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HuecoRat
Trad climber
NJ
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Topic Author's Original Post - Aug 18, 2018 - 03:02pm PT
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Well, 35 years of climbing have caught up with me, and I ended up with a torn meniscus in my left knee. Had surgery 2 weeks ago and they removed 2/3 of it. Doc says that one third will grow back. Virtually no pain, but the knee feels unstable, as if it wants to hyper-extend. Started PT this week to strengthen it. Have any of you had this done, and how well have you recovered? Are you back to your old climbing ability? How has this worked out for you?
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Ed Hartouni
Trad climber
Livermore, CA
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Aug 18, 2018 - 03:19pm PT
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had similar surgery in 2000, though sounds a lot less extensive then yours, my problem probably started as an injury in high school playing soccer, so that would have been about 38 years...
started PT immediately, doc wanted to make sure I used crutches until I was completely stable to twisting. after that it took about 8 weeks to be back on the rock (I think I had surgery on the new year, and was climbing again in March).
I could climb, but it took about 1 full year to be confident about the knee, and to have strengthened it and explored what knee I had. Some moves just don't happen (deep left drop knee, my surgery was on the left knee).
Doc said to expect arthritis symptoms in 10 years, it was more like 15, but I have to continually "rehab" the knee, paying special attention to keeping it strong.
my climbing has steadily improved since the surgery
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perswig
climber
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Aug 18, 2018 - 03:43pm PT
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As I understand meniscal histology, injury, and repair, the peripheral part (adjacent to the joint capsule) is more vascular and will regenerate somewhat, albeit slowly. The central part, which is also thinner, denser, and is responsible for decreasing the direct contact and impact of the articular cartilage of the femur onto the tibia, will not 'regrow'. The body may lay down cartilaginous material in its place.
If you look at images and diagrams of the medial and lateral meniscus, you'll see that they are semi-wedge-shaped, which mimics the curve of the femoral condyles. With removal of a substantial part of either meniscus, that 'wedging' support will be missing until the space is filled in with regrowth, fibrocartilage, or joint capsule thickening, which will make the joint feel more stable.
I know nothing about the role of stem cell treatments and meniscal regeneration, but I don't think it is particularly reliable since there is still significant decision-making about how much meniscus to remove and/or doing transplants.
Dale
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micronut
Trad climber
Fresno/Clovis, ca
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Aug 18, 2018 - 03:48pm PT
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I tore my left meniscus on an El Cap attempt in 2013. My first injury and my first surgery in my life. It really bummed me out and I feared that my adventure days might be coming to an end. I had just entered my early 40s and it was really humbling.
My surgery went well.... very little pain for the first two weeks and I felt great at three weeks. But then it started hurting and causing me lots of pain and after 3-4 months I was absolutely miserable again.
My surgeon said he couldn't see any problem and I went to a couple physical therapists who were mediocre at best. Then I found a sports medicine guru who told me I was striking funny when I walked and that the injury and had revealed some underlying instability in my joint. I committed to physical therapy three times weekly to strengthen my glutes/butt and my upper thigh/hip flexors. I have been quad dominant my whole life and could always crush it in the mountains since I had quads I was proud of. But being quad dominant is actually a terrible thing physiologically and after she strengthened my weak butt and stabilized/strength and some of the calf muscles and ankle muscles all of my pain in my knee went away.
The bottom line is, do your physical therapy early and stay on it if you need to and communicate with your team if your pain isn't going away. One lesson I learned is that the stock physical therapy company is recommended by the orthopedists are just to get your mobility back and get you out the door. Real physical therapy/training might be needed after word from a more nuanced/educated therapy team.
Now I climb hard, play hard, and rarely think about my knee except for sometimes in the gym when doing certain deep in the movements but otherwise I am stronger than ever.
Good luck!
Here's a shot from our climb this morning to keep you stoked!
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HuecoRat
Trad climber
NJ
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Topic Author's Reply - Aug 18, 2018 - 04:23pm PT
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Thanks, guys. This is encouraging.
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AP
Trad climber
Calgary
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Aug 18, 2018 - 04:40pm PT
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What ever you do don't hurry things.
Remember what counts is what you are doing a year from now, not a month from now.
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Fritz
Social climber
Choss Creek, ID
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Aug 18, 2018 - 04:43pm PT
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At age 67, about this time last summer, after Heidi & I had done a 12 mile, 2,500 vertical feet, round-trip on & off trail hike, with some steep-scrambling, in the Sawtooths, I woke up with a swollen & sore left knee that stayed sore until a torn meniscus was fixed, & a 1/4" bone chip, & some assorted arthritic junk removed, at the end of October.
The knee was immediately better, but still swelled up & hurt after exercise. After at home PT, I started doing moderate hikes again in early January, but after substantial exercise, I still had minor pain & swelling, until July, but now it's damn-near like new. I'm not doing much technical rock climbing, but 4 days of moderate 5.6 - 5.8 short routes in late June caused no problems. Last week, I completed an off trail mountain hike with steep scrambling & about 2,500' elevation gain & loss, with no problems at all.
Unfortunately, although I had previously tolerated aspirin & Iboprofen just fine, for old-age pains, the surgeon prescribed Meloxicam as his anti-inflamatory of choice after surgery. I soon developed an allergy & an itchy rash on my upper body & now both aspirin & iboprofen also cause that rash. I've had to go "cold-turkey" on post suffer-fest medication, except for alcohol, which I continue to take as needed.
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zBrown
Ice climber
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Aug 18, 2018 - 06:57pm PT
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Classic bucket handle tear since 1980 (left)
Complex degenerative since about 2008 (right)
No surgery
No restrictions on activity other than laziness
The process of programmed cell death, or apoptosis, is generally characterized by distinct morphological characteristics and energy-dependent biochemical mechanisms. Apoptosis is considered a vital component of various processes including normal cell turnover, proper development and functioning of the immune system, hormone-dependent atrophy, embryonic development and chemical-induced cell death. Inappropriate apoptosis (either too little or too much) is a factor in many human conditions including neurodegenerative diseases, ischemic damage, autoimmune disorders and many types of cancer. The ability to modulate the life or death of a cell is recognized for its immense therapeutic potential.
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perswig
climber
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Aug 19, 2018 - 03:44am PT
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Like folks have said, do your PT. Keeping your muscling AND your ROM up during the post-op instability is key.
Took me about 3 months before I could run or ruck after partial medial meniscectomy and some other debridement, but for another three months stubbing my toe would send needle pain from that side of the knee.
25 years later both knees have bucket tears and will pseudo-lock; most running is out but it never bothered climbing except during the rare times I tried to press from full flexion - thinking about it, this only occurred when high-stepping with crampons.
But I never climbed that hard, so there's that.
Dale
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10b4me
Social climber
Lida Junction
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Aug 19, 2018 - 07:48am PT
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Well, 35 years of climbing have caught up with me, and I ended up with a torn meniscus in my left knee. Had surgery 2 weeks ago and they removed 2/3 of it. Doc says that one third will grow back. Virtually no pain, but the knee feels unstable, as if it wants to hyper-extend. Started PT this week to strengthen it. Have any of you had this done, and how well have you recovered? Are you back to your old climbing ability? How has this worked out for you?
Had the same surgery in 2008, and unfortunately for me, my knee has only gotten worse. I've had injections, and laser treatment(which helped the most).
I don't climb anymore, and am limited to cycling.
I also have arthritis in both knees.
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zBrown
Ice climber
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Aug 19, 2018 - 08:58am PT
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The whole issue of growth/regrowth is a controversial one
Protein-releasing polymeric scaffolds induce fibrochondrocytic differentiation of endogenous cells for knee meniscus regeneration in sheep
Regeneration of complex tissues, such as kidney, liver, and cartilage, continues to be a scientific and translational challenge. Survival of ex vivo cultured, transplanted cells in tissue grafts is among one of the key barriers. Meniscus is a complex tissue consisting of collagen fibers and proteoglycans with gradient phenotypes of fibrocartilage and functions to provide congruence of the knee joint, without which the patient is likely to develop arthritis.
Endogenous stem/progenitor cells regenerated the knee meniscus upon spatially released human connective tissue growth factor (CTGF) and transforming growth factor–β3 (TGFβ3) from a three-dimensional (3D)–printed biomaterial, enabling functional knee recovery. Sequentially applied CTGF and TGFβ3 were necessary and sufficient to propel mesenchymal stem/progenitor cells, as a heterogeneous population or as single-cell progenies, into fibrochondrocytes that concurrently synthesized procollagens I and IIα. When released from microchannels of 3D-printed, human meniscus scaffolds, CTGF and TGFβ3 induced endogenous stem/progenitor cells to differentiate and synthesize zone-specific type I and II collagens.
We then replaced sheep meniscus with anatomically correct, 3D-printed scaffolds that incorporated spatially delivered CTGF and TGFβ3. Endogenous cells regenerated the meniscus with zone-specific matrix phenotypes: primarily type I collagen in the outer zone, and type II collagen in the inner zone, reminiscent of the native meniscus. Spatiotemporally delivered CTGF and TGFβ3 also restored inhomogeneous mechanical properties in the regenerated sheep meniscus. Survival and directed differentiation of endogenous cells in a tissue defect may have implications in the regeneration of complex (heterogeneous) tissues and organs.
http://stm.sciencemag.org/content/6/266/266ra171
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limpingcrab
Trad climber
the middle of CA
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Aug 19, 2018 - 03:47pm PT
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Had knee surgery a few years ago and found out my meniscus was messed up and I have almost no cartilage left on the end of my femur. They said the best thing to do it to keep it strong and active.
It’s been about 5 years and I can still go way too many miles with a pack in a day and have no issues. It’s a bit stiff at the beginning of hikes but improves as I go. As long as I keep exercising it I feel as good as ever, when I get lazy it feels a little weird.
Haven’t read the other responses but for me some leg strengthening and activity keeps me feeling good for any mountain trips. Not like in my teens when I could go for it off the couch, but I can still operate at the same levee with maintenance exercise. Stay in shape for prevention and keep having fun! (I was bummed and worried after my surgery so I hope this encourages you, but obviously every situation is different)
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Reeotch
climber
4 Corners Area
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Dec 24, 2018 - 04:32am PT
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So, Hueco', how's it going so far?
I just had meniscus repair surgery on Thursday. Reading these responses, it sounds like it could go either way. I am especially encouraged by Fritz's story.
I'm all good so far, with minimal swelling. No need for any prescription pain meds.
My doctor gave me a couple pages of photographs of the inside of my knee. It looked pretty messed up. I had a huge flapper in the medial meniscus that had to be stitched back down. I'll see if I can post up some of those pics.
My surgeon was a rock climber. He's even had some articles published in Climbing magazine. Maybe I can talk him in to posting up a little something on ST.
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Sierra Ledge Rat
Mountain climber
Old and Broken Down in Appalachia
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Dec 24, 2018 - 05:10pm PT
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I had knee surgery 3 months ago. I ran too many trail ultras when I was younger, and developed severe osteoarthritis of my knee, along with a shredded meniscus. This past year I suddenly had difficulty walking. The surgeon thought that that arthritis was so bad that that meniscus surgery wouldn't help. It didn't.
How is it going for me now? Yesterday I tried to go downhill skiing. On a green run. I got halfway down the run and had to quit because the pain was unbearable. Ski patrol gave me a courtesy ride back to the lodge.
Life is over for me.
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Fritz
Social climber
Choss Creek, ID
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Dec 24, 2018 - 05:15pm PT
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SLR! It is distressing to read of your knee problem, but life is not over for you. It's simply new knee time. My ex-US Ski team racer friend Pete got new knees for both legs back in 2006 & 2007.
After a few months of mostly self PT, he has continued as a ski guide, hiker, & climber ever since. I did a trip with him fall 2017, before my meniscus surgery, & at age 60, he hiked everyone's asses off.
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fragglerockjoe
Trad climber
space-man from outer space
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Dec 25, 2018 - 09:20pm PT
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I can't say that I have had a surgery. But I can say that I've been jogging 2-4 miles regularly, working as a climbing arborist, and recreational rock climbing for a few months out of the year for over 10 years now; with a ruptured ACL and a full thickness tear in the meniscus. The pain is nagging sometimes minimal sometimes none at all. Other times I break down into tears because I was once a top contender and avid athlete. I don't foresee myself ever being back at 100%. But I am one tough S.O.B. and I am not going to allow a little partially dislocated Knee prevent me from success! Therefore all should be warned that I, Joe Chauvin; was at one time the ATA Taekwondo WORLD CHAMPION in the sparing division and that I have received the rank of 1st Degree Black Belt, under "grand master" H.U.Lee! So I will red point all the fist cracks until my knuckles bleed and I will succeed!
WAARRRR!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
P.S. Watch out for the spinning hook kick it's a dozzzy!
And Merry Christmas And if you are in Hueco, climb 'split crack' every day.
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perswig
climber
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Dec 26, 2018 - 03:47am PT
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The surgeon thought that that arthritis was so bad that that meniscus surgery wouldn't help. It didn't.
Life is over for me.
Is TKR an option?
Dale
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Sierra Ledge Rat
Mountain climber
Old and Broken Down in Appalachia
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Dec 26, 2018 - 03:54am PT
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Is TKR an option? The insurance companies say that they are not practicing medicine, but also say that a TKR is an unnecessary elective procedure because it doesn't affect my desk job.
We have been appealing since August, and I just changed insurance companies again.
Trump and his Republicans want to eliminate protections for "pre-existing conditions." If they manage to do what they promise, then I'm really screwed.
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perswig
climber
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Dec 26, 2018 - 02:00pm PT
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The insurance companies say that they are not practicing medicine, but also say that a TKR is an unnecessary elective procedure because it doesn't affect my desk job.
And yet you'd have to wonder if their actuarial tables don't give weight to the long-term effects of debilitating DJD and resulting enforced sedentary existence. Like increasing BMI, decreased CV health, decreasing bone density and muscle mass, spinal compression, and not leastly mental health.
Given your previous travel history and current occupation, have you considered sx OCONUS?
Dale
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Robert Yoho
Social climber
Los Angeles,ca
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Dec 27, 2018 - 01:39am PT
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See
https://www.nejm.org/doi/full/10.1056/nejmoa1305189
You are too trusting. This surgery is a fraud.
A 5 billion a year placebo industry. It works no better than rehab alone. Probably worse.
Unless the knee is locking, it is done only
For $$.
Google sham surgery knee for more.
There are other studies. Yes.
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