Meniscus Root Repair; Meniscus Transplantation; Partial Meniscectomy; Patellofemoral Joint Repair. In radiologic terms, this is called a bony ossicle. The technique for a repair for a bony avulsion, called a type 5 meniscus root tear, is similar to the other techniques other than it should have the bone piece shaved down and cleaned off such that it can be pulled back into the area where it had been avulsed from. Other common symptoms include limping, a change in the patients gait and the inability to put weight on the affected knee. Controlling inflammation and swelling is still a key in this Phase, as increased motion without proper use of cooling therapy may put your meniscus at risk for re-injury. Heavy lifting, manual labor, strenuous exercise/activity, and sports should all be restricted until 3-6 months after surgery. Dr. Burnham and Jerrica did a great job taking care of all my orthopedic needs. Dr. Burnham is amazing. As surgical techniques are being developed and refined, rehabilitation protocols for meniscal root repairs must be defined and tested. . The next portion of the Smith & Nephew root repair device is a mini First-Pass device. Then, in September, at the Charm City Strongwoman Contest, I sprinted into the gym from the outside looking for one of my volunteers. Many surgeons will tie the meniscus root repair with the knee bent, so that one can start motion right after surgery and not have to worry about the meniscus root repair being stretched out. An ACL tear most commonly occurs from a turning, twisting, or deceleration mechanism in a noncontact mode. In addition, the design of the meniscus is such that the full pressure of weight bearing activities is transmitted through the root of the meniscus, meaning that it is constantly pulling and stretching the tear with every step. So that means youre good to go after two to three months. Phase 1: 0-2 weeks post-operatively Goals Protect repair Minimize pain Minimize swelling . Towards the middle of March, I was finally given wall slides (mini squats) and step ups for the left leg by my physical therapist. And get the pain under control and recover normally the way that you should have once you start doing the right things. Meniscus root tears are now being recognised as a significant cause of pain, disability, and rapid joint deterioration. This allows the meniscus to heal back to the bone. Many patients who do have a meniscus root tear note that they feel a pop in the back of the knee when they are doing squatting activities, such as cleaning floors, gardening, placing down carpet or plumbing. In this procedure, the torn meniscus is sewn back together using arthroscopy to place small stitches. Thus, these patients can often have early onset arthritis, the development of bony edema, insufficiency fractures, and the failure of concurrent cruciate ligament reconstruction grafts. The root attachments of the posterior horns of the medial and lateral meniscus are very important for joint health. After you have surgery to repair a meniscus tear, you may need to build up your strength in the muscles of your leg that support your knee. Kyle D. Morgenstern, MD . And its really concerning and very disappointing for somebody whos gone through the knee surgery. That night, I drove myself to the gym. If you break down what most healthcare provision professionals tell their patients, it could be an orthopedic surgeon, or even a physical therapist, its telling somebody whos just had a meniscus surgery, theyll say, well, 80% of healing is done in the first two to three months. They explain things very well. Among them, 32.60% demonstrated incomplete healing, loosening of the construct, or excessive scar tissues formation. You will feel tired for several days. United States. Do minor meniscus tears require surgery or can it repair itself? The exception is a patient that has contra-indications to surgery or already has too much cartilage wear and tear for the root repair to be beneficial. I was going to rehab myself, and keep training as normally as I could. As always, Dr. Burnham and his staff were caring, knowledgeable & professional at my recent visit. So you need to just have that expectation right now if youre going to go get a surgery, or if youve already had one, if its been more than six months, or youre in that you know, past six months, six to 12 months range or longer since your meniscus surgery, then its okay as long as you dont have another tear or some other massive injury to it, you can probably get that swelling under control, regain your motion back as long as it hasnt been too long. Meniscal repairs offer the benefit of preserving the native meniscus, but they require a longer rehabilitation protocol as compared to a meniscectomy. Definition/Description. A sports medicine specialist will examine your knee and any relevant imaging to determine which treatment you should start with first. Many surgeons will tie the meniscus root repair with the knee bent, so that one can start motion right after surgery and not have to worry about the meniscus root repair being stretched out. Therefore, it is strongly recommended to proceed with a meniscus root repair whenever possible, with patients up to the age of 70 being reported as having excellent return of function. Prior to that, they are recommended to use crutches. And unless you have been following my Instagram page and know about my rehab, you would never even know that I had knee surgery. The biggest mistake that people make after having a meniscus surgery is theyre doing too much way too soon. The steps in a meniscus root repair are very intricate and our biomechanical studies have validated that the steps are essential. 4 0 obj It is vital that meniscus repair patients do not squat for at least four months after the repair. Theyre kind of done with you too but what if you want to go play with the grandkids do you want to kneel what do you want to exercise youve got to set your expectations to still take it easy still rehab or strengthen the right muscles or do the right kind of treatment for yourself so that you can continue to heal. (it is still a bit swollen). Oftentimes healthcare providers will tell you go walk your knees operated on its good youre the we took out the chunk that was you know causing your need to lock up the meniscus we did a meniscectomy or we repaired the meniscus and its all sewn together now so you can go ahead and walk all you want and some people take that to heart and to go walk you know three miles a day or even 10-20 miles a week and their meniscus just doesnt heal enough and they get that swelling. There is often swelling of the knee and severe pain with walking, running, twisting, or moving the knee. I finally decided to make an appointment with a knee specialist. Healing kind of goes fast the beginning and then it tapers off. 1 doctor answer 2 doctors weighed in Dr. Jeffrey Sider answered Sports Medicine 41 years experience Depends: If surgery is on the left leg i let some patients drive the next day if they feel ok. Can you tear your meniscus again after a surgery and if you do how can you tell? Patients who have an ACL tear have a 10% chance of having a lateral meniscus root tear. In particular, it has been found that one of the most common reasons why younger patients need total knee replacements is because of a neglected or undiagnosed meniscus root tear leading to the development of osteoarthritis. Because this is a frequent question posed on Google, I will try to be modest in answering this. Later that summer, the left knee began to bother meagain. In determining if one can have a revision root repair, one needs to determine the cause of the failure as well as the amount of underlying arthritis. In terms of when, one should plan to perform a meniscus root repair as soon as it is diagnosed as long as ones articular cartilage is still fairly intact. xYIoH8(Jr@fI)/_U}|xW&JDIraqm I was adding 10 pounds a week for deadlifts but have now switched to pause deadlifts on Tuesday and add only 5 pounds a week to the heavy deadlift. This was going to be a complete root repair surgery: toe-touch weightbearing for four weeks, six weeks in a brace and crutches. One patient was noted to have an insufficiency fracture and spontaneous osteonecrosis of the knee (SONK) as part of the root tear and came in in a wheelchair and she has had6 years of successful return to activities after her meniscus root repair, including hiking and cycling. This technically challenging procedure should only be done by an orthopedic knee expert like Dr. Nwachukwu who has had extensive experience in performing the meniscal root tear repair correctly. The most common complication after a meniscus root repair is a re-tear. In some severe cases, they cant fully extend their knee out or bend their knee all the way. 515 Ray C. Hunt Drive, Suite 1100, Charlottesville, VA 22903 Phone: 434-243-7778 Fax: 434-243-5075 Meniscal Root Repair Post-operative Rehabilitation Protocol. I'm able to run and exercise without pain. I switched out the single leg deadlifts for trap bar deadlifts on mats, and added low step ups on the left leg. Later that day, I trained. The sutures are anchored to the tibia in order to stabilize the meniscus root attachment. Sit at home on the couch and watch T.V.? If there is tissue there, it usually means that the meniscus root repair has healed down to bone. I could no longer deadlift from the floor, and was having trouble squatting below parallel. We love you! W;5$u4Yxa_V_bm}q8=^_qbY,H(+",X'{|oMs"&A;3.E s&L=Z`)!]$],b }zb& Y@dy.Lif1:4@"Fz"U2`/h0|6^T&}56+Q:Dn{d:rqW@3 7 U. Your subscription could not be saved. Therefore, we strongly advocate using a button to fix the meniscus sutures or tape on the tibia to minimize the chance of loosening over time. Knee popping after meniscus surgery can occur due to fluid accumulation, scar tissue, swelling and stretching of the tendon and ligaments, weakened leg muscles, changes in patellar tracking, underlying knee arthritis, unstable meniscus, and inflamed plica. I would like to thank Dr. Jeremy Burnham for his wonderful work and surgery on my left shoulder. In fact 2 years ago I finished climbing the top 100 peaks in CO. The recovery time for meniscus surgery depends on the type of surgery you had. In general, patients have to develop good quadriceps strength to allow for maximum absorption with activities prior to returning back to any significant hiking, jogging or running activities. The posterior roots are the most important as this is where a root tear occurs most commonly. Range of motion exercises occur more slowly than a standard meniscus repair and will continue for the first 4 weeks. My calf swelled up into my ankles. You may need to leave a message. I think my clients thought I had lost my mind, but what else was I going to do? More diffuse pain over the inside of the knee which becomes progressive over time can be particular ominous because this may mean that the cartilage is wearing out fast or that one has an insufficiency fracture or spontaneous osteonecrosis of the knee, occurring due to the fact that the meniscus is such an important shock absorber. I have been very pleased with him at each visit..It's been almost 2 years since my meniscus root tear surgery and I have to say my knee feels great. Unfortunately, I was still not allowed to bend my knee completely, so I was still doing all benching on one leg. Amazing doctor, amazing family mantreats patients with the highest level of care, compassion, and quality! Meniscal Ramp Lesions. First, we performed quantitative anatomy studies, which allowed us to see exactly where a meniscus root tear should be reattached. You have two roots per meniscus which include anterior and posterior roots. Therefore, our surgical technique, using specific guides to avoid the eminences to ensure that one can place the guide exactly where one wants to have a cannula come out in the joint, using cannulas to allow for placement of passing sutures quickly and efficiently, having 2 separate cannulas with 2 separate tunnels for the meniscus repair, releasing the meniscus thoroughly to pull it back in the joint so it functions most effectively, and then having self-capture suture devices, which can place suture or tape into the meniscus substance, shuttle them down the tibia, and then tie them over a metal button on the tibia. Untreated meniscus tears can increase in size and lead to complications, such as arthritis. It is important to recognize that most patients who sustain isolated meniscus root tears happen with a medial meniscus root attachment. I could not bear weight on my right side though I tried repeatedly, but finally I went and got an MRI and one of the orthopedic surgeons that I worked with was shocked when he saw the MRI result. Therefore, a lateral meniscus root repair can be an essential portion of a surgery to address the secondary restrains for a concurrent ACL reconstruction procedure. Conservative treatment methods are typically reserved for patients who would not recover well with surgery (i.e. Historically, most root tears were treated with meniscectomies because the importance of the meniscus root as a shock absorber was not well known. I hope that you found hope now that if you got if you had a meniscus surgery in the past and youre dealing with these problems of swelling the pain the loss of motion please start doing this this taking this advice that i gave you start doing the exercises and get better it is possible to get that swelling down and to get your motion back and to recover and be normal. Multiple large loose bodies were removed from my knee joint, the largest of which measured approximately 20mm. Thank you for choosing Dr. LaPrade as your healthcare provider. with time whether there is healing or not. It is shaped like a C and it serves to cushion and stabilize the knee. For these, please consult a doctor (virtually or in person). Swelling and stiffness. Dr. Burnham was very thorough with his examination and diagnosis. I was worried for my future with my legs letting me walk but she put me at ease letting me know she will do everything in her power to fix me or send me to whatever specialist I need to see to make sure I have a good chance walking in my future, and they all truly fantastic doctors. I consulted with SSC and DPT Darin Deaton prior to my surgery and then afterwards, when I discovered it had been a meniscus root repair. A friend of mine picked me up, and took me to the gym, where I coached my clients, sometimes sitting, sometimes standing. He will now be caring for my hip and knee in the future. On Wednesday, February 20, 2019, I had a meniscus root repair surgery on my left knee. In our hands, because we have performed many second look arthroscopies, we have found that the 2-tunnel technique allows for a broader surface area of the meniscus against the decorticated bone and seems to allow for a more solid and secure repair. Meniscus (cartilage) Repair patients cannot do twisting, pivoting, squatting, deep knee bends or impact activities for four months. I definitely know that I would not have been able to do all that I can do now, if I had not gone into the surgery strong. This technique allows one to place passing stiches up the cannula, which has significantly decreased the operative time. I would have relied strictly on physical therapy. He is on the cutting edge of research and techniques around surgery, he has a memorably reassuring bedside manner, and Im thankful he was in charge of my evalution and treatment. No, I didnt say pain free, or I didnt say get back to normal, just strong enough to get back to standing and walking because nobody wants to be in a wheelchair or not be able to get to the bathroom in time because of your knee not working right or being very painful. Medial Patellofemoral Ligament (MPFL) Reconstruction . Eventually, as I get into the mid 100s again, I will start adding five pounds a week. 2 0 obj However, we felt that with a 6-week period of being nonweightbearing important for all meniscus root tears, that the 2 simple suture technique was valid. The therapists were a little surprised to see me so soon after my surgery, but I really wanted to know how much range of motion I had post-surgery. Knows his stuff. My MRI showed an extensive radial tear adjacent to the medial meniscus root insertion, as well as evidence of high-grade chondral loss involving the central trochlea. Dr. Burnham has an awesome bedside manner. I sat down and put together a training program with exercises I could do, and trained four days a week as normal. I would recommend his services to anyone. I decided right then and there I would not get the MRI. Single leg deadlifts on the good leg, reverse hypers, and dumbbell bench.
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