1500m Runner Faced With Dilemna: Surgery or No Surgery? (Meniscus)

Ok, here's the deal with meniscal injuries:

Unless you have a specific type of meniscal tear - a bucket handle tear, or a complete tear - you should not even attempt surgery until at least 9 weeks after the injury. This is well supported by the literature, and any Orthopedic surgeon who tells you differently is lying to you.

That said, the standard of care for minor meniscal tears is "conservative" management - rest and physical therapy. Only if this fails - and the standard is to give it 6 months - should you attempt surgery.

Meniscal tears are quite common in athletes, and many people are walking around with them without even knowing it (called "asymptomatic tears").

Your best advice is to find an orthopedic doc who will be straight with you (i.e. who will follow the literature concerning meniscal tears), take some time off, and do some P.T. No need to rush surgery at this time.

Here is a review article on the current standards of care for meniscal injuries. It may be a little bit technical, but is fairly easy to follow:

http://www.emedicine.com/pmr/topic75.htm

This section from webMD is also helpful, especially the "Decision Point" part on page #2, where it walks you through evaluating for surgery:

http://www.webmd.com/a-to-z-guides/meniscus-tear-topic-overview

Wow, thanks for the quick reply.

So anyway, you say that the standard care for minor tears is "conservative" management, but I forgot to mention that I am in my last year of college, and I was hoping to complete this season and possibly make a run at the trials. This would mean I would definitley be training hard.

Also, the tears on my meniscus are not located in the vascular part, so there is essentially no chance for it to heal according to what I have heard from dr's and read.

Does that change anything?

Aspiring Trials Athlete wrote:

Wow, thanks for the quick reply.

So anyway, you say that the standard care for minor tears is "conservative" management, but I forgot to mention that I am in my last year of college, and I was hoping to complete this season and possibly make a run at the trials. This would mean I would definitley be training hard.

Also, the tears on my meniscus are not located in the vascular part, so there is essentially no chance for it to heal according to what I have heard from dr's and read.

Does that change anything?

Two things:

1. If you are hoping to make the trials...with or without surgery, you are probably a long shot. If you had surgery tomorrow, you'd still face a minimum of 8 weeks of rehab before you could do anything more than light jogging. Standard treatment is 6 MONTHS of rehab after surgery. The accelerated rehab - which lasts 2-3 months, is commonly done for athletes. Regardless of the rest period, there is about a 10-20% re-operative rate.

So you'd have from mid-February at the earliest- after being off for a month - to get into the best shape of your life. Not impossible, but unlikely. Furthermore, as I mentioned above, the best results from surgery come 9-13 weeks after the injury, preferrably with a period of pre-rehab, to lessen the inflammation and create a clear field for minimal operative repair.

2. Can't judge without looking at films or examining, but be wary of "avascular" terminology when it applies to the meniscus. MOST (80%) of the meniscus is avascular. In fact, one of the relative reasons NOT to do surgery is involvement of the avascular section - they don't heal well with surgery either!

Read more here (Wheeless is THE orthopedic textbook, btw)

If you opt for surgery, and do it now, it's February at the earliest before you'll be back training. If you opt conservatively, - and wait the 9-13 weeks, then you'll be at a decision point: if it has healed and feels better, great! you don't need surgery, and you're no further behind than if you had the surgery tomorrow. If it still hurts, then you're in the window for the best results - and lets face it - you'd rather want the best chance at operative outcome rather than have multiple operations. You'll need your knees for the rest of your life, not just the trials in '08.

Good luck

In reality, all I need my knee is for about 15 yrs. So as long as it holds out until then, that's great! haha.

But seriously, thank you for the information. I had no knowledge of the 9-13 week waiting period, which I think is partially my fault since I was pretty adamant on getting it fixed ASAP. I will talk to my doctor about this information and thank you again.

I'm actually debating the same thing for my knee, although I'm not quite looking to compete at the trials. In my case, there was not one incidence of the injury, it just sort of popped up and never went away and for a long term p/t's and doctors just thought it was PFPS. What I'm worried about is the possibility, or guarantee, of arthritis in 5,10+ years...

Try to contact malmo; he has had several surgeries and I think he is having one on his meniscus on Tuesday or so.

I have had 3 meniscus surgeries and have come back from each one to run better than before. One word of caution, it can often take 6-12 months after the surgery before the knee starts to feel "normal" again. It sounds like they will probably remove the affected parts which is a relatively quick recovery..you walk out of the recovery room and start rehab immediately. Following my last partial menisectomy I was running in about 3 weeks. However, depending on the exact location/severity of the tear they may opt for a repair. In this case you are looking at crutches for a week or two and about 3 months of progressive rehab before you can start to run again.

My strong recommendation is to go ahead and get the surgery. You are young and if you don't take care of the tears now they will just get worse. Also you will bounce back alot quicker from the surgery now than you would if you had it when you were 30, 40, etc.

If you want any more details feel free to email me, i've got alot of experience with this stuff.

forgot to include my email