Monday, July 26th, 2010
I’ll cut right to the chase: I’ve torn my meniscus. The meniscus is the cartilage that acts as a shock-absorber in your knee, also preventing bones from rubbing on one another. It’s a pretty common whoopsie, and it’s likely that mine has been there for a while, I just made it extra mad by Warrior Dash-ing, taking on an “extreme” (per its name) lifting program, and starting up with running again. What’s just as common is the knee-jerk response (pun totally intended!) to have arthroscopic surgery, especially here in the United States. So common, that while it’s still a surgical procedure to repair or remove all or part of the meniscus, it’s still often lightly referred to as a “treatment” in the biz. Um… If you have to knock me out cold with anesthesia for something, it’s beyond a “treatment”. I just had a facial two weeks ago, I know the difference.
I’m sure most reading this already have an inkling that I’m not a fan of surgery. This is mostly true. I’m all about it for life-saving procedures. For less critical situations, I want more facts first. Being a chiropractor married to a physical therapist makes me both the best and worst patient ever for an orthopedist. The whole reason we stopped in to one the other week was because we were sure from our own analysis that something was wrong IN my joint, such as some torn cartilage, but we weren’t sure what exactly. After a 70 minute wait, some quick xrays, and about 10 minutes of the doctor’s assistant ruling out things we already had on our own, the doctor came in and spent a grand total of 90 seconds with me (tops) to say “torn meniscus, MRI to confirm, surgery will fix it no problem”. Well, 60 of those seconds were for that, the other 30 were spent on some snarky remarks about chiropractors and PTs, but that’s another rant…
I did schedule the MRI for a week later, but, after reasoning that it was not worth having one just for curiosity’s sake, I canceled. You see, I’d already decided I would not have surgery. Not just yet, anyhow. I’ve read enough stuff (see referenced articles at bottom for some examples) to know that, while having torn cartilage predisposes me to osteoarthritis, surgical repair of it does not improve that. Likewise, short-term (1 year) post-op recovery is particularly unsuccessful in females, through an as yet unknown mechanism. As a doctor, I’ve been around a lot of sloppy knees, many of which have had repairs to either the ACL (anterior cruciate ligament) and/or the meniscus. Throw into the mix my husband’s personal (he’s had 2 meniscectomies, 1 repair and he’s not a fan) and professional experience, and a recent random $.02 from a medical doctor that was decidedly anti (would you believe my GYN was discussing his torn meniscus with me during my pelvic exam? LOL), my own intellect-plus-intuition was confirmed and I decided I didn’t need a mugshot of my own meniscus. Probably best that I don’t know exactly what’s up, thus setting mental limitations on what I can achieve on my own. On that note, the orthopedist did mention that he believes I’ve been pretty much fine for so long because of all of the muscle in my legs. Score! It definitely added to my resolve to see what else I could achieve to on my own to support my knee for the time being.
So, what’s on deck? Well, my in-house PT has me on some specific exercises and modified ADLs (activities of daily living—example: I have to walk down the stairs one step at a time, injured leg leading. It takes forever!), and he performs this cool low grade joint mobilization on my knee that makes it feel so much better for a good bit. I’m on ice after activity and a therapeutic dose of ibuprofen for the short-term as we tackle the swelling and inflammation. Large amounts of glucosamine are in play as I build up my reserves of joint tissue making compounds, and sleep is an even higher priority these days. Acupuncture and massage will continue to play a role. The former because I know it’s capable of healing me on many, many levels as a whole person, not just as a knee with a person attached to it. The latter to keep trigger point development in surrounding tissues at bay while my knee is so sloppy. I’m so inspired and intrigued by meditation and guided imagery for healing, I’m investigating some programs for that now. I wear a knee brace. The compression feels good and I’m less gimpy after a lengthy stint of sitting. But, really, it’s mostly there to remind me not to be a jackass, especially while exercising. I don’t run, lift (with my legs), or jump, and I avoid bending my knees past 90 degrees. For example, while yoga is on the menu, my instructor knows to make sure I don’t fold up my knee during child’s pose, so I modify with a ton of blankets or stay on all-4s with something under my knees. I’ll admit it, I got depressed quickly. This is a BIG change for me, activity-wise. So I made a list of what I CAN do to make myself feel better. Here tiz: yoga, swimming, deep water aqua aerobics, NordicTrack, pilates, upper body lifting, biking, elliptical. (The cardio machines are not much of a consolation, but I have caught up on some reading.) Anyhow, I’ve learned to really like some of that stuff and my weight has held pretty steady, so I’m happy for now. Beyond that, everyone I work with is in the know, so I’m less tempted to demonstrate things that might make me regret having done so later in the day when my knee is barking.
Not only is my PT really smart, he's exceptionally handsome! 
What’s my point in telling you all of this? I’m not that unusual, for starters. This sort of thing happens all of the time, to people with fewer resources of information regarding alternatives. People like me are the ideal study subjects, in fact, because we are not professional athletes who are worth so much on the field, it’s considered a bad career move to not get duct-taped, spit-polished, and shined up until the next injury. Likewise, we are not children who might develop improperly if not repaired quickly. We are also active. Sedentary folks, especially those with other factors working against them, such as extreme obesity, are less likely to be studied too. So the information I have gathered showing that surgery does not provide an increase in favorable outcomes (ex. Pain reduction, decreased arthritis incidence, better functioning) is completely relevant to me. Finally, surgery will always be there. Once we re-evaluate my progress in 6 weeks, we’ll alter the plan, if needed. That plan may include surgery. Or the surgical option may play out years from now. Who knows? But I’m smart enough to know that if the knee being so dysfunctional starts to affect surrounding joints badly (ex. hip, lumbar spine), and surgery could correct that situation, then “duh”. Right now, the “duh” would be not trying to rehabilitate sans surgery.
The over-riding theme for the post is: Do your homework. We’re in a “patch ‘em up” society, especially in America. Get second and third opinions until you feel good about whatever decision you make. Know what you’re willing to do. Seek the advice of a variety of practitioners. Regarding ACL and meniscus repairs in those with formerly healthy knees, did you know that outcomes were equal between patients who had surgery + rehab as compared to patients who had rehab only? And that no study on those same knee surgeries in particular has been able to demonstrate a more favorable outcome for those receiving surgery? Kinda makes me think my husband should be making as much as an orthopedist! Especially when you consider the time involved with one versus the other. Nevertheless, check things out. It’s YOUR body. YOU’RE the boss of it. Always make informed decisions regarding the care and maintenance of it. And be flexible enough that, when new information and technology is available to you, YOU can change your mind. A win-win.
http://www.sciencedaily.com/releases/2010/06/100629081630.htm
http://www.sciencedaily.com/releases/2010/07/100722075224.htm
