Meniscal tears ... Why are they so common? Is surgery always necessary?
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- Опубликовано: 26 сен 2024
- Meniscus tears are VERY common... even in people who do not even know it! Not all meniscus tears require surgery. The more you learn, the better off you are. We treat patients, not MRI findings... and your physicians needs to take into account your quality of life and limitations to determine what the proper treatment plan should be for your meniscus tear and knee pain.
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Use this as a stepping stone to improve your discussion with your surgeon. Research is changing every month. The views expressed here may not be relevant in the coming years. This video is for your education only... This is NOT meant as medical advice.
Please remember, while I appreciate your questions, I cannot and will not offer specific medical advice by email, online, or in the comments at the end of these videos. My responses are meant to provide general medical information and education. Please talk with your physician or health care provider for your specific orthopedic and medical concerns.
You say the meniscus isn't regenerative, yet mine healed up. It does heal very slowly though. It took me 6 months and I had pain, stiffness and fluid buildup for the first 2 months and I could still feel the meniscus catching as I was walking for the next 4 months. I'm assuming it was a moderate size tear for it to be catching in my joint like that.
I hope my story provides words of comfort to those suffering from meniscus tears. The medical community will tell you that the body is weak and that you need their intervention to get better. Don't listen to them. Let your body heal.
What type of tear did you have
What steps did you take in the healing process?
FIrst was the effusion and where it really hurt sometimes when I extended it. That lasted 2 months. Then 2-4 months it felt like something was moving in there when i walked. It still hurt sometimes and was sensitive around my kneecap when I put pressure on it for almost 2 years and also when I wound put pressure on my knee when I was doing things like walking upstairs on that knee. It's still not completely back to normal yet. When I walk it's sometimes achy when I extend my knee and when I'm sitting and then extend it sometimes it clicks. Maybe it'll never go completely back to normal, but I'd never have surgery on now.
I did see an orthopedic surgeon about 8 months ago and he said my cartilage on the back of my left knee doesn't look good. I can only flex my leg right back 85 percent. My right leg is normal and can flex it back so my right foot is touching the buttocks. When I sit down for long periods and get up it sometimes gets achy and numb. Walking for long periods (a hour plus) makes it sore and achy. It hasn't really affected the quality of my life though it's just that I enjoy jogging but can't do that anymore. I recently bought a bicycle and I am enjoying that. I must admit I have been a bit slack with the exercises I am supposed to do to help my cartilage heal. I will work on that harder and give it more time to heal.
You misunderstood his point. What hes saying about 'being regenerative' is that itll never go back to 100% , which is what you said.
Great question Rafael ... That's why I always impress upon my students and residents to treat the patients and not their MRI. Many people are walking around with meniscus tears and do not even know it. Most orthopedists would agree.. and the scientific literature supports this. If you are comfortable, then you can delay the surgery. The tears do not necessarily heal.. they simply stop hurting. Yes, the tear can become larger... but this is rare. Good Luck.
I had a menisectomy when I was 19yrs old. The result was abysmal. The concept of a menisectomy is nonsense. Cutting a a thick meniscus which is a shock absorber, lubricant and most importantly creates a snug fit between the femur and tibia is nonsense, it can't and does not work. The only thing healthy after a menisectomy is the surgeons bank balance
Thanks so much! My doctor rushed me through and sent me to get an MRI, I'm seeing him again tomorrow and this info really equips me well to make my next decision. Much, much appreciated!
Excellent video! Calm, clear succinct and thorough description of each type of tear, and the causes. Thanks
Thank you for the video. I just got my MRI report and I got most of the answers from your video. I just searched medial meniscus and the first video was yours and it reflects my report.
:-) thank you!
MCL injuries can take months to not only heal... but to feel better. By far, MCL injuries are the most painful ligament injury around the knee. Good luck!
I need to find a doctor like you. I went to UM's Sports Clinic thinking they would handle my knee injury professionally, wrong.
The cookie cutter doc came in and out in less than 5 minutes recommended an MRI. I went to do the MRI but putting my knee straight created an onset of progressively worsening pain.
The clerk for the doc told me to reschedule, I told her the pain was unbearable, and I'll need some form of pain killer to finish, she said she'll call me back.
Day later she called and said I was claustrophobic, I restrained from cursing her out, but didn't understand how someone can come to think that a grown man would be afraid to have his leg inside a giant donut.
I'm going to a different hospital.
Sounds like the state run system we have is Spain......except you'd wait 2 years to even get an MRI scheduled
Benton n
Thank you for such a complete and informative explanation of a meniscal tear. You have helped a lot!
you are welcome! Thanks for he kind comments!
will continued cortisone shots to my knees cause further damage? I already have "moderate OA" in my left knee and a tear in my right.. but right now I have a subluxing right ulnar never that DOES need repair. Had severe right elbow pain and swelling for 8 months and nothing helped :(
grettagrids
+grettagrids- YES! Steroid injections do break down the cartilage.
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thank you. this is very informative and helpful for us active folks on the 40 and 50 side of life
standard strengthening exercises typically work well. Quad, hamstring exercises, while avoiding deep knee flexion and turning and twisting.
Good luck!
Thanks for a great short video. I injured my left knee medial meniscus and was told I should be OK with physical therapy. I cannot wait to get back to soccer but I will definitely remember and respect my age (being a good soccer player tends to make me be rough on my body). Thanks again.
Finally, some one who is not "surgery" happy!! I am a yoga teacher. My medial meniscus was totally removed, authorized by my Mom when I was very young. It's great to find a professional who is encouraging to give the body the chance to heal -at least "fix" it's injuries. My knee has been bothering me lately, (more than 40 years after the surgery). The first Dr. I saw last mnth immediately suggested Knee replacement. When I almost laughted at him, he went on to push injections.Sorry PT IS WORKING
Jay... It's good that your surgeon repaired your meniscus. Removing it would have put you at risk of developing pain and significant degeneration. It's going to take a number of weeks/months to heal and recover... time well spent to save your knee for years to come.
Good Luck!
HJL
If you have a meniscus tear look into PRP (Plasma Rich Platelet) or Stem Cell therapy.
Francesca G true... now we now that but this video is old...
Dr. Luks. Thanks for your reply and follow up. I am happy to say the swelling has gone down and the knee is feeling almost normal. I'm working on strength around the knee and generally feeling great!
I very much appreciate your feed back.
Joel
True Simon... flap tears can be a problem... but luckily very few meniscus tears present as flap tears. The most common type of tear is degenerative fraying. Meniscus tears also behave quite differently depending on age. Young folks tend to get more flap or bucket handle tears than people over 50. So the treatment options can vary.
A video with self-confidence!!! No better!!! Thank you, Dr. Luks!!!
excellent question... the meniscus has no nerve supply. So the pain associated with a menscus tear is due to irritation of the structures around the meniscus. So, if the tear is small and doesn't move around it will not irritate the structures around it... and you will not have much pain.
great video! I am a 3rd year medical student and was trying to figure out a practice shelf question for my surgery rotation. The clinical vignette you described was spot on. Thanks!
thanks!
My mom has bad knees. She doesn't know what the problem is so she tried to exercise to strengthen her knees, but after a mile of walking she is in too much pain to continue. What types of exercises should she do for strength?
Thank you for this thorough explanation of meniscal tears. Very helpful and helps put the mind at ease. :)
Thanks for such an informative video, I had a partial medial menisectom debridement 2 weeks ago.
Thanks Doctor Howard this helped me out alot 😊
Thank you, this answered most of my questions and was DEAD on with what is happening with my Left knee. MRI showed the horizontal cleaver tear... pain, turning, STAIRS, giving way a bit. I see the specialist monday. happy that it can be fixed and I can once again be active. People know when I am not walking they know it hurts. I function but added exercise NO NO. and after losing over 100 pounds and with about a 100 to still lose. I need to be active, Thank you again!
Whether or not a meniscus is going to heal is usually based on where the tear is, the quality of the meniscus tissue and how large the tear is. Some tears heal spontaneously, some require sutures to bring the edges back together.
Hi Derrick.. If you have a locked knee where you can not extend it.. there is a high likelihood that this is what we refer to as a "bucket-handle" tear of a meniscus. Best to be evaluated and examined sooner rather than later. Good Luck!
Why are they so common? Because they make a lot of money for surgeons who prey mainly on young people/athletes who dont know better
Is surgery always necessary? It does not work, hopefully that answers the question
@jnettle1 you are welcome... I'm glad it was of assistance to you~! I also hope you continue to feel better!
Hey Doc, just found your videos..great stuff very informative.
Thanks.
2 weeks ago, playing basketball, heard a snap, then I turned and heard another click..that was it..left knee in so much pain.
Could not walk, emergency room..
4 days on crutches and difeene meds and I could put weight on it.
It’s feeling better but, it’s feels very weak when I do something strenuous.
Back to Doctors next week for Physical therapy.
I swear I would never wish the pain I had on anybody..it was terrible..
I should have listened to my wife, she said I was to old 50..to be playing basketball with high school kids.
On a side not..”why are women always right??
Anyway great videos Thanks again.
Love the accent..
I miss Americans.
Back in Ireland now..
Have a good one.
"This was so so so so helpful to me" Very kind! Thanks!
Hi doctor I do have
It's not an easy choice when arthritis and a meniscus tear is present. Your doc appears to making the appropriate decisions so far. At this point, if your arthritis is "mild", your symptoms are "mechanical", and the tear is extensive, or a loose flap is present then it is reasonable to consider an arthroscopy... with the clear understanding that the arthritis might worsen.
THAT WAS A GOOD SECOND OPIONION YOU SAVED ME TIME/MONEY AND pain. good talk at firs i thought you were going to be uber boring and after a minute i felt you talking to me. Good job......
I agree with your assesment... it does not sound like a classic case of a meniscus tear. Runners knee is the more likely issue... but only a good exam by an Sports doc and perhaps an MRI can tell you for sure.
Felicity the problem is that a lot of the tissue in the knees does NOT get any blood flow, therefor does NOT regenerate. Once it is worn out, it is done. In many cases it needs to be removed or will cause problems. I lived 6 years with flap meniscus tears and it was NOT comfortable. She really needs an MRI to see what is going on. You cannot simply "strengthen" or "repair" it with exercise - it many cases only wears out more and more.
So clear and reassuring! Having just got MRI results that show a horizontal radial tear of the body of the lateral meniscus with associated meniscus cyst, which explains the problems of the last several years, especially when dancing! I shall listen carefully to all advice I'm given and if it does mean having an arthroscopic meniscus procedure I really hope I can hit the Zumba floor again and not literally! Thanks you so much for this video.
That's what I'm hoping. To hit the Zumba floor again. I have a tear in the posterior horn of the medical meniscus with fluid
How r u both
Thank you soooooo very much, your video was quite helpful.
Excellent comprehensive explaination. Well done & I thank you.
This was so so so so helpful to me. I am 35 and have started working out at the gym. the inner part of my knee is sooo tender to even touch. I can't walk down the stairs easily and when I go to stand up for the first time or now walking I am in pain... I also feel like it is going to just give out on me. I really need to work out because it is summer time and I want to lose weight. I can't even do the eliptical which is supposed to be the easiest on the knee.. I am so sad...
i
Did your knee ever heal or did you end up getting surgery? Why did you have pain coming down the stairs?
Many meniscus tears are just as easy to fix as ligament injuries :-) Non-impact, non-pivoting and twisting activities are usually well tolerated until you have a better idea of what's going on.
Ricky ... There are many different structures you could have injured. The kneecap - or patella- is one of them. If you feel the patella is no longer centered properly on the knee it would be worth it to have this evaluated. Good luck!
Thanks for the video. I am 51, play ice hockey, soccer, mountain unicycle and bicycle commute. I think I have a medial meniscus issue. I have mild to moderate pain but I think I will give it a few more weeks to see if it gets better on its own before seeking professional help.
Very informative, my doctor told me yesterday that I have a tear. But because I have Arthritis in that new he says, that it would be a 60/60 chance that surgery would make a difference. So I was referred to physical therapy. No surgery for now. However, I still have lots of questions and concerns.
If your doctor used the term 60/60 find a new doctor asap. He's clearly an imbecile.
Arthroscopy is avoidable in many patients with meniscus tears. In many people this boils down to a quality of life decision.
Good man, lots of intelligent information and advice.
Well done Sir!
Dr. I have been in major pain for 3 weeks. I will do anything for relief I am taking med but I need a cure.
56 year old female here, i over extended my right knee getting into low car and was in bad pain after that. Been 2 months or more now, saw a doc here, had x rays, only arthritis showed and boney growth. Referred to Ortho and all hes done thus far, is said, lets change your Celebrex(not workin) to Malxocam and change from Biofreeze to Lidocaine gel. Not helping at all, now other leg is as bad as the right one. So much pain, buckeling, getting up, bending, have been walking with cane for month.
Giving way or instability - -if your ACL and other ligaments are normal --- is an issue that should be addressed to minimize the risk of you injuring yourself falling down the stairs, etc.
Good Luck
Robert... thanks for reaching out. IF you have knee pain which is causing a feeling like the knee wants to give way then an MRI might be a good idea. In patients with minimal pain, an MRI might not be necessary... but if you have instability then you may injure yourself one day and it is worth looking into a little deeper. Good Luck!
Stupid advice. You do not need an MRI, you do not need surgery, you need to rehabiltate yourself and give yourself time to heal. These fucker surgeons don't give a damn about your health
If you knee no longer has an ACL then turning, pivoting and twisting are testing the limits of the knee. Each time you perform those motions, you are pushing the meniscal cartilage and the other structures of the knee to the max... sometimes that will result in tears of the cartilage or wearing away of the cartilage
Thank- you Dr. for making this an understandable informative video.
Yes what he said! I am not a doctor!!! Thanks Dr Luks!!!
my knee gives out...but i can straighten it out ...stretch and bend it...the only thing i cannot do is walk with it normal...i have to have my knee slightly bend everytime i. Walking
I had am MRI and it shows a lateral meniscus tear. I don't recall a pop or sharp pain. This happened in the beginning of december. My left knee started swelling, got really stiff and couldn't bend it or straightened it. I am very active and sprint and do weight lifting. I stopped squats, running, lunges, and continued to work upper body and did rowing machine. That made my knee swell again and got stiff. It seems like anytime i try to go back to my regular routine my knee swells up stiffness returns and can't even walk.
what exercises can i continue to do while i heal?
Should i use crutches?
What type of knee brace shoukd i wear?
How long do these lateral tears take to heal?
I don't want to have surgery but how do i know if i am a good candidate?
Please help. Your video is probably the most informative non BS found in RUclips
Laura L did you end up having surgery in the end my knee likes your know every time I exercise it swells and cant walk for days 😡😡😡
Dr Luks, thank You fro making this video and Explanation of meniscal tear.
i sustained my injury jumping in basketball, at the moment the knee cant fully contract. I'm getting the MRI today fingers crossed i dont need surgery
I get cortisone shots in both knees every few months.. as needed ( left knee already had 3 surgeries). I hope they keep helping me..
Very helpful info. Thanks a lot.
Hi Richard ... good question! Many people with a meniscus tear have very few symptoms and can put off surgery until their situation changes. Whether or not surgery is "necessary" depends on many variables... and one of them is your quality of life.
I hope this helps!
Good Luck!
Felicity ... Start with a simple exam and a set of X-rays. In many circumstances an MRI is not necessary since many people over a certain age have degenerative meniscus tears and don't even know it. Your mom's complaints seem to be more arthritic than anything.. and that will show up on an Xray.
Good Luck
fcp ... there are many people who lead active lives despite having a meniscus tear. Not everyone who has a meniscus tear will require surgery. In most cases the choice is yours. Once you know your options, and the risks associated with each choice you can make a solid, informed decision.
Thank you so much for your kind advise.
Definitely feel free to stop back
you will always have numbness around your knee and on the side of your knee. I had a medial meniscus repair done, and an acl reconstruction done back in 2010, and i still have no feeling on the side of my leg from the bottom of my knee to about halfway down my leg. Im actually getting anouther surgery done soon for my meniscus for my right knee.
As I understand it, some portion of the meniscus can heal - the outer third of each one. That's the bit that has its own blood supply. The remaining 2/3 is not regenerative. But please bear in mind that I'm not a medic - just a patient with a recent injury so I've been doing a lot of reading.
How damaging is kneeling for long periods of time to the knee joint?
Not a common location for meniscus pain... but not impossible. You may simply have a strain. If pain persists more than 2 weeks perhaps you can see an Orthopedist.
thank you thank you thank you!!!!! incredibly helpful. god bless you!!!!! i have an mri schedule but now i can have an informed discussion re the results! epic!
You are welcome!
Howard
Thank you - you have given me hope.
Hello I had am MRI of left knee. How bad did injure my knee. IMPRESSION: Peripheral tear and separation of the posterior horn of the medial meniscus with subcapsular fluid, soft tissue edema and a larger than 7 centimeter lobulated popliteal cyst
Low-grade partial tear of the anterior cruciate ligament
Partial tear of the posterior tibial insertion of the medial collateral ligament
Thanks
Thank you for this information.
So good analogy, l fee much better. Thank you doctor
I’m 14 and i play soccer. 6 months ago i dislocated my patella, and while my patella dislocated, it ripped of my LCL. 4 months ago i tore my medial meniscus.
I’m in pain every day, and i take pain killers. I’ve had 34 doctor’s, x-ray, ortho and PT appointments this year.
I have an appointment with my ortho coming up soon, and i’m freaking nervous.
I’ll have to get 3 surgeries. One to put my patella back in to place. One to fix my LCL. And one to fix my meniscus.
SirJared :-),
No one can truly say if tears will become larger or not. There are few if any good studies which followed people with tears and repeated their MRI to see if tears grew in size --- or even diminished in size. Some tears which we know to be repairable (with sutures) we will recommend surgery so that you do not lose any meniscus... however, if your tear will require a removal of the torn piece and you have few if any issues with your knee --- then think twice b4 having surgery.
Sorry to hear that... Your pain might be due to a combination of arthritis and a tear. Recent science has shown that physical therapy and occasionally injections (Synvisc, Orthovisc, etc) can help people suffering from both of these conditions. Time to have another talk with your doc... or another opinion.
Good Luck
Thanks doc, very informative!
This is my first real injury (knee) in 17 years of playing sports, and I am a bit scared about the possible outcome (haven't had MRI, because the public system in Portugal cuts a lot on more expensive diagnostic exams...). THANK YOU, for sharing your knowledge. Best regards.
How r u now ?
Damian .. If your knee pops then locks, there is a strong chance you have a "bucket-handle" tear of a meniscus. If it has not healed by now, it will likely not heal on its own.
Really helpful, thanks.
Wonderful video.I am Endocrinologist 63 yr old.I fell fell down on rt side recently & sustained fracture rt wrist.MRI of rt Knee showed oblique horizontal tear of the posterior horn of the medial meniscus communicates with superior articular surface. I am biker,runner & play tennis.I am asymptomatic.My Orthopod suggested Arthoplasty to repair tear to prevent further degeneration.I would like to have your opinion.
Did you eventually end up with surgery in that knee?
Dr Howard in this type of surgery it's a local anesthesia or genral? thank very much for your reply and thank you for the information, blessing.
It sounds like something is loose in your knee... time for an xray and possible MRI ... Good Luck
I fell ..never had knee problems...lock up..feels like my knee is going forward. Had xrays ..no breaks but possible tear..also said bad arthritis. Why did I not have pain until I guess twisted or tore something. I am used to walking alot...but can not now..ha e a brace and got a steroid shot. The nurse practioner said to leave it for now...no need for mri.
Hi, I am 55 yrs old, felt pain in my knee since August 2013. Had Cortizone shot October 2013, pain came back December 2013. Had MRI done Feb. 2014 and it shows: complex tear of the posterior horn of the medial meniscus with intercondylar fragment, small Bakers cyst, condromalacia Patellae grade II/III., Lateral Patellar Tilt . My doctor recommends surgery for the tear. I would like to get your opinion please. Thank you.
thank you doctor!
Speed up to 1.5x
I have a tear left and right…i still run but less intense.
hi ...i am 40 years of age. I fell down while bowling in a cricket match ..went to visit an orthopedition i was told that i have miniscus tears in both knees so i have to go for surgery. then went for 2nd openion and was told no need for surgery just do physio theray thatn after 6 months if i could not recover i have to go for surgery option . Now its almost 7 months passed .Condition improved but still my heel cant touch my hips. What should i do ???? please can your suggest any option.
Appreciate the response, thank you
MRI's "just to find out what's going on" is one of the reasons why healthcare costs are rising... and also the reason why many people end up with unnecessary surgery if a surgeon tends to treat MRI findings and not patients. IF your pain persists and interferes with your quality a life, then an MRI might be useful. But and X-ray may help too.... and is always the right place to start. Ultimately your decision and please understand... this is NOT medical advice.... just a general guide.
very clear, tks
Some meniscus tears can heal on their own... typically you will know within 4-6 weeks if it is healing. You will be more comfortable, etc. If you are more than 6 weeks out from your injury, and your pain persists, it is very unlikely the tear will heal itself.
Osteoarthritis and meniscus tears are an unfortunate combination of issues to have in the same knee. Arthroscopy generally does not work well for arthritis knees and you need to have a long talk with a solid orthopedist who will give you a realistic view of your choices and the desired results. The decision, to a large degree will be based on the severity of the arthritis... and the type of pain you're having.
Thank you for posting
Many sports docs will try a course of therapy in patients with certain meniscus tears. In many of those cases, the patient will feel better. Chances are you will know if therapy is going to work within a month or two. If it doesn't seem to be improving then you can explore other options.
Good Luck
hard to say without examining you... but it is not uncommon for people to develop a cyst (fluid filled sac) next to the meniscus tear... thus we call it a para-meniscal cyst. Have it checked out if it persists.
Hey David... Thanks for stopping by... Following that type of injury a meniscus or cartilage injury would be anticipated more so than a ligament injury... but that's what a physical exam will tell you :-)! Good luck --- Feel free to stop back after your visit.
I fell over on my knee on a night out and don't remember much as I also hit my head. The next day I woke up with a stiffness in my leg but no pain, only when I slightly turn my leg was there a small stabbing pain. I can straighten my leg when I am sitting down but cannot straighten my leg while standing and can limp on it with no pain and can fully bend the knee. I went to hospital and the doctor did the physical tests and there was a clicking in my knee..pleaser ead next post
my knee ligament is completly tear,i am not able to jump freely, there any problem occurs in future.....
Meniscus tear 1 , what should I do?
A bum knee?.. your expertise would be highly appreciated. . Thx