Knee Cartilage Meniscus Tear – My Personal Journey as a Physiotherapist Pt 2 Surgical Intervention

I have been managing my meniscal tear for almost 1 year now and I’m pleased to say that things have improved! However, the residual symptoms remaining will force me to have a surgical resolution and I’m going to explain why so that you may identify if your meniscus injury needs an orthopaedic review too.

In my first post, I described my journey from the onset of symptoms to today and you should read it if you’re struggling with a meniscal tear. You can read it here: Part 1 Conservative Management

My Current Symptoms

Pain when standing for > 2 Hours
Pain when walking the dogs or playing golf after approximately 1 hour
Pain with a deep squat
Pain if attempting to run
Tenderness when palpating the medial joint line
Intense clicking with any twisting movement of the knee
Intense pain when catching the foot at odd angles

How long do Meniscal Injuries take to heal?

It’s not uncommon for me to be treating patients suffering from meniscal pain and symptoms for up to 9 months before attaining full resolution.

This is partly due to the anatomy of the meniscus and in particular its blood supply. The meniscus does not have its own direct blood supply but rather relies on the bone it sits on to provide this nourishing, healing blood to the injured segment. This means that healing happens slower. I build this factor into the Meniscal tear management of my patients and I’ve done the same for my injury too.

I always recommend to patients that they should give a meniscal tear a full year of focused rehabilitation and time and to do everything in their power to exhaust all conservative options before considering surgery.

When might surgery be indicated for Meniscal tears?

You have had the injury for a year or more
Your knee is giving way (and it’s getting worse)
You have mechanical locking of the joint
You are unable to return to your usual activities of daily living

You have had the injury for a year or more

As I mentioned earlier, it can take the up to 9-12 months for full recovery to occur. In most cases, this should be adhered to. If your pain is worsening or your function day to day seems to be regressing then this needs to be re-evaluated. You need to seek the advice of your healthcare professional to help make this decision though. They will often re-evaluate your rehabilitation programme to ascertain if changes need to be made to push on your recovery.

Personally, in my journey with meniscal injury, I have triggered the 9-12 month birthday since onset. My pain has significantly improved as has my swelling and therefore my range of motion in the knee joint. I can play golf and train my legs in a (modified) way. But my pain is limiting how long I can walk for and it prevents me from running entirely.

Your knee is giving way (and it’s getting worse)

An important differentiation of this statement needs to be made.

Is your knee giving way completely? Are you falling to the floor?
Or; are you having a little instability which makes you feel like you are going to fall, but then the muscles kick in and you can save yourself?

If you have complete instability like in scenario 1 then this may need to be examined in a little more detail. This could be indicative of other structures being involved and this certainly needs checking by your local physiotherapist. Scenario 1 would also indicate a knee that requires a sooner orthopaedic review.

In scenario 2; the knee gives a mini giving way but without complete instability, conservative management should be continued. Unless…your giving way is becoming more frequent despite your best efforts with physiotherapy and/or exercise and strengthening generally.

I do not have giving way – so it hasn’t been a factor in my own conservative management and it hasn’t been a determining factor in my seeking an orthopaedic review.

You are having mechanical locking of the joint

By mechanical locking, I mean does your knee get stuck when the leg is straight out in front of you or when the knee is bent so that you need to wiggle your foot or use your hands to physically unlock the joint? This would classify as locking.

Sometimes patients will say to me that following meniscal injury, their joint clicks and cracks a lot more and they are understandably worried about this. But this does not classify as locking and although it should not be ignored, it is not an indication of needing surgery.

Appointment with the Orthopaedic Consultant

I booked an appointment to see a Knee Orthopaedic Consultant. During the consultation, he took a full medical history as well as performed a full physical examination of the knee. His initial thoughts were that he agreed that I’d sustained a medial meniscus tear and ordered an MRI scan to aid in diagnosis.

Several days later I underwent the MRI scan and after a few day’s wait the radiologist confirmed that I had sustained a large radial tear of the medial meniscus. The bone underneath was in good order and my consultant confirmed that surgical repair was indicated in my case.

He took the time to run through the potential side effects of having a knee arthroscopy these were really:

Slightly increased risk of earlier onset osteoarthritis in future years
Risk of the procedure failing and resulting in no improvement to my symptoms
Risk of infection

I weighed up the risks and based on my current restrictions, I have opted for surgery.

Conclusion

In my career, I have helped a lot of patients through both the conservative and surgical stages of the management of meniscal tears. People that have successful outcomes with surgical management are committed to following the correct advice and the correct rehab exercises at the correct stages of their injury. However, in some cases, surgical repair is the only possible option. It’s important that should your meniscal tear require surgery, building up the muscles around the knee and gluteals will remain important. This is to prepare you for a positive outcome post-surgery.

If you’re unsure what to do to manage your meniscal injury please contact me for an appointment either in person or online you can book here