%PDF-1.5 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. And get the pain under control and recover normally the way that you should have once you start doing the right things. I think my clients thought I had lost my mind, but what else was I going to do? I did a few jungle gym rows, and finished with planks. Should a meniscus tear repair surgery be hurting 7 weeks post-operation? Therefore, a lateral meniscus root repair can be an essential portion of a surgery to address the secondary restrains for a concurrent ACL reconstruction procedure. I am now adding 10 pounds a week to the bar for squats. Partial weightbearing status (<50%), unless otherwise ordered by MD. What do you suggest if my MRI says that I have a horizontal tear in the body of the lateral meniscus is shown do I need surgery? Dr. Benedict Nwachukwu, orthopedic knee surgeon has extensive experience in treating meniscus root tears and can help patients in Manhattan, Brooklyn, New York City and the surrounding New York boroughs. Just its a big deal to take your time and let that cartilage heal at the rate that it heals you generally can go faster than what it heals, And the question that i get often is do i take any supplements glucosamine chondroitin those types of supplements and you know the answer to that is its not going to hurt we the research is kind of mixed on it sometimes it helps sometimes it doesnt help what we know is that it generally doesnt hurt it doesnt make it worse so youre not going to youre not going to make things worse if you decide to take those supplements are generally safe to take but some people report no difference. This was going to be a complete root repair surgery: toe-touch weightbearing for four weeks, six weeks in a brace and crutches. What to do if I have a radial meniscus tear, what's the chance of it fully healing with surgery? The first step is usually to use especially designed cannulas and guides to drill up into the area that was decorticated. Most root tears involve either a direct tear of the meniscus off bone or a split of the meniscus within 1 cm of the root attachment. Phase 1: 0-2 weeks post-operatively Goals Protect repair Minimize pain Minimize swelling . Thank you Dr. Burnham for being so amazing! Life happens and our bodies will sometimes let us down. We recognized that meniscus root tears were a problem over 10 years ago and set out to perform a comprehensive research program to help us figure out how to diagnose the problem, where to place the meniscus repair, and how best to fix the meniscus tear to allow for maximal healing capability. This usually presents with pain along the inside or medial portion of the joint and with swelling with activities. 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. So happy I found them! General anesthesia and a nerve block. Takes his time with you and doesn't hurry to rush out of the room if you have questions. Each patient was randomly selected to have knee meniscus surgery followed by rehab or to simply attend physical therapy without having surgery. Dr. Burnham took his time and answered all my questions with explanations. Oftentimes, after having a meniscus surgery, people are told that theyll be fine. Timeline for Meniscus Repair Recovery: It will take around 4-6 weeks before you can walk, drive, and otherwise move normally as you would prior to your injury. Grant H. Garcia, MD 148 subscribers Dr Garcia demonstrates his new meniscal extrusion technique to further improve meniscus root repairs. 2018;47:762. You'll likely regain your previous muscle strength in the leg by. Among them, 32.60% demonstrated incomplete healing, loosening of the construct, or excessive scar tissues formation. Unlike some meniscus tears which can be observed or treated conservatively, most meniscus root tears need surgery. My daughter injured her ankle in cross country practice and we were able to get in the next day to see Dr. Burnham. Amazing doctor, amazing family mantreats patients with the highest level of care, compassion, and quality! 2 0 obj Identifying and properly treating meniscus tears (with or without surgery) will lead to the most rapid reduction in your symptoms and is crucial to optimize the long term health of your knee. Placing sutures or UltraTape on each side of the tear and pulling it down into tunnels should be a safe and reliable method for a bony avulsion root repair. In some cases, its important that you take away from this video today that it takes six to 12 months to heal from a meniscus surgery. Therefore, we strongly advocate using a button to fix the meniscus sutures or tape on the tibia to minimize the chance of loosening over time. The most common complication after a meniscus root repair is a re-tear. If you're an athlete needing a doctor that understands; this is the guy. So go check out that video on how to exercise your glutes theres five exercises in there that you can start doing them i would do them every day i do them a couple times a day even more if you can i would do what you can tolerate without it being too much soreness and your glute muscles and they should all generally be okay on your knee theres some where you got to kneel you can adjust it you can not do that exercise if you want. A torn meniscus can result in either sudden or gradual onset of pain. In particular, these younger patients have to look at a meniscus root repair as soon as possible to ensure that they dont develop arthritis. And if youve never worked out your glutes if you went through physical therapy never really targeted your glutes ever you better start quick because chances are youve got a muscle imbalance thats caused extra pressures inside your knee thats led to that meniscus tear to begin with thats been the root problem and glute strength is what offsets that forces inside the knee so that your meniscus can heal all the way. Jerrica, Dr. Burnham, and the therapy staff (Luke and Joey )were awesome. I have two good arms, and a good leg. Very thorough, knowledgeable and courteous. The feeling that your knee is giving way, locking, or catching when you bend it. My name is Dr. David Middaugh. My daughter journey was very trying and hard but we made it through with all of their help. That night, I drove myself to the gym. It takes longer for a meniscus repair to heal than a meniscectomy. Meniscus root tears are a particularly troublesome type of meniscus tear, because a failure to treat them can often result in the rapid development of osteoarthritis. Phase I of Rehab: Surgery until 8 weeks. I limped from the wedding venue to the car, and then from the car to my house. 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. His surgery and recovery has been perfect! In fact 2 years ago I finished climbing the top 100 peaks in CO. The meniscus root attachment is important because if the meniscus becomes detached, it can squirt out of the joint, called extrusion, which can lead to the meniscus not being functional. 28323545 Additionally, preparing 2 transtibial tunnels to secure the meniscal root to its attachment site further increases the While there are a small number of patients who do have their meniscus root re-tear, this has been nowhere near as common as the other sources noted above. Had I not been training all these years, I would not have had the slightest idea of how to rehab my knee after surgery. That means that the remaining meniscus is smaller, but still taking the same pressure. There is often swelling of the knee and severe pain with walking, running, twisting, or moving the knee. Amazing Doctor and wonderful staff!! My 14 year old son originally went in to see Dr. Burnham very scared (he hadn't had an injury before) and he was instantly made to feel at ease. Strength. And people are often disappointed to find out that as they begin to get back to normal, as theyve been told that they probably could and should they start to get swelling in the knee, they start to get a pain, of course. Highlights from the StartingStrength Community. Examination of the medial compartment revealed a complete radial tear proximally 1cm medial to the posterior root insertion. A meniscus that still has extrusion present also does not function as well over the long term. The length of time until patients are able to return to driving varies . In our hands, because we have performed many second look arthroscopies, we have found that the 2-tunnel technique allows for a broader surface area of the meniscus against the decorticated bone and seems to allow for a more solid and secure repair. Squatting, lifting from a squat and sitting cross-legged should be avoided for 3-4 months. And this channel is dedicated to helping people stay healthy, active and mobile. A meniscus root tear requires the meniscus to be repaired back to the lower leg bone; this is also performed arthroscopically. Using specific guides to ensure that one can place tunnels in the anatomic position and using self-capture devices, which have been devised to be small enough to not scuff up the cartilage, are some of the best means to perform a transtibial meniscus root repair with self-capture devices. Right Knee Surgery After Auto Bicycle Accident, Medical Second Opinion Service MRI/X-ray Review. He is walking without a limb and is on schedule with his progress. I really like and appreciate the time and effort he commits to research. And then after the surgery, the focus is doing physical therapy, typically if he gets sent there, and youre going to lose some motion in the surgery so your knee wont be able to bend or straighten all the way. 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. Some patients may experience catching, clicking, or locking of their knee. In some instances, the meniscus posterior horn may need to be released from scar tissue to allow it to be repositioned. Then, in January of 2018, while warming up in class one morning, a sharp, nauseating pain shot through my left knee, which made me start limping. I am currently on crutches for 6-8 weeks with no pressure on my leg at all. I have no issues taking the stairs, just a little knee discomfort here and there. Often the best medicine to take is NSAIDs like naproxen and ibuprofen. In January of this year, I finally decided to go back to my doctor to get that MRI. PT or exercise can be useful BUT take note of these the BoneSmart view on exercise BoneSmart philosophy for sensible post op therapy 5. 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 . Other non-medical modalities may help, such as using ice and elevating the leg. In patients who have open growth plates, consideration may be necessary to either plan to remove the sutures after the meniscus root repair heals or to consider placing the tunnels and suture repair above the growth plate such that is does not cross the growth plate and have a theoretical chance of causing a growth plate arrest. The healing phase is long, but he does A+ work. This is because the signs of arthritis are usually pain and swelling with activities. In general, in our practice, most patients who do have pain after a meniscus root repair fit into this category. Dr. Burnham has an awesome bedside manner. My daughter recovered fully from a total knee reconstruction and now she able to return to sports. This technique allows one to place passing stiches up the cannula, which has significantly decreased the operative time. Are you an athlete who participates in sports that involve running and jumping? I opened my gym shortly after taking up strength training in earnest to help address my back pain, and have been working for the past eight years to help others embrace their true potential and strength. Each week my leg brace is put to a different degree so I learn to bend my knee again. A meniscus repair to the knee cartilage is a minimally invasive surgery that can normally be performed on an outpatient basis. Appreciate the attention and time spent during office visits. He is on the cutting edge of research and techniques around surgery, he has a memorably reassuring bedside manner, and Im thankful he was in charge of my evalution and treatment. Thank you, Dr. LaPrade, for treating me with the care, focus, and expertise as if I was an Olympic athlete!- From your 63 year old very appreciative patent ~. To learn more, please visit our, If it is your left knee, you can probably drive very shortly after. So the focus of physical therapy after a knee meniscus surgery is getting your motion all the way back and then getting strong enough to stand and do some walking. Meniscal repairs offer the benefit of preserving the native meniscus, but they require a longer rehabilitation protocol as compared to a meniscectomy. 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. He has repaired both of my shoulders and he is awesome to the max. Prior to Starting Strength, I would have simply gone to physical therapy, done my exercises like the therapist told me to do, and that would have been it. The most important thing as one gets older is the quality of the cartilage present. Rehabilitation begins within a week of surgery. Begin passive range of motion exercises Start physical therapy or home exercise program 1-3 days after surgery Work on quad recruitment Brace/Crutch Use 25% weight bearing with crutches, brace 0-90 when ambulating and sleeping, can remove . We currently use UltraTape to do this. Please subscribe to this channel and turn on your notifications so that you dont miss a single video with great tips and advice that we put out every single week. And they can get back to normal in about two or three months after having the surgery. Hence, that remaining meniscus is more and not less likely to tear again. Surgical knee will be in a hinged rehab brace locked in FULL EXTENSION for 4 weeks postop. And thats all good if youre going to end up having the surgery. Other factors can also be present with extrusion, including the progression of arthritis which can cause a well-done meniscus repair to extrude outside the joint. When the tear is examined during arthroscopy, Dr. Hess will decide if the tear is able to be repaired . By far the best orthopedic team I have ever met. These results reveal that, since all the variables and possible concomitant injuries are investigated and addressed, MRR . Oftentimes healthcare providers will tell you go walk your knees operated on its good youre the we took out the chunk that was you know causing your need to lock up the meniscus we did a meniscectomy or we repaired the meniscus and its all sewn together now so you can go ahead and walk all you want and some people take that to heart and to go walk you know three miles a day or even 10-20 miles a week and their meniscus just doesnt heal enough and they get that swelling. I'm able to run and exercise without pain. It hurt like hell. There was a large grade 4 chondral defect involving the central aspect of the trochlea, approximately 30mm in width by 25mm in length. Most of these types of injuries, that are symptomatic, require surgery. In layman terms, I had completely torn my medial meniscus from the bone, and it had to be sewn back on. Monday: 8:00 am 5:00 pm Malempati C. Bonasia DE, Pellegrino P, DAmelio A, Cottino U, Rossi R. Meniscal Root Tear Repair: Why, When and How? Does a extruded medial meniscus towards the posterior root need surgery? The average pain levels after a meniscus root repair fit between a basic knee arthroscopy (minimal pain) and an ACL reconstruction (more severe pain). Therefore, we then looked at surgical techniques and due to the fact that we had multiple second look arthroscopies after bone grafting for ACL reconstructions with meniscus root tears, that the 1-tunnel technique had more of a spot welding healing of the meniscus to bone whereas the 2-tunnel meniscus root repair technique had a much better healing surface of the meniscus to bone. What made my recovery so fast? The first 6 weeks are a strict protection phase and the patient is non-weight bearing. The system also involves a drill with a cannula whereby one can drill through the tibial guide, see the drill bit come out inside the knee, and then pull the drill bit out and leave the cannula in place. Many patients do not have significant joint line pain like a typical meniscus tear, so having a patient stand up and squat down is often performed during the clinical exam to validate that the patient may have a meniscus root tear. Later that summer, the left knee began to bother meagain. Great doctor. I highly recommend him. #12. He has a great rapport with teenagers. Non-anatomic root repairs do not restore normal joint biomechanics . Usually, pain is minimal after this type of surgery. Historically, these root tears are often treated with benign neglect and either ignored or trimmed out. The Smith & Nephew root repair technique involves specific devices which can lower ones surgical time to perform a meniscus root repair. Walk with crutches. What was going to help my knee? Patients in Manhattan, Brooklyn, New York City and the surrounding New York boroughs can expect a variation of the following: Dr. Nwachukwu is extremely knowledgeable about his area of expertise. If a meniscal root tear is left untreated, meniscal extrusion can occur rendering the meniscus nonfunctional resulting in degenerative arthritis. I put a knee brace on and made it through class, but by the time I drove home I could barely bend my knee. Kyle D. Morgenstern, MD . Dr. Robert F. LaPrade operated on my right knee in May of 2010. Ibuprofen (Advil, Motrin) Naproxen (Aleve) The left knee was feeling great up until about a year and a half ago, when I started noticing some pain. 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. Therefore, any surgeon who performs ACL reconstruction should be well versed in performing a lateral meniscus root repair. My experience with Dr. Burnham and his staff was exceptional. In general, one can follow the small tunnels from the transtibial technique up to where the root attachment should be. . There was also proliferative synovitis present throughout the patellofemoral joint, including the medial and lateral gutters. <> If one does have quite a bit of arthritis of the same compartment, which we would call Kellgren-Lawrence grades 3 or 4, in most circumstances, other than possibly in very young patients, a root repair would generally not be indicated. Thanks to his staff for being so helpful. Procedure for Meniscus Root Repair. The technique of a meniscus root repair involves isolating the root, placing a minimum of 2 sutures in the remaining meniscal attachment, and trying to reposition it back to a more anatomic position. Everyone I was in contact with, from support staff to Dr. Burnham, was kind, friendly, competent, and generous with time and information. After a pretty serious car accident, Dr. Burnham performed knee surgery on me. Video chat with a U.S. board-certified doctor 24/7 in less than one minute for common issues such as: colds and coughs, stomach symptoms, bladder infections, rashes, and more. 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. I was still taking aspirin to prevent clotting after surgery, and I also tried to put as much weight on the left leg as I was allowed, and then more. It has now been demonstrated that the results of meniscectomies are almost the same as not treating the meniscus root tear at all with a large number of patients within 5 years proceeding to needing a total knee arthroplasty. Stated to me , in detail, what to expect and how long my recovery will take. El Paso, Texas 79903. Keeping each meniscus in place are two "roots" that attach to the tibia (shin bone). A written consent will be obtained from you after the surgical procedure has been explained in detail. This can occur in up to 20% of patients, even in the best of circumstances. His MA Michelle was very professional and kind. Please help. But youve got to figure out a way to get your butt muscles stronger if youre looking for a more comprehensive plan for making your knee better and getting your glutes stronger we also have a program called the, https://www.epmanualphysicaltherapy.com/wp-content/uploads/2020/01/Logo-copy-1030x429.jpg, Shoulder Impingement: Everything You Need To Know To Get Healthy Again, Top 5 Shoulder Impingement Exercises To Help Get Healthy Again, Top 6 At Home Treatments To Begin To Naturally Heal Cervical Radiculopathy, Click Here To Schedule A Phone Call With An Expert, Click Here To Ask About Cost & Availability, Copyright 2022 - El Paso Manual Physical Therapy, How To Tell If Youve Got A Rotator Cuff Tear, Request A Virtual Visit With One Of Our Expert PTs, 28 day knee health and wellness boost program, 28-Day Knee Health & Wellness Boost Program, 28 Day Back Health & Wellness Boost Program. The mini First-Pass device allows placement of either a suture or an UltraTape through the substance of the meniscus, capturing the end of the stitch as it is placed through the meniscus and then it can be pulled out of the joint. He answered all of my concerns about my knee. My MRI showed an extensive radial tear adjacent to the medial meniscus root insertion, as well as evidence of high-grade chondral loss involving the central trochlea. Ive dealt with other knee doctors in prior injuries, but Dr. Burham and his team clearly stood out. There are many factors that go into this, including a patients weight, with overweight patients putting more stress on the meniscus root tear, ones alignment, where one being bowlegged with a medial meniscus root repair putting extra stress on the repair, and also the amount of underlying arthritis present prior to the root repair. The meniscal roots are critical in maintaining the normal shock absorbing function of the meniscus. Most importantly, I have not missed a single coaching or training session since my surgery. And most likely, a meniscus tear.. He did a great job of explaining both the progress of my injury and the way ahead as it applied to recovery. The incisions leave scars that usually fade in time. It is our goal to provide the highest level of care and service to our patients. Heres the third practical tip if youre if you dont know where to go Ive got some exercises that i put on videos here for free on YouTube its linked in the description below theres one video in particular that i want you to take a look at its called top five glute exercises for knee problems go check out that video start doing those exercises youve got to exercise the heck out of your glutes if you got a meniscus injury if youve had a meniscus surgery in the past you need to get your glutes worked out. My MRI showed an extensive radial tear adjacent to the medial meniscus root insertion, as well as evidence of high-grade chondral loss involving the central trochlea. 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. If so, you may be at risk of tearing the root of your meniscus. Patients \50 years had outcomes similar to those of patients !50 years, as did . Towards the middle of March, I was finally given wall slides (mini squats) and step ups for the left leg by my physical therapist. If the patient is not comfortable walking without an aid, then they are usually provided with axillary crutches. As surgical techniques are being developed and refined, rehabilitation protocols for meniscal root repairs must be defined and tested. If the meniscus is extruded, the patient may not be having a restoration of their shock-absorbing capacity of the meniscus. We are so grateful and thankful. All I can say is Dr. La Prade did an amazing job and I am not limited in any of my activites. But theres still healing to be done and that 20% is really critical. Historically, most root tears were treated with meniscectomies because the importance of the meniscus root as a shock absorber was not well known. repair to heal. This is done to protect the repair and let the body heal it. During our biomechanical testing, we found that if we tied the sutures directly over bone, with cyclic loading, the sutures would cut into the bone and the repair would become loose over time. 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. Most patients will have pain with squatting and deep knee flexion with a root tear because a meniscus root tear occurs in the back of the knee. I wont ever go anywhere else. I continued to lower the box for squats, and started to add weight. Really cares for his patients! The menisci in the knee are two c-shaped pieces of fibrocartilage that act as shock absorbers.
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