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Aging & ArthritisImportant ConceptsJust PostedKnee

MENSICUS TEARS AFTER FORTY…a treatise

 

I could talk generally about meniscus tears, but not all meniscus tears are created equal. There are meniscus tears and then there are degenerative meniscus tears, and it’s the latter I’m talking about now. And the two types of meniscus tears are almost entirely different entities.

DEFINITION OF MENISCUS TEARS

But for starters, let’s just define the two types of tears, and to do this, it’s easiest to define acute meniscus tears and then just about everything else is degenerative. That way it will be easier for you to figure out which kind you have.

Just about any meniscus tear in a person under forty who injures their knee, is an acute tear…and NOT a degenerative tear. On the flip side, just about any meniscus tear in a person over forty who experiences the more or less spontaneous onset of knee pain, is a degenerative meniscus tear.

Now there is everything in between, with the exception of a young person having a degenerative tear. I don’t think I’ve ever seen that. Of course there are always exceptions, but in general, the youthful meniscus is a very resilient structure and tears only as a result of an injury: twisting the knee in a football game, falling off a bicycle, landing bad on a trampoline, etc. There are a few young people out there with naturally loose ligaments, who can tear their meniscus cartilage with only a minor injury, but those are rare circumstances.

My focus now is the degenerative meniscus tear…everybody else’s meniscus tear. I often see elderly patients who come to me with an MRI which demonstrates a meniscus tear. The patient may or may not have had X-rays which show signs of arthritis, sometimes advanced arthritis. They think the cause of their pain is the meniscus tear itself, and many have the expectation that surgical repair is what they need.

Sometimes surgery is an alternative, but not most of the time. Degenerative meniscus tears are simply a sign of the development of arthritis. In simple terms, arthritis is the result of the gradual wearing out of the joint cartilage and the subsequent inflammation triggered by this process. It just so happens that in the knee, we have two kinds of cartilage: the shiny white stuff on the ends of the bones (just like on the end of a chicken bone), and the meniscus cartilage.

As we age, our articular cartilage and our meniscus cartilages begin to wear out. Unfortunately, in some of us, they begin to wear out quite early in life, and we’re seeing younger and younger patients with early-onset arthritis, especially in the knees.

Conditions and activities associated with degenerative meniscus tears and early knee arthritis include:

-a genetic predisposition to arthritis (and it doesn’t matter whether or not your folks actually complained)

-obesity

-previous history of a knee injury

-activities involving a lot of squatting and climbing, cutting and high impact

If you experience the gradual onset of arthritis after the age of sixty, then you are likely just genetically “scheduled” to have arthritis. Your knees are just wearing out, and it doesn’t seem like such an unreasonable time in life to get it. But when you’re young, sometimes it just doesn’t make sense.

SIGNS & SYMPTOMS OF A DEGENERATIVE MENISCUS TEAR

Sometimes patients experience the gradual onset of an aching sensation in the knee, perhaps even in both. They notice swelling after standing for long periods of time. Their knees hurt when they abruptly stand up from a seated position, especially if they’ve been sitting for a while. The knees ache in the morning, after mowing the lawn, or after staying with grandchildren and having to walk up and down stairs or squat to the ground to change diapers. Sound familiar?

But almost as frequently, I see older patients who have the fairly acute onset of knee pain, most commonly on the inside or in the back of the knee. They might not recall a specific injury. But they might recall some activity, perhaps an exercise program, during or after which they noted the onset of pain. Or sometimes they might remember the onset of pain after slightly twisting their knee, doing something as simple as turning from the refrigerator. Perhaps a bad step off a curb. Maybe even after a fall. But often they can’t recall any injury. They just woke up one day with pain in the knee.

They started taking some anti-inflammatories, like Advil or Aleve. They iced their knee or applied heat. Maybe that helped a little. They often try to work through the pain. Many people think that doing more exercise might help the pain. Most of the time it just makes it worse.

Their knee might swell. It might feel stiff. It hurts to stand up after they’ve been sitting for a while. The knee hurts at night, especially if it’s resting against the other knee and it feels better to put a pillow between the legs.

Sometimes the pain is severe and constant. Other times it’s mild and intermittent. And everything in between!

If this sounds familiar…you might have a degenerative meniscus tear.

 

UNDERSTANDING YOUR MENISCUS TEAR

 The meniscus is a tough, rubbery cartilage in between the two bones of the knee. It’s attached to the lining of the joint and has a very poor blood supply, so when it tears, it won’t heal on its own. If you’re young and have a tear that’s close to the ridiculously poor blood supply, sometimes it can be fixed. But frankly, most meniscus tears can’t be fixed, and that goes double for degenerative tears. Sorry. We can’t treat forty-plussers like high school basketball players.

Many patients come to me with MRI scans, showing a degenerative tear of the meniscus, thinking that the tear can be fixed and put back together…just like new. They’re often surprised and dismayed to find out that not only can the meniscus not be repaired, in most cases it doesn’t even need an operation. There’s something very disheartening about a condition you have to live with! But many of you have other conditions like this! Take hypertension, for example. It can be treated, but not cured. And there’s no surgery for it.  Patients often think surgery can cure their problem. Certainly in many cases, that might be true. We can “cure” a broken femur with an operation. We can “cure” carpal tunnel syndrome with one, but not the degenerative meniscus tear. We can only “treat” it. An operation for it simply removes the offending piece of meniscus, leaving an empty void where it used to be. More on that later.

In general, when a patient over forty is diagnosed with a meniscus tear, it is usually a degenerative meniscus tear. I say “in general,” because occasionally a forty or fifty-year-old will sustain a meniscus tear during a game of soccer. But even in these instances, the quality of the meniscus is still poor, and they are usually not amenable to repair.

But this discussion is about degenerative meniscus tears, and it applies to most of my readers. These tears are a symptom of the development of arthritis. If you are diagnosed with a meniscus tear, and you’re over forty, then you are likely developing arthritis. It’s complicated, because most patients will say they’ve never had arthritis before, or they’ve never had knee pain before. They don’t understand how they could be developing arthritis. Many associate the onset of their pain with an injury, and in fact may have sustained an injury at work, so it’s hard to understand how that meniscus was already in a damaged or degenerated state. It’s a big dilemma with regard to workers’ compensation, because even though most insurers will accept the tear as a “compensable injury,” they won’t accept the ensuing symptoms of arthritis as part of the injury. It’s complicated.

 

WHAT DO MENISCUS CARTILAGES AND PANTS HAVE IN COMMON?

So if your meniscus is so tough, how did it tear so easily? I like to compare the meniscus to a pair of pants. When you buy a new pair of pants, the only way they tear is to catch them on something and rip them. That’s like the meniscus in a twenty-year-old. A twenty-year-old has to have an injury in order to tear their meniscus. They have to twist it playing soccer, or get hit from the side in a football game. They’re often associated with anterior cruciate ligament tears. But as the pants age, the seams begin wearing out. They get threadbare. Every day, you get in and out of chairs the same way. But one day you stand up from that chair, and the seam tears apart. And you can’t sew that seam back like it was when the pants were brand new because the fabric is all worn out. Sadly, unlike your pants, we can’t just go get a new meniscus.

 

 SO WHAT’S NEXT?

So what can we do with that worn out, torn meniscus? Well first of all, we can live with it. There’s no rule that says if you tear your old, beat up meniscus, you must have an operation on it. That’s right. Most people think that if they have a torn meniscus, it needs a surgery, just like the professional ball players. This is not the case. Sometimes if you can modify some aggravating activities like squatting, lunging, and running, you can get along with that tear. What did we do with degenerative tears before MRI scans and knee arthroscopy? People lived with aching knees and figured out how to modify the way they did things in order to decrease their pain. Of course, we’re much less tolerant of pain now, because we think there’s always a treatment…an operation.

 

NO SURGERY?

But wait. Even before that operation, there are other things to do. Sometimes all it takes is some relief of the inflammation. Remember, arthritis is the combination of the wearing out of cartilage (in the knee that’s the surface cartilage and the meniscus cartilages) and the inflammation it stirs up. A lot of your pain comes from the inflammation and by decreasing it, you just might be able to avoid surgery and get along with your aging knee!

Let me tell you a personal experience. When my mom was 60 years old, she came to see me as a patient! Yes, I made her make an appointment. Based on her symptoms: pain on the inside of her knee and a little swelling, I figured she was developing a little arthritis and maybe she had a degenerative meniscus tear. At the time she was doing a lot of yoga, and her program included a lot of squatting. I guess she didn’t read my Do Not Do Squats! blog! I told her to stop doing the squats. An X-ray was normal, and later an MRI demonstrated a torn meniscus…a degenerative meniscus tear. Because her knee kept swelling despite use of anti-inflammatories like Advil and Aleve, I gave her a cortisone injection. Her pain and swelling completely resolved. She also stopped all squatting exercises. I didn’t see her as a patient (we did see each other for other mother/daughter reasons) again until she was 81! I recently X-rayed her knee again. Her arthritis had advanced a little, and she had a puffy knee. I gave her another cortisone injection and then a Synvisc (hyaluronic acid) injection, and haven’t heard a peep from of her for over a year (other than the usual mother/daughter peeping). She and my dad are walkers, ballroom dancers and they travel all over the world! But they don’t squat because their orthopedic surgeon-daughter says not to!

 

WHAT ABOUT SURGERY?

Suffice it to say to stay out of the operating room unless it’s absolutely necessary. At 60 years of age, had my mom continued to complain of pain, despite conservative treatment, I probably would have recommended a knee arthroscopy in order to remove the offending cartilage. I would have counseled her that the surgery would not “cure” the meniscus. The cartilage would not be repaired, and nothing could be put back in its place. We could only remove part or all of the meniscus, depending on how much of it was torn. We might clean up some of the surface cartilage. Maybe remove loose fragments of cartilage floating around in her knee. But the arthritis could not be cured. It would persist, and over time it would progressively worsen. And someday she might need to have a total knee replacement.

I would have also told her that there were potential risks and complications of that surgery, like blood clots and infections, but that complications were very rare. The main thing I would have told her was that the surgery might not help her at all, and that occasionally people resume having the same pain within a short period of time. But I would have focused on the fact that most people actually do pretty well for quite a while. Knee arthroscopy is just a treatment for degenerative meniscus tears. It’s just one of the things we can do for a patient with a tear if it doesn’t get better with non-operative treatment. And it’s a good option when all else fails.

And so I say “baloney” to the experts who say that the operation “doesn’t work.” They use semantics to try to convince insurance companies not to pay for knee arthroscopy. Many of them are retired orthopedic surgeons, who don’t have a dog in the hunt anymore. Some are academicians, who might not be following these patients for long periods of time. Many of my patients have grown old with me. And some of these surgeons espouse this rhetoric, but in their practice, they continue to scope knees with degenerative meniscus tears! Why? Because it helps with the pain. Of course this surgery doesn’t “work.” That means, it doesn’t “cure” the condition of arthritis. But it helps, just like anti-inflammatories, and cortisone and hyaluronic acid injections help. It helps, just like hot and cold compresses, and knee sleeves and walking aides help. It helps, like rest and avoidance of squats and high impact exercises help. Once you have a degenerative meniscus tear, there is NO cure for what ails you. There is only treatment. And then there is total knee replacement.

It is incumbent upon your orthopedic surgeon to inform you of the difference between your degenerative meniscus tear and a college quarterback’s meniscus tear, so that you’re not disappointed when after the surgery, you aren’t exactly like you were the day before the onset of your pain. Your expectations have to be different. I often see patients for a second opinion, after they failed to achieve their expected goals following a meniscectomy for a degenerative meniscus tear. Their expectation was that the surgery would “cure” their condition…the condition of a degenerative meniscus tear, perhaps in the same way a meniscectomy would cure a 20-year-old football player, allowing him to return to the game in a few months or by the next season.

Of course, anyone who follows football or basketball knows that surgery after a torn meniscus doesn’t always cure those athletes either. You only hear about the ones who come back, but you never hear about the ones who don’t. Let’s face it. Your meniscus is a very important structure, and the loss of it is devastating no matter when a tear occurs.

 

MORE UNDERSTANDING

Let’s mention that football player briefly, if not to demonstrate how your meniscus tear is different from his, but to clarify some long term similarities as well. In a 20-year-old, you are dealing with a fresh and youthful knee. Other than the strain of the injury on muscles, tendons, cartilage and bone, that knee is otherwise normal. Once those supportive structures heal, even though the meniscus is torn, removed or repaired, the knee is kind of back to normal. The player returns to sport whenever his knee feels good or his orthopedic surgeon releases him to play.

The knee of a 50-year-old with a degenerative meniscus tear is not that otherwise normal knee. It is a knee which has been damaged repetitively by over forty-plus years of high impact exercise, squats, standing, taking stairs and gravity and weight and living, not to mention a gene pool of who-knows-what in terms of predisposition to arthritis, deformity, gait abnormality and inflammation! Your expectation for returning to what was hurting you when you started having knee pain should be different now.

Frankly, the twenty-year-old football player’s expectation should be changed as well. Once having torn that meniscus, he will likely develop arthritis within a ten-year period of time. I wish they would stop playing sports, doing squats and participating in high impact exercises immediately. We should be giving our athletes that information and asking them to consider that option. I do! And every once in a while, they listen. They get it. But that’s usually in athletes who are done with participation in interscholastic and collegiate level sports. Most sports medicine docs don’t even try to dissuade young athletes from returning to sports, because it falls on deaf ears. It often falls on the deaf ears of forty-year-old weekend warriors too!

But sadly, a large number of high-level athletes find it impossible to ever return to sports, either because the knee cannot sustain the beating, once it recovers from the injury and surgery, or because something is missing upstairs. They lack the pain tolerance or the will to persevere. And it’s not because they’re wimps. It’s because in many there is a natural protective intuition. “This is not good for me! Stop!”

But more often than not, they don’t stop. You see them out there.  The J.J. Watts of the world. There is some element of pain tolerance, work ethic, adrenaline, hardheadedness and love of the game that keeps them coming back. There’s the money and the glory too, but that’s not all of it because I see weekend softball players like this. And there’s no money in that. Just a little glory and camaraderie. So we make our choices, and we will suffer. Because there is no question about this. You will eventually suffer if you have a meniscus tear.

 

TREATMENT OF DEGENERATIVE MENISCUS TEARS

Other than the patient who is a candidate for arthroscopy and meniscectomy, the treatment for degenerative meniscus tears is the same as the treatment of arthritis. Because that’s what degenerative meniscus tears are: a sign…a symptom…a part of having arthritis. And when you understand this, you can begin to understand what you and I need to do!

So who’s a candidate for knee arthroscopy, remembering that this is only a treatment and not a cure for the degenerative meniscus tear and some early degrees of arthritis? The people who are candidates for arthroscopic meniscectomies include:

Relatively young patients. And I say “relative” because there are forty-year-olds and there are forty-year-olds, and so on and so forth. Occasionally a seventy-year-old shows up with a degenerative meniscus tear which he sustained while exercising and it has locked up his knee! But truthfully, age is a factor. Allow your doctor to tell you that, even though you don’t want to hear it.

-Patients with fairly normal looking X-rays. There are early X-ray signs of arthritis, like little spurs on the edges of the bone or narrowing of the space between the femur and the tibia. As those X-ray findings become more apparent (large spurs which appear to flatten and spread the bone, or bone-on-bone arthritis) the likelihood that you will benefit from surgery lessens because these are just signs that the arthritis is advanced and the meniscus tear is not your only painful problem.

-Patients who have a fairly normal MRI. The MRI is a much more sensitive test and will show not only meniscus tears but also damage to the articular cartilage. Often a patient with a relatively normal looking knee on an X-ray will have MRI evidence of advanced arthritic changes.

-Patients who are active in their leisure time as well as in the workplace, and for whatever reason, cannot modify their activities. This can be particularly difficult for folks in their fifties and sixties, who are manual laborers or stand all day at their job. This is not a time when they can easily modify their job description, and it’s too early to retire.

Patients who have failed a course of conservative treatment, and rest, anti-inflammatories, physical therapy, cortisone or hyaluronic acid injections have failed to result in improvement.

The very elderly, those with advanced arthritic changes on X-ray or MRI, those who can modify their activities to the point where the knee no longer hurts, or those who have not yet undergone a course of conservative treatment should consider alternatives to knee arthroscopy. It’s rare for me to scope the knee of a 70-year-old or someone with advanced arthritis. I wouldn’t scope the knee of someone who was no longer complaining of pain after they stopped doing squats or had improvement in their pain after a course of P.T., taking some Aleve or having a cortisone injection. And frankly, this is a large percentage of the folks who come to see me with MRIs demonstrating a degenerative meniscus tear!

 

INSTEAD OF SURGERY

The first line of treatment for degenerative meniscus tears is to try to stop doing the activity or activities which may have caused or exacerbated the pain. Stop running. Stop squatting. Stop playing ball. See if you can have a light duty job modification temporarily or even permanently. Remember, meniscus tears don’t heal, and the most we can do for them surgically is to remove them. You will still have the arthritis.

Meniscus tears cause inflammation or swelling in the knee. So the next line of treatment is to try to decrease inflammation. If there are no contraindications to non-steroidal anti-inflammatories (NSAIDs), then you can try a prescription level NSAID (like meloxicam or Celebrex), or an over-the-counter NSAID (Advil, Aleve). These medications have the potential for side effects, so we don’t want to keep you on them indefinitely, but it’s certainly worth a try for a month or so. If you have liver or kidney disease, stomach ulcers or you’re taking a blood thinner, you should not take prescription or over-the-counter NSAIDs.

Cortisone injections are also an option. There are very few side effects of cortisone injections. Nevertheless, it’s a shot, and many patients don’t like the sharp, pointy object. But if your doctor uses a local anesthetic, and does the injection in a gentle, caring way, it shouldn’t be too terribly painful. Often they result in tremendous pain relief, and can be a part of the long-term treatment for arthritic knees. But for the person suffering from a degenerative meniscus tear, they can also provide temporary relief of pain in addition to giving the doctor an idea as to whether or not your pain is coming from the inside of your knee. There is always bad press out there about cortisone. It can cause significant side effects in people who take them for a long time. There are studies showing that they can be associated with damage to articular cartilage. This has yet to demonstrate clinical significance, and anecdotally, we can all tell you that cortisone helps, and clinically doesn’t seem to cause rapid deterioration of the already deteriorated knee! There are many choices for those of us who are too young or too overweight to have total knee replacements!

Physical therapy can be beneficial. As we age our muscles atrophy and weaken, and our balance deteriorates. These factors can affect your ability to recover from a degenerative meniscus tear. But it’s not a cure, and in some cases, patients have increased pain after PT!

Arthritic knees can also benefit from injections of hyaluronic acid (HA). Synvisc, Euflexxa, and Orthovisc are a few brand names. The reasons why these injections benefit arthritic knees are complex, and there are many theories regarding this issue. But suffice it to say, there are many patients (including some of my own family members) who are benefiting from these injections, which can be given every six months. Most skilled orthopedic surgeons can give these injections in their office, and without the use of ultrasound guidance, which can add to the cost.

There is a lot of controversy regarding cortisone and hyaluronic acid injections. They are not cheap, and insurers (including Medicare) are becoming more and more reluctant to authorize their use. But in some areas where insurers opted not to pay for HA injections, the number of total joint replacements went up an amazing 500%! Given no other options, patients in pain had to turn to joint replacement earlier than they might ordinarily have done when the injections were an option. Suffice it to say that in the hands of thousands of orthopedic surgeons around the country…and frankly, the world…cortisone and hyaluronic acid injections remain an extremely viable option for those suffering from arthritis.

But for the average patient suffering from a simple degenerative meniscus tear, with little arthritic changes on X-ray or MRI, hyaluronic acid injections might not be the mainstay of treatment. They would be indicated for those with more advanced arthritic changes in addition to the tear.

 

KNEE ARTHROSCOPY

And when all else fails, and you continue to experience pain, swelling or locking…there is the knee arthroscopy. It should probably not be the first thing considered when that MRI demonstrates a degenerative tear. The conservative treatment protocol discussed above should at least be offered and discussed as an option. You are not the same as that 20-year-old football player. Knee arthroscopy is the first option for him! He will fail to improve with anti-inflammatories. He will not get better with P.T. and an injection will be ineffective. We will scope his knee and repair or remove the torn cartilage. He’ll get arthritis in that knee eventually, but he does not have it at the time of his injury.

Knee arthroscopy can be very effective for some patients who fail to improve with a conservative course of treatment. It’s not a complicated operation, and you’re not likely to experience a complication. Sure, you’ll have a grand list of potential complications, which can seem daunting when you read it. You could even die from an infection or a blood clot. Blood clots do occasionally occur following knee arthroscopy, but they’re rare, and if caught early, can be treated with blood thinners, to avoid a potentially deadly pulmonary embolism. Infections almost never occur. Persistent swelling and stiffness can result, more from the condition itself than from the surgery. And last but not least…persistent pain! Occasionally, a patient gets NO relief from the surgery at all. This is extremely rare, and not likely if we select the right patients for surgery. If a patient has advanced arthritis, they are unlikely to get long term benefit from the operation, and six months later, might find that their knee is hurting just as much as ever.

Bottom line. It’s an operation. You have to undergo anesthesia. There are potential complications and if you’re the one who has them, you won’t be happy. Which is why, when you decide to sign up for that operation…and frankly, any elective operation…you should make sure you’ve done everything you and your doctor decided on to avoid that operation. Then you can go into that operation knowing that the operation was the best alternative for you at that time.

The good news! If you’re the right patient for a knee arthroscopy, you will get some pain relief and have a good result, with little potential for complications!

Remember, NSAIDs, P.T., injections and arthroscopy are not a “cure” for the arthritis or the meniscus tear. They’re a treatment. We can’t give you back your twenty-year-old knee, and eventually that arthritis is going to catch up with you no matter what. But hopefully with these treatment options, we at least hold off on total knee replacement until you get a little older.

 

TOTAL KNEE REPLACEMENT

When all else fails, and you have advanced arthritis in your knee, which has failed to improve with use of medications, injections, activity modifications and yes, even knee arthroscopy, then you might be a candidate for total knee replacement.

And just for the record…why is it important to hold off on that total knee replacement? People ask me this all the time, because they see more and more neighbors, friends and family members having successful knee replacements at younger and younger ages. Knee replacements are the “cure” for knee arthritis. The problem is that knee replacements don’t last forever. And once they loosen or wear out, they have to be revised. Revision surgery is more complicated, and more likely to result in complications like infection, or fracture, pain and stiffness.  Frankly, the objective is for the original knee replacement to outlive you. Sorry to say it in that course way, but that’s the idea. You don’t want to have to have a revision. So if an average knee replacement lasts around 20 years, you don’t want to be thinking about revision when you’re 90. Or even 80. So it’s ideal to wait to get your knee replaced until your well into your sixties.

Many of you and your docs will say, “Why wait until my quality of life is so poor that I’m miserable?” Because you don’t want a revision.

Additionally, young patients simply aren’t as satisfied with their total knee replacements as older patients. The reasons for that are complex, but take my word for it. If you have a replacement when you’re 50, you just won’t be as happy with it as when you’re 65.

And here’s one more thing. Many of you think that when you have your knee replaced you can just go out and play ball, ski, run, squat and do anything you were doing before the knee went bad. And some of your surgeons will tell you that’s fine. Since I don’t do total joints, it’s easy for me to tell you that you shouldn’t do those things. Knee replacement is a pain relieving operation. It’s not a basketball-enabling operation. It’s not a mogul-skiing-enabling operation. And the more stuff you do to tear it up, the faster it will wear out and get you to…a revision…which we don’t want. So when you start thinking about a total knee replacement, don’t think of it as something which you need to do early so you can get back to playing sports. Think golf, walking, swimming, cycling…maybe doubles tennis with other old folks.

I think I’ve said just about everything there is to say about degenerative meniscus tear, and if you made it this far…then you know what to do!

53 comments
  1. Judy Miller

    When your doctor tells you that you have arthritis it is like learning there’s no Santa Claus. How could you possibly have arthritis at the young age of 70? No way, not me!! It iseems like a right of passage to old age. What do I do? I increased my walking and joined a gym with no squats or high impact knee activities..I will win this battle! I recently went to Italy and walked up thousands of steps with no problems…..

  2. Vicky

    VERY, VERY, VERY COMPREHENSIVE ARTICLE. At first I thought I was learning too much about knee problems, but then I realized I was learning things I didn’t know…..and also things I NEEDED to know as an 82 year old woman with 82 year old knees. NO SQUATS for sure! More WALKING for sure! ……and root-beer floats with vanilla ice cream?……..well,only once a while.

  3. Laura Van Rossum

    Awesome article, Barbara! I had meniscus surgery in April. It worked amazingly for me, but I also can see what you are saying about the knee is not “cured”. It’s not as strong, etc but, thankfully, for me, it stopped the pain. Since then I have lost 22 lbs. so that helped also. I walk 10,000-15,000 steps a day depending on my work schedule. I pray the old arthritis is gonna take his time coming my way!

    1. Barbara

      Laura,
      Yes, that surgery is very successful in many people, but should not always be the go-to treatment in the face of a degenerative meniscus tear. As I said in the article, I disagree with many orthopedic surgeons and insurance companies, who deny patients this valuable treatment option when their pain does not improve with conservative treatment. I’m so glad you have had successful relief of your pain. Remember…avoid squats, deep knee bends and lunges, as well as high impact exercise. Your goal now is to hang on to your own knee as long as possible! Thanks for following my blog!

  4. Jana

    I injured my knee (large dog ran into the side of it) when I was 40. I was a runner and 5x a week aerobic and step exerciser at the time. the surgeon I saw diagnosed severe chondromalacia and said no more vigorous exercising or running. Fast forward 7 years and without the exercising and with a painful knee, I’d gained 40 lbs, lost endurance and muscle tone and due to several falls on my knees, had severe knee swelling and pain and could barely walk. I saw a new surgeon who had me in the OR in 2 days, removed the folded over torn meniscus flap in the knee I’d injured 7 yrs prior, plus all the floating cartilage bits and pieces. He did the other knee 6 mos later. Those 2 surgeries brought rapid pain relief and decrease of swelling and helped me exercise to lose a lot of that weight. That was an additional 7 yrs ago and although I know partial and TKA is in my future, I’ll forever be grateful to the 2nd surgeon for buying me so many more mobile and less painful years.

  5. Daniel Therrien

    Fantastic Article! I am a 44 years old acrobatic dancer (yes you read that right) doing musicals here in Germany. As you can imagine my job is very hard on the knees. I also coach gymnastics and hit the weight room pretty hard (including deep squats which I will stop doing TODAY after reading this!)

    I tore my meniscus 5 years ago doing ‘Cats’. It is a raked stage and I landed straight legged out of a tumbling pass. Tore my ACL (minor) and ripped the side of my meniscus, small tear. Went to 6 doctors (best in Austria/Germany) and they all recommended surgery. I was weary and decided R&R was a better option. I made a full recovery and have done shows for 5 years until I just bent down in the show last month and my knee popped. -sigh- so here starts the trouble. Went to the doctor and he told me (almost verbatim) what your article states. It is a degenerative tear from my last tear. Also I busted some kind of sac and there was water looking stuff in my bones. Here was the diagnosis:
    -The cruciate ligaments are intact. It shows a low joint effusion. The posterior horn of the outer meniscus shows a vertical crack. Edematous swelling in the posterior horn of the inner meniscus without circumscribed tear. Ruptured Baker’s cyst. Cartilaginous lesions in the lateral compartment with bone edema in the lateral tibial plateau-

    It is a The problem is I am contracted for shows through 2020! My pain is minor, it is just uncomfortable and tightness at the back of my knee. An unstable knee isn’t what you want to have when you are flying about and landing on an 8 show a week basis.

    My question would be what would you recommend to make my career last as long as it can? I have another Doctor appointment next week, but found your article so WELL written and understanding of exactly what I am going through, I thought it would be great to have your opinion as well. I am in Germany and EVERYTHING is free, so any option is within my grasp. No one has recommended surgery yet (like they did when I was in my 30’s), but I have to keep working. I really don’t know what else to do. Would you recommend the cortisone shot? Like I said, I’m not in pain, I just want my knee to be stable and to be able to straiten it without discomfort.

    1. Barbara

      Daniel,
      This is disappointing for you, and hard for me to hear…even though I hear it every day. You’re in somewhat of a bind, in that your physical activity is part of your job, and not some voluntary exercise you can stop and trade for something else. So, having had the same injury as you, and expecting one of these days to have the same problem as you, this is what I would recommend. Limit your extreme practicing as much as you can. Do the more low impact, less squatting kind of practices, and only do the jumping-flying-through-the-air stuff when you absolutely must. And certainly do none of those things at any other time! Baby your knee as much as you can. Consider occasional cortisone injections, especially prior to performing, like if you’re going on a tour. Try viscosupplementation (hyaluronic acid injections). In countries with universal health care, they might not provide these injections, because they will use false studies (as our insurers and the government do here in the US) to keep you from access to a treatment which is very beneficial to MOST patients, including many of my blood relatives, and my horse, with whom I currently compete. So I wouldn’t recommend a treatment to you that I wouldn’t do on a member of my family, or myself, or my horse for that matter. But you might have to pay for it. I would be curious to know this information from you. Then you can also try other injections (biolologics) such as platelet rich plasma, stem cell , or exosomes. In the US, patients all have to pay for these themselves. Read my post called Decrease Pain from Arthritis to see if there are any non medical, non injection and non surgical things you could do, like wear a brace. These things I mention in the post do help. Last, but not least, at your age (being relatively young and not close to the age where you might take a total knee replacement), sometimes going in there arthroscopically and “cleaning things out,” helps. It’s only temporary, but when you’re young, this is often an alternative, and might get you to 2020!

      Do you live in Germany? You might be my first German reader. I have lots of readers from England and former colonies (English speaking countries), but not yet from Germany. Please forward my blog to friends and family, as I would love to get a German following. I’m currently studying German on Duolingo, und ich spreche ein bisschen Deutsch! I probably didn’t spell all of that right, and I don’t have German spell check on my computer, like I do on my cell phone. Having lots of trouble with gender in German. The sad thing is, I probably won’t EVER get it down. Very difficult stuff. If you ARE German, you write English very well! Auf Wiedersehen!

  6. Diane

    I’d like to be able to give my mom some advice – and perhaps a reality check. She has a complicated meniscus tear – and she’s 97. She also has arthritis and severe osteoporosis. Her doctor, an orthopedic surgeon, has given her a shot in the knee, advised her to take over-the-counter pain medication, and to walk – or she won’t walk again. She’s been using a scooter and walking minimally with her walker. She thinks there is something out there that should cure her. What would you advise/tell a 97 year-old? Thank you.

    1. Barbara

      Wow, this is a complicated situation, which I haven’t seen too often, simply because there aren’t that many people alive with this condition. She most certainly has a degenerative meniscus tear, and I would have to say that I would never do a knee scope on a 94 y/o. Once, I scheduled a carpal tunnel release on a 90ish woman, who was unable to button her shirt because her hand was so weak and numb from compression of that nerve in the wrist. Well, she passed away the night before her surgery! Can you imagine, if her time was the night AFTER her surgery! I can’t even think of a circumstance under which I would do an “elective” operation on a person that age. Sure, we do emergency surgery, or urgent surgery on people that age all the time. If she broke her hip, she would have a hip replacement. And in fact we do total hip replacements on fairly old individuals, simply because the rehabilitation is so easy. But total knees are a whole different animal. The pain is greater and the rehab more strenuous, and most elderly people simply can’t do it. Additionally, in the very elderly, there are some potential untoward effects of anesthesia. Sometimes extreme, intolerable pain is due to a stress fracture or stress reaction, and it is necessary to stay off the leg, in other words, temporarily get in a wheelchair. I know we don’t like for people to do this, because sometimes they never get back out of the wheelchair, but at 94…how bad would that be? It’s terrible to be that age and have pain. Usually SEVERE pain is not due to a meniscus tear, because by that time, the meniscus has been squished for a long time. Continue to try cortisone injections, rest, heat, and perhaps viscosupplementation, “the gel shots.” But first make sure there is not some other underlying cause of her pain.

  7. Gail

    Thank you for such a great article! I just turned 50 and can barely walk – My right knee has a degenerative meniscal tear. Two years ago I started feeling some pain on the medial side of the right knee which progressed to the point where I had an MRI showing the tear. The right leg and knee are very week. Since that time, I have managed to bang that knee twice, most recently two weeks ago, when it locked on me and I hit a table straight on with that knee. I had an X-Ray of the knee which was fine. However, the pain is not allowing me to walk. I saw an orthopedic surgeon in an urgent care who just told me to take NSAIDS. I was also given Voltaren cream which works for 1-2 hours to help take the edge off the pain. Not walking has caused me to quickly gain 10 lbs. I started thin so I am 135 lbs now but want to get back to being active, thin and pain-free. I have been doing PT but I can’t do much exercise. The PT mostly consists of nerve stimulation and massage. I am concerned the massage may cause further damage. What other options do I have? Will I ever be pain free? Will I regain strength in this knee? I want to be able to walk and exercise.

    1. Barbara

      Gail,
      Most of what I have to say about degenerative meniscus tears is in that treatise. Injuries can certainly set you back, because your knee is not a resilient to injury as it was when you were twenty. So have some patience with it. If you have exhausted a conservative course of treatment, you may eventually need a meniscectomy, as I mentioned in my post. I do believe you will eventually be able to exercise. I can’t tell you that you’ll be able to walk long distances, with or without a meniscectomy. Cycling and swimming are better for your knee. Eventually you may require total knee arthroplasty, and I can’t tell you how far away from that you are. I can say, that you are too young to expect to have a good long term outcome from a total knee replacement. As I said in the blog post, younger patients do not have as good an outcome. No reasonable orthopedic surgeon would perform a total knee replacement on a patient with a degenerative meniscus repair who had sudden increase in pain after a blunt injury. That would not be the proper indication for the surgery. You would have to have advanced degenerative changes and have gotten over the injury. But my assumption is that you don’t have advanced arthritis changes in your knee. Continue the conservative course of treatment your doc recommends. Massage therapy is unlikely to “harm” you, even though it could “hurt.”

  8. Carol Jabs

    This is a great article of information. I am a workers comp “victim” and needed this cause the Drs have beat around bush and never talked to me. Now I know what to ask, in their language, so I can get the help and treatment I need for my meniscus tears. Thank u

  9. Jim Maher

    As a 68 year old physician who has a goal of walking around the world before I am 75 (I have 10,000 miles in and try to do a minimum of 5 a day) I found this very informative and helpful. I have a small posterior tear and have had pain for 3 months, have used minimal meds but have found I can’t kneel and have pain with weight bearing about 80% of the time. X rays normal and other than mild chondromalacia patellae the MRI shows only the tear. I’m not sure I am ready to use crutches or a walker for 6 weeks while healing from a repair, but also am having trouble doing patient care with the pain, unable to kneel to take a blood pressure on a house call, etc. will be talking to my ortho soon (MRI done this AM). Thanks for all the info– will be needing to digest and prioritize, I guess.

    1. Barbara

      You’re absolutely right. You will need to prioritize. You’re walking a lot, and as you recall from my blog post, it’s really not natural for you to walk that much every day, and in a natural world you probably wouldn’t live this long anyway! Some of the things you must consider are the following:
      1) Is one of your priorities to avoid a total knee replacement? If so, then you should back off a little on the walking, maybe ride a bicycle part of the way around the world. And if you think that having a total knee replacement will enable you to walk more, think again. A recent study demonstrated the obvious. People who increase their activities after a total knee replacements, had to undergo revisions sooner than those who didn’t increase their activity after a knee replacement. It’s always best to avoid surgery. And by the way, you would not have a “repair.” The torn portion of your meniscus would simply be removed. As we get older, we are no longer candidates for repair, as the meniscus doesn’t have a good blood supply, even when we’re 20, nevermind when we’re 68.
      2) Is one of your goals to be able to continue to work? If so, back off on the walking. You don’t really have a sedentary job. If you’re like me, you’re up and down, standing while you dictate a chart or look at your computer, make calls, etc., and sitting a little while you interview a patient. Standing to examine them. Walking around the office or the hospital, etc. Yes, you’ll be in less pain after a total knee replacement, but there’s no guarantee that you’ll be in less pain after a knee scope.
      3) Is your goal to be able to kneel. Well, don’t make that a goal. Sit in a chair to take blood pressures. Don’t kneel or squat. Your femoral condyle tugs on the posterior third of the meniscus when you kneel or squat, and that’s where 95% of degenerative tears occur. And you won’t be able to kneel after a knee replacement. The plastic patellar button won’t hold up to it, and the front of the knee is forever sensitive following that operation. So get in the habit of not kneeling, and your knee will thank you for it.
      4) Is your goal to keep walking “around the world?” Then make that your goal, and stop the other activities which are aggravating your knee.

      You DO have to prioritize. Make the choices. Your knee won’t allow you to have it all at this point in your life. I’ll make a small bet with you. Stop squatting, kneeling, don’t do any deep knee bends for exercise, avoid stair climbing as much as possible, use handicap toilets, so your knees don’t have to bend as far, use your hands to help push you in and out of chairs and couches…and I’ll bet you can keep walking and working, and maybe avoid surgery altogether.

  10. Jennifer

    I loved reading your article. Thank you so much. My husband is 49 and has worked in a factory on concrete (22 years) walking several miles per day in steel toe shoes. His knee started bothering him about a month ago after vacation. He’s not worked since October 19th. Orthopedic doctor prescribed Celebrex (and he ices several times per day) but it has not helped. Had scope about 8 years ago so doctor told us surgery only had about 50/50 chance of helping. MRI done Thursday and we go back tomorrow to discuss options. Problem is he cannot alter his working conditions but cannot work in the amount of pain he feels when walking. Will probably try lubricating injections next. What are options if injections or cortisone don’t work? Would they do surgery and remove meniscus? Thanks! I’m going to ready your other article about squats. I’m 47 and recently joined a gym. I mainly just walk with a friend but now want to be careful and avoid squats or things that could cause problems for myself. Thanks again for providing such a great article!

    1. Barbara

      Glad you’re getting something out of my blog. Sorry to hear about your husband. If you read that entire article, you will know that he fits into that grey zone category where decision-making is difficult. He’s probably got somewhat advanced degenerative changes in his knee. Second surgeries are often of little benefit, unless there is a new condition. Nevertheless, he is young, and way to young to throw in the towel. His situation is complicated by his work. He must strive to diminish the amount of walking that he does. If this is impossible, he must not be doing any exercise or participating in any sports which also stress his knees. He should be swimming or riding a bike. He should try the “gel shots.” They are very effective. If you have a lot of cash sitting around, burning a hole in your pockets, he could also try PRP or stem cell injections. They work too, but insurance doesn’t cover them, so you have to pay cash for them. When all else fails, because he is young, a second arthroscopy might be indicated. But not if he has a lot of bone edema on his MRI. Then he’s got to rest. No matter what happens, he needs to see if there’s any way he can eventually work himself into a less physical job. I hope this information helps. Have a happy Thanksgiving! And thanks for reading my blog. Please pass it on to friends and family!

  11. Jennifer

    Thank you for this article — I learned SO much!
    I’m a 54-year old professional actor/dancer/director/choreographer. A year and a half ago, I suffered a broken ankle, torn meniscus and chipped tooth in rehearsals for a show I was in. I had 2 surgeries on the ankle and once the ankle “recovered” (PT, etc), the torn meniscus was discovered (it had been overlooked by the more obvious ankle break). I had arthroscopic surgery on the meniscus last May. Was in PT/Work Conditioning — doing LOTS of squats (wish I had read this before!). I still have a lot of swelling in the knee and discomfort. PT has released me, saying I’ve hit a plateau. Now, I’m glad they did – as they obviously were not moving me in the direction that is best for my injury. But I’m left with not knowing where to go from here. Am I just S.O.L.? My ortho surgeon hasn’t released me to return to work – a problem with insurance folks, because they don’t “get” the demands of my job as an actor/dancer. He has me restricted to no squats, no ladders/steps. He offered (not sure it’d be covered) cortisone shots. Is this my best option – but long term?? I’d so appreciate your insight. Thank you!

    1. Barbara

      Jennifer,
      Sorry for the late response. Just busy, and my blog took a back burner.
      You likely have some degenerative changes, as most people with meniscus tears over the age of forty do. It doesn’t matter that you had an injury. Injuries can precipitate the presentation of those arthritic changes. But at this point…it’s a moot point, because you have this meniscus tear and there’s no going back to your 20-year-old, or even 40-year-old knee. He’s right about squats. Even if your knee started feeling better, you would still likely have problems with extremes of exercise and work (as is inherent in dancing). I do think your best options at this point, besides activity modifications, are the occasional use of anti-inflammatories (if you can take them), and injections (cortisone, hyaluronic acid, platelet rich plasma, stem cell). These things work, and there’s really no downside to using them. Ignore what you read. THEY WORK! And what choice do you have. A second surgery won’t help. Eventually you will likely have a total knee replacement, but you want to put that off for as long as possible. Get old before you have that surgery, if you can wait.

  12. Jon

    I would welcome any advice you can give – I am 58 years old 6’4” 18 stone and played quite a bit of social tennis. Left knee gone a bit wobbly recently, probably because of tennis. MRI said the I have “unstable – parrot beak tear of the posterior horn of the medial meniscus adjacent to the posterior root, with a horizontal cleavage tear extending into the posterior horn”. Walking is fine but I can feel there is an ache there all the time, whcih does not go away. We put a steroid injection in there but that seems to have done nothing. Dilema now is whether to remove the tear surgically and maybe I will then be able to walk without any pain at all (and hopefully even go back to tennis), or whether I am kidding myself and I am going to have to live with a painful knee even if I have surgery ???

    1. Barbara

      As I said in that post, there is no guarantee on any of this, other than the fact that your knee will gradually get worse over time, as a progression of the disease process. So you will likely live with some level of discomfort, and that definition depends on your tolerance for it. Root tears are complicated because they essentially destabilize the meniscus, so we often have to remove the entire meniscus. Not always though. I just did one yesterday, in which I just removed a part of the meniscus, until I got to a point where the cartilage was stable. These patients usually do well. I had operated on his other knee, with a similar situation 5 years ago, so he wanted me to scope this one when he failed to achieve adequate pain relief with injections and activity modifications. At 64, there would be little value to repairing a root tear. In younger patients that’s what we do. But you likely already have a lot of degenerative changes in your knee. No matter what course you take, you must modify activities: no squats, etc. Avoid stairs as a matter of course. No high impact exercise. You know the routine. Expect to have a little discomfort when you get out of a chair. Look for my blog called “10 Tips to Decrease Knee Arthritis Pain” or something like that. Merry Christmas!

    1. Barbara

      Ossama,
      Glad you got some good info from my post regarding meniscus tears. It’s complicated, and the more you understand, the more you are prepared to help your doc make a plan for YOU. So…stem cells. Okay, we’re using them pretty much in the same way we use cortisone or hyaluronic acid (gel/viscosupplimentation) injections: for pain relief. They’re like your body’s own super-charged anti-inflammatories, but no one really knows about their potential for healing or repairing. Somethings we’re looking into are liposomes and exosomes, which might have more reparative potential. The problem for older patients with degenerative meniscus tears, is that even if you repair the meniscus, the surrounding articular cartilage is shot. Additionally, at this time there is no such thing as “recreation” of the meniscus. In a younger patient, with normal articular cartilage, and a meniscus tear, the PRP, stem cells, etc., could be used to assist the repair. It might be injected at the meniscocapsular junction, where the repair is performed. Stem cells can be harvested at the time of a meniscectomy, and injected in the knee, perhaps hoping for diminished inflammation, and a prayer for reparation.

  13. Tammi P.

    Your article was very inforative and brings up questions I have regarding my right knee chronic pain. In Feb 2017 I had a painful pop in my right knee. Did a MRI and had a torn meniscal tear posterior horn. Mar 2017 had arthroscopic surgery to repair. Still had pain post-op. In speacking with my surgeon he felt it best to do a patella-femoral replacement. I begged for a total knee but he felt it best for the parcial. Dec 2017 the patella-femoral surgery was performed. 2 months after my surgery and continuing with my painful PT, I kept telling my surgeon I had sever pain throughout my right knee and pressure in the back of my knee. My surgeon kept telling me my knee was recovering and to give it a year. All throughout 2018 I had sever pain and pisterior pressure in my knee making it very difficult to walk or stand and wasn’t able to returned back to my job as a nurse in the OR. I tried steroids and the gel injections still no relielf. In July 2018 I even had a second opinon and the xray showed all my hardware in good standing but I told the doctor I had sever pain. He told me to give it a year. (His way of telling me he didn’t want to help me). So after dealing with pain since my Dec 2017, in Nov 2018 I seeked a 3rd orthopedic surgeon opinion and he ordered an MRI “MARs” and I was diagnosed with a Complex Posterior Horn Meiscus Tear. So a whole year I was walking around with a menuscus tear causing sevier pain. Dec 13, 2018 had another Arthroscopic surgery to repair the tear. Surgery went great but once again I felt presume posterior of my knee. Two weeks after surgery I felt a pop in my knee with sever pain. Ugggggg. I called my surgeon and left a message but no return calls as of yet. I’m back to sevier pain and can’t walk without aggravating it. Today I have my first post-op surgery follow up and will tell him about my pop and pain.

    Sorry for the long note but wanted you to have the full background on my knee. My question to you is this. Is it time I get a total knee revision? I’m 50 yrs old and in your article you suggest not to go this route at my age. I believe my meniscus is shot and the tissue is not strong enough to keep from tearing again. Or, should I undergo another meniscus repair to hold off from a total knee revision? Your opion would be deeply appreciated. Thank You

    1. Barbara

      Tammi,
      Sorry you’re having so much pain. I have to be honest, and tell you I can’t just give you specific information because you’re not my patient, I haven’t examined you or looked at your studies. But I can tell you that total knee arthroplasty would not be a good idea in any 50-year-old. I would do everything to try to keep your own knee for many more years. Because you’ve had a patellofemoral resurfacing, you will be having a revision knee replacement. More bone will be cut off. You’re not as likely to have a great result, and you’re more likely to have a complication. You are also not likely to be having a “repair” of your meniscus. In older patients, it’s using a partial or complete meniscectomy (removal) and not a repair. I also can’t tell you what is generating your pain. It might be the meniscus, but it could also be your articular cartilage, adhesions or mechanical issues causing pain. Sorry I can’t be of much help. You must rely on the recommendations of your surgeon…or get a second opinion.

  14. Tim Newell

    Hi Barb,

    I had meniscus surgery on both knees, right one great, left one had a complex tear and i fair amount of meniscus was removed. I have not been pain free since the surgery, tried all the shots and exercise. I am looking into the meniscus replacement NUSurface but it is not yet approved in the USA. I am 62 185 and active, use a brace and avoid squats. I know you dont have my entire case, but I really dont want a TKR but looking for relief. Are there any other remedy’s for this condition? I think if I I could get the NuSurface replacement it would replace the bone on bone condition.
    Thanks,
    Tim

    1. Barbara

      No. It will not relieve your pain because you already have arthritis, and that’s why the knee scope did not relieve your pain. I can tell you that in my experience, most patients do get some relief from the surgery. That can range from 50-100% relief, and it can last from 6 months to many years. But every once in a while a patient gets no relief and they recognize it shortly after surgery. This is why I try as much as possible to initiate a course of conservative treatment BEFORE surgery, and go over everything I have written in my blog. That way patients understand exactly what’s going on in their knee, and why the surgery is not meant to permanently eliminate pain…especially those who insist on surgery because they are “young and active” and don’t want to undergo a conservative course of treatment. Once patients begin to experience pain after the knee is scoped…and EVERYONE does eventually because it is a treatment, and NOT a cure for the problem, then I re-initiate a course of conservative treatment, including activity modifications (rest), NSAIDs (if they can take them), injections (cortisone, hyaluronic acid, PRP, stem cell, whatever), until that fails and they get old enough to have a total knee replacement (TKR). But because you likely have significant degenerative changes in your knee, and you are 62 y/o, you should now undergo conservative treatment until you are ready for TKR. The meniscus transplant will not replace the bone on bone condition. No more surgeries until TKR, please. The more surgeries you have, there is a slightly higher incidence of infection of your TKR. I’d like for you to try to make 65, or just get as old as possible, before TKR, because they eventually loosen, and then you have to have a revision, which is more complicated than the original TKR, and more likely to have complications, such as infection, stiffness or just a less than ideal outcome. Back to see your orthopod, and try some injections maybe.

  15. Lorraine

    Thank you for your extensive article concerning meniscus tears. I had surgery for a torn meniscus in October 2018. Prior to that, I had
    P T for 8 weeks hoping to avoid surgery and relieve the discomfort of the tear. I say discomfort because I was not in severe pain, only when I would twist my leg or when I walked a long distance. I am an avid walker, hiker, and practice yoga, I also work out at the gym several days a week. Six months after the P T, I decided to have the surgery. I wanted relief from this nuisance. My Orthopedic surgeon said that the M R I showed arthritis and he mentioned that there could still be pain after the surgery but, he glanced over it. I say that because I don’t recall him ever giving any warning to me of the possibility of severe pain. I was literally pain free for two weeks after the surgery. I was so excited to feel this good. P T was scheduled and I felt home free. I went to an event, I wore a slightly raised heel boot for about an hour. The next day I had a stabbing pain in the medial area of my knee when walking. It felt as though something was rubbing against a bone in my knee and it continued. I started P T right after that thinking that I would get relief. I’m on my 6th week of
    P T 3days a week with little to no relief. The pain is a stabbing, grinding, scraping pain that occurs only when I walk. I still have good range of motion, strength in doing exercises but when I walk, this pain wears me down, it is terrible. I have seen my Dr. and he gave me a cortisone injection but, there was no relief from that. The Dr. said I have arthritis but gave me no indication as to what is next. Cortisone injection, “I’ll see you in 8 weeks”. That was his response. My P T has shown more concern and put more energy into providing relief to me than my Dr. So, needless to say, I’m feeling very discouraged and quite frustrated. The confusion for me is did I do this to myself by wearing a pair of heels for one hour that were less than 2 inches high? Did I cause something to move inside my knee? Did I cause something to irritate my knee? Or……is this caused by arthritis? My P T had me try B F R – blood flow resistance therapy. His thoughts were that I would build up my quad quickly which would provide support. I did one series and ended up with a bad headache and lightheadedness so, I didn’t continue with that routine. My left quad measures an inch smaller in size than the right quad. I’m still in pain when walking. Today my P T taped my knee and I’m happy to say that I have been without pain for five hours. I also purchased a pair of sneakers that provide me good support due to the fact that I’m flatfooted and I pronate in. Now, what is next, I don’t know? Am I looking at getting a knee replacement in the not too distant future if this pain continues? I’m 73 years young, small stature, just under 5 ft. not overweight, I’m active, (or have been), walking, working out, gardening, traveling, lot’s of energy and enjoying all that life has
    to offer. This terrible pain has slowed me down so much. Your blog is so direct and honest, no sugar coating. I’m hoping that you can give me some indication as to where to go from here, KR surgery is the last thing I want to do, and, since reading this blog I realize that it is not the answer for everyone. I do want to remain active and healthy. Is a second opinion in order? It doesn’t seem that K R surgery will be the fix and yetI have the feeling that this is where the Ortho Dr. is headed.
    Thanks for any input and advice that you can give.

    1. Barbara

      So sorry you’re having so much pain. I can’t examine you and so keep that in mind when I make a general recommendation. Obviously, it’s not based on you. It’s based on all the factors you mention. At 73, I would say the next choice is total knee replacement. You already had arthritis when you had the surgery. The hope was that the meniscectomy would relieve the pain. It simply didn’t work. It has nothing to do with your high heels. It’s just the natural progression of your disease. You’ll be happy with the total knee! You’re the right age, have the right condition and are a small person. This is ideal! Don’t try any more treatments.

  16. Lauren

    A great read and very informative article. I’m currently undergoing investigations for a suspected meniscus tear in posterior horn of my medial meniscus in my left knee. 10 years ago I had a partial menisectomy in my right knee for a bucket handle tear, 10 years on I am 95% pain free apart from mild crepitus but have full ROM and minimal problems. Nowadays my Dr mentioned that partial/total menisectomies are not as common and would often go for physio as treatment instead. My concern is I am an active 25 y/o female with a very active job on my feet all day and currently unable to perform well at work due to the pain, stiffness and locking in my left knee. I’ve had symptoms for over a year now but no incident or injury that I can recall to have caused this meniscus tear. My question – is it possible for a young, active 25 y/o to have a degenerative meniscus tear? Should I push to have an arthroscopy or let physio treatment take its course? I’ve currently had a couple of months of physio and yet no alleviation of locking and pain. Thank you in advance for your advice.

    1. Barbara

      This is a complicated problem, especially at your age. Studies and experience demonstrate that we develop post-traumatic arthritis (arthritis as a long-term complication of injury) about 10 years after meniscus or ACL tears. If your history is that you tore your meniscus at the age of 15, then you are likely developing post-traumatic arthritis. In general, we try to repair the meniscus cartilages of young patients, but sometimes this is not possible, and partial or complete meniscectomies are necessary. These patients will most certainly develop arthritis at a young age. Your surgeon is correct when he says that a conservative course of treatment is indicated. This is definitely the current recommendation as it pertains to degenerative meniscus tears. However, I am reluctant to call any meniscus tear in a 25 y/o “degenerative,” even if you are developing post-traumatic arthritis. If you already have significant loss of articular cartilage, then indeed, there is little value in a second surgery, unless you have a large tear. I would give PT, and perhaps injections of hyaluronic acid, PRP or stem cells a chance. However, if you do not have much articular cartilage damage, I would consider meniscal transplantation. This is often done in younger patients with little damage to articular cartilage. Needless to say, I do not know you or your knee, so I cannot specifically guide you in your decision-making, and am simply reciting some options available to you. I’m sorry you sustained an injury at such a young age. This is common however, and often, even after our children have been injured, they return to sports, only to add insult to injury. I always try to talk my injured athletes out of continuing to participate in sports. It’s bad for the knees…

  17. Sally smith

    Thanks for the article. Very informative. I had surgery after lateral tear to meniscus on knee at 20 years old. Now at 26, woke up this morning to it feeling exactly like prior to having surgery. Before I had surgery, it used to lock up and I’d drop to the ground. Because of my age I don’t want to continue with it being an issue. However thank you for your recommendation to avoid on the knee replacement surgery. I’m going to get it checked out soon if the symptoms continue. This can happen to anyone. Surgery did not last for more than 6 years for me.

    1. Barbara

      Sally, Sorry to hear this story, but I hear it often. That is a common experience. You might have a recurrent meniscus tear, or simply the beginning of post-traumatic arthritis. Please stop squats, deep knee bends, lunges, high impact exercises, if you’re doing them. Agree with a plan to see your doc.

  18. David

    There was no mention of stem cell therapy in your excellent article? Is that an alternative? iORTHOBIOLOGIX did some work for me and it helped. I’m 63, left knee pain, inside front part of knee, a little arthritis, arthroscopic surgery to remove a lot of miniscous 20 years ago.

    1. Barbara

      As you’re probably aware, stem cell, PRP, exosomes, etc., are not FDA approved for the treatment of arthritis. No double-blind studies have been done (nor will they likely ever be done, because plenty of docs are using them with variable success…without double-blind studies)which confirm their efficacy in “re-growing cartilage.” Nonetheless, they have been studied as a treatment for arthritis, and compare well to hyaluronic acid (viscosupplementation). They might be a little better. What we do know is that they are great anti-inflammatories. At the time of the writing of that blog, I had mixed feelings about whether or not I felt they should be mentioned or even used. Very expensive. Since then, I have started using PRP and stem cell treatments, simply because of patient demand. And to be honest, they work just fine. My approach is to use PRP in the office setting, and stem cell in the OR. In patients with chondromalacia, arthritis, degenerative meniscus tears, I might use them intra-operatively, when scoping their knees. If we’re going forth with conservative treatment, I’ll use them if HA hasn’t helped, or even in addition to HA, when necessary.

  19. Helen

    `I am a 59 year young women. I had enyjoyed running with my dogs and and work as a Ultrasound Technologist. I fell 2 1/2 months ago and it’s has been horrible pain day and night cramping in my thighs and knee unstable. I have a meniscus tear and I want my life back doing patient care I need to be able to move to catch a patient if need and lift.

    1. Barbara

      Basically, I’ve said it all in that gynormous post regarding degenerative menisicus tears. You gotta look at all my recommendations, and go through each of them to see what gives you relief. You could also add platelet rich plasma and stem cell therapy to that list. They’re just options. Insurance doesn’t cover it though. If conservative treatment fails, you might need a scope. Sorry.

    2. Barbara

      Sorry for the delayed response. I don’t know how your query got lost, but it’s found now. At 59, your tear is likely to have a degenerative component to it, and so it’s not an automatic indication for surgery, like it would be if you were 20, with an otherwise normal knee. No matter what though, you need to follow the recommendation of your orthopedic surgeon. They are the only ones who have seen you and examined your knee. You will get your life back, unless you already have advanced arthritis.

  20. Caroline

    I am almost 59, female and am recovering from a total hip replacement last October. We got given squats and steps ups and after a couple of weeks both my knees became painful. The right knee became a problem in 2004. I got orthotics, they really helped. I was told it was probably a meniscus tear. I got a steroid injection and the pain went away. Last summer my left knee suddenly became painful after a walk. I now understand I have mild arthritis in both knees with degenerating meniscus in both knees too. My knees are settling down two weeks after stopping the squats and step ups exercise. I really want to keep my knees going for as long as possible. What advice do you give me to do this – i do yoga, walking and swimming. Should I go and see the knee consultant from 2004 again. I had hoped to be free from medics following my THR as my right hip deteriorated swiftly over two years. PS your article is amazing and has really helped me.

    1. Barbara

      No squats, deep knee bends, lunges, avoid stairs, no high impact exercises. Consider injections: cortisone, hyaluronic acid, PRP, stem cell, exosomes.

  21. terry

    Hi Barbara, just read your article and the comments, best article i have read to date and have looked at many, in feb 2017 i had an mri that revealed an oblique tear of posterior horn of medial meniscus, did rehab prescribed by physio and seemed to recover well, however in july 2018 i experienced similar feelings and had 2nd MRI which revealed tearing undersurface and radial free edge posterior horn medial once more, all acl, fcl, quadriceps and colaterall ligaments are intact, i have been back on rehab since and saw a consultant last week who after looking at both MRI’s said i have a degenerative horizontal medial meniscus tear, i am 51 but a very fit young 51, my query is that all strength exercises after both diagnosis have plenty of squats and lunges in them (goblet squats etc) so i am confused as to why a physio to olympic team level would recommend them when you say to avoid them completely? i have seen improvement since taking up cycling a month ago, doing 20-30k cycles and am able to run, straight line running without pain more times than not, the odd 5k but usually 1k at a time doing circuit training, its the football i want to play really and this is where i get the problems the following day, have not played in 2 months but will go back to it this week and see reaction, consultant recommended continued rehab, if not working possibly a cortisone injection and then op if required, funnily enough he said he has exact same injury and that his thighs etc were killing him from squatting the day i visited, he also said that he has since had an injection and feeling much better, i feel no clearer on what to do however, well done again on a fantastically concise article, regards, terry

    1. Barbara

      I don’t know why people (trainers, doctors, yoga instructors) recommend squats. I make a lot of money off squats. Does that tell you something. I really think that people just don’t understand. There is no benefit from doing squats that you can’t achieve with something else, like walking, jogging, cycling or swimming. No one needs that level of intensity to function throughout life. NO ONE! It’s totally optional, and there is great potential for injury, and it’s part of the reason I have a job. I should be promoting squats! I really think these professionals just don’t understand, or don’t care. They’re just oblivious. And the reason for that, is that people just disappear from their program, so they are unaware of the damage being done. I had to develop my own program, which I give to my patients, because even the physical therapists were having them do squats. There you have it. Keep doing what intuitively seems to be working for you. No squats. Injections of cortisone, hyaluronic acid, platelet rich plasma or stem cells, can all have a beneficial effect. Stay out of the OR if you can. But as you read in my post, if all else fails, at your relatively young age, I would still consider a scope, if your degenerative changes weren’t advanced. Hope this helps. I’m so glad you are getting something out of my blog. Please pass it on to your friends and family too!

  22. Conrad

    hi Barbara
    Brilliant article – very in-depth and informative.
    I’m a 52 year old male with no ACL in my right knee (old sports injury), 2 previous athroscopies and now a further, almost certainly, degenerative meniscus tear which is very painful!. My MRI shows I have the onset of arthritis.
    I played tennis 5 times a week, I can’t bear to go without it. Can I get an ACL reconstruction to increase stabiity? Or do I have to live with the degenerative tear, get a cortisone injection, do physio and reduce the tennis to gentle hitting?
    My Left knee has been brilliant since i had an ACL reconstruction in 2012 (aged 45) but my consultant is telling me that I shouldn’t have an ACL reconstruction in the right because of the poor state of the cartilage.
    thank you in advance for your thoughts Barbara.

    1. Barbara

      You’re spot on regarding your assessment of the situation. Once a person has degenerative changes, an ACL reconstruction would be contraindicated. You could end up worse off. Back off on the tennis a little. Get cortisone, hyaluronic acid or PRP injections, and hang in there with your own knee for as long as you can. Remember this…studies show that folks who get more active after total joint replacement, end up with a revision at a younger age. Total joint replacement revisions are salvage operations and more likely to be complicated. So it’s not a good idea to play a bunch of tennis after TKR. Hope this helps. Thanks for reading my blog and I’m glad you got something out of it. Please recommend it to friends and family!

  23. Conrad

    Thanks Barbara – really helpful. I have already recommended your blog to a couple of similar middle aged knee pain sufferers.

    My consultant has actually suggested an osteotomy may end up being the way to go to take pressure of the arthritic part of the knee, but he warns this is a big op, so steroid inhection first, as you rightly suggest.
    Thanks again

    1. Barbara

      Okay, you must have some significant deformity around your knee. That’s different. You must also be relatively young. We don’t do as many osteotomies now, as in the past. Patients actually do pretty well with them though. I had a patient whose knees lasted about 20 years after the osteotomies! Now he has total knee replacements, but he’s the right age for them. It IS a big operation. A little potential for complications. When I do surgeries on people, or even when I treat patients, I always ask myself…”Is this what I would do for my child, husband, parents, best friend?” So ask your doc that question.

  24. warren

    Thanks I have a understanding of my knee now. My high energy life style will be modified now.My 64 year old knee will not squat any more.Family genes kept all of my family members living to 90,s.No skiing and sandlot football.I had meniscus surgery 3 years ago .Sitting and the first 3 steps is the worse.I am too young for knee replacement.Once a year ok for cortisone shot?

    1. Barbara

      If you haven’t already read this post on my blog…check it out: https://drbarbarabergin.com/decrease-pain-from-knee-arthritis/
      Yes, cortisone is fine once a year. It’s even fine 3-4 times a year, if it keeps you out of the OR. Don’t suffer long though. You’ve reached a good age to consider TKR. So go through all the conservative measures first: cortisone, hyaluronic acid (gel shots), and whatever else you can do. Then total knee replacement when all else fails, assuming your health is good, and you’re not morbidly obese.

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