Meniscuses. Menisces? Meniscii?! (not a grammar Q, I kneed help)
August 14, 2020 1:43 AM   Subscribe

Two months ago nagging pain and stiffness developed into real pain and hard time rising, sitting, going downstairs etc. My bodywork person said they were worried about my meniscus. Physio and doctor etc were thinking no trauma, no meniscal problem, but MRI confirms damage to outer meniscus and some ACL involvement. Fucksticks.

Ok, so appointments made with better physio and am being referred to an orthopedic person.
In the meantime I have some questions re. management and amelioration etc. What can I do, what should I absolutely not do, how can I continue to work out (I train crossfit and they will scale for me). Should I rest or walk, I am limping within a few hundred meters. Should I counter the limp or let it happen? How fucked am I for the future? They mentioned laproscopic surgery, should I? YANMD.

Secondary question: The knee has been bugging me for about a year, the extreme pain only coming into play about two months ago. Thinking back, I did have a bad fall more or less a year ago, but was more concerned with the damage I did to my upper body at that time. Might this have started there? Could it have been a little damaged but not enough for anyone to really notice or for people to think was posture related or referred pain. I managed to also give myself a really good calf strain in the same leg about two months before the knee pain got worse which also probably muddied the waters.

Hope that's not too many questions baked into one, have at!
posted by Iteki to Health & Fitness (7 answers total) 2 users marked this as a favorite
IANYD, and am addressing a tiny aspect of your question: how fucked are you. TLDR, you may be looking at osteoarthritis in ten to twenty years, but physical therapy, controlled weight, and NOT stressing the knee with impact activities can maybe delay knee replacement for your lifespan.

In 2005, I damaged my meniscus in the right knee (overuse by carrying many many heavy boxes of books up steep stairs). If I maintained the physical therapy exercises, the dysfunction and pain were manageable, but when I slacked off, or stressed it (like to run across the street on a yellow, or do high impact exercise), it would leave me in pain and limping.

Ten years after the original injury, I went to an orthopedist who specializes in sports injuries. Scans showed I had developed stage three osteoarthritis in that knee, there was meniscus derangement. He said it was a common progression (the osteoarthritis developing from the original injury). He also said that osteoarthritis is a degenerative condition, and that the end point is a knee replacement. Depending on the wear and tear on the knee, you can delay that point for ten to forty years.

The management of the knee is essential, and reducing the wear and tear. (For me, I took the Pilates path and worked with a skilled trainer, learning how to use my muscles to share the load and support the joint. I also lost forty pounds, and five years in from the orthopedist’s diagnosis, I have ditched the cane and take ibuprofen sporadically instead of eating it like candy.)
posted by Dogged Persistence at 5:20 AM on August 14, 2020 [2 favorites]

ESPN sports injury glossary (skipping ahead to the knee). Menisci don't heal on their own; in surgery they can either resect the damaged portion or try to suture it down. The former lets athletes return in 2-4 weeks; the latter is a multi-month recovery but doesn't remove meniscus tissue, so should reduce long-term degenerative effects.
posted by Huffy Puffy at 5:31 AM on August 14, 2020

A small related data point: I was being assessed for meniscus damage based on knee pain a couple years ago (did the MRI, luckily only normal wear) and the doctor told me that meniscus related surgery for small / medium damage (which he suspected mine was before the MRI) is not better than placebo/stretching for pain reduction. He was saying that if I wanted to go there in the end, it was certainly an option, but he would be hesitant to recommend it.
posted by chiefthe at 5:44 AM on August 14, 2020 [1 favorite]

IANAMD, but I have a history of knee issues, including a meniscus tear when I was a teenager. In the long term, knee injury is associated with development of osteoarthritis. Ordinarily the ends of your knee bones are covered in very slippery cartilage which lets your knee bear several times your body weight without complaint for decades. Over time, the nature of the cartilage in some people changes and becomes less slippery and wears away. Many people experience pain when the cartilage is gone and go in for a total knee replacement, but how much cartilage is left does not appear to be associated with the pain that people feel.

People aren't one hundred percent sure of what the mechanism is, some people say it's inflammatory, and some people say it's mechanical, or maybe it's both. We do know that people who have their meniscus removed entirely tend to develop OA afterwards. OA is associated with previous knee injury and being a heavier person.

In my most recent knee injury, the area where my meniscus tear was sewn back up was evaluated as still good, decades later. Recovery from that first surgery was a bit rough; all of my surgeries have been arthroscopic, but the meniscus was the most difficult -- it wasn't that bad, not even really a lot of pain, but they told me not to walk around too much, and I didn't listen because I was a teenager, and it swelled up and I had to have it drained a couple of times. In my past two arthroscopic surgeries, I experienced no pain, and recovery was very fast.

I would talk to your doctor about what you can and cannot do in the meantime; I have found sports medicine doctors to be better at letting you continue activity than regular doctors. I am banned from doing deep squats and lunges for the rest of my life, however, some people suggest that leg strength is associated with less pain for OA, so I am bicycling. I am currently taking glucosamine/MSM/etc. but the evidence for this is not strong. My surgeon suggested tumeric, but I think the evidence for that is also not strong -- but I don't think it can hurt. I was told that my body would tell me when I should not do things; if I do something and my knees are swollen and painful, I should not do that thing.

It does not appear that you're in the USA, but the brace that I found to be the most comfortable for exercising was: It's knit and breatheable, but tends to degrade in the wash fairly easily, so you may have to use laundry bags or buy a few of them. I train with people who have knees that are even worse and they put one of these under a big heavy-duty hinged knee brace.

Good luck, and be kind to your knees ...
posted by Comrade_robot at 6:05 AM on August 14, 2020

Can you clarify what "some ACL involvement" means? The pain and limping are likely from the meniscus stuff, which other people have good advice on re: management. But if you've torn your ACL, that's a whole other thing.
posted by catoclock at 6:10 AM on August 14, 2020

Do you have any detailed info from the MRI report? Was the meniscus damage classified as traumatic or degenerative, did they specify the shape or location of the tear? What did they say about the ACL damage? Did they notice any evidence of OA in the joint? Whether or not the meniscus will heal on its own or after surgery is dependent on what part of the meniscus was damaged (most of it doesn't have great blood flow, but some of it does), and what type of tear it was.

Your ortho should be able to give you more specific guidelines for surgery, but in general meniscus surgery has better outcomes if the main symptom is catching/locking of the knee (not pain), the tear was acute, was in the outer or middle third of the meniscus, and there is no evidence of OA. Depending on your age and the tear, surgery would either be a meniscus repair, or a meniscectomy where they remove the damaged portion (and because the meniscus helps to bear forces through the joint, removing it increases joint loading, which is part of why you can get OA earlier). ACL repairs do not have significantly better outcomes than conservative management and there is high re-injury rate either way, so surgery might not be necessary. Make sure you feel comfortable with your ortho and don't get surgery "just because"!

A good physio can answer most of your questions, but in general you want to avoid pain -- so no deep knee flexion, no loaded knee flexion -- and you don't want to limp, so get yourself some crutches. You want to try to keep your quads strong, so you're fine to bike, swim, or use an elliptical if they're not painful.
posted by autolykos at 7:27 AM on August 14, 2020 [1 favorite]

And to answer your question about when/how this started - it's really hard to say. 1/3 of people over age 50 without OA and closer to 2/3 of people over 50 with OA are walking around with meniscal damage visible on MRI, but they don't necessarily have pain. Damage doesn't necessarily go hand-in-hand with pain, and unless you had MRIs of both knees before/after the incident you mentioned, no one can say for sure what caused it. The best answer you'll be able to get is that based on the timing of symptoms and the mechanism of injury, it was "probably" or "probably not" that incident.
posted by autolykos at 7:33 AM on August 14, 2020 [1 favorite]

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