the left. I just wanted to share my perspective on why I opted not to get surgery.
Background about myself, I'm a hip hop dancer and I consider continuing to dance in the future as very important to my mental health and only partially important to my financial security (income from teaching dance is only about 5% of my total income.) I'm only physically active with dance, I'm not involved in any other sports or physical activity other than walking or occasionally cycling in the warm months of the year.
The injury first happened when I was preparing for a dance competition when I was in my early twenties. I felt an immediate pain, as I had simultaneously strained / pulled two ligaments in the same joint (MCL and PCL). Being young and dumb as I was, I decided to continue preparation without much needed rest.
Afterwards, I had an MRI done on the joint. The first doctor suggested surgery, the second said to complete physical therapy and strengthen my muscles around my thighs instead. In short, the surgery option would mean I would be out of commission for months, I would still have to complete physical therapy, and despite the surgery, my knee may still not fully recover. The upside would be that getting surgery done while young is better than waiting until the joint becomes weakened when I'm older when recover is more difficult.
Even today, about 8 years later, I do occasionally feel pain in my knee, particularly when I bend my knees to a very acute angle (anything smaller than 30 degrees results in pain.) I always sleep with a flat pillow underneath my right knee to prevent the joint from hyper extending in my sleep. When this happens, I wake up and it feels like my knee is "locked" in place, and when I walk my joint feels unsteady. I can alleviate this problem by popping my knee - I usually do this by lying down on my back, bending my knee and bringing it close to my chest, and while keeping my thigh close to my chest, I'll slowly extend my foot outwards while letting my leg come back to the bed / floor. Sometimes it takes a couple tries, but once it pops, my knee feels good for the rest of the day. I had to do this many times a day within the first year of my injury, but after that it only happened on rare occasions, maybe about once a month or if I don't sleep with my knee bent at night.
I'm sorry to hear of your injury, and I know how aggravating one of these injuries can be. Best of luck with your decision.
Thank you for posting @knircky.
Query....is the surgury to be the sort that is robotic assisted with minimal invasion as in davincisurgery? Is the surgeon acquainted with sports injuries?
There are Sports Surgeons who perform Orthopaedic surgery for all sorts of injuries including knees. The key is to have minimal invasion in order for the area to heal in a timely manner. Knowing quite a few atheletes with injuries for the very same reasons you have mentioned....it is probably more comman than you might think. You will want the surgeon to have performed quite a few of these type injuries. If you are interested in going to a well respected sports surgeon in the States...bleujay will forward the details. All the best. Cheers.
NB The points above sound correct...you can probably shorten the two weeks off to,a week and a half and with regard to the physical therapy....they can teach you the exercises at the first workout which will include some exercise bands that you can do at home in lieu of attending furthur workouts.
@knirky....just to let you know @meesterboom wrote an article concerning a similiar mishap....Return of the Boot? .... may be helpful.
Thank you for your support. All the best. Cheers
Thank you!
Can you post a direct link?
https://steemit.com/life/@meesterboom/never-give-up-the-day-i-returned-my-power-foot
Here you are....hope the link works.
All the best.
I have just come across this post and have just now read the history from your initial post. I do not have a medical degree if that is important to you. However, I have long been an advocate for alternatives to surgeries whenever possible and have researched and studied the different options available.
In the case of meniscus tears, restoration of blood supply should be the goal. Surgery will not fix that. Also, long term, surgery will most likely lead to the degradation of that joint and the future problems that will cause.
I suggest you look into Platelet Rich Plasma Prolotherapy (PRPP). It has been around for awhile and it's goal is to restore the blood flow to the meniscus through stimulating the natural growth factors in the body. It is obviously more complicated than that, but I suggest you look into it. Your down time will be minimal without the complications that surgery might cause. Hopefully you are in an area that has this option available to you. Good luck with your decision. (Repost from today's post "$200 Bounty: Meniscus Torn. What to do?" Two more days to submit your answer) Thanks.
This post has been ranked within the top 80 most undervalued posts in the first half of Nov 17. We estimate that this post is undervalued by $3.51 as compared to a scenario in which every voter had an equal say.
See the full rankings and details in The Daily Tribune: Nov 17 - Part I. You can also read about some of our methodology, data analysis and technical details in our initial post.
If you are the author and would prefer not to receive these comments, simply reply "Stop" to this comment.
Hey @knircky - sorry that this is a little off topic for your post, but I thought you would be interested in it. I hope you get the information you need, and that you get better!
https://steemit.com/bounties/@timcliff/proposal-for-a-bounty-management-forum
Na this is totally cool! and thank you for mentioning me. I commend you for doing this!