Meniscal Tear

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enduro2
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Meniscal Tear

Postby enduro2 » Tue Jul 18, 2017 12:28 am

Hi all. I am aware I have meniscal tears in both my knees. In 2009 i had surgery to staple iin on my right knee. The other tear in that same knee was reported to have healed up by the time the surgery was done, some 4 mo after the incident.

Since about 2012 I've been cycling regulalry and in the last 9 months been a lot more consistant with reaching 3x50km rides a week and the odd 100km in between. About 3 weeks ago, I went out on a 50km ride and noticed some dull pain in my knee, the pain continued through the ride and on tje next ride I really couldn't go far at all ... maybe 2km before limping it home peddling with one leg.

The knee is still a problem, and gtes stiff and swollen inside after walkong or other thijngs. I'm stayjjng off the bike for a bit.

Any ideas on recovery?

Hoping not to have further surgery.

Pity it's flared up again after so long of being very good.

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redsonic
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Re: Meniscal Tear

Postby redsonic » Tue Jul 18, 2017 11:31 am

I have had 2 meniscal tears (not repaired surgically), and a knee reconstruction on the same knee (plus problems with the other), and fortunately for me the only knee pain I get on the bicycle now is if I do a lot of seated climbing. I have fastidiously set up all my bikes following Steve Hogg's bike fitting advice.
All I can suggest is to make sure your bike fit is spot on, especially saddle height and set back, plus cleat position. If your knee swells, strap it every time. A swollen knee is prone to more damage as the joint capsule is stretched and ligaments can be over strained.
Good luck with your recovery. Hopefully, someone more knowledgeable than I can make suggestions on how to get back on the bike from here.

enduro2
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Re: Meniscal Tear

Postby enduro2 » Mon Jul 24, 2017 9:07 am

Thanks for the replies.

I've seen a physio who did an examination and gave me some stretches and tubigrip. She was impressed there was no swelling and the pain was very local and specific while not limiting joint movement. My current plan is rest for 6 weeks, using anti inflammmatories and a light knee brace for part of that time and hope to avoid surgery.

Prior to getting back on the saddle I will got a proper bike fit done. That's something I'd been hedging around for a bit since getting the new bike.

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Re: Meniscal Tear

Postby vander » Thu Jul 27, 2017 12:04 am

WIthout having a proper look its hard to give advice. So broad advice.

The body is strong and adaptable play to that. Meniscal tears rarely need surgery and can be managed quite well conservatively.
Get strong. You cant go wrong with getting strong. This is mostly off the bike.
Figure out what you can do comfortably and do it. If you can ride easy 30km without stirring it up do that, do it often it will be protective.
Load it slowly. Dont jump your loads up massively this is the most likely thing to aggravate your pain.
Pain (and swelling for that matter) does not equal always damage.

Swollen knee is not more prone to damage because of stretched ligaments that is incorrect. There is debate as to whether a swollen knee is more prone to damage at all but if it is it is not because the ligaments are stretched and strained. If anything it is due to altered muscle activation (which can happen in the presence of swelling) and possibly altered joint mechanics. This has not been proven though. I have seen people with significant knee swelling have not any issues on the bike often.

If you have minimal swelling and full ROM I cant see the need for resting for 6 weeks this will just detrain you and make it harder when you start again (However I have not seen your knee but as a general rule of thumb it should be OK).

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Re: Meniscal Tear

Postby brumby33 » Thu Jul 27, 2017 9:04 am

I had a meniscal tear earlier this year and man was it painful, never had that happen before in all my 57 yrs.

I beleive it began with a bicycle ride around the Cooks River bikeway on January 2nd, it was a nice day for a ride so it was only a 53km round trip from my place and return, about 2/3rds of the way round, I developed cramping in my right leg on top of the calf muscle so i got off an walked a bit to relive the cramp while rehydrating with water. after about 10 minutes i was ok to get back on the bike. I continued to get some stiffness in the calf for the rest of the ride so i just put it in the lowest gear to feel as painless as possible....I was able to ride home without too many dramas. After the ride though is where I got a lot of swelling and pain at the top of the calf muscle under the knee so I thought i might've overworked a tendon but it was bad enough the next day, I had to come home from work halfway through my shift. I'm a bus driver so constantly pressing down on the accelerator and brakes as we do with stop/ start work really aggravated the back of the knee to the point it was dangerous for me to continue to work.
I had a few days off sick for it to heal a bit. The next week I returned to work but still limping badly, I came off my first half of shift and headed upstairs to the mealroom, I was on the 2nd last top stair and felt a massive "ping" like a huge elastic band snapped behind my knee and almost brought me down with excrutiating pain. Luckily for me i was hanging onto the rail while climbing the steps otherwise i'd be rolling down them.

My OH&S officer drove me to a hospital where I was diagnosed with a meniscal tear, I walked out with crutches and my right leg in one of those removable splints. My Neighbours thought i came off my motorcycle lol as it was still parked at work and not in the garage.

I only needed the splint for a day and used a walking stick to support my weight but I had 3 weeks leave to work on it. I done some light leg movement exercises to get the blood flowing into the affected area and now back on the bike but not every day but enough so that my knee still gets to move but i just use much lower gearing and just keep spinning.

I still get the occasional twinge but no more pain in the meniscus area.

One of the exercises i did was to sit on something high so my feet off the ground and just swing my lower leg to and fro in a shallow pattern so as to create movement on the knee. I beleive that also helped as well as buying a exercise pedal apparatus that allows me to pedal freely whilst sitting and watching TV, it's like riding a recumbent with the pedals out front. I can stiffen the ride but i find it was best to just free pedal at a regular cadence.

The meniscus will repair itself eventually, you just gotta keep moving it to get the blood flowing in that area as your cartlages don't have their own blood flow unless you move them...or something like that.

It's been a slow and labourous 6 Months but I feel my knee is ok again apart from some osteo-arthritis issues that arn't too bad at the moment.

Cheers

brumby33
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enduro2
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Re: Meniscal Tear

Postby enduro2 » Thu Jul 27, 2017 9:08 am

Thanks for the reply.

I do have full range of movement in the knee and there is essentially no swelling, that is the swelling is not visible extenally. After a ride or 2km walk the knee is quite painful in any positiin and taking ibuprofen helps eith the pain, thus there must be localized swelling at the injury site.

From the sensation I feel the [edit] torn lateral meniscus is rubbing against the cartlidge on the head of my femur. Feels a bit sharp.

I agree that I ought to do some exercise and may give riding a go soon but on my last attempt I couldn't make it up the street. :(
Last edited by enduro2 on Fri Jul 28, 2017 7:00 am, edited 1 time in total.

vander
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Re: Meniscal Tear

Postby vander » Fri Jul 28, 2017 1:52 am

Menisci are meant to rub against the femur that is normal and nothing to worry about. That is actually what they are designed to do. It may be best to see someone and help you on your journey. I hope its the right person and they can steer you in the right direction.

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Re: Meniscal Tear

Postby NASHIE » Fri Jul 28, 2017 8:33 pm

I took 6 months of the bike, no ladders, limited twisting motions on one leg i.e. getting into the car. Spend all day on my feet so wore a sock brace for 4 months. 2 yrs later and all good although I'm a bit of a grinder so knee can get a bit sore after a day in the hills, but all part of being the wrong side of 40 i guess.

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Re: Meniscal Tear

Postby Duck! » Wed Aug 16, 2017 2:51 am

vander wrote:Menisci are meant to rub against the femur that is normal and nothing to worry about. That is actually what they are designed to do. It may be best to see someone and help you on your journey. I hope its the right person and they can steer you in the right direction.

While this is true, if the rim of a meniscus gets torn, or the the "cup" surface gets gouged, which can occur from prolonged high-load use, loosened daggy bits of cartilage can cause interference in the joint which affects nornal movement. I had meniscus damage, in the forms of both rim tears and surface gouging, which was a secondary effect from a long-term knee misalignment, and I could feel the daggy bits getting caught in places they shouldn't have been. In the MRI pictures I have of my knee, the loose bits on the cup surface can be quite clearly seen, and it looks like someone has done a few runs over it with a lemon rind peeler!

My left knee had its major blow-up when I was about 24, but the misalignment that triggered it had developed over the previous 19 years as I had a bit of a habit for long-distance running (I was doing 5km runs by the time I was 5 years old, and went up from there!), but sailing and cycling, and my work at the time as a paver played their part in the final catastrophe. I gave up the paving and running pretty well straight away, but kept going with the sailing and cycling, but over the next three years the longer-term effects of the cartilage damage began to increasingly hamper those activities, so I went under the knife to have the tears and other daggy cartilage cleaned up, and to address the underlying misalignment.

In the ensuing 14 years I've ridden more than I ever was before the injury, and changed from road to much more demanding MTB endurance riding. Both knees let me know when I've had a tough day on the bike or on the water, but my right knee, the one that has not had work done, is now my more temperamental one.
I had a thought, but it got run over as it crossed my mind.

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Re: Meniscal Tear

Postby 10speedsemiracer » Wed Aug 16, 2017 3:59 am

get scans, get an orthopedic surgeon to at least look at it. Better to have full details, makes for better decisions.
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Re: Meniscal Tear

Postby vander » Wed Aug 16, 2017 11:33 am

I am just going to leave a couple of these here for people to make up their own mind.

https://www.painscience.com/articles/knee-surgery-osteoarthritis.php

http://bottomlineinc.com/health/knee/torn-meniscus-common-surgery-for-knee-pain-works-no-better-than-fake-surgery

http://bmjopen.bmj.com/content/7/5/e016114?utm_source=TrendMD&utm_medium=cpc&utm_campaign=BMJOp_TrendMD-1

The summary is knee arthroscopies work no better than a sham procedure (they cut the skin like an arthroscope and that is it). This is the case so long as the person doesnt know if they got the procedure or not. There is more to it then you think and those little tears in the meniscus dont mean as much as you think. Unfortunately most orthopods wont tell you this as it means they dont get paid.

Disclaimer: There is some cases in which the surgery is justified (although that is open to debate at the moment) however >90% of people do not need the surgery.

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Re: Meniscal Tear

Postby London Boy » Sat Aug 19, 2017 5:12 pm

vander wrote:The summary is knee arthroscopies work no better than a sham procedure (they cut the skin like an arthroscope and that is it). This is the case so long as the person doesnt know if they got the procedure or not. There is more to it then you think and those little tears in the meniscus dont mean as much as you think. Unfortunately most orthopods wont tell you this as it means they dont get paid.

Disclaimer: There is some cases in which the surgery is justified (although that is open to debate at the moment) however >90% of people do not need the surgery.

Fascinating reads.

I've just had an arthroscopy done, and will make myself a case study in it. My meniscal tear was symptomatic; more than that it extended from front to rear and was described as 'complex'. I looked at the MRI and it was fairly clear in showing that the medial meniscus was not worn, in the sense described in those articles, but fissured. The knee cartilage itself was fine, no evidence of wear except behind the kneecap (but then I was first diagnosed with chondromalacia patella around 35 years ago, so that was not surprising).

The recommendation was to continue with the conservative approach for the kneecaps, and to clear out the medial meniscus.

I've seen the pictures of the surgery so I know what was done, so let's see.

enduro2
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Re: Meniscal Tear

Postby enduro2 » Sun Aug 20, 2017 9:50 pm

So today, after about 7 weeks off the bike I took my first ride of about 5km. It was mostly flat with some lengthy inclines. 8 weeks ago I wouldnt have been able to ride up the street.

Thankfully all went well and it's now a few hours after the ride and I don't appear to have any swelling or joint stiffness.

Can anyone please make sugestions on an activity plan for thr next few weeks? I want to get back upmto my 3x50km rides each week asap.

Thanks for your input that has helped myself and will help others.

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Re: Meniscal Tear

Postby PiratePete » Tue Nov 21, 2017 4:58 pm

enduro2 wrote:So today, after about 7 weeks off the bike I took my first ride of about 5km. It was mostly flat with some lengthy inclines. 8 weeks ago I wouldnt have been able to ride up the street.

Thankfully all went well and it's now a few hours after the ride and I don't appear to have any swelling or joint stiffness.

Can anyone please make sugestions on an activity plan for thr next few weeks? I want to get back upmto my 3x50km rides each week asap.

Thanks for your input that has helped myself and will help others.


Where are you at on this journey?

I've only just got back on the bike after over three months due to two tears on my right knee. My Physio has done half a bike fit as he didn't have a thru axle axle adapter to suit my bike. When he gets one (ordered) we will finish the job, however in the mean time he wants me riding. Besides the massive loss of fitness, I managed 110km on the weekend (he wanted a 100km - as that was what killed my riding). Knee was slightly sore when I arrived home, and was stiff that night. Next morning was fine.

What he observed was that my Achilles was curved due to my foot rolling inwards. A orthotic wedge was added to the arch on my right foot which corrected this curve. I'm not convinced that this has made any real difference as its been 3 months of rest since the pain killers could kill the pain.

So my current plan is exercises to strengthen my Vastus Medialis which apparently is weak and resume riding at a much reduce intensity to start with to what I consider normal. The other suggestion on top of my current plan is for surgery to clean/smooth the areas, however I'm not suffering any locking so being a bit of a chicken, i'm trying to avoid this if I can.
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enduro2
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Re: Meniscal Tear

Postby enduro2 » Tue Nov 21, 2017 8:10 pm

From my reading and talking to physios etc it's worth delaying surgery as long as the injury is not limiting lifestyle and health. I'm happy cor the snip or staple fix again but want to explore other options first.

So I've essentially had 6mo off my bike and the knee is a little better.

Last week I went to a bike ergo specialist physio who undertook some electronic muscle tests and and ergonomic adjustment of my bike. Suprisingly I still have good muscle bulk but have put on 6kg. I was aware of the latter.

On Sunday I took a 30km ride and didn't get numb hands of numb man bit. The latter only seemed to come on during a longer ride though.
The major changes were angle of handlebar, seat and knee bend. My previous set up had me bending my knee at 35' the new one 28' if I remember right.

The knee didn't fail me on the ride but after I was a bit tight inside and still tender today (4 days later). Some ibuprofen makes a difference as does stretching.

When stretching, I find I am still very flexible however the muscles on the outside (lateral side) of my leg are quite tight and I think this relates to the discomfort in the lateral meniscal tear on thst side. More regular stretching needed.

Anyway so I'll take another ride on the weekend and hopefully build up again to longer rides and post again as I do so.

I am worrried a it that the tear my damage the surface or my femur cartlidge if that's possible.

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Re: Meniscal Tear

Postby ValleyForge » Wed Nov 22, 2017 8:10 pm

vander wrote:I am just going to leave a couple of these here for people to make up their own mind.

https://www.painscience.com/articles/knee-surgery-osteoarthritis.php

http://bottomlineinc.com/health/knee/torn-meniscus-common-surgery-for-knee-pain-works-no-better-than-fake-surgery

http://bmjopen.bmj.com/content/7/5/e016114?utm_source=TrendMD&utm_medium=cpc&utm_campaign=BMJOp_TrendMD-1

The summary is knee arthroscopies work no better than a sham procedure (they cut the skin like an arthroscope and that is it). This is the case so long as the person doesnt know if they got the procedure or not. There is more to it then you think and those little tears in the meniscus dont mean as much as you think. Unfortunately most orthopods wont tell you this as it means they dont get paid.

Disclaimer: There is some cases in which the surgery is justified (although that is open to debate at the moment) however >90% of people do not need the surgery.

I guess the articles are facile at best - they relate to degenerative disease (osteoarthritis) and pain. Arthroscopic surgery is excellent for what it is good at - treating locking and clicking, assessing the chondral surface and intra-articular structures where MRI does get it wrong.

So - if you have a painful "virgin" (meaning no history of trauma) knee that doesn't lock or click and on MRI there isn't a foreign body or a cruciate injury, then an arthoscopy isn't going to make your knee pain go away. That level of knowledge is well above most GPs, but a junior trainee in surgery will know.
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Re: Meniscal Tear

Postby trailgumby » Wed Nov 22, 2017 11:21 pm

Be careful when seeking advice from orthopedic surgeons (aka carpenters). To him with a hammer, every problem is a nail.

I had surgery for a meniscal tear but it didn't actually solve the problem. He didn't try other alternatives first, he went straight to surgery. I didn't question it because he was the top guy who did all the elite NRL and ARU players. It took 6 months for the knee to settle after surgery and I still had the same pain from walking down steep uneven surfaces as before. So no bushwalking with my son.

What I really needed was $100 thermally moulded custom orthotics fitted by a specialist physiotherapist. The transformation took about 2 weeks as my ligaments settled down. That particular discomfort has never returned.

So it turns out the issue for which I had surgery (bucket handle tear of the right lateral meniscus) was unnecessary as it wasn't the cause of my knee pain

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Re: Meniscal Tear

Postby enduro2 » Fri Dec 01, 2017 12:43 am

I've now done two ~30km rides since the pro ergo bike fit a couple of weeks ago.

The other change I have made is to my stretching timing and method. Currently, I am stretching up to twice a day and have located the outer leg muscles as significantly tighter than others. This is a likely contributor to the injury I have been describing. Stretch people!!!

After my few 30km rides, I haven't noticed any knee pain at all. Of course that is no related to the injury I sustained many years ago, but would say highly relevant to the rem
edy I have been applying - stretching and exercise.

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