said I would think about knee surgery. Help me think about it.

June 5, 2018 2:44 AM

I'm leaning towards the surgery, but I'm always terrible in the moment of thinking what I should ask a doctor. I asked him what he would do if it was his knee and he said "it's so hard to know". Very helpful, thanks man. I told him I would have to think about it. Help me think about it.

I've had four years of knee pain, getting better, getting worse, when it suddenly got much worse after I did a weird speedy side step to get past some people in a crowd. Had an MRI last week, saw the doctor today. He told me I have a meniscus tear (also some osteoarthritis) and we could do injections for pain or a 20 minute arthroscopic surgery that would trim the torn flap, drain some fluid, and "clean up" some of the arthritis, with about a week of recovery

What should I ask?

did anyone have a similar knee surgery and regret it? what's the worst that could happen? I won't have to go under general anesthesia, just twilight sleep.

posted by Jenny'sCricket to Health & Fitness (17 answers total)

Both of my parents have had meniscal tear surgery, and in both cases it seems to have helped—bought them a bunch more years before they need knee replacements, essentially. However, my understanding is that it's a little bit of a crapshoot whether or not meniscal tear surgery actually helps anything—it doesn't help everyone who it's indicated for, and it's hard to predict whether it will help any given person.

Personally, if my doctor was on the fence about meniscal tear surgery, I would hold off. Start with the injections and see where that gets you—it's less invasive and you won't have to recover from surgery. If that doesn't work to your satisfaction, rethink having the surgery.
posted by Anticipation Of A New Lover's Arrival, The at 2:57 AM on June 5, 2018 [1 favorite]

Three years ago I had this surgery - my left knee was a mess of shredded and ripped meniscal cartilage. I ignored the clicking and pain until I couldn't bend on that knee anymore. The doctor did a great job - I saw pictures of before and after, it looked slick after. But it didn't heal right.

Turns out my body makes a whole lot of scar tissue, and I don't heal well. And after about a year the knee was a frozen mess. I found a physiotherapist to free it all up (so painful it made me laugh!) and help me on the path to recovery but I'm still not recovered and have given up the idea I ever will be. I've regained a lot of the motility but not all and the muscle is still quite atrophied.

So, 1) are you a 'regular' healer? (had surgery before and it was not big deal?)
2) good post care is as important as the surgery itself. I met someone recently who had both knees 'done' and he said one knee was fine within three weeks, the other took six months. Which is to say luck probably plays a greater role than any doctor wants to admit.
posted by From Bklyn at 3:01 AM on June 5, 2018 [1 favorite]

My ex-husband had the same surgery for what just about the same diagnosis about twenty years ago. He never recovered to the same level of mobility/strength/pain he was at immediately before the surgery. I’d think really hard about whether you were sure this was a good idea.

(Honestly, any surgery where the doctor isn’t affirmatively telling you they think it’s a good idea? I wouldn’t do it.)
posted by LizardBreath at 3:05 AM on June 5, 2018 [2 favorites]

My story. Drs recommended total knee replacement. However, one administration of steroid shots cleared up inflammation and allowed pain-free walking. Ha, I saw why athletes get addicted to cortisone. Subsequently I was bicycling 100 km most Saturdays and exercising on a stationary bike otherwise. Caution plus controlled exercise have worked quite well for me for nine years. Recently after foolishly kneeling to look under a desk, the knee went ka-klick, and I was limping for a month. I am about recovered and back on the stationary bike. I walked 7 km yesterday. I haven't ruled out surgery. Relevant med tech has improved slightly in the interim.
posted by gregoreo at 3:45 AM on June 5, 2018

I am not a doctor or anyone with relevant expertise, but I remembered reading something about this so I googled it and found a couple of articles that question how effective this sort of surgery is relative to placebo. One from 538, one from the NHS.
posted by Bloxworth Snout at 5:08 AM on June 5, 2018 [1 favorite]

Because I am not a doctor, I am also not 100% sure that the sort of surgeries referred to in those articles are the same as you would be having.
posted by Bloxworth Snout at 5:08 AM on June 5, 2018

A friend who is in her sixties just had that surgery and her insurance is refusing to pay for it because she's overweight and had arthritis in addition to the torn meniscus. Her husband's a lawyer and they're fighting it. So, if you're in the US, make sure your insurance will actually cover this beforehand, and get it in writing! Oh, and her recovery is longer than a week, by a lot.
posted by mareli at 5:30 AM on June 5, 2018

My mother had one of the cortisone shots and was given exercises to do afterwards. The doctor said she'd need the shot again in six months to two years. My mom does the ten minutes of exercises two to three days a week. It's been over five years since the shot and she occasionally ices the knee after a long day of gardening or hiking but still leads an active painfree life.


Personally I had some pretty intense knee pain in my early twenties, with my knees getting black and blue just from walking around town, and fixed my knees by correcting my posture and gait mainly through the book Walk Yourself Well written by a Physical Therapist. I can now rest in the low position of squats for ten plus minutes, hike up the tops of ten thousand foot plus mountains, and my knees no longer bother me at all.
posted by GregorWill at 5:31 AM on June 5, 2018 [4 favorites]

I tore the meniscus in my left knee quite severely about 2 years ago. The doctor explained that surgery was a possible option, but didn't seem very enthusiastic about it because there was no certainty it would make anything better. I ended up choosing the other option he suggested: seeing a physiotherapist and doing daily exercises recommended by the physio at home. After a couple of months of that, I started private Pilates lessons (after giving the Pilates teacher a detailed write-up from the physio about my injury and what kind of exercises I should avoid), and these days I rarely have any trouble with the knee, although I have to be careful not to twist it or I get some pain and discomfort. YMMV, but I would strongly recommend trying conservative options like physical therapy first, and only go for surgery if everything else fails.
posted by mydonkeybenjamin at 5:57 AM on June 5, 2018 [1 favorite]

I am relatively young and healthy. I had surgery for a torn meniscus 3 years ago. The doctor deemed it a success and I did too. It was sore for a couple of weeks but except for the actual day of surgery, Advil gave me plenty of pain relief. I made a complete recovery and am as active now as before the injury.

My surgeon specialized in knees and I trusted him. He offered to watch and wait or go in and fix it. For me there was nothing to even think about. I wanted it fixed. I have no regrets, just gratitude that it worked out so well.
posted by Kangaroo at 6:35 AM on June 5, 2018 [1 favorite]

I have on again/off again knee problems starting in my teenage years, including major surgery on one knee, and I had a recent talk with my GP about knee pain. She says that the evidence is that, surgery or no, the key is fairly heavy physical therapy. Surgery with light therapy has a really low success rate, while heavy therapy without surgery works pretty well, In most cases. You might see if a course of physical therapy doesn’t help before moving on to surgery.
posted by GenjiandProust at 6:48 AM on June 5, 2018 [3 favorites]

I lived with a torn meniscus for 20 years. It would fold and my knee would lock during sports, if I sat on the floor, if I crossed my legs wrong, when I danced.... I used physio and caution for two decades, because when I hurt it in the 90s meniscus surgery really was a crap shoot: your knee might be better or if might never feel good again.

Eventually it was a daily issue because kids like to spend time on the ground and I couldn't. After injuring my knee again, my physio asked why I didn't have knee surgery. So I had arthroscopic surgery. The idea was to either sew the meniscus back together if possible, or remove it if necessary. I had it removed, and my knee is so much better now. Not perfect, but I can sit on the floor and I can run again. Last week, I even tackled something. I'm glad I had the surgery, but I am content I didn't get it in the 90s.

(Note: deciding to have this surgery would have been way more difficult if I had to weigh possible benefits against cost. I live in Canada, so my bill was $0)
posted by Sauter Vaguely at 7:10 AM on June 5, 2018 [1 favorite]

You have a persistent, recurring injury. There's really no downside in the hands of a practiced surgeon to having it resolved for good. Ask your surgeon how many he's performed.
posted by DarlingBri at 10:52 AM on June 5, 2018

I would seek out a second opinion, preferably from a doctor recommended to me.
posted by benbenson at 11:10 AM on June 5, 2018

Best answer: No matter what you do, if you get physical therapy, NEVER STOP DOING the exercises they recommend. I have seen so many people , myself included, make this mistake and end up in pain again.
posted by evilmonk at 12:38 PM on June 5, 2018 [4 favorites]

Meniscal tears are really varied and the outcomes and interventions depend heavily on the type, location, etiology, and severity of the tear. I don't know whether anecdotal stories from people who may have had entirely different tears are going to be helpful to you and are certainly no substitute for a second opinion from a specialist looking at your actual MRI.

That said, my anecdote:

A few years ago, I got back from a run and my knee ballooned to twice its normal size over a short time. No traumatic damage, just a sudden swelling and onset of severe pain. If I remember correctly, the MRI showed a complex degenerative / horizontal tear of the medial meniscus, along with accompanying fluid buildup/cyst structures.

The surgeon I talked to was pretty equivocal about the outcome. Yes, the surgery would probably fix some immediate issues like the fluid buildup in the cyst and clicks/grinding when I walked, but he couldn't promise that the long-term outcome would be better with the surgery than without it. Losing cartilage in my knee (particularly from the medial meniscus, which is much thinner than the lateral meniscus), would likely eventually lead to earlier/more pronounced osteoarthritis. But he was also accustomed to working with a mix of patients (professional athletes, the elderly) and had seen good outcomes with a conservative approach with minimal intervention.

I did a lot of reading about meniscal tears and surgical interventions and eventually I opted to not have the surgery and to take a wait-and-see approach. For a few months, walking was painful and frustrating (it's hard to go from running long distances to near-total inactivity), but slowly got better, and over the last four years I've been able to gradually resume distance running and other activities, though my knee occasionally aches and behaves a bit oddly. Right now, not having the surgery still seems like the right decision, but I know the tear is still there and could become symptomatic again.

That said, my circumstances then were certainly different from yours now. I didn't have significant pain prior to the unexpected swelling and pain. No osteoarthritis. Probably a different tear type. Possibly a different meniscus. Don't listen to me (random guy who once had a vaguely similar knee problem) - talk to the experts who know your specific details and have the relevant expertise.
posted by verschollen at 3:15 PM on June 5, 2018 [2 favorites]

I had an ACL reconstruction combined with a meniscal tear repair a couple of years ago.

I am disappointed that my knee is not more like it was before the injury - I still have stiffness and simply cannot do high impact activity anymore. But, whilst the knee is not as good as new it is far better than the injured knee was. The constant dull ache went away.

So my disappointment is because I had unrealistic expectations, I wanted to be bouncing around again but that ship sailed the moment the injury happened. Had my expectations been to be more comfortable, they would have been met.
posted by Ness at 6:10 AM on June 8, 2018