Torn meniscus: Can I run? Lift?

i think lots of us have experienced this. If you got your doctor opinion , all you can do is make your own judgement and decide what kinda wear and tear you wanna put on your body and the consequences down the line. I was advised by my ortho surgeon that over 40, even with healthy knees, i should not run, and i should not lift heavy. I do both, although i did cut down on running because its not comfortable anymore after my knee injury. I lift heavy, and i may suffer consequences in 10 or 20 years from it, or i may not. who knows, I dont do anything that causes pain and i just listen to my body. I think the benefits of the activities far outweigh the dangers, but thats just my opinion. There are a lot of people running and lifting with all kinds of injuries.

FWIW, here is my experience. I have had 3 surgeries for meniscus tears--R knee 1994, L knee 2004, R knee again 2007. Ist was from running, other two from dogs.

For me, while the overall pain was not super bad, the meniscus damage precluded me from running so there was never a question of not having the surgery. I tried "medical management" for the first one in 1994 and it was a complete waste of time--did not prevent the surgery and did not reduce the pain by one bit.

The knee surgeries have not hampered my ability to run or to lift weights. TBH, I have had very little knee pain since 1994.

Now, to balance that: The first surgery coincided with a sharp increase in work duties and other issues over the next years, so my running sharply decreased. I would say that 90% of my running since then has been on a treadmill, but even 10 miles on a treadmill has not affected the knees in the least.

The same with resistance training--I can lift as heavy as I can, doing any exercise I can, with no issues. However I am also not very flexible and cannot reach full parallel when doing heavy squats, so maybe it would be different if I could go down lower (I can reach parallel with goblet squats, and no problems with that).

I think your rehab has a big effect on the length and completeness of recovery. I waited 2-3 weeks to start rehab for surgery one and developed a nasty case of PFS. For 2 and 3, I started home rehab the day after surgery, aggressively worked on reducing the swelling and restoring ROM. I played golf six days later, and was back to running within 4 weeks. Causal? Coincidental? No idea, but it certainly felt better.

My husband recently went through meniscus surgery. He tore it on 1/2. He was off work due to it because of the kind of job he does (80% calm, 20% very active.) His ortho suggested surgery right away. After a delay to get insurance approval for the MRI, he had surgery on 2/15. It was really easy surgery and the recovery has been swift. He didn't do any PT type rehab but starting the second day after surgery he walked a bit and then moved to riding a bike. By 2/28 he was comfortable enough to walk around a car show for a couple of hours. He went back to work last week.

GiddyupTim wrote: »

Thanks, fitmom. It is true, I think. The surgery is so successful and so minimally invasive that people opt for it.
But there is this new realization that the outer edge of the meniscus does actually heal. They used to think it never healed.
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
And here is an article about that study: http://www.nytimes.com/2013/12/26/health/common-knee-surgery-does-very-little-for-some-study-suggests.html
Mostly, I think, I believe my knee has been improving. The swelling has resolved. The pain and discomfort have been abating. But i play tennis, a sport with much starting and stopping and twisting, on a hard surface. So, I am worried that it may be just a matter of time before I make my tear worse.

The research studies you cited are helpful--it's always important to subject popular surgical interventions to scientific analysis and rigor.

In the case of meniscus arthroscopy, I think one must exercise a high degree of caution when taking general results and trying to apply them to an individual situation. The authors of the studies stated as such. They also indicated that those most likely to benefit from the surgery are those with sport-related injuries. IMO, it is incorrect to draw the conclusion that the studies show that "rehab can be about as successful as surgery". It would be more accurate to say that one should not automatically assume surgery is necessary because of a meniscus tear and most people should definitely try medical/rehab management first.

Studies that look at the general population tend to have pretty broad definitions of "success". Combine that with all of the other health factors that exist in the general population--condition of the knee in general, body weight, muscle strength in the legs, etc--and, quite frankly it doesn't surprise me that medical management comes out "just as good" in many cases. I see SO many people who have surgery but who don't make any other changes, or don't go through rehab, or had generally crappy knees to begin with. Yeah, for those people the surgery was probably a waste of time and money.

It usually boils down to what types of symptoms do you have and what kinds of activities do you need/want to do. I was very surgery-averse before my first one. I did "prehab" for a solid six months before I agreed to surgery. I could do a lot of things--the night before the surgery, I did a 30-minute workout on a slide board-but I couldn't run and I had pain going up stairs. It became apparent that all the rehab in the world wasn't going to change that. Because of that experience, I didn't even question the other two--just tried to get it scheduled ASAP so I could get to recovery.

Conversely, I most likely have a rotator cuff tear in one shoulder that I would never consider surgery for unless I was in dire straits. I can do almost everything--including lifting heavy weights--except throw a baseball. And shoulder surgery is 10X tougher than knee surgery IMO.

I think that if you go the medical/rehab route, the decision will resolve itself in due time. If you still have symptoms after 6 mos or so, it will be a pretty good indicator that surgery is indicated. But other than time, I don't think you have anything to lose by taking a more cautious approach.

GiddyupTim wrote: »

I am sorry. dominette. That does suck.
Thanks, Azdak. But, isn't it true too that, once I have surgery, and they snip out part of my meniscus (more of my meniscus, since I already had it done once) that I will have a permanently compromised meniscus?
I kinda feel that way.

If it is torn, it is already compromised. It will not grow back. And the torn piece will most likely always cause pain, (that's why they trim it). It really just depends on your individual situation. That's why they do MRI's...so that they can see what has happened. You really should talk to your ortho. He can answer all your questions.

http://louisvilleorthopedics.com/knee-injuries/do-i-need-surgery-for-my-meniscus-tear/

Do I Need Surgery for My Meniscus Tear?

Posted by: Dr. Samuel Carter

What exactly is the meniscus?

The meniscus is a rubbery, fibrocartilage structure inside the knee that provides cushioning and support for the knee during impact and weight bearing activities. I often describe it to patients as the shock absorber of the knee. There are two menisci in each knee, one on the medial side (inside) and one on the lateral side (outside). The medial meniscus is slightly larger than the lateral meniscus, and is more commonly torn than the lateral meniscus.

What causes a tear in the meniscus?

In young people, meniscus tears are usually traumatic and a result of a twisting injury of the knee. They can be seen in isolation or in conjunction with a ligamentous injury of the knee – particularly in association with an ACL tear. In older patients, a meniscus tear may occur without any significant trauma. These tears are termed degenerative tears, and occur because the substance of the meniscus may degrade and weaken after years of wear and can tear more easily.

What are the symptoms of a meniscus tear?

Meniscus tears generally cause pain along the joint line and (at least initially) swelling in the knee. Depending on the size and type of the tear, they can also cause mechanical symptoms such as clicking, catching, or even locking of the knee. The symptoms generally will improve slowly over time, but may recur or worsen with activity. Some tears will cause chronic pain, but some may resolve almost completely.

Can a meniscus tear be fixed?

The most common question that I am asked by patients with a meniscus tear is “Can you stitch it back up?” That is a very logical question, and the answer to that question is “sometimes”. In young patients, for example a high-school athlete with a meniscus injury, the best treatment is an attempted meniscus repair. This decision is based on many factors, but unless the meniscus is torn beyond repair then I will almost always try to fix it in a young person. Why? The meniscus with its role as a shock absorber helps to protect the articular cartilage of the knee joint over the life of the knee. If this protection is lost at a young age, then the knee may become arthritic at an early age, which is an orthopaedic problem without a good solution. So, even if the meniscus repair fails in a young person and it requires a further surgery, I feel like it is worth the attempt.

Why wouldn’t you always fix a meniscus tear?

The reason that meniscus tears aren’t always fixed is that the meniscus has no blood supply in adulthood and as a result has very limited healing potential. This is especially true in degenerative type tears, where the meniscal tissue is already compromised and the healing potential is almost zero. Many times, trimming out the torn portion of the meniscus is a better option than repair.

If you trim out the meniscus tear, does it grow back?

No, the meniscus has limited healing potential and essentially no regenerative potential, so it won’t grow back. If it is trimmed out, there is some loss of the shock absorption and protective function. This function was basically lost when the meniscus was torn with most types of tears, so trimming out the tear does not add further damage.

GiddyupTim wrote: »

Thanks again, everyone.
I really appreciate all your help.
And, I don't mean to argue......but
I have read that people's symptoms and pain often gets better with time.
And, if there is not healing that can occur, when do they suture some tears together? The sutures dissolve. Isn't that because if you put the two edges together they will knit and mend?

Really, you should be asking your ortho. But I researched the hell out of this before my surgery so I understand your persistence.

There are different kinds of tears. Mine was not a result of any sudden trauma or injury. It was degenerative. Came up slowly. I'm older (61) and that is usually the case for older people.

For younger folks, sudden meniscus tears often happen during sports. A player may squat and twist the knee, causing a tear. Direct contact, like a tackle, is sometimes involved.

Older people are more likely to have degenerative meniscus tears. Cartilage weakens and wears thin over time. Aged, worn tissue is more prone to tears. Just an awkward twist when getting up from a chair may be enough to cause a tear, if the menisci have weakened with age.

You might feel a "pop" when you tear a meniscus. (I never did) Most people can still walk on their injured knee. Many athletes keep playing with a tear. Over 2 to 3 days, your knee will gradually become more stiff and swollen.

The most common symptoms of meniscus tear are:

Pain (I had a little, not much though)
Stiffness and swelling (I had some stiffness, but no swelling except I could tell when I bent my knee all the way, there was one swollen area on the outside/front)
Catching or locking of your knee ( I had this - the "catching" was driving me nuts!)
The sensation of your knee "giving way" (I had this too)
You are not able to move your knee through its full range of motion (and this)

Without treatment, a piece of meniscus may come loose and drift into the joint. This can cause your knee to slip, pop, or lock. I had this, as well as a loose flap at the tear. I had to have it trimmed and cleaned out, there was simply no way that it was going to repair itself.


The outside one-third of the meniscus has a rich blood supply. A tear in this "red" zone may heal on its own, or can often be repaired with surgery. A longitudinal tear is an example of this kind of tear. The only way to determine if this is what you have, is to have an MRI.

In contrast, the inner two-thirds of the meniscus lacks a blood supply. Without nutrients from blood, tears in this "white" zone cannot heal. These complex tears are often in thin, worn cartilage. Because the pieces cannot grow back together, tears in this zone are usually surgically trimmed away.

Along with the type of tear you have, your age, activity level, and any related injuries will factor into your treatment plan.


So...given all of that^^...it DEPENDS ON YOUR SITUATION. What kind of tear (if in fact you have a tear) you have. And the only way to know this, is to have an MRI. GO GET ONE.

GiddyupTim wrote: »

I am looking for the experience of people who have had a torn meniscus and have not had surgery.
I may have torn my meniscus a few months back. However, I am quite active and it has not stopped me. It has slowly, gradually been getting better. The swelling took some months to resolve completely, but it has now. I ran with pain, and played tennis, but did not move very well; but those things too seem to be resolving.
I recently saw my orthopedist, just because I thought I should. He too thought I have probably torn my meniscus. But said he was not going to recommend surgery or even an MRI, assuming, I guess, that if I was in a lot of pain I would have told him so.
Does anyone else have an experience with this? Anyone played tennis or another sport with a torn meniscus? Has anyone jogged, and continued jogging?
What about lifting weights? I know of people who had torn menisci who were advised to stop deadlifting, for instance. But those people deadlift much, much more than I do.
Thanks.

I have torn up both knees over time. After my last surgery, I had physical therapy. The main thing was to strengthen the knee. This was accomplished using exercises that used your own body weight as weights. I also found riding an exercise bike really helps post -op. As my physical therapist explained it, it helps break up the scar tissue in the knee. Also, a really good brace/or Neoprene sleeve to support the knee is very helpful.

I have one small and one "tiny" tear in my right medial meniscus. In the beginning (three or four years ago) it would sometimes hurt to the point where I almost couldn't walk, but now I just get a bit of pain or discomfort once in a while. I actually went to my doctor some months ago to get a referral for surgery, but he said that since my knee has never locked, he would recommend physical therapy instead.

I didn't do the physical therapy, but I have slowly started to squat and deadlift, and so far it's going well. Until then, I had done hip thrusts and Romanian deadlifts, and I think strengthening my leg muscles has helped a lot. I don't want to start running again before I have talked to my physical therapist, though.

GiddyupTim wrote: »

I promise, after this, to stop belaboring this point.
But, here is the link to an abstract to a report in the American Journal of Bone and Joint Surgery, in which they followed a bunch of people who had meniscus tears.
If I am reading it correctly, it says that when these people were examined anywhere from two to 10 years after their initial injury, only six of fifty-two patients needed any treatment for those tears. And, when they looked, about two-thirds of those tears had healed completely (It depended a lot on the type of tear) and, even when they didn't, the tear usually did not end up causing a problem with the opposing cartilage on the femur, even when the tear itself had not healed, meaning it was not likely to result in any arthritis in the future.
www.ajkd.org/article/S0272-6386(17)30536-X/fulltext
I'm not saying don't have surgery if you have continuing pain. Obviously, I am no doctor. But, maybe there is a part of the story that we don't always get from surgeons?

That study is about kidney injuries. Do you have a link to the one you referenced? What type of activity did the patients participate in on a regular basis? That would be my concern.

I had this last summer. Derailed all activity for several months, couldn't climb the steps to the bedroom floor, and more. I'm older, and a big guy, with no specific, overt cause to this injury. About healing: my ortho said it would never be 100%, and the MRI even showed some residue of an old high-school football injury to the area, so I guess that's my fate. Surgery wasn't recommended. Phys therapy seemed to work for me, and I've continued a series of step-up exercises all winter. Now that it's getting warm again, I'll be walking. Pedaling a stationary bike also seems to help me, as does those lower-leg resistance machines (front and back of calf resist) at the gym (not overdoing the weight used).

We're sailors, and I lost the season last year due to this injury. Also, I was reluctant to go to the beach in case the surf knocked me around. Just got back from a sailing vac in the BVIs where I was able to do all activities (sail, swim, snorkle), with some aches/pains and some slowness, so I was quite thankful of all the time I spent in both rehab and self exercise in preparation for the trip. I only wished I had pushed myself a bit more. The other thing the doc mentioned was getting as much weight off the knees to retard further damage as I continue aging.

Good luck in your own journey.

When they fixed my meniscus my acl was 90% torn. They didnt fix it because i wasnt having any stability issues and didnt need the fix for the level of sports i was competing. At some point over the intervening years it tore fully. Ortho said probably soon after my surgery.

Not fixing it at this point because of my age, recovery time and because i am still not having stability issues. Doc basically told me to keep running and if it started to hurt he would go it.