Two cannulas are subsequently placed into the area of bone that was decorticated to allow for the transtibial 2-tunnel technique to be performed. His extensive schooling, research, and commitment to his craft shined through at every turn as he evaluated my injury, presented all my options (clearly explaining non-surgical options and expected outcomes), and helped me plan my course of treatment and recovery. Phase 1: 0-2 weeks post-operatively Goals Protect repair Minimize pain Minimize swelling . W;5$u4Yxa_V_bm}q8=^_qbY,H(+",X'{|oMs"&A;3.E s&L=Z`)!]$],b }zb& Y@dy.Lif1:4@"Fz"U2`/h0|6^T&}56+Q:Dn{d:rqW@3 7 U. Now my intent on this video is not to throw anybody under the bus surgeons are doing the best they can with what they know and saw our physical therapists in any health care providers that you may be seeing for your meniscus problem. Therefore, addressing a meniscus root tear prior to the development of osteoarthritis would be indicated. One of the most common is in patients who may have some underlying arthritis and the arthritis is causing the pain or the arthritis has progressed further after the meniscus root repair. Healing kind of goes fast the beginning and then it tapers off. Really cares for his patients! My repair will be later this week on my right leg. The drill tip can then be pulled out, leaving the cannula in place, which allows one to place a passing stich up it to subsequently shuttle sutures down the tibial tunnel. Historically, most root tears were treated with meniscectomies because the importance of the meniscus root as a shock absorber was not well known. <> Other sources of pain can include scarring within the joint that occurs as a normal part of a surgical procedure, or pain from other pathology and joint, such as arthritis under the kneecap. That was day one. And theres things that you can do, which Ill allude to here in the middle. While you're recovering from your meniscus surgery, you can expect to feel pain while you heal. There are some isolated reports of using suture anchors to repair a meniscus root repair, but this area of the knee is very difficult to access and the suture anchors can leave large knots which could subsequently interfere with the cartilage surfaces in the knee. My MRI showed an extensive radial tear adjacent to the medial meniscus root insertion, as well as evidence of high-grade chondral loss involving the central trochlea. Robert LaPrade, MD, PhD There are two ways to initiate a consultation with Dr. LaPrade: You can providecurrentX-rays and/or MRIs for a clinical case review with Dr. LaPrade. Iatrogenic meniscus root tears have been described for all 4 meniscal attachments in the knee. Meniscus root repair surgery recovery Most patients can return to full activity 4-6 months after a meniscus root repair. The exception is a patient that has contra-indications to surgery or already has too much cartilage wear and tear for the root repair to be beneficial. 1 doctor answer 2 doctors weighed in Dr. Jeffrey Sider answered Sports Medicine 41 years experience Depends: If surgery is on the left leg i let some patients drive the next day if they feel ok. In addition, the other factor is if the meniscus was released significantly enough from scar tissue to pull it back into the joint. Two important criteria exist to begin driving after meniscus surgery. The general published success rate for a meniscus root repair is between 80% and 85%. Placing sutures or UltraTape on each side of the tear and pulling it down into tunnels should be a safe and reliable method for a bony avulsion root repair. (Please keep reading below for more information on this treatment.). Therefore, our surgical technique, using specific guides to avoid the eminences to ensure that one can place the guide exactly where one wants to have a cannula come out in the joint, using cannulas to allow for placement of passing sutures quickly and efficiently, having 2 separate cannulas with 2 separate tunnels for the meniscus repair, releasing the meniscus thoroughly to pull it back in the joint so it functions most effectively, and then having self-capture suture devices, which can place suture or tape into the meniscus substance, shuttle them down the tibia, and then tie them over a metal button on the tibia. Two weeks to the day, I got on my spin bike at the gym and did what I could do. If the patient has or has developed significant arthritis, which is usually designated at Kellgren-Lawrence grades 3 or 4, it is felt that a revision root repair may not be indicated. I was very pleased seeing Dr. Burnham, however I was not pleased to learn I was expected to pay an additional co- pay within the same week to receive the results of my MRI. He is on the cutting edge of research and techniques around surgery, he has a memorably reassuring bedside manner, and Im thankful he was in charge of my evalution and treatment. Nothing. I was told it would be about 6 weeks, but my instructions are to wear a brace at full extension for the duration of this time. It was glorious. When I said I was not on any medication, he said when I could bend my leg 90 degrees. Being aware of the location of the meniscal attachments at the time of ACL and PCL surgeries is essential to minimize the chance of an iatrogenic root tear. For this reasons, it is crucial to identifiy and treat meniscal root tears in a timely manner. Untreated meniscus tears can increase in size and lead to complications, such as arthritis. MRI is used to look more closely at the meniscus and determine if it is something that needs surgical treatment, although not all meniscus root tears show up on MRI. How long after surgery for a meniscus tear will i be able to drive again. An ACL tear commonly has a pop on the outside of the knee, whereas a patient who has meniscus root tear commonly feels a pop in the back of the knee. (C, D) Arthrex MU (multiuse) guide with 6-mm FlipCutter drill positioned on footprint of posterior root of lateral meniscus. We have published on several of these, noting that a PCL tunnel which is placed too close to the joint can detach the posterior horn of the medial meniscus and lead to the development of arthritis of the medial compartment. He and his staff could not have been more helpful and professional. Ive already talked about this but I cant drive the point home enough if youve gone to the doctor. For this reason, much research has gone in to meniscus root repairs over the last several years. I have two good arms, and a good leg. Meniscal repair may be performed either by open surgery under direct vision or minimally invasively using an arthroscope that can be inserted into the knee through a very small key-hole incision to locate and repair the damaged meniscus. Therefore, we then looked at surgical techniques and due to the fact that we had multiple second look arthroscopies after bone grafting for ACL reconstructions with meniscus root tears, that the 1-tunnel technique had more of a spot welding healing of the meniscus to bone whereas the 2-tunnel meniscus root repair technique had a much better healing surface of the meniscus to bone. If it is the right knee, the average time until the patient is able to drive is 6-9 weeks. My daughter injured her ankle in cross country practice and we were able to get in the next day to see Dr. Burnham. And they can get back to normal in about two or three months after having the surgery. Edina, MN 55435, EAGAN-VIKING LAKES OFFICE 4. No swelling. The torn meniscus is corrected via a minimally invasive procedure depending on the kind of injury. The meniscus is a piece of cartilage in the knee, often injured in sports. Meniscus root tears are now being recognised as a significant cause of pain, disability, and rapid joint deterioration. On Wednesday, February 20, 2019, I had a meniscus root repair surgery on my left knee. Meniscal repairs offer the benefit of preserving the native meniscus, but they require a longer rehabilitation protocol as compared to a meniscectomy. I limped from the wedding venue to the car, and then from the car to my house. He provided a thorough explanation without wasting time. I press and bench with no modifications. The Smith & Nephew root repair technique involves specific devices which can lower ones surgical time to perform a meniscus root repair. Request Case Review or Office Consultation, Lateral Patellotibial Ligament Reconstruction, Anatomic Analysis of the Posterior Root Attachments of the Menisci, Posterior Root Avulsion Fracture of the Medial Meniscus, Not Your Fathers (or Mothers) Meniscus Surgery, Anterior Intermeniscal Ligament of the Knee An Anatomical Study, Popliteomeniscal Fascial Tears Causing Symptomatic Lateral Compartment Knee Pain, Prospective Outcomes Study of Meniscal Allograft Transplantation. So getting swelling, or if its been a year since you had your meniscus surgery, and youre better overall, but youre still getting some swelling and pain, then its normal. But youve got to figure out a way to get your butt muscles stronger if youre looking for a more comprehensive plan for making your knee better and getting your glutes stronger we also have a program called the 28 day knee health and wellness boost program you can also find that in the link and as a link in the description below. The most important aspect to assess when one is looking at a root repair is to ensure that ones cartilage surfaces are still fairly normal. Repetitive motions, overuse, and muscular imbalances ar twitter.com/i/web/status/1, Digging Deeper into the Data: Is Suture Bridge Repair + #PRP really the best technique for #rotatorcuffrepair? twitter.com/i/web/status/1, Wild Life of the Last #BlackJockey to Rule the #KentuckyDerby If you think you may have a meniscus tear, it is recommended that you see a sports medicine physician as soon as possible. Dr. Robert F. LaPrade operated on my right knee in May of 2010. One of the main portions of the system is a guide that can be placed inside the joint that fits around the tibial eminences and allows the surgeon to place the tip of the guide right at the area that has been decorticated of bone, where one wants to perform the root repair tunnel. My calf swelled up into my ankles. I have looked many times for answers on my tibial tubercle osteotomy and never found any as detailed as i needed. Unlike some meniscus tears which can be observed or treated conservatively, most meniscus root tears need surgery. Created for people with ongoing healthcare needs but benefits everyone. This is done to protect the repair and let the body heal it. He was outstanding. In fact 2 years ago I finished climbing the top 100 peaks in CO. Thus, the entire weight of the body is transmitted through the femur into the cartilage of the knee. Protect repair Minimize pain Minimize swelling These include 1-tunnel and 2-tunnel techniques. Your subscription could not be saved. Can you tear your meniscus again after a surgery and if you do how can you tell? The next portion of the Smith & Nephew root repair device is a mini First-Pass device. After meniscal surgery, rehabilitation with a physical therapist or athletic trainer is needed to restore range of motion, strength, movement control and guide the athlete's return to sport. Very positive experience at Bone and Joint Clinic in Baton Rouge. Therefore, most meniscus root tears need to have the scar tissue released so the meniscus can be pulled back into the joint. That night, I drove myself to the gym. They can occur in younger patients as a result of high energy trauma, but are more common in patients between 45 and 60 as a result of degeneration of the meniscus with age. A meniscus root tear occurs when one or both of these roots tear away from the bone. 4 0 obj It is important to recognize that most patients who sustain isolated meniscus root tears happen with a medial meniscus root attachment. My day is pretty much elevate the leg, ice the leg, do the exercises permitted twice a day. So if youre sitting at home right now, and you just had your meniscus surgery a month or two ago, and youre thinking, gosh, why arent I much better already. I have now biked five to six days each week since my surgery. His interaction with me around my surgery calmed me, and his excellent work in the operating room speaks for itself. I asked him about biking, and he told me that he allowed his patients to start biking two weeks after surgery. Thank you Dr. Burnham for being so amazing! A sports medicine specialist will examine your knee and any relevant imaging to determine which treatment you should start with first. Steadman Clinic, 181 W Meadow Drive, Suite 400, Vail, CO 81657, USA (email: drlaprade . This is because the signs of arthritis are usually pain and swelling with activities. The recovery time for meniscus surgery depends on the type of surgery you had. Most meniscus root tears occur very close to the root near the meniscus itself and are called radial root tears. And this channel is dedicated to helping people stay healthy, active and mobile. Meniscus (cartilage) Repair patients cannot do twisting, pivoting, squatting, deep knee bends or impact activities for four months. Therefore, the patient should be worked up in a timely fashion when they do have a posterior horn medial meniscus root tear to determine if they are a candidate for a posterior horn medial meniscus transtibial root repair. Malempati C. Bonasia DE, Pellegrino P, DAmelio A, Cottino U, Rossi R. Meniscal Root Tear Repair: Why, When and How? There can be many factors which can potentially cause pain after a meniscus root repair. Great doctor. endobj However, if the meniscus re-tore or is placed into a non-anatomic position and ones cartilage surfaces are still fairly intact, an attempt at a revision repair should be made. A lateral meniscus root tear involves a tear of the meniscus either at or close to the root attachment in the back part of the lateral meniscus. In terms of when, one should plan to perform a meniscus root repair as soon as it is diagnosed as long as ones articular cartilage is still fairly intact. Just its a big deal to take your time and let that cartilage heal at the rate that it heals you generally can go faster than what it heals, And the question that i get often is do i take any supplements glucosamine chondroitin those types of supplements and you know the answer to that is its not going to hurt we the research is kind of mixed on it sometimes it helps sometimes it doesnt help what we know is that it generally doesnt hurt it doesnt make it worse so youre not going to youre not going to make things worse if you decide to take those supplements are generally safe to take but some people report no difference. This allows the meniscus to heal back to the bone. There are many factors that go into this, including a patients weight, with overweight patients putting more stress on the meniscus root tear, ones alignment, where one being bowlegged with a medial meniscus root repair putting extra stress on the repair, and also the amount of underlying arthritis present prior to the root repair. The average pain levels after a meniscus root repair fit between a basic knee arthroscopy (minimal pain) and an ACL reconstruction (more severe pain). A meniscus root tear can occur due to a traumatic event or degeneration. Knows his stuff. This can occur with turning, twisting, or pivoting activities or sports. Now, the focus when you go into a surgeons office, theyre looking at your MRI, theyre looking at your meniscus on the MRI, theyre telling you the tear in the way that its torn and how theyre going to repair it. As always, Dr. Burnham and his staff were caring, knowledgeable & professional at my recent visit. Everyone made us feel comfortable, and they were all polite and professional. Most patients will also have some numbness around the surgical incision, but this is not a true complication and is anticipated with any type of surgical incision. After about five minutes, the wheels were spinning. In determining if one can have a revision root repair, one needs to determine the cause of the failure as well as the amount of underlying arthritis. Your care after surgery may involve: Crutches to take stress off the knee as it heals. Meniscus root repair vs meniscectomy or nonoperative management to prevent knee osteoarthritis after medial meniscus root tears: Clinical and economic effectiveness. Usually, pain is minimal after this type of surgery. Bottom line, it was pretty clear from the MRI that if I wanted to be out of pain, surgery was my only option. There was also proliferative synovitis present throughout the patellofemoral joint, including the medial and lateral gutters. This technique allows for the meniscus to be pulled down into a broad surface area, maximizing its chance for biologic healing. Eagan, MN 55121, I struggled with my knee for 18 months - having gone from 10,000 steps a day to only walking as needed. I did a few jungle gym rows, and finished with planks. You will feel tired for several days. It is very important for proper healing, that the placement of the root matches the original Footprint or attachment site. Im telling you right now its going to take six to 12 months just erase that number that they gave you in your head and i wouldnt go argue with them because they may not have all the knowledge and understanding behind it and truth be told surgeons oftentimes you know once they finish their surgery theyre kind of done with you. . This may be recommended depending on the type of meniscus tear. amount of, supply and beyond the age of 15 has limited healing without surgery. During our biomechanical testing, we found that if we tied the sutures directly over bone, with cyclic loading, the sutures would cut into the bone and the repair would become loose over time. I am so glad I did! In layman terms, I had completely torn my medial meniscus from the bone, and it had to be sewn back on. My name is Dr. David Middaugh. Appreciate the attention and time spent during office visits. There was a large grade 4 chondral defect involving the central aspect of the trochlea, approximately 30mm in width by 25mm in length. Call your doctor or 911 if you think you may have a medical emergency. Patients who have an ACL tear have a 10% chance of having a lateral meniscus root tear. I consulted with SSC and DPT Darin Deaton prior to my surgery and then afterwards, when I discovered it had been a meniscus root repair. I have been very pleased with him at each visit..It's been almost 2 years since my meniscus root tear surgery and I have to say my knee feels great. Very professional! And its really concerning and very disappointing for somebody whos gone through the knee surgery. I have successfully repaired meniscus root tears in patients that were 70 and 71 years old respectively and they are some of my happiest patients. And slowly, I started bending the knee more, and eventually took the box away from my bench. I wasnt taking any pain medication either, so I was alert. Realize that, as discussed above, the torn part of your meniscus was removed. The American Journal of Sports Medicine. We use the 2-tunnel technique to maximize biologic healing of the meniscus down to a broad surface. MENISCAL ROOT REPAIR POST-OPERATIVE ORDERS . It took almost a week and a half for the swelling to go down, but there was still considerable swelling in my knee. Posterior horn medial meniscus root tears have been particularly noted to be a problem with a large number of patients developing arthritis rather quickly. Controlling inflammation and swelling is still a key in this Phase, as increased motion without proper use of cooling therapy may put your meniscus at risk for re-injury. The arthroscopic meniscus repair is a procedure done to repair torn knee cartilage, usually for athletes. In our hands, because we have performed many second look arthroscopies, we have found that the 2-tunnel technique allows for a broader surface area of the meniscus against the decorticated bone and seems to allow for a more solid and secure repair. (including injections and arthroscopic surgery), I heard Dr. La Prade was going to practice in the Twin Cities - where I live, & waited for him, based on his renown reputation. Meniscus root tears usually occur in patients with deep flexion such as skiers, or home gardeners, plumbers, or carpet layers or people doing similar activities. There are two menisci in the knee, medial and lateral. Dr. Burnham and his remarkable staff have been a godsend for our son. They are also important to the stability and function of the knee, keeping the meniscus in place. In addition, if the medial meniscus is involved, active My pain was gone. I'm able to run and exercise without pain. The meniscus is a crescent-shaped pad of cartilage located in the knee that helps stabilize and . Dr. Burnham and Jerrica are AMAZING! Therefore, any surgeon who performs ACL reconstruction should be well versed in performing a lateral meniscus root repair. What was going to help my knee? Two main repair techniques are described: (1) suture anchors (direct fixation) and (2) sutures pulled through a tibial tunnel (indirect fixation . While there are many factors that can go into extrusion, a maximum attempt should be made by the surgeon to try to pull the meniscus back in the joint to give the meniscus the best chance to function as a shock absorber after it heals. El Paso, Texas 79903. The pain is usually located one the sides or front of the knee, although it can occasionally be located in the back of the knee. Each horn is anchored to the bone at the meniscus root (anterior and posterior). A meniscus root tear usually will not heal on its own. First, we performed quantitative anatomy studies, which allowed us to see exactly where a meniscus root tear should be reattached. And cartilage is one of the slowest healing tissues in the body. After repairing the meniscus root, it is imperative that the patient remain 100% non-weight bearing for 6 weeks. It is critical that patients following a knee joint repair refrain from squatting for at least four months after the procedure. And I feel my rode to recovery will be wonderful. Following this 6 weeks, they begin weight bearing at 25% with crutches for 1 week, and then 75% weight bearing using 1 crutch for 1 additional week. Conclusion: Outcomes after posterior meniscal root repair significantly improved postoperatively and patient satisfaction was high, regardless of age or meniscal laterality. It takes longer for a meniscus repair to heal than a meniscectomy. The roots of the meniscus are responsible for transmitting weight evenly across the surface of the tibia. Thursday: 8:00 am 5:00 pm, What causes #runners knee or patellofemoral pain syndrome? Often, when a meniscus root is torn, it will retract in the joint and become stuck in place. While regular functionality isn't immediate, patients will be asked to move the knee within 1-2 days after surgery. In particular, these younger patients have to look at a meniscus root repair as soon as possible to ensure that they dont develop arthritis. This is probably due to many factors, including the chronicity of the tear, the quality of the tissue, if the meniscus was released from scar tissue and pulled back in the joint, ones age, ones weight, and ones alignment. Meniscal Ramp Lesions. The steps in a meniscus root repair are very intricate and our biomechanical studies have validated that the steps are essential. 2700 Vikings Circle Once my doctor started the procedure, it was obvious that this would not be a simple surgery. By far the best orthopedic team I have ever met. I did a little internet searching, and diagnosed myself with a Bakers Cyst, which I discovered was pretty common with meniscus tears. <>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 12 0 R] /MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Later that day, I trained. I was referred to Dr. Burnham from my spine doc, Chambliss Harrod, MD and he turned out to be a way cool guy. A physical therapist will be assigned to you and begin a routine of light exercise to help stabilize the knee. On Thursday, February 21, the day after my surgery, I went to work, in my brace and on crutches. Meniscal Root Repair Post-operative Rehabilitation Protocol Phase 1: 0-2 weeks post-operatively Goals . The most important thing as one gets older is the quality of the cartilage present. An ACL tear most commonly occurs from a turning, twisting, or deceleration mechanism in a noncontact mode. Swelling and stiffness. As a result, two weeks after surgery I was able to start driving my car, which is a manual. Dr. Burnham and Jerrica did a great job taking care of all my orthopedic needs. We had a wonderful experience and I highly recommend him. I felt very informed and well cared for. In radiologic terms, this is called a bony ossicle. The technique for a repair for a bony avulsion, called a type 5 meniscus root tear, is similar to the other techniques other than it should have the bone piece shaved down and cleaned off such that it can be pulled back into the area where it had been avulsed from. It hurt like hell. The following Tuesday, I saw my doctor. When the tear is examined during arthroscopy, Dr. Hess will decide if the tear is able to be repaired . Did you have any meniscus surgery in the past and youre still dealing with pain, swelling and possibly even losing motion in your knee? My 14 year old son originally went in to see Dr. Burnham very scared (he hadn't had an injury before) and he was instantly made to feel at ease. Dr. Burnham was very thorough with his examination and diagnosis. In patients who have open growth plates, consideration may be necessary to either plan to remove the sutures after the meniscus root repair heals or to consider placing the tunnels and suture repair above the growth plate such that is does not cross the growth plate and have a theoretical chance of causing a growth plate arrest. In some cases, its important that you take away from this video today that it takes six to 12 months to heal from a meniscus surgery. What most people just don't get from their medical professionals is that the meniscus is a type of cartilage. Also, I had to make numerous visits to the Ochsner Clinic due to my injury and Dr. Burnham's team and the staff at Ochsner were always very professional and courteous. If you break down what most healthcare provision professionals tell their patients, it could be an orthopedic surgeon, or even a physical therapist, its telling somebody whos just had a meniscus surgery, theyll say, well, 80% of healing is done in the first two to three months. He will now be caring for my hip and knee in the future. In January of this year, I finally decided to go back to my doctor to get that MRI. I highly recommend him. If the patient is not comfortable walking without an aid, then they are usually provided with axillary crutches. He spent a great amount of time explaining everything to me in a way that I understood everything. Removal Repair Example of Root Tear Repair Q: HOW DOES THE SURGEON DECIDE WHETHER TO PERFORM A REPAIR OR REMOVAL? Meniscus root repair is a surgery performed to repair a torn meniscus root. 2601 E. Yandell Drive, Suite 232 They explain things very well. The meniscus is a cushion of the knee joint. It involves removal of some or all of a meniscus from the tibio-femoral joint of the knee using arthroscopic (keyhole) surgery. While there are a small number of patients who do have their meniscus root re-tear, this has been nowhere near as common as the other sources noted above. In younger patients, meniscus root tears often occur with a piece of bone being avulsed off the tibia. Patients in Manhattan, Brooklyn, New York City and the surrounding New York boroughs can expect a variation of the following: Dr. Nwachukwu is extremely knowledgeable about his area of expertise. Early weightbearing has been found to be the cause of meniscus root repair failure, and this has been validated by our colleagues In general, almost all meniscus root tears require a 6-week period of being nonweightbearing to maximize the healing potential. The knee buckled and I thought, Shit. You'll likely regain your previous muscle strength in the leg by. The knee will be swollen for 2-3 months. During the procedure, Dr. Vidal will isolate the root, pull it against the tibia and place sutures in the meniscal attachment. I was told by one of the orthopedic surgeons that I worked with that I would never run again and would be lucky if I could ever hike again.