How to choose a meniscus surgeon, and cope with surgery anxiety?
December 9, 2019 1:54 PM Subscribe
One year out from ACL reconstruction surgery, I have a meniscus tear which is only getting worse. I've scheduled meniscal surgery soon with the ACL surgeon, but I have misgivings about them, and medical care is notoriously bad in my area. Should I seek surgery elsewhere, at the risk of waiting longer and the tear getting worse? Or should I take my chance with the ACL surgeon?
*** The questions***
1. What would you do in my shoes?
2. I’m convinced I need surgery, but who should do it? What does one look for in a surgeon, and are there metrics to look up? How do I choose a stranger whose judgment I can trust to snip away *just enough* of a structure that can’t be replaced? I find practically nothing on my surgeon when I look online- just their name and places they’ve graduated from, certifications and membership. Nothing really on health grades (2 reviews, on procedures unrelated to mine), though even if there were, I’m uncertain it would be helpful.
3. Are my doubts about my surgeon unfounded? Aside from not spending much time with me, and being seemingly dismissive of my concerns, I have various pains in different areas of the knee that are still unexplained. A friend of mine had the same surgery, on the same day, with the same surgeon, and her recovery experience has been completely different than mine. Even our scars look vastly different, which prompted my PT to ask “are you sure you had the same surgeon?”
4. How might I manage my mental health (potential PTSD?) so that I am not immobilized with fear, and so that I can recover & return to work properly? I was a raging mess with the ACL surgery, it negatively affected my work, and left me feeling awful for no apparent reason. I have problems with depersonalization, which impedes my work and personal life when unchecked. Posting to AskMefi has never failed in the past, so thank you in advance for your kind attention <3
5. How much should I heed the advice of my community? Are they a bunch of bitter laymen who feed the rumor mill, or do they know something I don’t? Am I just bad at searching for healthcare information? I’ve lived in the area for 10 years, but have never before sought more than routine care.
*** More details***
The story (doctor pronouns and locations intentionally vague):
I’m a 28 y/o female, moderately active. In Dec of 2019 (1 year ago) I had arthroscopic ACL reconstruction with a patellar graft. While they were in there, they found some surprise meniscus damage which they agitated with a rasper to facilitate healing. I was not told the extent of the damage. Five days after surgery, my crutch slipped and I bore all my weight on the injured leg (which I suspect is when the meniscus tear happened/began).
I told my surgeon (who I’ll call “ACL Surgeon”) and PT, so they checked the ACL (via Lachman test) and said my ACL is fine. I continued PT for many months, still complaining of pain whose progress plateaued. After continual complaint, I got an MRI (this past August) which confirmed my meniscus didn’t heal/is now torn.
ACL surgeon (who consistently only spends about 30 seconds with me after I’ve waited in the office for 40 min), asked “will you let me go back in?” and being in a state of shock I said, “sure, fine.” I requested for them to come back into the room because I had more questions. What would happen if I do nothing but PT? It would get worse. What kind of tear is it? Complex radial/horizontal. There are other questions I’ve since wanted to ask, (like, how big is the tear, how long can I wait, is it in the red or white zone, but I they don’t allow phone conversations, and have no appointment openings until my pre-op appointment. So I’ve sought as many opinions as I can find.
Who I’ve consulted, and what they said:
- Young ER Doctor, the spouse of a friend, over the phone – 1) Orthopedic surgeons are some of the best of the best, and especially for a routine surgery like this (meniscus repair or partial meniscectomy), you can’t go wrong with whoever you choose. 2) It’s best to stick with the same surgeon, as they know their own work, and have seen the inside of my knee before. 3) Surgeons universally tend to have bad bedside manner- don’t let that deter you.
- My GP – Insists local surgeons are qualified.
- Orthopedic surgeon in a nearby city, in person, official second opinion- Checked me out, had me squat, performed the McMurray test (heard/felt some clicking which means positive I assume, and since this test my knee has been hurting and getting worse). Looked over my MRI images with me, and said ACL Surgeon did a fine job with the ACL, but recommends meniscus surgery ASAP. This is when I asked more questions and they confirmed I have a 4mm (apparently quite large) tear in the posterior horn of my medial meniscus.
- Colleagues, locals – I work at a major, wealthier U.S. university, so you’d think care in the area would be top notch. But none of the professors ever take themselves or their children locally for surgery. My peers, my therapist (LCSW), my colleagues (some of which have spouses who work in healthcare locally) agree that the local care is problematic. Though I don’t know what specifically that means. Staff like me often can’t afford anything other than what’s available locally.
- My best friend- Not a professional, rarely offers firm advice, but gave me their honest opinion that I get surgery elsewhere. They are very concerned about the reputation of medical care here, and also find it telling that no professors choose to seek care locally.
On the surgery:
Currently scheduled for 3 weeks from now. If they can repair it they will, but t’s likely they’ll just snip away the damaged part. Keeping as much of the meniscus as possible is key for staving off the onset of arthritis. I’m trying to find a surgeon in the nearest city, but it will take a some time to get my insurance in order, make the necessary appointments, get them up to speed, or anything else I’m not thinking of. My knee has been getting worse since that McMurray test and I’m out of my mind anxious. I wasted so much time doing preliminary research, and not enough time calling surgeons’ offices.
Aside from worsening damage, waiting to do surgery will be incredibly inconvenient for my job. But 10 years down the road, I don’t want to regret not getting myself proper care just because it was an inconvenience for work.
On mental health:
It should be noted that I’ve reacted to the injury, and news of both surgeries, as if I’ve received a cancer diagnosis. I feel silly, as it’s a routine procedure, and common injuries. I am nonetheless having a spontaneous cry at work whenever I feel a sharp pain, or when I get off the phone trying to contact a new surgeon. I am having more panic attacks in the past few months than I normally do in a year.
I already have PTSD from childhood, and my therapist suggested my reaction might be PTSD from the initial orthopedic injury. I desperately, desperately do not want to have this surgery, and the surgeon makes me feel massively nervous. But this could just be my poor mental health talking. I’m ready to do what I have to do… But I’m not sure what that is.
Thank you again for reading, and I look forward to reading your comments. I'm willing to disclose my location through MeFi Mail if you want to message me directly. I'm just paranoid about bad-mouthing my local medical community on here...
*** The questions***
1. What would you do in my shoes?
2. I’m convinced I need surgery, but who should do it? What does one look for in a surgeon, and are there metrics to look up? How do I choose a stranger whose judgment I can trust to snip away *just enough* of a structure that can’t be replaced? I find practically nothing on my surgeon when I look online- just their name and places they’ve graduated from, certifications and membership. Nothing really on health grades (2 reviews, on procedures unrelated to mine), though even if there were, I’m uncertain it would be helpful.
3. Are my doubts about my surgeon unfounded? Aside from not spending much time with me, and being seemingly dismissive of my concerns, I have various pains in different areas of the knee that are still unexplained. A friend of mine had the same surgery, on the same day, with the same surgeon, and her recovery experience has been completely different than mine. Even our scars look vastly different, which prompted my PT to ask “are you sure you had the same surgeon?”
4. How might I manage my mental health (potential PTSD?) so that I am not immobilized with fear, and so that I can recover & return to work properly? I was a raging mess with the ACL surgery, it negatively affected my work, and left me feeling awful for no apparent reason. I have problems with depersonalization, which impedes my work and personal life when unchecked. Posting to AskMefi has never failed in the past, so thank you in advance for your kind attention <3
5. How much should I heed the advice of my community? Are they a bunch of bitter laymen who feed the rumor mill, or do they know something I don’t? Am I just bad at searching for healthcare information? I’ve lived in the area for 10 years, but have never before sought more than routine care.
*** More details***
The story (doctor pronouns and locations intentionally vague):
I’m a 28 y/o female, moderately active. In Dec of 2019 (1 year ago) I had arthroscopic ACL reconstruction with a patellar graft. While they were in there, they found some surprise meniscus damage which they agitated with a rasper to facilitate healing. I was not told the extent of the damage. Five days after surgery, my crutch slipped and I bore all my weight on the injured leg (which I suspect is when the meniscus tear happened/began).
I told my surgeon (who I’ll call “ACL Surgeon”) and PT, so they checked the ACL (via Lachman test) and said my ACL is fine. I continued PT for many months, still complaining of pain whose progress plateaued. After continual complaint, I got an MRI (this past August) which confirmed my meniscus didn’t heal/is now torn.
ACL surgeon (who consistently only spends about 30 seconds with me after I’ve waited in the office for 40 min), asked “will you let me go back in?” and being in a state of shock I said, “sure, fine.” I requested for them to come back into the room because I had more questions. What would happen if I do nothing but PT? It would get worse. What kind of tear is it? Complex radial/horizontal. There are other questions I’ve since wanted to ask, (like, how big is the tear, how long can I wait, is it in the red or white zone, but I they don’t allow phone conversations, and have no appointment openings until my pre-op appointment. So I’ve sought as many opinions as I can find.
Who I’ve consulted, and what they said:
- Young ER Doctor, the spouse of a friend, over the phone – 1) Orthopedic surgeons are some of the best of the best, and especially for a routine surgery like this (meniscus repair or partial meniscectomy), you can’t go wrong with whoever you choose. 2) It’s best to stick with the same surgeon, as they know their own work, and have seen the inside of my knee before. 3) Surgeons universally tend to have bad bedside manner- don’t let that deter you.
- My GP – Insists local surgeons are qualified.
- Orthopedic surgeon in a nearby city, in person, official second opinion- Checked me out, had me squat, performed the McMurray test (heard/felt some clicking which means positive I assume, and since this test my knee has been hurting and getting worse). Looked over my MRI images with me, and said ACL Surgeon did a fine job with the ACL, but recommends meniscus surgery ASAP. This is when I asked more questions and they confirmed I have a 4mm (apparently quite large) tear in the posterior horn of my medial meniscus.
- Colleagues, locals – I work at a major, wealthier U.S. university, so you’d think care in the area would be top notch. But none of the professors ever take themselves or their children locally for surgery. My peers, my therapist (LCSW), my colleagues (some of which have spouses who work in healthcare locally) agree that the local care is problematic. Though I don’t know what specifically that means. Staff like me often can’t afford anything other than what’s available locally.
- My best friend- Not a professional, rarely offers firm advice, but gave me their honest opinion that I get surgery elsewhere. They are very concerned about the reputation of medical care here, and also find it telling that no professors choose to seek care locally.
On the surgery:
Currently scheduled for 3 weeks from now. If they can repair it they will, but t’s likely they’ll just snip away the damaged part. Keeping as much of the meniscus as possible is key for staving off the onset of arthritis. I’m trying to find a surgeon in the nearest city, but it will take a some time to get my insurance in order, make the necessary appointments, get them up to speed, or anything else I’m not thinking of. My knee has been getting worse since that McMurray test and I’m out of my mind anxious. I wasted so much time doing preliminary research, and not enough time calling surgeons’ offices.
Aside from worsening damage, waiting to do surgery will be incredibly inconvenient for my job. But 10 years down the road, I don’t want to regret not getting myself proper care just because it was an inconvenience for work.
On mental health:
It should be noted that I’ve reacted to the injury, and news of both surgeries, as if I’ve received a cancer diagnosis. I feel silly, as it’s a routine procedure, and common injuries. I am nonetheless having a spontaneous cry at work whenever I feel a sharp pain, or when I get off the phone trying to contact a new surgeon. I am having more panic attacks in the past few months than I normally do in a year.
I already have PTSD from childhood, and my therapist suggested my reaction might be PTSD from the initial orthopedic injury. I desperately, desperately do not want to have this surgery, and the surgeon makes me feel massively nervous. But this could just be my poor mental health talking. I’m ready to do what I have to do… But I’m not sure what that is.
Thank you again for reading, and I look forward to reading your comments. I'm willing to disclose my location through MeFi Mail if you want to message me directly. I'm just paranoid about bad-mouthing my local medical community on here...
I'm sorry to hear about your injury. I just had knee surgery a few weeks ago, and I've had the same knee operated on three times before, albeit for something with an easier recovery. I was also told by an ER doctor friend that basically for something this straightforward any orthopedic surgeon would be able to handle this equally well, but on the other hand I'm like 90% sure that if LeBron James needed knee surgery, they wouldn't be all "Yeah, whoever is fine!"
I think some nervousness with surgery is certainly normal; it's surgery, no matter how minor. I would, however, say that all of my orthopedic surgeons have really taken the time to explain what was going on. Do you have friends or acquaintances who have had knee surgery? Do you have a primary care physician who would be able to recommend somebody?
posted by Comrade_robot at 9:06 AM on December 10, 2019
I think some nervousness with surgery is certainly normal; it's surgery, no matter how minor. I would, however, say that all of my orthopedic surgeons have really taken the time to explain what was going on. Do you have friends or acquaintances who have had knee surgery? Do you have a primary care physician who would be able to recommend somebody?
posted by Comrade_robot at 9:06 AM on December 10, 2019
Check your MeMail!
posted by zeusianfog at 11:37 AM on December 10, 2019
posted by zeusianfog at 11:37 AM on December 10, 2019
Best answer: Ok, I'm finally back. I can answer your questions -
1. In your shoes, I would talk with more physical therapists and find some athletic trainers (they work with sports teams). Because studies have now shown that after a few months (I think it's 6-9) results from surgery and PT on meniscus injuries are the same. I would put off surgery until I was sure I felt comfortable. I know I would do this because I've done it twice.
2. I understand you're convinced about surgery, so for choosing a surgeon, talk with the PTs you know or find some to ask. They know the records of the doctors and who's having a good run or a bad run. I think you also have to talk with more surgeons and see who you feel comfortable with. Your own state of mind will impact your surgery success and recovery success.
3. Your doubts are not unfounded. Your surgeon might be wonderful, and you have different scars because there was a medical or anatomical difference that you don't know about. Or, the doctor could be trying a new technique. Or, lots of things. But, it could also be because he had an off day. Things in his personal life could be impacting his work. You won't ever really know though, and you'll have to live with that. If I were in your shoes, I probably would trust the second opinion, that your surgeon did a fine job. Is surgery with surgeon #2 an option? Do you feel more comfortable with him?
4. I don't know about mental health - I had a tough time accepting I needed my most recent surgery and I waited until I knew I'd done as much PT as I could to try to avoid surgery. I also had some PTSD feelings around my earlier surgeries that were impacting my latest surgery decisions. I didn't realize it until a PA called me out on it. Just realizing that was very helpful to me.
5. If you're crowd-sourcing information, try to source from people who know what they're talking about. In your shoes, again, I'd ask lots of physical therapists. They see how surgery patients really recover. Your GP and even other surgeons probably won't know as well as the PTs do.
Overall, I'd say, wait until you're sure.
Long, rambling history that qualifies me to have these opinions:
A few years ago, I tore my right knee up - ACL, LCL, meniscus, bone bruising, etc. I had a ton of trouble with my original doctor but stuck with him because I was referred to him by a well-regarded sports doctor. First, a pin came loose and a screw came out, and so I had to have another surgery to get that taken care of. I stuck with my original surgeon because when I researched that problem, I found it could happen to anyone. Then, after that, I still felt unstable and I kept falling and having pain. My surgeon did the manual tests and told me my knee was stable and I was mistaken. But, that maybe my meniscus was causing me pain. He wanted to set up another surgery.
I said no, and marched around to 3 other surgeons to get other opinions. All 3 confirmed my knee was still loose. The one I went with had me do therapy and injections and everything possible before another surgery. Eventually, when it was right for me, I had a 3rd surgery to start an ACL revision surgery. Turns out, my LCL was never fixed. Surgeon #2 fixed that and it healed up well. Sadly, with all that falling, and all those surgeries, I now have terrible arthritis in that knee.
I finally found a martial arts practice that I could do to get exercise that didn't hurt my right knee. Yay! Unfortunately, in Feb of this year, I fell, and tore my left knee-ACL, ALL, meniscus. I fought surgery all I could with tons of PT. I got really strong, but it was just still too unstable. Finally in Sept. I had surgery with surgeon #2. And this recovery is 10X better than any recovery I had on the other knee. It makes me thankful for the additional opinions I got, thankful for waiting until I was comfortable with surgery, and also make me wish surgeon #2 had done my first surgery on my right knee.
I wish you the best. Keep up with your therapy!
posted by banjonaut at 10:04 AM on December 11, 2019
1. In your shoes, I would talk with more physical therapists and find some athletic trainers (they work with sports teams). Because studies have now shown that after a few months (I think it's 6-9) results from surgery and PT on meniscus injuries are the same. I would put off surgery until I was sure I felt comfortable. I know I would do this because I've done it twice.
2. I understand you're convinced about surgery, so for choosing a surgeon, talk with the PTs you know or find some to ask. They know the records of the doctors and who's having a good run or a bad run. I think you also have to talk with more surgeons and see who you feel comfortable with. Your own state of mind will impact your surgery success and recovery success.
3. Your doubts are not unfounded. Your surgeon might be wonderful, and you have different scars because there was a medical or anatomical difference that you don't know about. Or, the doctor could be trying a new technique. Or, lots of things. But, it could also be because he had an off day. Things in his personal life could be impacting his work. You won't ever really know though, and you'll have to live with that. If I were in your shoes, I probably would trust the second opinion, that your surgeon did a fine job. Is surgery with surgeon #2 an option? Do you feel more comfortable with him?
4. I don't know about mental health - I had a tough time accepting I needed my most recent surgery and I waited until I knew I'd done as much PT as I could to try to avoid surgery. I also had some PTSD feelings around my earlier surgeries that were impacting my latest surgery decisions. I didn't realize it until a PA called me out on it. Just realizing that was very helpful to me.
5. If you're crowd-sourcing information, try to source from people who know what they're talking about. In your shoes, again, I'd ask lots of physical therapists. They see how surgery patients really recover. Your GP and even other surgeons probably won't know as well as the PTs do.
Overall, I'd say, wait until you're sure.
Long, rambling history that qualifies me to have these opinions:
A few years ago, I tore my right knee up - ACL, LCL, meniscus, bone bruising, etc. I had a ton of trouble with my original doctor but stuck with him because I was referred to him by a well-regarded sports doctor. First, a pin came loose and a screw came out, and so I had to have another surgery to get that taken care of. I stuck with my original surgeon because when I researched that problem, I found it could happen to anyone. Then, after that, I still felt unstable and I kept falling and having pain. My surgeon did the manual tests and told me my knee was stable and I was mistaken. But, that maybe my meniscus was causing me pain. He wanted to set up another surgery.
I said no, and marched around to 3 other surgeons to get other opinions. All 3 confirmed my knee was still loose. The one I went with had me do therapy and injections and everything possible before another surgery. Eventually, when it was right for me, I had a 3rd surgery to start an ACL revision surgery. Turns out, my LCL was never fixed. Surgeon #2 fixed that and it healed up well. Sadly, with all that falling, and all those surgeries, I now have terrible arthritis in that knee.
I finally found a martial arts practice that I could do to get exercise that didn't hurt my right knee. Yay! Unfortunately, in Feb of this year, I fell, and tore my left knee-ACL, ALL, meniscus. I fought surgery all I could with tons of PT. I got really strong, but it was just still too unstable. Finally in Sept. I had surgery with surgeon #2. And this recovery is 10X better than any recovery I had on the other knee. It makes me thankful for the additional opinions I got, thankful for waiting until I was comfortable with surgery, and also make me wish surgeon #2 had done my first surgery on my right knee.
I wish you the best. Keep up with your therapy!
posted by banjonaut at 10:04 AM on December 11, 2019
Response by poster: This is all great advice! Banjonaut, I didn't even think to ask PTs. I will get right on that.
posted by Dendrites at 7:30 AM on December 13, 2019
posted by Dendrites at 7:30 AM on December 13, 2019
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