In some severe cases, they cant fully extend their knee out or bend their knee all the way. This is important because these repairs are still quite tenuous with current technology, so it is important to try to put the meniscus back into a position where there would not be a lot of tension on the repair with knee range of motion. What was going to help my knee? HealthTap uses cookies to enhance your site experience and for analytics and advertising purposes. Later that day, I trained. while avoiding unnecessary surgery, injections, and medications. And theres things that you can do, which Ill allude to here in the middle. It can also occur while bending the knee deeply. El Paso, Texas 79903. Currently, there are mini First-Pass devices that curve to the right and the left, which allows increased access to a root tear, especially since most root tears tend to squirt to the back part of the joint and can be more difficult to access with a straight biter. 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. The sutures are anchored to the tibia in order to stabilize the meniscus root attachment. What do you suggest if my MRI says that I have a horizontal tear in the body of the lateral meniscus is shown do I need surgery? Please note, we cannot prescribe controlled substances, diet pills, antipsychotics, or other commonly abused medications. On Wednesday, February 20, 2019, I had a meniscus root repair surgery on my left knee. A meniscus root tear usually will not heal on its own. They explain things very well. I highly recommend him. It is critical that patients following a knee joint repair refrain from squatting for at least four months after the procedure. The surgery performed was a knee partial meniscectomy, a common surgical procedure used to repair a torn meniscus. Studies comparing repair with either meniscectomy or conservative treatment found greater improvement and slower . xYIoH8(Jr@fI)/_U}|xW&JDIraqm I was very pleased seeing Dr. Burnham, however I was not pleased to learn I was expected to pay an additional co- pay within the same week to receive the results of my MRI. For this reasons, it is crucial to identifiy and treat meniscal root tears in a timely manner. Little information has been published regarding specific rehabilitation parameters for meniscal root repairs through all phases of rehabilitation. Physical therapy exercises can help to improve muscle strength, knee range of motion, and decrease sensitivity to the pain. Thus, when one does sustain a lateral meniscus root tear with an ACL tear, consideration should be given to having a concurrent lateral meniscus root repair so the ACL graft does not stretch out. Meniscal Repair. These two steps are considered to be the two main preparation steps, where the release of adhesions to be able to allow the meniscus to be pulled back in the joint and also decortication of bone to prepare a bony bed to repair the meniscus back to the tibia. When these are torn, the loading of the joint is equivalent to having no meniscus on the affected side. Dr. Burnham was very helpful for my injury! I kept training, modifying my squatting as needed until I could get back to proper depth. I'm able to run and exercise without pain. They walked me through the process from beginning to end. In addition, there is no low age for meniscus repairs, with some root repairs being done in patients as young as 6 or 7 years old. Meniscus root repair rehab will usually start 1-2 days after surgery. So getting swelling, or if its been a year since you had your meniscus surgery, and youre better overall, but youre still getting some swelling and pain, then its normal. The results of meniscus root repairs in the literature are encouraging, but more improvement is necessary in the future. The steps in a meniscus root repair are very intricate and our biomechanical studies have validated that the steps are essential. And this channel is dedicated to helping people stay healthy, active and mobile. He has a great rapport with teenagers. Doctor Burnham and his staff were so helpful providing all the pros and cons associated with having surgery. I had shoulder cuff repair, involving 2 ligaments & bone spurs, only 6 weeks ago. I was life flighted to MCR in Loveland, CO. My orthopedic injuries were severe, but totally missesd by the orthopedic team at Poudre. I was training one afternoon, and I noticed some swelling, not too much, but enough for me to start keeping an eye on it. Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. A meniscus repair to the knee cartilage is a minimally invasive surgery that can normally be performed on an outpatient basis. If patients put weight on the knee immediately after the repair, the forces on . In terms of how, the transtibial technique has been felt to be the most effective way to pull the meniscus root back to its normal attachment site. From April 22 until May 1, my program changed again, slowly becoming more like my regular training. I would recommend his service to any recreational athlete. There was a large grade 4 chondral defect involving the central aspect of the trochlea, approximately 30mm in width by 25mm in length. And thats all good if youre going to end up having the surgery. 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. We have published on several of these, noting that a PCL tunnel which is placed too close to the joint can detach the posterior horn of the medial meniscus and lead to the development of arthritis of the medial compartment. 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. Protect repair Minimize pain Minimize swelling Rehabilitation begins within a week of surgery. For these, please consult a doctor (virtually or in person). 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. Patients are allowed to initiate weightbearing at 6 weeks, but should avoid any significant squatting, squatting and lifting, or sitting cross-legged for a minimum of 5-6 months. Meniscus repair recovery While everyone's recovery is different, here's what you can typically expect with a repair surgery: You may be on crutches for four to six weeks. Dr. Burnham took his time and answered all my questions with explanations. I wont ever go anywhere else. Unlike some meniscus tears which can be observed or treated conservatively, most meniscus root tears need surgery. Arner, J.W., Herbst, E.. Meniscal Root Repair Article. He made my daughter feel comfortable and made sure to listen to both of our concerns prior to his diagnosis. Most root tears involve either a direct tear of the meniscus off bone or a split of the meniscus within 1 cm of the root attachment. Did you have any meniscus surgery in the past and youre still dealing with pain, swelling and possibly even losing motion in your knee? Is this a tear? No swelling. While you're recovering from your meniscus surgery, you can expect to feel pain while you heal. As of August 20, 2019, it will be six months post-op. As surgical techniques are being developed and refined, rehabilitation protocols for meniscal root repairs must be defined and tested. For this reason, much research has gone in to meniscus root repairs over the last several years. In this technique, sutures are placed into the torn meniscus root and then shuttled down tunnels in the tibia to tie the repair into place. We will determine during your consultation whether general or regional anesthesia would be appropriate - either way, no pain will be experienced during the procedure itself. 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. All I can say is Dr. La Prade did an amazing job and I am not limited in any of my activites. One of the most common is in patients who may have some underlying arthritis and the arthritis is causing the pain or the arthritis has progressed further after the meniscus root repair. Dr. Burnham was very thorough with his examination and diagnosis. My right knee was totally destroyed; ACL, MCL, PCL all severely torn; the patella was the only thing intact in my right knee. Two days after my surgery, Diego took me to my first PT session. I was hit by a car on my bicycle near Horsetooth Reservoir in CO. Therefore, most meniscus root tears need to have the scar tissue released so the meniscus can be pulled back into the joint. 181 West Meadow Drive Suite 400 Vail, CO 81657. Meniscal repair may be performed either by open surgery under direct vision or minimally invasively using an arthroscope that can be inserted into the knee through a very small key-hole incision to locate and repair the damaged meniscus. We currently use UltraTape to do this. The average pain levels after a meniscus root repair fit between a basic knee arthroscopy (minimal pain) and an ACL reconstruction (more severe pain). I really like and appreciate the time and effort he commits to research. repair to heal. Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. Historically, most root tears were treated with meniscectomies because the importance of the meniscus root as a shock absorber was not well known. Please try again. This technique allows for the meniscus to be pulled down into a broad surface area, maximizing its chance for biologic healing. Being aware of the location of the meniscal attachments at the time of ACL and PCL surgeries is essential to minimize the chance of an iatrogenic root tear. There goes my knee again.. Keeping each meniscus in place are two roots that attach to the tibia (shin bone). 4. The meniscal roots are critical in maintaining the normal shock absorbing function of the meniscus. In layman terms, I had completely torn my medial meniscus from the bone, and it had to be sewn back on. I finally decided to make an appointment with a knee specialist. Monday: 8:00 am 5:00 pm The best surgeon is Baton Rouge that actually care about his patients!!! 2 0 obj Now my intent on this video is not to throw anybody under the bus surgeons are doing the best they can with what they know and saw our physical therapists in any health care providers that you may be seeing for your meniscus problem. 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. Drivers: The meniscus repair surgery to prevent osteoarthritis is expected to drive market development. So that means youre good to go after two to three months. 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. His MA Michelle was very professional and kind. 2018;47:762. He listens and address every concern with appropriate solutions. I have two good arms, and a good leg. That was day one. I continued to lower the box for squats, and started to add weight. endobj His surgery and recovery has been perfect! If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you b. Dr. Burnham made sure I knew what was happening and what could happen. And get the pain under control and recover normally the way that you should have once you start doing the right things. The arthroscopic meniscus repair is a procedure done to repair torn knee cartilage, usually for athletes. I dont remember how or when I tore my meniscus. The next portion of the Smith & Nephew root repair device is a mini First-Pass device. Repair of the meniscal root significantly increased functional outcomes scores in 14 of 14 studies and the rate of conversion to TKA was considerably less than those observed following conservative treatment or partial meniscectomy. My 14 year old son originally went in to see Dr. Burnham very scared (he hadn't had an injury before) and he was instantly made to feel at ease. 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. Tuesday: 8:00 am 5:00 pm Dr. Burnham and his remarkable staff have been a godsend for our son. Connect with a U.S. board-certified doctor by text or video anytime, anywhere. Dr. Burnham was very thorough and took the time to explain what he thought my root problem may be, why, and how he suggested we proceed with my care. Meniscus root repair is a surgery performed to repair a torn meniscus root. The most important thing as one gets older is the quality of the cartilage present. Your doctor put a lighted tubecalled an arthroscope or scopeand other surgical tools through small cuts (incisions) in your knee. Contact Dr. Nwachukwus team today! Factors Affecting Meniscus Tear Healing and Prognosis AOSSM Lecture from Jeremy Burnham, Ochsner-Andrews Sports Medicine Institute, Copyright 2022Jeremy Burnham, M.D. The next steps involve placing self-capture sutures into the end of the meniscus root and then drilling cannulas into the area that was decorticated such that the sutures placed into the meniscus can be shuttled down the cannulas and then tied over the tibia. If not treated, part of the meniscus may come loose and slip into the joint. importance of the meniscus root has become more apparent. The first step is usually to use especially designed cannulas and guides to drill up into the area that was decorticated. This specific type of tear makes up 90% of all meniscal root tears. I press and bench with no modifications. A patient who has a Meniscus (cartilage) repair cannot twist, pivot, squat, deep knee bends, or engage in any impact activities for four months. Surgical repair can successfully allow the meniscus to heal. At the end of March, my doctor told me I could take my brace off completely, and use crutches for another week if I needed to. Deconditioning of ones quadriceps muscles can also cause similar symptoms, so it is important to determine if one has any atrophy of their thigh muscles, usually measured as the thigh circumference 15 cm above the patella and compared to the opposite leg. endobj But the next day, I woke up and literally ran down my stairs. But youre also not alone. Heel lift in opposite shoe to normalize gait. 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. Early weightbearing has been found to be the cause of meniscus root repair failure, and this has been validated by our colleagues In general, almost all meniscus root tears require a 6-week period of being nonweightbearing to maximize the healing potential. And then after the surgery, the focus is doing physical therapy, typically if he gets sent there, and youre going to lose some motion in the surgery so your knee wont be able to bend or straighten all the way. 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. The menisci in the knee are two c-shaped pieces of fibrocartilage that act as shock absorbers. PT or exercise can be useful BUT take note of these the BoneSmart view on exercise BoneSmart philosophy for sensible post op therapy 5. Later that summer, the left knee began to bother meagain. The technique of a meniscus root repair involves isolating the root, placing a minimum of 2 sutures in the remaining meniscal attachment, and trying to reposition it back to a more anatomic position. I asked when I could start driving, and he said when I was off my pain medication. In particular, making sure the meniscus has a thorough release from scar tissue and making sure that ones sutures or UltraTape are placed into the best substance possible for the meniscus root repair, are important considerations to maximize the chance of healing of the revision root repair procedure. Get answers from Family Physicians and top U.S. doctors, Our doctors evaluate, diagnose, prescribe, order lab tests, and recommend follow-up care. I started Brazilian Jiu-Jitsu about four years ago. He diagnosed the problem quickly and accurately. 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 meniscus is a cushion of the knee joint. I got rid of the box for squats the end of July. Instead of wall slides, I opted for high box squats. Really a national leader in sports medicine! In addition, because of studies from our biomechanical studies showing significant stress on the meniscus with deep flexion, as well as the fact that many meniscus root tears occur with deep flexion, we have patients avoid squatting, squatting and lifting and sitting cross-legged (which puts extra stress on a root repair) for a minimum of 4 months postoperatively to maximize the healing potential. The pain during my recovery has actually only been minimal, requiring no pain meds. Had a meniscus root repair yesterday and the surgery was successful. They are connected to your tibia by meniscal roots. There are some isolated reports of using suture anchors to repair a meniscus root repair, but this area of the knee is very difficult to access and the suture anchors can leave large knots which could subsequently interfere with the cartilage surfaces in the knee. Thank you Dr. Burnham for being so amazing! Each patient was randomly selected to have knee meniscus surgery followed by rehab or to simply attend physical therapy without having surgery. If there is tissue there, it usually means that the meniscus root repair has healed down to bone. After a meniscus root repair, there is a prolonged period of non-weightbearing and restricted range of motion to allow proper healing. We found that the technique was very successful at restoring function to patients and significantly reducing their pain. 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. If I could give more than 5 stars, I would. But now I know more about the body, about rehab, and about what being stronger really means. This can occur in up to 20% of patients, even in the best of circumstances. They are also important to the stability and function of the knee, keeping the meniscus in place. A meniscus root tear requires the meniscus to be repaired back to the lower leg bone; this is also performed arthroscopically. I also found that there were patients being referred to me who had meniscus root repairs that were done well, but the meniscus was not pulled back in the joint and these patients continued to have pain. Heres the third practical tip if youre if you dont know where to go Ive got some exercises that i put on videos here for free on YouTube its linked in the description below theres one video in particular that i want you to take a look at its called top five glute exercises for knee problems go check out that video start doing those exercises youve got to exercise the heck out of your glutes if you got a meniscus injury if youve had a meniscus surgery in the past you need to get your glutes worked out. I switched out the single leg deadlifts for trap bar deadlifts on mats, and added low step ups on the left leg. It can create another problem later on youve got to listen to your knee youve got to listen to your body and make sure that you only go with what you can tolerate without making it worse without swelling pain or definitely not losing motion and you might consider staying in physical therapy longer than they want you to or finding something to help you out. Posterior horn medial meniscus root tears have been particularly noted to be a problem with a large number of patients developing arthritis rather quickly. To accomplish this goal, Dr. Nwachukwu drills a small hole from the outside of the tibia (shin bone) into the knee joint next to the natural attachment of the meniscus root. The most common complication after a meniscus root repair is a re-tear. The feeling that your knee is giving way, locking, or catching when you bend it. Should a meniscus tear repair surgery be hurting 7 weeks post-operation? 28323545 Additionally, preparing 2 transtibial tunnels to secure the meniscal root to its attachment site further increases the It takes longer for a meniscus repair to heal than a meniscectomy. An ACL tear commonly has a pop on the outside of the knee, whereas a patient who has meniscus root tear commonly feels a pop in the back of the knee. In some instances, the meniscus posterior horn may need to be released from scar tissue to allow it to be repositioned. He is amazing and a blessing to have in the medical industry. What could you eat or do for a meniscus tear to heal faster after surgery? I asked him about biking, and he told me that he allowed his patients to start biking two weeks after surgery. This was going to be a complete root repair surgery: toe-touch weightbearing for four weeks, six weeks in a brace and crutches. If one has fairly normal cartilage of that side, the success rate is going to be better than those patients that have mild to moderate chondromalacia (arthritis) of the same compartment as the root repair. Well, this is not normal. MRI is used to look more closely at the meniscus and determine if it is something that needs surgical treatment, although not all meniscus root tears show up on MRI. And if youve never worked out your glutes if you went through physical therapy never really targeted your glutes ever you better start quick because chances are youve got a muscle imbalance thats caused extra pressures inside your knee thats led to that meniscus tear to begin with thats been the root problem and glute strength is what offsets that forces inside the knee so that your meniscus can heal all the way. Therefore, any surgeon who performs ACL reconstruction should be well versed in performing a lateral meniscus root repair. We use the 2-tunnel technique to maximize biologic healing of the meniscus down to a broad surface. questions after your surgery, during business hours call 763-302-2231. There are 2 main variants of the transtibial root repair technique. Full recovery usually takes 6 months but can take up to 1 year. But theres still healing to be done and that 20% is really critical. This allows the meniscus to heal back to the bone.