You may need to leave a message. 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. If one does a meniscus root repair in that extruded position, the chance of a meniscus root repair working over the long term is very minimal. Please note, we cannot prescribe controlled substances, diet pills, antipsychotics, or other commonly abused medications. Therefore, addressing a meniscus root tear prior to the development of osteoarthritis would be indicated. Phase 1: 0-2 weeks post-operatively Goals Protect repair Minimize pain Minimize swelling . Two weeks to the day, I got on my spin bike at the gym and did what I could do. If you had a knee surgery if youve been seen physical therapy or any other health care professionals and theyre telling you youll be fine in three months back to normal youll be dancing youll be exercising youll be playing with the grandkids again just smile and remember this video. I can run, bike, & climb mountains. Lateral meniscus root tears can lead to arthritis, but they also result in the ACL being a little looser and the clunk that comes with an ACL tear (pivot shift) being more unstable. Really cares for his patients! Little information has been published regarding specific rehabilitation parameters for meniscal root repairs through all phases of rehabilitation. Fig 1 (A) Meniscus 4 A-II device. You may need surgery to restore full knee function. It can also occur while bending the knee deeply. What was going to help my knee? Great doctor. Each horn is anchored to the bone at the meniscus root (anterior and posterior). Many patients do not have significant joint line pain like a typical meniscus tear, so having a patient stand up and squat down is often performed during the clinical exam to validate that the patient may have a meniscus root tear. When the tear is examined during arthroscopy, Dr. Hess will decide if the tear is able to be repaired . Meniscal repairs offer the benefit of preserving the native meniscus, but they require a longer rehabilitation protocol as compared to a meniscectomy. The meniscus is a very important piece of cartilage in the knee. 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. And cartilage is one of the slowest healing tissues in the body. As always, Dr. Burnham and his staff were caring, knowledgeable & professional at my recent visit. Historically, these root tears are often treated with benign neglect and either ignored or trimmed out. Definitely a Bakers Cyst, my doctor said when I saw him. If there is tissue there, it usually means that the meniscus root repair has healed down to bone. At the end of March, my doctor told me I could take my brace off completely, and use crutches for another week if I needed to. The knee will be swollen for 2-3 months. They are also important to the stability and function of the knee, keeping the meniscus in place. very elderly patients). And I feel my rode to recovery will be wonderful. His team is prompt, thorough, and fun - always smiles. As surgical techniques are being developed and refined, rehabilitation protocols for meniscal root repairs must be defined and tested. Definition/Description. Highly recommended! 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. A meniscus root tear usually will not heal on its own. 2700 Vikings Circle The RICE (rest, ice, compression, elevation) principle can be useful in the first several days after a meniscus tear to help reduce inflammation, swelling, and pain. I rate him 5stars. The protocol is divided into phases. I would have relied strictly on physical therapy. Most root tears involve either a direct tear of the meniscus off bone or a split of the meniscus within 1 cm of the root attachment. A meniscal repair or arthroscopic meniscectomy is a surgical procedure to repair a torn meniscus via keyhole surgery. You will begin to focus on regaining your ROM and begin more in muscle strengthening. I wont ever go anywhere else. I really like and appreciate the time and effort he commits to research. . In the early stages of your meniscus tear you can take these conservative and essential treatments which are as follows: Rest Ice every 15 minutes in every 4-6 hours Compression with an ACE wrap or sleeve Elevation of the leg Nonsteroidal anti-inflammatory medications (NSAIDs) for pain. In addition, the design of the meniscus is such that the full pressure of weight bearing activities is transmitted through the root of the meniscus, meaning that it is constantly pulling and stretching the tear with every step. The therapists were a little surprised to see me so soon after my surgery, but I really wanted to know how much range of motion I had post-surgery. The length of time until patients are able to return to driving varies . Two cannulas are subsequently placed into the area of bone that was decorticated to allow for the transtibial 2-tunnel technique to be performed. If one does have quite a bit of arthritis of the same compartment, which we would call Kellgren-Lawrence grades 3 or 4, in most circumstances, other than possibly in very young patients, a root repair would generally not be indicated. My daughter journey was very trying and hard but we made it through with all of their help. There goes my knee again.. We recognized that meniscus root tears were a problem over 10 years ago and set out to perform a comprehensive research program to help us figure out how to diagnose the problem, where to place the meniscus repair, and how best to fix the meniscus tear to allow for maximal healing capability. 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. And the good news is that it can be helped without another surgery. I decided right then and there I would not get the MRI. 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. In some instances, the meniscus posterior horn may need to be released from scar tissue to allow it to be repositioned. The next steps involve placing self-capture sutures into the end of the meniscus root and then drilling cannulas into the area that was decorticated such that the sutures placed into the meniscus can be shuttled down the cannulas and then tied over the tibia. El Paso, Texas 79903. Non-anatomic root repairs do not restore normal joint biomechanics . It was tough, and it hurt like hell, but I took it slowly. This can occur in up to 20% of patients, even in the best of circumstances. He and his staff could not have been more helpful and professional. When a tear of the meniscal root, or even a tear near the root, occurs, the meniscus can no longer convert axial loading forces into hoop stresses. Once my doctor started the procedure, it was obvious that this would not be a simple surgery. My calf swelled up into my ankles. Progression of range of motion is more limited than for a standard meniscus root repair, usually limiting patients to 0-60 or 0-90 degrees range of motion for the first 4 weeks and then slowly increasing range of motion as tolerated. You can't walk right after surgery. He has a great rapport with teenagers. 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. I plan to squat 135 pounds for three sets of five on this day and am scheduled to deadlift 200 pounds on August 23. Call your doctor or 911 if you think you may have a medical emergency. 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. Most meniscus root tears occur very close to the root near the meniscus itself and are called radial root tears. Life happens and our bodies will sometimes let us down. Conclusion: Outcomes after posterior meniscal root repair significantly improved postoperatively and patient satisfaction was high, regardless of age or meniscal laterality. They are also important to the stability and function of the knee, keeping the meniscus in place. Other non-medical modalities may help, such as using ice and elevating the leg. You have two roots per meniscus which include anterior and posterior roots. If the lateral meniscus root tear is not repaired at the same time as an ACL reconstruction, it is now recognized that this could lead to ACL graft failure or loosening over time. Steadman Clinic, 181 W Meadow Drive, Suite 400, Vail, CO 81657, USA (email: drlaprade . I was going to rehab myself, and keep training as normally as I could. Normally, you should refrain from driving for at least 1 week after an arthroscopic knee operation, until the swelling reduces and the knee motion improves, but you should establish with your doctor when it is safe to start driving. So if thats your feeling youve taken them and it hasnt really made a difference for you dont take them if you feel like to help you out please take them but dont just take the supplements in hopes of that replacing doing the right exercises and having the right expectations youve got to do them both together give us a like if you thought this video was helpful and please drop a comment if you have any questions and i hope that you get better real soon have a wonderful day guys. When I went in arthroscopically and thoroughly released the meniscus, pulling it back into an anatomic position and revising the repair; all of these patients seemed to have much improved pain relief. Dr. Burnham was very thorough and took the time to explain what he thought my root problem may be, why, and how he suggested we proceed with my care. Arrange for someone to drive you home as you will not be able to drive yourself after surgery. After sutures are placed arthroscopically into the meniscal attachment, a small diameter tunnel, usually 5 millimeters in size, is reamed to the meniscal root attachment site, the sutures are pulled down the tunnel, and tied over a button on the anterior cortex of the tibia. What most people just don't get from their medical professionals is that the meniscus is a type of cartilage. He answered all of my concerns about my knee. He did a great job of explaining both the progress of my injury and the way ahead as it applied to recovery. You'll likely regain your previous muscle strength in the leg by. The High Tech Shirt Problem in the Squat Rusty Holcomb, Observations on Training by an Old Guy Phil Ringman. Using specific guides to ensure that one can place tunnels in the anatomic position and using self-capture devices, which have been devised to be small enough to not scuff up the cartilage, are some of the best means to perform a transtibial meniscus root repair with self-capture devices. Patients are usually kept non-weight bearing for the first 4-6 weeks, then advance gradually. 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. This allows the meniscus to heal back to the bone. Medial Patellofemoral Ligament (MPFL) Reconstruction . This answers all my questions! So happy I found them! To learn more, please visit our, If it is your left knee, you can probably drive very shortly after. It was glorious. Posterior horn medial meniscus root tears have been particularly noted to be a problem with a large number of patients developing arthritis rather quickly. Timeline: 1 week to 5 weeks after Surgery. Meniscal Repair. Squatting, lifting from a squat and sitting cross-legged should be avoided for 3-4 months. Then, in September, at the Charm City Strongwoman Contest, I sprinted into the gym from the outside looking for one of my volunteers. Dr. La Prade had just moved to Vail and I was his 2nd patient @ The Steadman Clinic. PHONE: (952) 442-2163 | WEB: TCOMN.COM/PHYSICIANS/KYLE- MORGENSTERN/ . Therefore, a lateral meniscus root repair can be an essential portion of a surgery to address the secondary restrains for a concurrent ACL reconstruction procedure. <> And if youve already had your meniscus surgery, then you know what to do so that youre not getting more swelling, pain and not losing motion than that knee and youre staying out of the surgeons office, so you dont have to go back again for another knee surgery. I hope that you found hope now that if you got if you had a meniscus surgery in the past and youre dealing with these problems of swelling the pain the loss of motion please start doing this this taking this advice that i gave you start doing the exercises and get better it is possible to get that swelling down and to get your motion back and to recover and be normal. It has been found that one suture alone for the repair does not work well, so a minimum of 2 sutures is required to maximize meniscal healing. Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. Amazing doctor, amazing family mantreats patients with the highest level of care, compassion, and quality! A week later, I got my MRI results and I was told that this was going to be a very long recovery, but I had other plans. Walk with crutches. Dr. Robert F. LaPrade operated on my right knee in May of 2010. 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. If patients put weight on the knee immediately after the repair, the forces on . I was cleared to drive at my followup appointment 2 weeks after surgery, which was exactly what my surgeon had told me to expect. The feeling that your knee is giving way, locking, or catching when you bend it. Full recovery usually takes 6 months but can take up to 1 year. Heavy lifting, manual labor, strenuous exercise/activity, and sports should all be restricted until 3-6 months after surgery. In the end he offered the best treatment for me.This is the first time in months that I have felt myself. (it is still a bit swollen). My name is Dr. David Middaugh. They are connected to your tibia by meniscal roots. PT or exercise can be useful BUT take note of these the BoneSmart view on exercise BoneSmart philosophy for sensible post op therapy 5. I have looked many times for answers on my tibial tubercle osteotomy and never found any as detailed as i needed. The most important difference is that rehabilitation following a meniscal repair requires limiting early postoperative weight bearing and knee flexion beyond 90 degrees to . Thanks to Dr. Burnham and his staff. At the beginning of April, I was dancing at a friends wedding when I suddenly heard and felt a loud pop in my left knee. This is because the signs of arthritis are usually pain and swelling with activities. 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. Currently, there are mini First-Pass devices that curve to the right and the left, which allows increased access to a root tear, especially since most root tears tend to squirt to the back part of the joint and can be more difficult to access with a straight biter. But its just not common knowledge to take six to 12 months to heal after a meniscus surgery. There are two menisci in the knee, medial and lateral. 181 West Meadow Drive Suite 400 Vail, CO 81657. It hurt like hell. Therefore, it is strongly recommended to proceed with a meniscus root repair whenever possible, with patients up to the age of 70 being reported as having excellent return of function. I am a coach, and I have two boys playing sports, the best thing I can say is that my sons will go see Dr. Burnham in the event they are injured, and I will always recommend him to my athletes. The next portion of the Smith & Nephew root repair device is a mini First-Pass device. In addition, the other factor is if the meniscus was released significantly enough from scar tissue to pull it back into the joint. This specific type of tear makes up 90% of all meniscal root tears. 515 Ray C. Hunt Drive, Suite 1100, Charlottesville, VA 22903 Phone: 434-243-7778 Fax: 434-243-5075 Meniscal Root Repair Post-operative Rehabilitation Protocol. I was worried for my future with my legs letting me walk but she put me at ease letting me know she will do everything in her power to fix me or send me to whatever specialist I need to see to make sure I have a good chance walking in my future, and they all truly fantastic doctors. The meniscus root attachment is important because if the meniscus becomes detached, it can squirt out of the joint, called extrusion, which can lead to the meniscus not being functional. 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. Dr. Burnham & his staff are very personable & caring. Country. At my third visit to PT, I was told that I had completely broken my PT protocol, and was better for it. 2601 E. Yandell Drive, Suite 232 stream Other factors can also be present with extrusion, including the progression of arthritis which can cause a well-done meniscus repair to extrude outside the joint. xYIoH8(Jr@fI)/_U}|xW&JDIraqm It is our goal to provide the highest level of care and service to our patients. Prior to Starting Strength, I would have simply gone to physical therapy, done my exercises like the therapist told me to do, and that would have been it. Therefore, most meniscus root tears need to have the scar tissue released so the meniscus can be pulled back into the joint. Dr. Burnham was very thorough with his examination and diagnosis. 2 0 obj These UltraTape or sutures can then ultimately be shuttled down the cannulas and then tied over a metal button on the front part of the tibia. 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. This technically challenging procedure should only be done by an orthopedic knee expert like Dr. Nwachukwu who has had extensive experience in performing the meniscal root tear repair correctly. Amazing Doctor and wonderful staff!! The meniscus is a cushion of the knee joint. Other complications can include a blood clot, which is usually treated preemptively with some type of blood thinner, and irritation around the surgical button and/or surgical knot from the meniscus root tear. Single leg deadlifts on the good leg, reverse hypers, and dumbbell bench. Early weightbearing has been found to be the cause of meniscus root repair failure, and this has been validated by our colleagues. He is walking without a limb and is on schedule with his progress. Had I not been training all these years, I would not have had the slightest idea of how to rehab my knee after surgery. 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. Meniscus repair recovery While everyone's recovery is different, here's what you can typically expect with a repair surgery: You may be on crutches for four to six weeks. Return to driving after surgery is okay once narcotic pain medication has been stopped and you are cleared by your surgeon. The patients are mostly allowed to walk immediately after arthroscopic knee surgeries. These include 1-tunnel and 2-tunnel techniques. The second step is to prepare a bony bed where the meniscus repair will be performed. Two days after my surgery, Diego took me to my first PT session. Meniscus root repair vs meniscectomy or nonoperative management to prevent knee osteoarthritis after medial meniscus root tears: Clinical and economic effectiveness. while avoiding unnecessary surgery, injections, and medications. After creating two transtibial tunnels, passing sutures through the detached root of the meniscus and down the tibial tunnels, the sutures are tensioned to reduce the root of the meniscus to anatomic position. And then they lose motion. Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. Therefore, any surgeon who performs ACL reconstruction should be well versed in performing a lateral meniscus root repair. 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. How long after surgery for a meniscus tear will i be able to drive again. What most people just dont get from their medical professionals is that the meniscus is a type of cartilage. Patients who have an ACL tear have a 10% chance of having a lateral meniscus root tear. Dr. Nwachukwu and his team will have an individualized recovery program for the best healing success after your meniscal root repair. First, we performed quantitative anatomy studies, which allowed us to see exactly where a meniscus root tear should be reattached. Your doctor may give you a nerve block before surgery and will prescribe pain-relieving medications after surgery. The study, " Patients Who Undergo Rotator Cuff Repair Can Safely Return to Driving at 2 Weeks Postoperatively ," was published online on July 21, 2022 in the Journal of Bone & Joint Surgery. - Privacy Policy - Louisiana Retina, Dr. Jeremy Burnham, MD - Sports Medicine, Orthopedic Surgeon, Knee Doctor, Jeremy Burnham, MD - Sports Medicine & Orthopedic Surgeon, __CONFIG_colors_palette__{"active_palette":0,"config":{"colors":{"f3080":{"name":"Main Accent","parent":-1},"f2bba":{"name":"Main Light 10","parent":"f3080"},"trewq":{"name":"Main Light 30","parent":"f3080"},"poiuy":{"name":"Main Light 80","parent":"f3080"},"f83d7":{"name":"Main Light 80","parent":"f3080"},"frty6":{"name":"Main Light 45","parent":"f3080"},"flktr":{"name":"Main Light 80","parent":"f3080"}},"gradients":[]},"palettes":[{"name":"Default","value":{"colors":{"f3080":{"val":"rgb(23, 23, 22)"},"f2bba":{"val":"rgba(22, 23, 22, 0.5)","hsl_parent_dependency":{"h":120,"l":0.09,"s":0.02}},"trewq":{"val":"rgba(22, 23, 22, 0.7)","hsl_parent_dependency":{"h":120,"l":0.09,"s":0.02}},"poiuy":{"val":"rgba(22, 23, 22, 0.35)","hsl_parent_dependency":{"h":120,"l":0.09,"s":0.02}},"f83d7":{"val":"rgba(22, 23, 22, 0.4)","hsl_parent_dependency":{"h":120,"l":0.09,"s":0.02}},"frty6":{"val":"rgba(22, 23, 22, 0.2)","hsl_parent_dependency":{"h":120,"l":0.09,"s":0.02}},"flktr":{"val":"rgba(22, 23, 22, 0.8)","hsl_parent_dependency":{"h":120,"l":0.09,"s":0.02}}},"gradients":[]},"original":{"colors":{"f3080":{"val":"rgb(23, 23, 22)","hsl":{"h":60,"s":0.02,"l":0.09}},"f2bba":{"val":"rgba(23, 23, 22, 0.5)","hsl_parent_dependency":{"h":60,"s":0.02,"l":0.09,"a":0.5}},"trewq":{"val":"rgba(23, 23, 22, 0.7)","hsl_parent_dependency":{"h":60,"s":0.02,"l":0.09,"a":0.7}},"poiuy":{"val":"rgba(23, 23, 22, 0.35)","hsl_parent_dependency":{"h":60,"s":0.02,"l":0.09,"a":0.35}},"f83d7":{"val":"rgba(23, 23, 22, 0.4)","hsl_parent_dependency":{"h":60,"s":0.02,"l":0.09,"a":0.4}},"frty6":{"val":"rgba(23, 23, 22, 0.2)","hsl_parent_dependency":{"h":60,"s":0.02,"l":0.09,"a":0.2}},"flktr":{"val":"rgba(23, 23, 22, 0.8)","hsl_parent_dependency":{"h":60,"s":0.02,"l":0.09,"a":0.8}}},"gradients":[]}}]}__CONFIG_colors_palette__, Cartilage Damage: Symptoms, Causes, & Treatment, Elbow Rehabilitation and Postoperative Protocols.