Is knee surgery any good???

[Mike Fernandez]

http://www.npr.org/blogs/health/2013/12 ... -operation

http://online.wsj.com/news/articles/SB1 ... 2014913458

[day]

Hey Mike,
Very interesting article. Thanks for posting it.
Personally I wouldn't jump to the conclusion that this study "proves" that knee surgery for meniscus injuries are not effective.
I would exam the original study carefully and ask more questions for clarification:
Such as:
1. What are they measuring in the two groups that resulted in the conclusion of no difference? Subjective pain? Degree of swelling? Actually functional task? Range of motion? Strength? .... Did they measure your ability to knee board??? Bottom turn, cut back, hanging over your inside rail while riding the tube????? Ha!

2. What about beyond the one year that the study looked at? Do patients that have a loose piece of cartilage or a torn irregular meniscus surface, or a piece of cartilage causing locking, develop arthritis in their later years (beyond one year that the study looked at) more than patients who on the surfaces cleaned up with surgery? If the surgery can slow or prevent the development of arthritis years down the line, it may be worth it. You just have to measure from a longer time line than a year.

3. What about athletes??? Those that engage in high demand activities. Like kneelos, runners, soccer players, basketball players, football players, skiers, etc. ?? Did the study measure athletes and athletic activities if there was a difference???
Or were the study subjects more sedentary or old folks??

So before we tar and feather our orthopedic surgeons that do meniscus surgeries (I am not one, if you are wondering), lets ask more questions and get more clarity.
Still I think it is good that you brought up the article Mike. I think we should challenge old practices and see if they stand the test of deep investigation. If no one questioned the use of just one fin, where would we be now?

[MWROBERTSON]

I had my surgery about eight weeks ago. Getting better each week.

I can say, my tear got so painful and irritating that I could not sleep at night.

Now I can at least sleep and that nagging pain has gone away.

My doctor gave me a series of photos of the before and after results. It's clear that he cleaned up some wear and fraying of the meniscus.

I put off the surgery for well over a year trying therapy and everything else. It was the last resort and I wished I had done it sooner.

I'm back in the water at about 85% now and getting better.

Interesting study though.

[day]

Thanks MR for sharing your experience.

I have heard and seen many similar testimonials of pain and dysfunction/impairment helped by meniscus surgery and follow up rehabilitation.

Whether they would have gotten better eventually down the road is hard to say. But most that I have been involved with, that had no secondary problems or complications, got good post surgical relief and progressive return to higher level of activities.

Being an appropriate candidate, having the right procedure done, having an experienced and skilled surgeon, being a good patient that follows directions and follow ups and good post surgical rehab are all essential for the optimal outcome.

[Scott]

Mark, did you have a history of knee issues, or did the miniscus suddenly get damaged not too long ago and it just went from bad to worse?

[MWROBERTSON]

Scott,

I have had many issues including constant water on the knee. I had like seven draings over a two year period.

As for the meniscus, my knee really started hurting about two years ago. I had an MRI and the Dr. confirmed that I did have a tear. He suggested that if I could try rehab and live with the pain. He would advise that before surgery. I did that for as long as I could, then.....see my last post. I had to do something.

[loonylen]

I had a torn meniscus taken out about 18 years ago as the torn tissue was falling into the joint and locking the knee, the next day after the injury was x-mass eave and the ER doctor got the nurse to hold my ankle while he pushed down on my knee and straightened my leg (with no pain killers, it was agony), they back slabbed it strapped it up, gave me crutches and told me to come back in the new year to see the orthopaedic surgeon after his x-mass break. Now to the present, the knee gives me a lot of grief, and after the last scan 2 years ago the Doc said the joint is so worn its almost bone on bone and I'm looking at a Knee replacement in 5-10 years, I'm 52 my dad is 82 and he just had a knee replacement. Good luck guy's

[Scott]

so....what is the best way to prevent miniscus tears as a kneeboarder, since that seems to be one of the paths to chronic knee problems in our sport? My knees are great and I'd like to keep them that way, especially as I turn 60 this summer!

This last year, I've taken to wearing a general knee support brace under my wetsuit, protecting against hyperextension and adding general support.

https://www.shockdoctor.com/dual-strap-knee-wrap

[Daryl D]

For the most part, I've waited to weigh in on this discussion, but after four knee surgeries and two replacements, it's time. First, make surgery the last alternative, not the first. I think finding a good physical therapist specializing in sports rehabilitation is a good move, even if you pay. If necessary, he should be able to direct you to a good orthopedic knee specialist. I believe it's most important to build the support for the knee and work to retain flexibility and strength through directed exercise and training. Expect pain and struggle, but worth it. Remember, every surgery will cost strength and flexibility that will need to be regained, even beyond the original injury. The goal should be to retain and build both. If things don't improve and surgery appears to be the only option, don't hesitate, get it done and get into recovery. The longer you wait, the weaker the knee becomes, and the longer the recovery time is. Included in all this, I also believe a good training program aside from your sport will work to build your body and essentially protect you when you're letting it all hang out on the face of the double overhead!

[loonylen]

My injury was not from kneeboarding, it was work related and I had a piece of tissue about 3/4 of an inch long by 1/8th x1/8th of an inch torn and floating around in the joint. A fairly large piece which as an Electrician by trade became a problem when the tissue would fall back into the joint whilst I was up a ladder or on a roof or in a ceiling ect. Surgery was the only answer....

[Fossil Man]

Scott, I was looking at your Shock Doctor 868 Knee Wraps, and I think we talked about it last year when you were here, when you wear that under a wetsuit, doesn't it kind of bind and fight your ability to flex your knee ?

[Scott]

No, I don't sense any lack of mobility from the Shock Doctor. It's not rigid or anything, just adds some support.

[day]

Daryl D,
If you care to share some details about your knees, I am curious, was your two knee replacements, one for each knee or two on same knee? Were you able to return to knee boarding after the knee replacements? What did your surgeon that did the replacement say about you knee boarding after knee replacement surgery?

[Daryl D]

Basically damaged both knees in high school, sports related. Torn patella tendon and bone impact damage to the femur at the joint. In the 60's, when the original surgeries were done techniques weren't so good and rehab wasn't a consideration, you just got on with life. Stand up surfing was what it was about. Because I've worked on my feet on concrete for the last almost 50 years, there was continued wear, with band aid repair. I started giving up on athletic endeavor in the early 90's, legs hurt too much and joints were worn out, but I was told I was too young for replacement. I was able to keep things pretty normal until the mid 90's, then I quit. Also, in '95, my 1st son came along, when I was 45. In 2008, I couldn't take it anymore and both knees were replaced. At that time my son took up surfing. In about 2010, I got back on a board to go out with him. The limitations became leg and core strength, and joint flexibility. A pop up became a scramble up that the majority of the time didn't end up, up. Very frustrating, but to be back in the waves was outstanding. I found I could knee ride on a long board, so I looked at knee boarding. That created a new level of frustration because of the speed and flexibility of the shorter board. The major limitation is the flexibility in the knees, on joint more so than the other because of the condition at time of surgery. I can't lean back, pivot, and turn. Most often, I have to lean forward on one hand for support, but I do get down the line, sometimes. I've been riding paipos now for a while, but just decided to get back to the knee board again. That's the history.

Since the replacements, I've kept a pretty solid work out schedule, except a year due to a long term illness in the middle of it all. In all this, particularly after the replacements, and working around other knee patients, what I learned personally and from observation, is that rehab is the deal. Exercise for flexibility, strength, and joint support is really what it's about. I didn't consult the surgeon specifically about knee surfing. It was his opinion that you do what you can, but avoid impact situations. I personally don't run or jump. I do a rowing machine, exercise bike, and modified cross - fit work outs since rehab. It is my belief, through all this, that involving oneself with medical professionals who specialize in the knee is necessary when you want the best chance of recovery. Also, when athletics are involved, and knee surfers are athletes, sports minded medical professionals need to be who one goes to.

I think the 13 year break did more damage than anything because of the deterioration of my overall condition. That's why I believe that if it needs being done, get it done and get rehabbed. If repair needs to be put off, it's important to take care of your body exercise wise so you maintain as much of your conditioning as possible. End result is I'm 64, still get in the water, and am privileged to experience the surf with some really great people, even if it's in limited fashion. But I still want those limitations minimized.

[day]

Hey Daryl,
Thanks for sharing your story.
You the first guy I know that knee boards after total knee replacement! Kudos to you for getting back out there on a knee board.
I am curious to know how much flexion range (bending) you were able to get after your knee replacement and rehab?
If there are any others out there, please share your experience.

I totally agree with you on the need to rehab and to keep fit.
Keep fueling your drive to get into the water, for fun and exercise.
Keep pushing on those limitations.