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Glad you found it helpful!

Thanks for the question. There are many factors that go into treating a tear like that. Some include: Patient age Cartilage status Precise location of the tear Symptoms Mechanical alignment Patient's ability to comply with postoperative restrictions and rehabilitation Certainly trimming a tear like that may be the right way to go. Some tears involve only the very inner margin of the meniscus which has historically been called the "white / white" zone. This just means that the blood flow is poor to non existent and a repair wouldn't heal anyway. In these cases, trimming as little of the tear as possible to remove the unstable tissue is all that is needed to get rid of pain and popping / clicking (mechanical symptoms). You can run into problems when a radial tear involves the entire meniscus body. In those cases, the meniscus will lose its shock absorbing function and consideration of a repair becomes more paramount. NOTE: Please understand that this does not represent the formation of a formal doctor patient relationship and is for educational purposes only. All comments should be considered as informal suggestions regarding any matters of medical care. Please also be aware that this is a public forum and any information you share is not secure.

Thank you!

Thanks!

Mike, Let me see what I can do. Do you have an email you would be willing to share on here?

¡De nada, señor!

You're welcome! ¡de nada!

Do you have an email you would be willing share on here?

I appreciate the questions. I will try and respond to each one. I'll copy your question and then respond in CAPS. Only con , to me, is when doing the sliding knot, it seems that doing it once or twice, then explaining it may take more knots to secure the suture, is enough to get the idea across. Don't have to actually do it 4 or 5 times. Anyway, that's me. WHEN WE TIE A SLIDING KNOT WE ACTUALLY HAVE TO THROW MULTIPLE KNOTS ON TOP TO HELP INCREASE THE INTERNAL FRICTION WITHIN THE SUTURE TO AVOID SLIPPAGE. TYPICALLY 3 OR SO TIMES. is there a difference as to where you put the sutures? In one example you put the sutures almost in the middle of the tendon. In another example they were close to the edge, and in another, the sutures actually come over the edge of the tendon. Does it matter where the sutures are put? IN THE VIDEO I WASN'T PUTTING THE SUTURE IN ANY LOCATION IN PARTICULAR OTHER THAN TO ILLUSTRATE THE TECHNIQUE. DURING SURGERY, WE TRY TO BE VERY STRATEGIC WHEN PLACING THE SUTURES. A TEAR CAN BE IN DIFFERENT PATTERNS, MULTIPLE PATTERNS AND HAVE VARYING DEGRESS OF STRAIN ACROSS THE TENDON. WE TRY TO PLACE THE SUTURES IN SUCH A WAY TO ACCOMODATE FOR THAT AS BEST AS POSSIBLE Also, is it the surgeon's preference as to what type of anchor and suture method to use? Is the tear (the type and where it is) the determining factor? Is that the case as well with the type of surgery - arthroscopic or other? Can the patient have a say as to the type of surgery? A GOOD SURGEON WILL WELCOME PATIENT INPUT. I WILL SAY THOUGH THAT MULTIPEL COMPANIES MAKE VERY SIMILAR TYPE SUTURES AND ANCHORS. OVERALL WE TRY TO USE THE RIGHT TOOL FOR THE JOB. SOME SURGEONS MAY USE A PARTICULAR COMPANY JUST BECAUSE OF FAMILIARITY. IN SOME CASES A COMPANY MAY HAVE A DIFFERENT PRODUCT THAT WOULD BE BENEFICIAL FOR A PARTICULAR SITUATION. Is it like plastic fishing line (which I had in my carpal tunnel surgery back in the early 1980s)? Is it a sort of fabric? What are sutures nowadays made of? What thickness are the ones used for rotator cuff surgery? IRRITATION FROM THE SUTURE IS CERTAINLY POSSIBLE. IN ABOUT 10 YEARS OF PRACTICE I HAVE HAD ONE PATIENT I HAD TO GO BACK AND TAKE A KNOT OUT. OTHERWISE, I HAVE NOT NOTICED ANY DIFFERENT BETWEEEN THE "KNOTLESS" AND THE SUTURES YOU HAVE TO TIE. EACH TECHNIQUE HAS ITS OWN BENEFITS. I BELIEVE THE SIZE OF THE SUTURES IN THE ANCHORS IS NO.2 BUT THE WIDER TAPES ARE AROUND 2MM THICK I BELIEVE. THE SUTURES ARE NOT LIKE MONOFILAMENT FOR FISHING. THERE ARE SURGICAL SUTURES THAT ARE SIMILAR BUT THESE ARE MORE FIBER LIKE AND NOT AS "PRICKLY". ad the same experience with my carpal tunnel surgery. Wouldn't that cause additional pain, especially when having to move the arm during rehab, etc.? Eventually the surrounding tissue would cover those ends, kind of like scar tissue would form (?) but in the meantime, would it add to the pain experienced? My pain threshold is really low :( just one more reason to put off surgery.) IF YOU HAVE THE OPPORTUNITY TO GO BACK INTO A SHOULDER THAT HAS A SUCCESSFUL REPAIR (FOR A DIFFERENT REASON PERHAPS) THE TENDON CAN HEAL RIGHT OVER THE SUTURES AND THEY ARE PRETTY WELL COVERED. ITS CERTAINLY POSSIBLE THAT SOME PAIN FROM THE SUTURE ENDS COULD OCCUR BUT I THINK THIS IS RARE. Without surgery, if the arm is immobilized for 6 months, would the tendon reattach to the bone? Would that be more likely if the tear isn't as great? Would it be likely/unlikely even with a large tear? Would it depend on where the tear was? FOR A SIGNIFICANT ROTATOR CUFF TEAR THE CHANCE OF IT HEALING BACK TO BONE IS VERY LOW. ONE OF THE BIG CONCERNS WITH SUCH TEARS IS THAT THE TENDON TEAR CAN ACTUALLY GET BIGGER AND BEGIN TO RETRACT INTO THE SHOULDER MAKING REPAIR MORE DIFFICULT. THE MUSCLE CAN ALSO ATROPHY IN THOSE SITUATIONS. Is there a preference, either by the surgeon or the condition of the tear, as to whether an arthroscopic surgery is done or an open?? surgery (forgot the actual term) is done? CURRENTLY, I WOULD GUESS THE VAST MAJORITY OF ROTATOR CUFF TEARS ARE DONE IN AN OPEN MANNER. OPEN MEANS THAT THE SURGERY IS PERFORMED THROUGH A LARGE SURGICAL INCISION AND NOT THROUGH MULTIPLE SMALLER HOLES WITH ASSISTANCE OF THE CAMERA (ARTHROSCOPY). YOU CAN FIX EVEN VERY LARGE TEARS ARTHROSCOPICALLY. Hopefully, this answers the majority of your questions. I will try and get back to the others. All the best. _______________________________________________________________________ Please understand that this does not represent the formation of a formal doctor patient relationship and is for educational purposes only. All comments should be considered as informal suggestions regarding any matters of medical care. Please also be aware that this is a public forum and any information you share is not secure.

Glad you liked it!

Thanks for the feedback!

Thanks for the feedback. I have wondered about the cursor and thought the same thing. I'll make it bigger next time.

Thanks so much for the feedback! It took a LOT of editing to get it to look that way. I'm really glad it paid off!

Good question. The answer is "it depends". I have seen two general situations with bucket handle tears. 1) The meniscus will pop in and out of place. Essentially this means that the meniscus will be torn (obviously) but remain in the correct location within the knee. The tear is unstable so at time it will shift out of place and lock the knee up but it will shift back into the normal position. In this case, I have found the tear to be repairable. 2) The second situation is when the meniscus is locked and is stuck in that position. If it remains stuck out of place for a long time the tear can be very difficult if not impossible to fix. The reason for this is the tissue will slowly deform and contract and you physically can not push the meniscus back into place. In this situation it will have to be removed. I hope this answers your question. Good luck! _______________________________________________________________________________________________ Please understand that this does not represent the formation of a formal doctor patient relationship and is for educational purposes only. All comments should be considered as informal suggestions regarding any matters of medical care. Please also be aware that this is a public forum and any information you share is not secure.

@@JeffreyWittyMD thanks a lot dr.

Glad it helped!

Sometimes you don't need an anchor if you can stitch the tendon back side to side and don't need to pull it back down to the bone. That sounds like what he / she did for you. I have done this exact thing for calcific tendinitis.

Haha, its been a while since we made the video but I think we were trying to hide brand names/logos.

I think I got it off Amazon (search "knee model")

I replied to your other comment.

justbrowsing5279, A "shoulder" MRI should be able to pick up the vast majority of rotator cuff tendon problems - if not all of them. That being said, it can be hard to see certain types of tears. You bring up an interesting point. Your description of pain (lift off test etc) as you say could be a sign of subscapularis tearing. Subscapularis tears can be hard to pick up on a MRI. You can see them but you have to be looking very closely and often looking for other indirect signs of the tear. It is very possible you have a subscapularis tear and its just not being recognized. Given your weight lifting injury (bench etc but really any similar motion) another consideration is a tear of your pec major. This would not be seen on a shoulder MRI because the pec tendon inserts further down and out of the field of view of the shoulder MRI. We usually have to order a "chest MRI" and often specify our concerns to the MRI tech / radiology team to make sure they get the appropriate area. Partial tears of the pec major can be very difficult to see on a physical exam (even when looking for them). A tear of the teres major would be really unusual in my experience but would probably be too far down for a shoulder MRI. 47 years old is not too old to have a tear of the subscapularis or pec major. I respectfully disagree with the person you spoke with if that is what they said. I hope this helps! _______________________________________________________________________ Please understand that this does not represent the formation of a formal doctor patient relationship and is for educational purposes only. All comments should be considered as informal suggestions regarding any matters of medical care. Please also be aware that this is a public forum and any information you share is not secure.

I'm glad you found it helpful!

Good luck! You can do it!

If you can't get your knee straight the meniscus may be displaced out of its normal position. I typically recommend surgical repair of bucket handle meniscus tears. I would recommend prompt evaluation from an orthopaedic surgeon. I would avoid meniscus removal at all costs. ___________________________________________________________________________ Please understand that this does not represent the formation of a formal doctor patient relationship and is for educational purposes only. All comments should be considered as informal suggestions regarding any matters of medical care. Please also be aware that this is a public forum and any information you share is not secure.

Thank you!

Thanks for watching!

I had a colleague give me the model. Not sure where they got it. I bet you can find on Amazon.

Hopefully it was helpful!

Thank you for the compliment. All the best.

You're so welcome!

Thanks for watching! I hope everything goes well with your surgery!

Thanks for the question. I agree when you say a "complex" MM tear. The meniscus is classically divided into the anterior horn (toward the front of the knee), the midbody, and the posterior horn (part in the back of the knee). A bucket handle tear is when a tear that extends along a large area of the meniscus actually shifts from its normal position. See the videos in part 1 and part 2 for clarification. A horizontal tear is a different pattern of tear to the meniscus than a bucket handle tear. However, complex tearing can involve combinations as appears to be the case in the situation you describe. The patient in this case should make sure they followup promptly with an ortho surgeon to discuss the injury. Even though the tears are "complex", I will prefer to attempt repair in the right situations. I avoid trimming the meniscus (even small parts) if at all possible. _______________________________________________________________________ Please understand that this does not represent the formation of a formal doctor patient relationship and is for educational purposes only. All comments should be considered as informal suggestions regarding any matters of medical care. Please also be aware that this is a public forum and any information you share is not secure.