. repair to heal. These UltraTape or sutures can then ultimately be shuttled down the cannulas and then tied over a metal button on the front part of the tibia. His staff is very friendly and upbeat, knowledgeable and thorough. And slowly, I started bending the knee more, and eventually took the box away from my bench. 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. 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. Many meniscus tears can be treated successfully without surgery. So happy I found them! They moved my knee a bit, and I had decent ROM, better than expected. It is critical that patients following a knee joint repair refrain from squatting for at least four months after the procedure. The meniscus is a piece of cartilage in the knee, often injured in sports. Dr Burnham is so personable. In general, one can follow the small tunnels from the transtibial technique up to where the root attachment should be. The sutures are anchored to the tibia in order to stabilize the meniscus root attachment. And thats all good if youre going to end up having the surgery. Medication may be needed for 2-3 weeks. 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. Keeping each meniscus in place are two roots that attach to the tibia (shin bone). Created for people with ongoing healthcare needs but benefits everyone. I was hit by a car on my bicycle near Horsetooth Reservoir in CO. 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. Oct 24, 2020. The pain is usually located one the sides or front of the knee, although it can occasionally be located in the back of the knee. I started Brazilian Jiu-Jitsu about four years ago. . I was going to rehab myself, and keep training as normally as I could. We validated that the 2 simple suture technique had the least amount of loosening over time, but the other techniques were stronger. Previous attempts to make it better provided only temporary relief. I got rid of the box for squats the end of July. 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? If it is your right knee, it will be at least a week before you can drive, as it would be risky to have to hit the break too soon after surgery, and you would be a risk to yourself and everyone else on the road. These results reveal that, since all the variables and possible concomitant injuries are investigated and addressed, MRR . Patients are allowed to walk 4-6 weeks after surgery. Great shoulder doc. A meniscus that still has extrusion present also does not function as well over the long term. The most important thing as one gets older is the quality of the cartilage present. Factors Affecting Meniscus Tear Healing and Prognosis AOSSM Lecture from Jeremy Burnham, Ochsner-Andrews Sports Medicine Institute, Copyright 2022Jeremy Burnham, M.D. Educational text answers on HealthTap are not intended for individual diagnosis, treatment or prescription. What was going to help my knee? Oftentimes, after having a meniscus surgery, people are told that they'll be fine. Sutures are passed through the meniscus, and then pulled down into a bone tunnel located at the same site as the root attachment before it tore. They are also important to the stability and function of the knee, keeping the meniscus in place. In some cases, its important that you take away from this video today that it takes six to 12 months to heal from a meniscus surgery. They have poor healing potential, and are extremely important to the stability and cushioning of the knee. 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. . Darin helped me understand that it was going to be a very slow recovery due to the nature of the surgery, and to be patient. Strength is one of the most important aspects of our lives. I really like and appreciate the time and effort he commits to research. It was glorious. Oftentimes, after having a meniscus surgery, people are told that theyll be fine. Continuing to train, moving it as much as I could, bearing weight as much as I could tolerate, not sitting around, and NOT just doing PT exercises 1-2x times a week. Video chat with a U.S. board-certified doctor 24/7 in less than one minute for common issues such as: colds and coughs, stomach symptoms, bladder infections, rashes, and more. I highly recommend him. We recommend the use of 2 cannulas such that the meniscus can be pulled down over a broader area and have a better chance of healing to the bone. At my third visit to PT, I was told that I had completely broken my PT protocol, and was better for it. In layman terms, I had completely torn my medial meniscus from the bone, and it had to be sewn back on. A patient who has a Meniscus (cartilage) repair cannot twist, pivot, squat, deep knee bends, or engage in any impact activities for four months. When a tear of the meniscal root, or even a tear near the root, occurs, the meniscus can no longer convert axial loading forces into hoop stresses. They may start the use of a stationary bike, and may slowly wean off crutches starting at 6 weeks post-operatively. This is called decortication of the medial tibial plateau (for a medial meniscus root repair). Your subscription could not be saved. Please try again. After sutures are placed arthroscopically into the meniscal attachment, a small diameter tunnel, usually 5 millimeters in size, is reamed to the meniscal root attachment site, the sutures are pulled down the tunnel, and tied over a button on the anterior cortex of the tibia. Fortunately, this is usually done arthroscopically and with good results. If one does have quite a bit of arthritis of the same compartment, which we would call Kellgren-Lawrence grades 3 or 4, in most circumstances, other than possibly in very young patients, a root repair would generally not be indicated. But youve got to figure out a way to get your butt muscles stronger if youre looking for a more comprehensive plan for making your knee better and getting your glutes stronger we also have a program called the 28 day knee health and wellness boost program you can also find that in the link and as a link in the description below. Crutches will be used until the patient can walk without a limp on the repaired knee, which takes about 2 weeks after surgery. But theres still healing to be done and that 20% is really critical. Matthias J. Feucht1,4 Received: 19 May 2022 / Accepted: 13 February 2023 Grant H. Garcia, MD 148 subscribers Dr Garcia demonstrates his new meniscal extrusion technique to further improve meniscus root repairs. (C, D) Arthrex MU (multiuse) guide with 6-mm FlipCutter drill positioned on footprint of posterior root of lateral meniscus. My name is Dr. David Middaugh. 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. I would recommend his service to any recreational athlete. A meniscal repair is a keyhole surgery technique for repairing a ripped meniscus.. Prior to that, they are recommended to use crutches. The arthroscopic meniscus repair is a procedure done to repair torn knee cartilage, usually for athletes. Dr. Burnham was very helpful for my injury! You can't walk right after surgery. 2018;47:762. Surgical knee will be in a hinged rehab brace locked in FULL EXTENSION for 4 weeks postop. The thoughtful, open communication and treatment was everything I could have asked for pre-, during, and now post surgery. The healing phase is long, but he does A+ work. My pain was gone. Robert LaPrade, MD, PhD When the tear is examined during arthroscopy, Dr. Hess will decide if the tear is able to be repaired . How long recovery takes depends on the type of meniscus surgery and the severity of the injury, but expect two weeks down time, at minimum. In general, almost all meniscus root tears require a 6-week period of being nonweightbearing to maximize the healing potential. There was also proliferative synovitis present throughout the patellofemoral joint, including the medial and lateral gutters. (including injections and arthroscopic surgery), I heard Dr. La Prade was going to practice in the Twin Cities - where I live, & waited for him, based on his renown reputation. There are two menisci in the knee, medial and lateral. Once my doctor started the procedure, it was obvious that this would not be a simple surgery. The root attachments of the posterior horns of the medial and lateral meniscus are very important for joint health. A physical therapist will be assigned to you and begin a routine of light exercise to help stabilize the knee. with time whether there is healing or not. After repairing the meniscus root, it is imperative that the patient remain 100% non-weight bearing for 6 weeks. 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. There are two ways to initiate a consultation with Dr. LaPrade: You can providecurrentX-rays and/or MRIs for a clinical case review with Dr. LaPrade. The most common root repair technique is called a transtibial technique. Following this 6 weeks, they begin weight bearing at 25% with crutches for 1 week, and then 75% weight bearing using 1 crutch for 1 additional week. Fig 1 (A) Meniscus 4 A-II device. Dr LaPrade performed a deep root repair to my meniscus, which saved me from a knee replacement at this time. I am now adding 10 pounds a week to the bar for squats. Other sources of pain can include scarring within the joint that occurs as a normal part of a surgical procedure, or pain from other pathology and joint, such as arthritis under the kneecap. Ibuprofen (Advil, Motrin) Naproxen (Aleve) Using specific guides to ensure that one can place tunnels in the anatomic position and using self-capture devices, which have been devised to be small enough to not scuff up the cartilage, are some of the best means to perform a transtibial meniscus root repair with self-capture devices. 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. He is amazing and a blessing to have in the medical industry. Is this normal? Bottom line, it was pretty clear from the MRI that if I wanted to be out of pain, surgery was my only option. Thank you Dr. Burnham for being so amazing! A possible cause for knee pain 1 year after meniscus surgery would be a re-tear of the meniscus. It is important to recognize that most patients who sustain isolated meniscus root tears happen with a medial meniscus root attachment. Connect with a U.S. board-certified doctor by text or video anytime, anywhere. We are so grateful for you both! Ive dealt with other knee doctors in prior injuries, but Dr. Burham and his team clearly stood out. I felt very informed and well cared for. In addition, the other factor is if the meniscus was released significantly enough from scar tissue to pull it back into the joint. Recommend highly. 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. 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. So go check out that video on how to exercise your glutes theres five exercises in there that you can start doing them i would do them every day i do them a couple times a day even more if you can i would do what you can tolerate without it being too much soreness and your glute muscles and they should all generally be okay on your knee theres some where you got to kneel you can adjust it you can not do that exercise if you want. Very reassuring, showed me X-rays and explained the healing process very clearly. Most of these types of injuries, that are symptomatic, require surgery. A Guide to Orthopedic Care, Pediatric & Adolescent Sports Medicine Injuries, Get the Perfect Grip on Your Next Game: Adaptive Golf Gloves, Healthcare Journal of Baton Rouge Mentions Dr. Burnham Performing New Surgery to Repair Torn ACL, Sports Medicine Near Me: Finding the Right Doctor for You, When to See a Doctor for Knee Pain When Bending: The Complete Guide, 11 Benefits of Exercise: It Can Change Your Life, Knee Bursitis: Causes, Symptoms, and Treatment Options, Your Childs Knocked Knees: Everything You Need to Know, BioUni OATS Procedure Cartilage Replacement for the Knee, Capsulorraphy Shoulder Stabilization Procedure. This may be recommended depending on the type of meniscus tear. Hence, that remaining meniscus is more and not less likely to tear again. The results of meniscus root repairs in the literature are encouraging, but more improvement is necessary in the future. This is done to protect the repair and let the body heal it. Heavy lifting, manual labor, strenuous exercise/activity, and sports should all be restricted until 3-6 months after surgery. Dr. Robert F. LaPrade operated on my right knee in May of 2010. But its just not common knowledge to take six to 12 months to heal after a meniscus surgery. The High Tech Shirt Problem in the Squat Rusty Holcomb, Observations on Training by an Old Guy Phil Ringman. Knows his stuff. It is our goal to provide the highest level of care and service to our patients. Timeline: 1 week to 5 weeks after Surgery. I was told by one of the orthopedic surgeons that I worked with that I would never run again and would be lucky if I could ever hike again. The mini First-Pass device allows placement of either a suture or an UltraTape through the substance of the meniscus, capturing the end of the stitch as it is placed through the meniscus and then it can be pulled out of the joint. A surgical guide can then be placed in a drill tip where the cannula around it is placed into the area of the decorticated bone. dressing in 48 hrs and may let them drive Meniscus Root Repair The most common method to fix meniscus root tears is through a tibial bone tunnel. 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. This specific type of tear makes up 90% of all meniscal root tears. Never disregard or delay professional medical advice in person because of anything on HealthTap. Then I trained. Meniscus root tears are a particularly troublesome type of meniscus tear, because a failure to treat them can often result in the rapid development of osteoarthritis. All I can say is Dr. La Prade did an amazing job and I am not limited in any of my activites. It involves removal of some or all of a meniscus from the tibio-femoral joint of the knee using arthroscopic (keyhole) surgery. If I could give more than 5 stars, I would. Just its a big deal to take your time and let that cartilage heal at the rate that it heals you generally can go faster than what it heals, And the question that i get often is do i take any supplements glucosamine chondroitin those types of supplements and you know the answer to that is its not going to hurt we the research is kind of mixed on it sometimes it helps sometimes it doesnt help what we know is that it generally doesnt hurt it doesnt make it worse so youre not going to youre not going to make things worse if you decide to take those supplements are generally safe to take but some people report no difference. while avoiding unnecessary surgery, injections, and medications. 2 0 obj If the lateral meniscus root tear is not repaired at the same time as an ACL reconstruction, it is now recognized that this could lead to ACL graft failure or loosening over time. I would highly recommend him. Can you tear your meniscus again after a surgery and if you do how can you tell? Then, in January of 2018, while warming up in class one morning, a sharp, nauseating pain shot through my left knee, which made me start limping. 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. The roots of the meniscus are responsible for transmitting weight evenly across the surface of the tibia. I was training one afternoon, and I noticed some swelling, not too much, but enough for me to start keeping an eye on it. We have published and validated our results in the peer-reviewed literature, which was at the time the largest series of meniscus root repairs reported. endobj This mechanism of injury and the description of a pop is the classic description of one who has a meniscus root tear occur. Identifying and properly treating meniscus tears (with or without surgery) will lead to the most rapid reduction in your symptoms and is crucial to optimize the long term health of your knee. When I woke up I was in significant pain but the nurses had it under control by the time I left. Arrange for someone to drive you home as you will not be able to drive yourself after surgery. Usually, pain is minimal after this type of surgery. You will feel tired for several days. I'm taking pain meds regularly to try and ease pain. It took almost a week and a half for the swelling to go down, but there was still considerable swelling in my knee. One should assess the range of motion at that point in time that can be performed in a safe zone to make sure that the physical therapist does not flex them harder in this time frame. Now, the focus when you go into a surgeons office, theyre looking at your MRI, theyre looking at your meniscus on the MRI, theyre telling you the tear in the way that its torn and how theyre going to repair it. My surgery was at 8:30am Wednesday, February 20. The meniscus is a crescent-shaped pad of cartilage located in the knee that helps stabilize and . If it is the right knee, the average time until the patient is able to drive is 6-9 weeks. 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. And its really concerning and very disappointing for somebody whos gone through the knee surgery. Therefore, the transtibial meniscus root repair technique is by far the most common procedure that is performed. Upon examination, the doctor told me that I most likely had a meniscus tear, and that I should get an MRI. This is one of the first video demonstrations of this. Bottom line, it was pretty clear from the MRI that if I wanted to be out of pain, surgery was my only option. A week later, I got my MRI results and I was told that this was going to be a very long recovery, but I had other plans. In this procedure, the torn meniscus is sewn back together using arthroscopy to place small stitches. This was devastating news after being a top triathlete (3rd in the world in my age group in 1989 & 1st nationally in my age group) and a big marathon runner. As surgical techniques are being developed and refined, rehabilitation protocols for meniscal root repairs must be defined and tested. This results in premature arthritis and cartilage damage in the knee. Placing sutures or UltraTape on each side of the tear and pulling it down into tunnels should be a safe and reliable method for a bony avulsion root repair. Because this is a frequent question posed on Google, I will try to be modest in answering this. (it is still a bit swollen). The left knee was feeling great up until about a year and a half ago, when I started noticing some pain. Meniscus root repair rehab will usually start 1-2 days after surgery. He answered all my questions satisfactorily and his entire staff were polite and professional. Two cannulas are subsequently placed into the area of bone that was decorticated to allow for the transtibial 2-tunnel technique to be performed. 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. Medial Patellofemoral Ligament (MPFL) Reconstruction . What could you eat or do for a meniscus tear to heal faster after surgery? I think my clients thought I had lost my mind, but what else was I going to do? The . These are totally different. He made my daughter feel comfortable and made sure to listen to both of our concerns prior to his diagnosis. I rate him 5stars. I finally decided to make an appointment with a knee specialist. The why answer is that the meniscus root is an important stabilizer to the meniscus to ensure that it can function as effectively as possible as a shock absorber. The American Journal of Sports Medicine. I did a few jungle gym rows, and finished with planks. Highlights from the StartingStrength Community. Meniscal Repair. 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. It is very important for proper healing, that the placement of the root matches the original Footprint or attachment site. While regular functionality isn't immediate, patients will be asked to move the knee within 1-2 days after surgery. My right knee was totally destroyed; ACL, MCL, PCL all severely torn; the patella was the only thing intact in my right knee. This step involves making a surgical incision or extending a previous surgical incision (such as with an ACL reconstruction) and ensuring that one is dissected down directly to bone. Meniscus root repair surgeon, Doctor Benedict Nwachukwu provides diagnosis as well as surgical and nonsurgical treatment options for patients in Manhattan, New York City, NY who need meniscus root repair surgery. We use the 2-tunnel technique to maximize biologic healing of the meniscus down to a broad surface. One should not look at age as a factor for meniscus root repairs. Other common symptoms include limping, a change in the patients gait and the inability to put weight on the affected knee.
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