Torn meniscus: Can I run? Lift?

fitbethlin

GiddyupTim wrote: »

Plus, there was the study -- widely cited, though perhaps not accepted by surgeons -- showing that rehab can be about as successful as surgery.
Here is a link: http://www.nejm.org/doi/full/10.1056/NEJMoa1301408#t=article

FWIW: In that study, the outcomes of interest were set at 6 months and 12 months....but 1/3 of the PT group actually had surgery within 6 months. The conclusion found no difference 6 months after the subjects were randomized into one of the two groups. They did mention the problem with crossover subjects in the methods section and the fact that their method of accounting for this can't overcome some of the inherent bias (because you can't crossover in the other direction). The study population also included people with MRI evidence of osteoarthritis. That might make it more or less relevant to you. I think you mentioned a prior surgery as well - this study excluded anyone who had a prior surgery on the knee followed for the study.

I would ask my surgeon for their reason for not accepting a study like this. I feel like there's some inherent methodological concerns (including a patient selection bias - 26% of eligible subjects were enrolled?? A 74% screen-failure rate seems high to me, but I work in dermatology, not ortho). That might be a great way of understanding how your surgeon really evaluated the research. I pick my surgeons based on board certification and their ability to analyze and apply research to my particular case. Also, a cutter's gonnna cut - a surgeon who recommends waiting or trying non-surgical interventions first gets my attention in a very positive way.

<My Personal Soapbox>: This study was funded by the NIH. Getting a 7-center randomized trial paid for by the private sector when there's not a clear profit motive (like in pharmaceutical trials) is pretty difficult. I love that this data is out there, that we can get an actual idea of what works and what doesn't. I love that, because it is funded by the government (ie, us), you can just go pull this off of PubMed. I love that I live in a country that will let me vote for other people who will stop cutting vital scientific research that would be tough to fund in any other way. <Jumping Off Soapbox Now>

fitbethlin

GiddyupTim wrote: »

Here is the appropriate reference. https://www.ncbi.nlm.nih.gov/pubmed/2745476

This is actually a retrospective study. They didn't follow people, they looked back at the records. Totally valid scientific method, and a pretty cost-effective one, but not nearly as powerful as the randomized prospective trial from the NEJM article. Worth considering when weighing the evidence.

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AnnPT77

I think I'm about to be not-helpful, but not-helpful in a different way from others who've replied.

I have a torn meniscus (with a bit of osteoarthritis, and some debris in the knee, as I understand it). I have not had surgery. This got diagnosed when I reached the point of sufficient pain that it was interfering with sleep and activities, but I think I may've had the condition for some (many?) years, as I've long had episodes of knee problems.

A few (3?) years back, I had one cortisone shot. I used the respite time from that to go through physical therapy; The main focus was how to move in ways that would reduce future stress on the knee. (My PT didn't involve a lot of knee strengthening because the PT folks agreed that my legs were already comparatively strong, and the problems were mainly elsewhere.)

It was helpful - pain was not gone, but much reduced. I practiced the PT exercises even after PT ended, and felt they helped. It wasn't until a year or so later that I started losing weight, and the weight loss has been extremely helpful. (One note: I'd been very active for over a decade before the knee diagnosis, while remaining 60 pounds overweight.)

Post PT, post weight loss, with no further cortisone shots, I still have some discomfort (it mostly doesn't reach the level I'd call "pain"), but not constant, and not severe. I have a fairly clear understanding of what will aggravate my knee, and mostly avoid doing it. I've also found it soothing to ice my knee after any intense workouts or other knee stressors.

I don't intend to have surgery until pain interferes with everyday life, limits my preferred athletic activities, and doesn't yield to non-surgical interventions.

Why this is not helpful to you: I don't run. It hurts my knee (impact is the problem). I don't even like or want to run, so that's not a problem for me. Though I avoid walking as a regular exercise mode (time-consuming, not very fun), I can walk as many miles as I ever seem to want to, recreationally - 4 to 5 at speed for me (4mph), at least, and I've walked 7+ at a stretch without paying any big pain price. I lift some, rather desultorily but progressively/heavy, as an off-season cross-training thing, and haven't had any particular knee problems associated with that.

What I do, and (for my own satisfaction) need to keep doing is rowing (sliding-seat rowing, in rowing shells, so it's fairly intense leg work, but only in a straight-line hinge fashion, with little/no impact or torque on the knee). I also do some machine rowing in Winter, bike off and on recreationally, and routinely take spin classes twice a week. Ice after, and it stays manageable.

FWIW.

GiddyupTim

Thanks all.
So many who have had surgery.
Sigh.
I was hoping for otherwise......

cforsyth617

Hi, I was a marathon runner, started having knee pain 1 years ago september I think I tore my meniscus running, quit running. In April Physio recommended only running if my pain was less than 3/10 and recommended running with a knee brace. Ran only 6 miles per week as any more caused pain.Found out in July through MRI of this year I had a torn meniscus, Went to see the surgeon in October, by then I was able to run 5 miles twice a week without pain. When I asked about surgery he said that if I could run 5 miles pain free I didn't need surgery. He said that if I decided I needed surgery to come back, I am up to 10 miles at one time without pain. I am slowing working my way up to marathon distance. I find the brace really helps.Also the more weight I lose the less my knee hurts. Losing 18 pounds has made a big difference.

GiddyupTim

Thanks, c
You give me hope.
I've been running. I probably should not have been. I had much pain.
But, I too am finding that the knee seems to be getting better. The other day I ran six miles without almost any discomfort.
Fingers crossed.

Pecosbill7

Giddyup Tim, ive read through this post and was wondering if you opted for the surgery. I tore my left medial meniscus in 2014. Hurt really awful, especially when I was walking down stairs. Went to see the doc who MRI’d it and confirmed the tear. One of the treatment options offered me was Platelet Replacement Prolotherapy (PRP). It’s basically you own blood which is withdrawn from your arm, centrifuged to separate the platelets from the rest and then the platelets are injected into the knee to provoke a healing response. Had two PRP injections about three weeks apart. Around the two month mark I started noticing a little improvement, to where I wasn’t sure if I was imagining it or not. But by month three I was running down the stairs totally pain free.

Fast forward to August 2019. Playing senior league baseball (I was then 68), I took off running after a fly ball on a very rough outfield and somehow managed to not only tear the meniscus again but to also suffer a big bone bruise where the tibia and the femoral head collided where there wasn’t enough meniscus to cushion the blow. That was incredibly painful. Doc gave me three PRP injections, spread out over several months but the pain persisted. Even walking was difficult. Doc finally suggested surgery, but I had read too many stories of people having meniscus surgery and having it lead to instability, then arthritis, then an eventual knee replacement. I told the doc I wanted to give PT a fair shot first so he sent me to a PT center and the relief was evident after about the third visit. I have a friend who tore the same meniscus in an accident and who also opted for PT over surgery but I have had much better luck than she has. Her PT was significantly more aggressive than what I received and I think it almost did her more harm than good. I, on the other hand, have returned to lifting weights and playing ball, although I wear a brace and do have occasional discomfort. My philosophy is, any meniscus, as long as it’s not causing a locking of the knee, is always better than no meniscus.

ninerbuff

Although this is a zombie thread, I'll still comment. 3 years ago I took a bad spill and not only tore my meniscus, but almost detached my MCL. MRI confirmed the menicus tear and the damaged MCL. Luckily as a trainer in rehab, I knew what I had to do to rehab myself. So I took 4 solid months of daily rehab training slowly getting my knee strength back. Well after 4 months, I went back to squatting. And noticed I couldn't do ATG without pain in my knee. I dealt with it for 2 months then opted to talk to my orthopedist. He told me he could operate but couldn't guarantee that would resolve it. Well if it didn't than I knew where I stood. After the operation, I took another 4 months to rehab again and this time I was able to squat again ATG, which is still what I do now. And today I'm 57 still going strong. Even did a 36" box jump just to verify I still got skills.

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