knee surgery

So im about to have my first(and hopefully last) knee surgery. My meniscus is on the edge of repairability, as in a repair has a 50\50 chance of working. With that in mind is their anyone who has had meniscus removal who can give me some insight on the recovery for that surgery? how long till you were back climbing, does your knee function in a useable manner, and is there anything you just cant do? would you try the repair first. Just looking for some people who have had meniscus surgery and their experience.

FYI, im only 18 so arthritis is a big concern.(the doc says to quit climbing, and skiing but that is obviously not going to happen.)

Thanks

I had a meniscus repair in early February of this year. I had a complete blowout of my right lateral meniscus (complete tear, and a large tear at that) from high stepping on a sport climb. I had a partial tear for about 8 years; this was just the final blowout. In this instance, the torn piece flipped into the joint and jammed it, locking my knee at 90 degrees. It wasn't until surgery (less than 48 hours post-injury..fairly urgent) that it became unstuck. They did a repair, because of the size of the tear and my fairly young age (23). I was a very good candidate for repair, and thus far it seems to have been successful (knock on wood).

The recovery from repair takes WAY longer than a removal/meniscectomy. I was totally non-weight bearing on my right leg until the 4 week mark, partial weight bearing from 4 to 6 weeks, and then still pretty gimpy for a few months after that. I got back to climbing at the 4 month mark, and just started running again yesterday (~7 months post-surgery). It took about 5-6 months for it to feel normal. By contrast, with a meniscus removal, the recovery time is very short. A friend of mine had meniscus removal surgery done this summer, and was back to climbing, with only minor stiffness, after 1.5 weeks.

I don't have any advice for which surgery to get. The repair is a much more involved surgery and recovery than the removal, but you get to keep your mensicus. Chance of success is another consideration...lots of factors at play.

I do have some very emphatic advice about choosing the right doctors and PTs. You need a doctor that understands your needs as a patient, and understands the level of activity that you wish to return to (in the long term) after the surgery. If your doctor tells you to quit climbing/skiing, you absolutely need to find a new doctor. You need a doctor who understands that you want to get back to full athletic performance, and will help you to do that.

When I had my surgery done, I was living in Bishop, so the nearest orthopedic practice was in Mammoth (the ski town). This was very lucky, because the surgeon I went to is a doctor for the US Ski Team. As a result, he was used to working with young, athletic people who want to get to get back to a high level of performance relatively quickly. I was never told to quit climbing, but rather was told I would be able to get back to climbing after 3-4 months of recovery. This was a correct prediction, and despite the time off from climbing, I was able to redpoint at a higher level this summer than I ever had in the past, so I'd say I'm pretty well recovered at this point.

Basically, find a doctor who is used to dealing with athletes, and who shares the goal of getting you back into athletics.

Whatever you do, be a zealot about PT, and don't push too hard too soon.

I had a very small meniscus tear, that became very painful to the point of not being able to work (carpenter) and icing it constantly. I had arthroscopic surgery, they sliced the small bit away, I was under general anethesia, for which I was thankful.

The surgery was done by a very competent, confident OS. For the first 12 hours the knee was pretty tender. Within 8 hours I was accidentally walking on it. The next day it felt better than it had for months. I was climbing 2 weeks post op.

I basically had the ideal situation. A very minor tear on the inside, a very good surgeon and an exellent recovery. I wish you the same. I kicked my self for waiting as long as I did. These surgeons work magic.

Do yourself a favor and be conservative with your recovery. Stick with the ice and the painkillers at first, both will help avoid inflamation complications. Don't over do it and you'll be just fine.

Relax and don't worry. These guys do this stuff every day.

+1 for Jon's excellent run down.

This is just my opinion: I work in health care and knowing what I do, if I were in your shoes I would go the crappier route and have the repair done v.s. the removal.
The recovery is going to be much more of a pain in the ass but if you can keep the meniscus intact it will give you years more life out of the knee, which given what you like to do will be a small trade off for the amount of suffering you put in now.
Good luck no matter which way you go.
BA

I had a repair two years ago and raced a mountain bike race two weeks after...crashed, ripped out stitches...and it was still fine. Make sure you get right on the PT as they will help eliminate any atrophy quicker. I'm 42 and the knee feels fine.

thanks for the help, i have a appointment with a new doc next week, so till then im stuck with my leg at 90 degrees.

I've had three torn meniscus surgeries and with a high level of activity from Mtn climbing some major mtns, skiing for years, and rock climbing, too...I vote for keeping the meniscus. Eventually a lot of people lose all cartilage and end up with a bone-on-bone situation...ouch! Then you're waiting 'till you're old enough for total knee replacement. A great doc in the Boulder/Louisville area is Dr. David Grauer. Good luck and take care!

"thanks for the help, i have a appointment with a new doc next week, so till then im stuck with my leg at 90 degrees."

Crypply..... I tore mine 4 pitches up while doing a FA in the back country a few years ago. My heal was stuck up to my ass while I rapped off and crawled the 200 yards back to our camp... yes it hurt some. I rigged up a pulley system and over the next 48 hours I pulled the leg to 90 degrees.... then I hiked 12 miles out to a road. (Always bring many pain killing drugs on climbing trips)

My Doc had me wate about 4 weeks before he would do the surgury. They shaved it down, didn't tear it out, and removed lots of broken bits. Take your time on the PT.

Don't worry the fix works and the knee is better then ever.

Good luck to you.

I had a partial right medial meniscotomy 3 weeks ago and was able to climb 2 weeks post op. As a medical professional, there are a few things to consider. Location/severity of the tear, direction of the tear, and the patients activity level. The meniscus is avascular (it lacks a local blood supply) and therefore has a much longer healing time than other parts of the body. typical healing time for a repair is 4-6 months, whereas a removal is usually only 2-6 weeks depending on swelling and the arthroscopy vs open surgery. If the tear is a vertical (more common), than a repair is usually more viable. However horizontal tears are usually less likely to heal, and are usually just removed. The actual meniscus consists of different zones that relate to the amount of padding and support the provide to the knee. Depending on where/which way the tear is, will determine the procedure that works best for you. I was unfortunate enough to have a complex tear that went both horizontally and vertically through the meniscus, which led to them trimming the torn section off. Short term you will probably not notice much as far as your mobility and climbing ability. However with the removal of the meniscus you will see an increase in arthritis (approx 5%) in the long term. Remember too that any activity is going to put wear and tear on your knee, so rehab is definitely a good idea. I am lucky to have a PT in the family who suggested doing things to isolate and strengthen the supporting muscles (quad, hamstring, calf, ect). I would be glad to offer more in depth advice based on your specific injury and treatment/recover plan. Do you have any films or studies done? To answer your other question, repair is almost always a better option, provided there is a decent chance for it to heal. If you can keep any of that padding in your knee it will help you in the long term, and decrease your risk for arthritis and other joint disorders in the long term. Feel free to email me with any other questions :). I am happy to help fellow climbers with anything I can medical. Take care and be safe
Steve

As someone recovering from a recent knee surgery and in the medical profession I'd offer the following advice:

1.) focus on long term outcomes not recovery times when choosing a type of surgery. Don't opt for the quick fix or 'accelerated' rehab programs unless you're a pro athlete

2.) the cartilage in your meniscus is avascular which means it takes a long time to heal. I'm 5 months post op and still have pain high stepping.

3.) kiss this ski season goodbye. You're only 18. Better to miss one season and ensure that you'll still be kicking ass at 50.

4.) you will never be back to 100% of strength and mobility. (99 though if your lucky)

5.) take glucosamine supplements after surgery. Evidence is iffy at best about their effectiveness but there are no bad side effects so give me a shot.

Sorry for the bleak outlook. Lots of people will tell you they were back to skiing/climbing within a few months. However I can assure you your meniscus is NOT fully healed at that point and you risk further injury. it's real tough forcing yourself to sit on the sidelines but don't worry it's only temporary!