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Hi Dr. Stoll
I totally agree with your philosophy. I spoke with your brother (who publishes your book) and told him how enlightening this site is.
I am 49 - female - have a torn lateral meniscus (horizontal tear). I also had stretched my lateral collateral ligament from too much biking. I do SR -oils, vit c , glucosamine sulfate and selected vitamins that seem to work for me. I have always been a fairly healthy eater - whole foods, little protein from meat, fresh veggies, etc. I have recently been diagnosed with a heritable connective tissue disorder - ehlers-danlos (similar to marfans.) I have a systemic type affecting all the internal organs as well as hyper flexible ligaments, joints and thin skin. I walk 2 miles per day and bike 5 - never get sick. Last summer I biked 10 miles a day consistently and stretched out my ligaments. I had to stop fast, jumped off my bike and hyperextended my knee. This is how I tore my lateral meniscus. That was 8 mos. ago. I kept riding on it for about 3 weeks when the bakers cyst that had formed behind my knee finally ruptured. Meniscal tear was diagnosed through MRI - also some thinning of lateral collateral lig. I have been taking glucosamine to try to help it heal on its own - also went to chiro who used activator method along with ultrasound to promote healing. The swelling went down some and pain became more localized. It has gotten somewhat better and my knee has tightened up since I stopped walking and biking. The clunking stopped but it still makes a soft grinding noinse as I bend it. I did lots of PT exercises. Water ex. don't work for me - because of the loosejointedness - they aggravate low grade arthritis. Walking and biking are my fav. things to do. I would give anything to be back to that, but want to do what is best in the long run. I am willing to wait if you think the tear will ever heal completely. At this stage I feel some weather related pain - can't do stairs at all without pain and it feels like the outside of my knee joint rides too high as I take a step and the inside is too low. Could this be that the torn portion is really degenerated and this is what it would feel like only moreso after scoping the knee to remove the torn portion. How stable will my knee really be after this surgery. The ortho said it will be fine cause the major stablizers are intact. (I did get 2 opinions) I've read all the archives and you say that if I walk on it for a long time with even some pain I am damaging the cartiledge on the ends of the bones. Would you recommend I do surgery soon or is there still a chance it will still heal on its own?
Thank you for your time. I know this is lengthy.
Maggie
In Reply to: torn meniscus posted by maggie1 on April 06, 2001 at 23:50:13:
I have been down this road before-- and the mesicus DOES NOT heal in my experience..
You are in a no-win situation when you tear your meniscus..
Since it does not really get a mentionable blood supply, it won't heal on it's own...
There are a few options
1. You get torn cartilage removed (meniscectomy) - it might stop the locking & clocking; but down the road you will suffer arthritis most likely as your shock absorber has been partially removed.. Remember you have articular cartilage on the ends of the bone, and meniscal cartilage as the shock absorbers.. when you get something removed that does not grow back-- degenerative changes can only occur down the road
2. a meniscal repair--sutures-- if you are lucky, the surgeon can repair your cartilage if conditions are just right----keep your fingers crossed
3. a meniscus transplant--- cadever cartilage - long healer; still in the seeing how it really works phase... remember again-- if you remove something, it has to be somehow replaced, else degenerative changes have to happen
be it months, or years... when things get toooooo bad, a knee replacement could be the only solution
4. collagen meniscus implants... injections into the cartilage to attempt to bond, heal the cartilage,, check the WEB...
do your homework RWAL GOOD before you decide to go under the knife.. because once it's gone.. it's gone.....
I am living proof... many surgeries,, ,major degeration now,,, knee replacements definitely down the road
BEST OF LUCK
Rob
In Reply to: torn meniscus posted by maggie1 on April 06, 2001 at 23:50:13:
Hi, Maggie.
Peter told me you had called. Thanks for your kind words.
I totally agree with Rob (Thanks, Rob.)
Your Ehlers-Danlos makes it sure that you will have to work harder, than a normal person, to prevent more injury. The best you can do is practice a serious form of wellness (see the homepage and archives). You are already better in that area than most but you will have to be pretty perfect to deal with your congenital problem.
ALso, you are a perfect example of someone who would profit by Hellerwork (tell her about your E-D) and practicing Alexander Technique OR Feldenkrais.
If I were you, I would get the fragment of the cartilege removed ASAP and then try to prevent further damage with the above.
Let us know how you do.
Namaste`
Walt
In Reply to: Re: torn meniscus (Archive in knee.) posted by Walt Stoll on April 08, 2001 at 09:05:30:
Hi Dr. Stoll - Thanks for your prompt reply. Should I be looking for a surgeon that is willing to try to repair the tear? The 2 I saw said they wouldn't because I was too old (49.) I did read about and mention the transplant and injection alternatives and they said they were only in the experimental stage....here at least - Madison, WI.
You said to get the fragment removed ASAP - so I won't wait any longer for it to heal. My hesitation has been that it has been feeling somewhat better and I thought maybe new connective tissue was filling in around it, holding it in place. Something is keeping my knee in place better. Maybe it's the glucosamine. Is the degree of degeneration directly proportionate to the amount of meniscus that is removed? Your archives were the only source that told me not to walk a lot on it. Thank you. The orthos I saw said I could keep going on it and not do any further damage.
Also do you have any information on holistic alternatives to aid in the collagen production as is needed for Ehlers-Danlos? Have you heard from others with this disorder? I didn't see it on your BB. Most of the docs I have seen think it's a fairly benign hyperflexibility syndrome. They are unaware of the involvement of other organs.
Again thanks so much for your helpful information.
Maggie
In Reply to: Re: torn meniscus - my insigt posted by Rob on April 07, 2001 at 21:54:35:
Hi Rob,
Thanks for you info. I did read about the implant and transplant options. As I told Dr. Stoll, my surgeon said it was too experimental. Do you know of someone who has successfully done these procedures? I'm assuming you had at least part of your meniscus excised. How long was it before you had to have another surgery and/or were bothered by the arthritis? Does age have anything to do with it? Like you said - I am in a no win situation. Your info was clear and concise. Thank you so much. Maggie
In Reply to: Re: torn meniscus - my insigt posted by maggie1 on April 08, 2001 at 17:13:29:
Hi Maggie---
I have several surgeries....
No medial menisuc left in either knee-- later meniscus beginning to wear away.... also, the kneecap tracking differently causing me to have what is called chondromalacia patallae... I have also had surgery for this called a fulkerson tibial tubercle transfer....
Maggie-- again once you get the cartilage removed - degenerative changes will begin---
No-- I don't know of any Dr's that perform meniscus transplants or collagen meniscus implants..
I know the gymnast JC phelps I think her name is had a meniscus transplant at 20 years old--doing good I guess...
Check the stone clinic site-- www.stoneclinic.com
Dr. stone is one of the leading orthopaedic surgeons in the country....... read up on transplants....
Also, keep seaching / researching on the collagen meniscus implants (injections)----
if you do nothing you meniscus will most likely keep tearing, thing will be locking more & more & like I said in the earlier post--- you are in a no win situation...
When you get it removed, it takes care of the immediate problem (for years--hopefully---but you will most likely have degenerative changes down the road)--
I would say check into the meniscus transplants......
let us know-----
I sure wish I had the magic answers-- I keep wishing everyday that I could know what I know today-- Doctors never explained it to me that when they were removing my meniscus they were taking out my shock absorber that doesn't grow back...
Do your homework, ask questions, the answers have to be out there-- best wishes ROb
In Reply to: Re: torn meniscus (Archive in knee.) posted by maggie1 on April 08, 2001 at 17:06:51:
Hi, Maggie.
Personally, I think everyone is "too old" to try to repair a tear in a cartilege.
I know of no specific way to promote cartilege healing, other than glucosamine (& possibly MSM) which would not do a tear anyhow.
However, since the human genome project is now proving that our nutrients are "messengers" to your genes, to promote their best expression (phenotype), one might see some improvement of even Ehlers-Danlos by doing an intensive micronutrient diet and supplement program for a year or so. In other words, flood the market and let God sort it out.
Let us know what you learn and how you do.
Walt
In Reply to: Re: torn meniscus (Archive in knee.) posted by Walt Stoll on April 10, 2001 at 11:27:23:
Hi Dr. Stoll,
Thanks again for the prompt response. I told you I got 2 opinions. This is how they differ. One surgeon said he would not do surgery with a local anesthetic because the muscles wouldn't be completely relaxed and he didn't want to risk scraping the other surfaces with the scope or tools. He wants to use a spinal. He was the older of the two and is from a university hospital in a city of 300,000. He only does knee scopes - sports med. clinic. Also he wants to use a cephalosporin as an IV antibiotic - said penecillin wouldn't do much. The other is a general ortho - but holds a good reputation (word of mouth) in a city of 50,000. He is willing to do local - the anesthesiologist said he would use a whole lot of it and it should work just fine. He actually was opposed to a spinal - he thought with the ehlers-danlos and fragile easily damaged vessels it might cause a hematoma(?). Scoliosis and arthritis were also factors in his decision. He asked me what antibiotics I had used and tolerated (cause I am allergic to so many meds.) I told him penecillin and he said that would be fine. Now who should I go with? I didn't expect such a variance of approaches. I like your philosophy better than any doctor I have ever talked to - so I am most interested in your reply. Have you ever read Michael Murray's books? He has similar ideas.
Thanks so much - Maggie
In Reply to: Re: torn meniscus (Archive in knee.) posted by Walt Stoll on April 10, 2001 at 11:27:23:
Hi Dr. Stoll,
Thanks again for the prompt response. I told you I got 2 opinions. This is how they differ. One surgeon said he would not do surgery with a local anesthetic because the muscles wouldn't be completely relaxed and he didn't want to risk scraping the other surfaces with the scope or tools. He wants to use a spinal. He was the older of the two and is from a university hospital in a city of 300,000. He only does knee scopes - sports med. clinic. Also he wants to use a cephalosporin as an IV antibiotic - said penecillin wouldn't do much. The other is a general ortho - but holds a good reputation (word of mouth) in a city of 50,000. He is willing to do local - the anesthesiologist said he would use a whole lot of it and it should work just fine. He actually was opposed to a spinal - he thought with the ehlers-danlos and fragile easily damaged vessels it might cause a hematoma(?). Scoliosis and arthritis were also factors in his decision. He asked me what antibiotics I had used and tolerated (cause I am allergic to so many meds.) I told him penecillin and he said that would be fine. Now who should I go with? I didn't expect such a variance of approaches. I like your philosophy better than any doctor I have ever talked to - so I am most interested in your reply. Have you ever read Michael Murray's books? He has similar ideas.
Thanks so much - Maggie
In Reply to: Re: torn meniscus - my insight posted by Rob on April 08, 2001 at 20:36:43:
Rob - Thanks again for answering. I am still hesitant to do the surgery. It does feel somewhat better - and I can feel that my knee has adjusted to accommodate the torn portion as best as it can cause I walk a little differently. I do not want to do permanent damage by not doing the surgery, like Dr. Stoll says in the archives. Look at my last post to Dr. Stoll about the difference in opinion of my surgeons. What do you think? It leaves me really confused. Thanks for your insight.
Maggie
In Reply to: Re: torn meniscus (Archive in knee.) posted by maggie1 on April 12, 2001 at 22:44:06:
Hi, Maggie.
It is very hard to give an opinion from here. However, from what you have said, if it were me, I would go with the general ortho (second doc you mentioned).
Let us know how you do.
Walt
In Reply to: Re: torn meniscus (Archive in knee.) posted by Walt Stoll on April 14, 2001 at 09:46:50:
Hi Dr. Stoll,
That's where my gut feeling has led me, too. I am curious, though, as to why you picked this doc. Do you think penecillin is OK as an antibiotic during surgery? And do you think there is any risk of the muscles seizing up while using a local plus sedation, thus causing permanent damage to the articular cartilege from the scope? Those were the issues I was puzzled by and being an art teacher, not a surgeon, I have no clue. That's why your opinion is invaluable to me. Thanks again for your input. My surgery is Apr. 23rd. I can't wait til I'm on the other side of it.
Maggie
In Reply to: Re: torn meniscus - my insight posted by maggie1 on April 13, 2001 at 11:09:38:
Maggie-- without a doubt do the orthopaedic surgeon....
I have always been knocked out .. vs having a spinal...
I attempted a spinal many many years ago; but it didn't take-------- leary ever since....
The surgery is very simple & again take the orthopaedic...
The recovery can be somewhat slow; just ask for therapy sessions almost immediately--- I have had doctors who said just take it easy -- don;t do much of anything WRONG--- make sure you demand theraoy to get things moving...
good luck rob
In Reply to: Re: torn meniscus - my insight - I would..... posted by Rob on April 15, 2001 at 01:14:53:
Hi Rob,
Thanks for responding. I'm not sure I made myself clear. The specialist who only does knees wants to do a spinal. The other general ortho thinks he can do fine with a local (being just a regional block). They want to avoid general (being knocked out) with me because I have had a pneumothorax (partial collapse of lung) in the past and adverse anesthesia reactions. Do you have any recommendations?
Thanks,
Maggie
In Reply to: Re: torn meniscus (Archive in knee.) posted by maggie on April 14, 2001 at 17:53:43:
Hi, Maggie.
ALL research (many repeats) say that prophylactic antibiotics for surgery are NOT indicated. Both surgeons are going against those statistics. Since no benefit can come from either of them, and the penicillin is less likely to actually cause harm, that is what I based my antibiotic thoughts on.
If you want more, go to the medline and ask for research about surgical prophylactic antibiotics. Let us know what you learn and confront your surgeon about it.
Walt
In Reply to: Re: torn meniscus (Archive in knee.) posted by maggie on April 14, 2001 at 17:53:43:
Hi, Maggie.
ALL research (many repeats) say that prophylactic antibiotics for surgery are NOT indicated. Both surgeons are going against those statistics. Since no benefit can come from either of them, and the penicillin is less likely to actually cause harm, that is what I based my antibiotic thoughts on.
If you want more, go to the medline and ask for research about surgical prophylactic antibiotics. Let us know what you learn and confront your surgeon about it.
Walt
In Reply to: Re: torn meniscus (Archive in knee.) (prophylactic antibiotics) posted by Walt Stoll on April 16, 2001 at 09:39:49:
HI Dr. Stoll,
Thank you - My dentist told me that, too. I'm still puzzled about the possibility of the muscles seizing up when the scope is in there and doing some damage if I just have a local. Do you think this might be a problem and I should ask for a spinal? Thanks again.
Maggie
In Reply to: Re: torn meniscus - my insight - I would..... posted by maggie1 on April 15, 2001 at 11:30:34:
Maggie--- I don't know--- only experience I ever had with a spiunal was a nightmare------ I always get knocked out;;;;;
several folks who I know have had success with the spinals (my sister just recently) so probably should be OK----
sounds good--& it seems like your only choice----
good luck-----
rob
In Reply to: Re: torn meniscus (Archive in knee.) (prophylactic antibiotics) posted by maggie on April 16, 2001 at 10:03:25:
Hi, Maggie.
IF the muscles "seized up" it would mean that the local was inadequate. Many surgeons try to do the local and the surgery at the same time, themselves--that way they get both fees. An adequate local requires an anesthesiologist in attendance just like a spinal or a general.
I wonder why the other surgeon is not worried about this???
Hope this helps.
Walt
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