Best Practice Health TV
By Grace Lieberman A torn meniscus is one of the most common knee injuries. The meniscus cartilage in your knee acts as a shock absorber between your shin and thigh bones. It can tear when someone twists their knee while bearing weight, usually through physical activity. Athletes and older people who have experienced years of [...]
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From our YouTube channel visitor: "I tore my medial collateral ligament and medial meniscus. I had the steroid injection which lasted about a month. I then had three injections of hyaluronic acid. I'm 52 and active so I really do not want a knee replacement. One day last week I was carrying an IV pump, [...]
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The NBA season is barely underway and one of my favorite players is already out with a torn meniscus. The Phoenix Suns forward Cam Johnson tore his meniscus on a maddeningly routine play as he walked down across the court. As it happens, I was at the game and Cam was a few feet in [...]
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For most people with a torn meniscus surgery is the next step. Surgery is recommended in particular for young people with tears in the outside meniscus to reduce the risk of developing arthritis that could lead to the need for total knee replacement.
During surgery the torn meniscus can be removed (meniscectomy) or repaired. The surgery is done under general or regional anesthesia using an arthroscope through several tiny stab incisions.
The recovery from meniscus surgery depends on what was done. After meniscectomy, you can walk out of the surgery center and get back to full activities in a week. If a repair was done time is needed for the repaired meniscus to heal. After an arthroscopic meniscal repair, you are non-weight bearing and wear a brace for 6 weeks, followed by 6-8 weeks of physical therapy. Twelve weeks after arthroscopic meniscal repair surgery you can run in a straight line; full-blown sports require a total of 4-6 months of strengthening to give time for complete healing.
Meniscus injuries cause pain at the joint line and often have associated popping, clicking, catching and locking, and swelling of the knee. In sports injuries, meniscal tears are common after bending and rotating and commonly happen in football, tennis and basketball. However, most meniscal injuries don’t happen during sports; the most common cause of a meniscal injury is just getting out of a low car seat. Old folks are sometimes found to have a torn meniscus without even having a known injury, and the pain may be in the back of the knee due to the formation of a Baker’s cyst due to excessive fluid n the knee joint.
If you suspect you have a torn meniscus you should see an orthopedic surgeon and avoid walking around. Younger people can walk on a torn meniscus, but they should avoid it: putting pressure on a torn meniscus can cause additional damage to the knee. The emergency department, primary care, and chiropractic doctors will typically just pass you on to an Orthopedic surgeon. On examination, the orthopedic surgeon evaluates for tenderness to palpation at the joint line and will perform the McMurray test. During the McMurray test the orthopedic surgeon determines whether twisting the shin bone with the knee bent reproduces the pain. X-rays are helpful in alerting the doctor to the presence and stage of arthritis. Magnetic resonance imaging (MRI) is needed if the examination is not clear.
The meniscus is largely unable to heal by itself. There are two menisci on the end of the shin bone. They are made from cartilage. If a small tear occurs on the edge of the meniscus where the blood supply is good then it could potentially heal on its own in six weeks. If you have a torn meniscus that is severely painful after six weeks, then surgery should be considered. In older folks with multiple medical problem when surgery is not a safe option, then a steroid shot may help relieve the pain temporarily.
In most people with a torn meniscus surgery is needed. Surgery is recommended in young people with tears in the outside meniscus to reduce the risk of developing arthritis that could lead to the need for total knee replacement.
During surgery, the torn meniscus can be removed (meniscectomy) or repaired. The surgery is done under general or regional anesthesia using an arthroscope through several tiny stab incisions. Arthroscopic meniscectomy surgery takes 30-60 min; if repair is needed that adds an additional 30 more minutes. The surgery is done in an ambulatory surgery center (ASC), and does not require hospitalization.
The recovery from meniscus surgery depends on what was done. After meniscectomy, you can walk out of the ASC and get back to full activities in a week. If a repair was done time is needed for the repaired meniscus to heal. After the arthroscopic meniscal repair, you are non-weight bearing and wear a brace for 6 weeks, followed by 6-8 weeks of physical therapy. Twelve weeks after arthroscopic meniscal repair surgery you can run in a straight line; full-blown sports require a total of 4-6 months of strengthening to give time for complete healing.
You should do 3 weeks of physical therapy before considering an MRI—studies show worse results if you get imaging at this point. If you are not better after 3 weeks of therapy, then (6 weeks since the pan began) you should get an MRI and referral to a board-certified anesthesiologist or physiatrist with subspecialty certification and specialization in pain management. They will do a medial branch block and radiofrequency ablation as appropriate. Don’t let anyone talk you into epidural injection; that is not what you need.
You should do 3 weeks of physical therapy before considering an MRI—studies show worse results if you get imaging at this point. If you are not better after 3 weeks of therapy, then (6 weeks since the pan began) you should get an MRI. We can help you find a board-certified anesthesiologist or physiatrist with subspecialty certification and specialization in pain management who doesn’t over-prescribe dangerous narcotics.
They will offer you medial branch block and epidural injection. Those don’t really work for this problem. Your options are (off label) intradiscal injection of stem cell-derived growth factors, denervation with the relevant procedure, and then referral to a spine surgeon for interbody fusion if those fail.
You need an MRI now and referral to a spine surgeon for possible laminectomy decompression surgery. We can help you find one who is board-certified and specializes in minimally invasive surgery.
You need an MRI now and referral to a board-certified anesthesiologist or physiatrist with subspecialty certification and specialization in pain management. Don’t go to one that prescribes a lot of narcotics, they may get you killed. If you’re not better after 3 epidural injection you will be referred at 12 weeks to a spine surgeon to consider microdiscectomy. Note that you DO NOT need radiofrequency ablation; so, don’t let anyone talk you into a medial branch block.
This stuff can be confusing. Don’t sweat it. We’ve got you. Your MRI came with a report by a radiologist which describes the findings. If you don’t have a copy of your report, you can get one from the imaging center where the x-ray was taken. The doctor who prescribed the MRI has a copy as well. Find the section labeled Impression. First, under the impression, look for the word normal. If you see something like “Normal MRI of the hip then you are done. You do not need to check anything.
Next, search the impression section for the words osteonecrosis or avascular necrosis. If you see either one in the report, then ignore the rest of the report and check the osteonecrosis box. If neither of those is in the report, ignore the rest for now and continue.
This stuff can be confusing. Don’t sweat it. We’ve got you. Your x-ray came with a report by a radiologist which describes the findings. If you don’t have a copy of your report, you can get one from the imaging center where the x-ray was taken. The doctor who prescribed the x-ray has a copy as well. Find the section labeled Impression.
First, under the impression, look for the word normal. If you see something like “Normal x-ray of the hip then you are done. Check the box normal. Next, search the impression section for the word hypoplasia. If you see hypoplasia in the report then ignore the rest, and check the hypoplasia box.
If you are still going, then look for the word arthritis. The radiologist should have given the arthritis a grade from 1 to 4. If you see arthritis in the impression section but there is no grade, then look at the rest of the report for a grade 1,2,3 or 4 and check the appropriate box. If there’s no grade then you have every right to call the imaging center and ask them to have the radiologist to do their job and redo the report with a grade.
Not all orthopedic surgeons are the same. You deserve the best. That means a surgeon who is
In my experience less than 10% of orthopedic surgeons meet all five of these criteria. That means if you go to the surgeon you’ve been seeing, or the one recommended by friends or family, there’s a 90% chance you will not be getting the best.
At Phoenix Spine and Joint we make it our business to know the best. Call us for help finding the best surgeon near you who takes your insurance and is accepting new patients.
If you have any of the following red flags you need to see a doctor NOW!
Radiculopathy. This condition is most often due to herniated disc, but can also be caused by bone spurs, or compression of nerve roots as they leave the spinal canal. The traditional treatment is to confirm the herniation or compression by MRI, followed by a trial of epidural injection, with microdiscectomy or laminectomy surgery if all else fails.
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Facet syndrome. Your low back pain is most consistent with arthritis. Look for confirmation on your x-ray and MRI reports with discussion about “arthritis.” The traditional treatment is radiofrequency ablation done by a pain management physician.
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Discogenic low back pain due to an annular tear. Sorry, this is the least common and the hardest to treat. Traditionally, the recommended procedure is fusion; however, that does not always work and causes adjacent level issues. More recently a denervation procedure was approved called the Intercept procedure from Relievant. Some doctors recommend injection, The two options are stem cell-derived growth factors, and ozone.
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