On Wednesday, February 20, 2019, I had a meniscus root repair surgery on my left knee. Why would I? Medication may be needed for 2-3 weeks. So its important at the very beginning its appropriate at the very beginning to make sure that all your emotions back and that you can do some simple walking to and from the house even though hurts so that youre not you know having accidents and better so youre not having emergencies happening you need the function of your leg back. 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. 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 to do if I have a radial meniscus tear, what's the chance of it fully healing with surgery? Meniscal Root Repair Post-operative Rehabilitation Protocol Phase 1: 0-2 weeks post-operatively Goals . Unlike some meniscus tears which can be observed or treated conservatively, most meniscus root tears need surgery. Does having a cortisone shot help a meniscus tear or is surgery the only option? The sutures are anchored to the tibia in order to stabilize the meniscus root attachment. The knee will be swollen for 2-3 months. The drill tip can then be pulled out, leaving the cannula in place, which allows one to place a passing stich up it to subsequently shuttle sutures down the tibial tunnel. Many meniscus tears can be treated successfully without surgery. 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. I would have relied strictly on physical therapy. Fortunately, this is usually done arthroscopically and with good results. The swelling started to go down, but there was now a lump behind my knee that felt like fluid. I dont remember how or when I tore my meniscus. Meniscus root tears usually occur in patients with deep flexion such as skiers, or home gardeners, plumbers, or carpet layers or people doing similar activities. 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. And its really concerning and very disappointing for somebody whos gone through the knee surgery. Figure 5:: Cortical fixation of transtibial meniscal root repair. No, I didnt say pain free, or I didnt say get back to normal, just strong enough to get back to standing and walking because nobody wants to be in a wheelchair or not be able to get to the bathroom in time because of your knee not working right or being very painful. <>>> 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. Surgical repair can successfully allow the meniscus to heal. Nothing. In general, one can follow the small tunnels from the transtibial technique up to where the root attachment should be. The posterior roots are the most important as this is where a root tear occurs most commonly. The feeling that your knee is giving way, locking, or catching when you bend it. You can schedule an office consultation with Dr. LaPrade. Two days after my surgery, Diego took me to my first PT session. Should a meniscus tear repair surgery be hurting 7 weeks post-operation? The left knee was feeling great up until about a year and a half ago, when I started noticing some pain. 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. Tuesday: 8:00 am 5:00 pm Each horn is anchored to the bone at the meniscus root (anterior and posterior). Historically, these root tears are often treated with benign neglect and either ignored or trimmed out. I highly recommend Dr Burnham for your orthopedic needs hands down. (Please keep reading below for more information on this treatment.). This can occur in up to 20% of patients, even in the best of circumstances. Thank you for choosing Dr. LaPrade as your healthcare provider. Meniscus repair is usually done with arthroscopic surgery. We found that the technique was very successful at restoring function to patients and significantly reducing their pain. I decided to continue with my usual four day split with two upper body days and two lower body days, although I did also incorporate a few extra upper body exercises as my lower body work was not that intense. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again. And if we know anything about cartilage, if you want to look this up, it takes about six up to 12 months to fully heal depending on the severity of that injury on the meniscus on that cartilage. Their sense of compassion and understanding is more than we have ever experienced. For this reason, much research has gone in to meniscus root repairs over the last several years. The back attachment of the medial meniscus, called a posterior horn attachment, is the most common location for meniscus root tears to occur. They can occur in younger patients as a result of high energy trauma, but are more common in patients between 45 and 60 as a result of degeneration of the meniscus with age. During the procedure, Dr. Vidal will isolate the root, pull it against the tibia and place sutures in the meniscal attachment. Amazing Doctor and wonderful staff!! The . 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. Thank you Dr. Burnham and Jerrica for everything! They might have a follow up visit or two but its really physical therapy that suppose take over at that point in physical therapy just has you for two to three months and once theyre done with you same thing once youre back to walking and bending your knee all the way and straightening out your knee all the way. Appreciate the attention and time spent during office visits. 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. Therefore, the patient should be worked up in a timely fashion when they do have a posterior horn medial meniscus root tear to determine if they are a candidate for a posterior horn medial meniscus transtibial root repair. At the beginning of April, I was dancing at a friends wedding when I suddenly heard and felt a loud pop in my left knee. As surgical techniques are being developed and refined, rehabilitation protocols for meniscal root repairs must be defined and tested. Are you an athlete who participates in sports that involve running and jumping? Medial Patellofemoral Ligament (MPFL) Reconstruction . Meniscus root repair is a surgery performed to repair a torn meniscus root. When I returned home around 1pm that day, I sat in my living room for a bit, emailing and texting people to let them know I was alive and well. 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. Meniscus (cartilage) Repair patients cannot do twisting, pivoting, squatting, deep knee bends or impact activities for four months. We currently use UltraTape to do this. It takes longer for a meniscus repair to heal than a meniscectomy. I am now adding 10 pounds a week to the bar for squats. 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. endobj Two weeks. 4010 W. 65th St. Other complications can include a blood clot, which is usually treated preemptively with some type of blood thinner, and irritation around the surgical button and/or surgical knot from the meniscus root tear. 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. Dr. Burnham was very thorough with his examination and diagnosis. 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. In general, almost all meniscus root tears require a 6-week period of being nonweightbearing to maximize the healing potential. This technique allows one to place passing stiches up the cannula, which has significantly decreased the operative time. xYIoH8(Jr@fI)/_U}|xW&JDIraqm Further study into meniscus root tears and radial root tears is ongoing by our research laboratory to try to improve the treatment of these complex problems. 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. Proper fixation of the meniscal root can prevent or slow down the development of arthritis in that area of the knee. Many patients who do have a meniscus root tear note that they feel a pop in the back of the knee when they are doing squatting activities, such as cleaning floors, gardening, placing down carpet or plumbing. Dr. Burnham clearly cares about his patients and their follow up care. Patients \50 years had outcomes similar to those of patients !50 years, as did . But youre also not alone. 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. It took almost a week and a half for the swelling to go down, but there was still considerable swelling in my knee. Is this normal? The meniscus is a very important piece of cartilage in the knee. Thank you Dr. Burnham for being so amazing! This usually presents with pain along the inside or medial portion of the joint and with swelling with activities. Meniscal root avulsions are a challenging injury causing meniscal extrusion and loss of hoop stress distribution, which can lead to the development of knee arthritis.1 Securing the meniscus in a small bone socket has proven to be an effective means to restore hoop stresses and improve outcomes.2 The FlipCutter II reamer and meniscal root marking hook allow for a minimally invasive . 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. Meniscal repairs offer the benefit of preserving the native meniscus, but they require a longer rehabilitation protocol as compared to a meniscectomy. Definition/Description. In addition, the design of the meniscus is such that the full pressure of weight bearing activities is transmitted through the root of the meniscus, meaning that it is constantly pulling and stretching the tear with every step. Phase I of Rehab: Surgery until 8 weeks. But typically physical therapy goes two to three months you get 80% better and a lot of times people have the expectation setting themselves that they can get back to everything that theyre doing before and thats just not the case they can do a lot of things now that they couldnt before the surgery typically. - Privacy Policy - Louisiana Retina, Dr. Jeremy Burnham, MD - Sports Medicine, Orthopedic Surgeon, Knee Doctor, Jeremy Burnham, MD - Sports Medicine & Orthopedic Surgeon, __CONFIG_colors_palette__{"active_palette":0,"config":{"colors":{"f3080":{"name":"Main Accent","parent":-1},"f2bba":{"name":"Main Light 10","parent":"f3080"},"trewq":{"name":"Main Light 30","parent":"f3080"},"poiuy":{"name":"Main Light 80","parent":"f3080"},"f83d7":{"name":"Main Light 80","parent":"f3080"},"frty6":{"name":"Main Light 45","parent":"f3080"},"flktr":{"name":"Main Light 80","parent":"f3080"}},"gradients":[]},"palettes":[{"name":"Default","value":{"colors":{"f3080":{"val":"rgb(23, 23, 22)"},"f2bba":{"val":"rgba(22, 23, 22, 0.5)","hsl_parent_dependency":{"h":120,"l":0.09,"s":0.02}},"trewq":{"val":"rgba(22, 23, 22, 0.7)","hsl_parent_dependency":{"h":120,"l":0.09,"s":0.02}},"poiuy":{"val":"rgba(22, 23, 22, 0.35)","hsl_parent_dependency":{"h":120,"l":0.09,"s":0.02}},"f83d7":{"val":"rgba(22, 23, 22, 0.4)","hsl_parent_dependency":{"h":120,"l":0.09,"s":0.02}},"frty6":{"val":"rgba(22, 23, 22, 0.2)","hsl_parent_dependency":{"h":120,"l":0.09,"s":0.02}},"flktr":{"val":"rgba(22, 23, 22, 0.8)","hsl_parent_dependency":{"h":120,"l":0.09,"s":0.02}}},"gradients":[]},"original":{"colors":{"f3080":{"val":"rgb(23, 23, 22)","hsl":{"h":60,"s":0.02,"l":0.09}},"f2bba":{"val":"rgba(23, 23, 22, 0.5)","hsl_parent_dependency":{"h":60,"s":0.02,"l":0.09,"a":0.5}},"trewq":{"val":"rgba(23, 23, 22, 0.7)","hsl_parent_dependency":{"h":60,"s":0.02,"l":0.09,"a":0.7}},"poiuy":{"val":"rgba(23, 23, 22, 0.35)","hsl_parent_dependency":{"h":60,"s":0.02,"l":0.09,"a":0.35}},"f83d7":{"val":"rgba(23, 23, 22, 0.4)","hsl_parent_dependency":{"h":60,"s":0.02,"l":0.09,"a":0.4}},"frty6":{"val":"rgba(23, 23, 22, 0.2)","hsl_parent_dependency":{"h":60,"s":0.02,"l":0.09,"a":0.2}},"flktr":{"val":"rgba(23, 23, 22, 0.8)","hsl_parent_dependency":{"h":60,"s":0.02,"l":0.09,"a":0.8}}},"gradients":[]}}]}__CONFIG_colors_palette__, Cartilage Damage: Symptoms, Causes, & Treatment, Elbow Rehabilitation and Postoperative Protocols.