What to do?

Painting of Tommy

I have a bad knee, probably a torn meniscus. (That’s what my physiatrist thinks.) He’s been working on it for a year: acupuncture, massage, a couple of steroid shots. He’s at the point now where he thinks I need to consider surgery. (Which means an MRI, which means orthos can always find some justification for surgery. Between 36-76 percent of asymptomatic patients show tears on MRI.)

And there’s a sizable chance of deep vein thrombosis after the surgery.

So I’ve been doing a lot of reading, and I’m not so sure. Surgery has a 20-30% failure rate, it would put me on crutches for weeks (have I mentioned I live alone?) and I’d have to do a month of physical therapy ($50 co-pay for each visit, which adds up to a shitload of money).

And then we have that famous study which indicates the surgery has more of a placebo effect, anyway.

So I think to myself: “Self, what happened in the old days? Was everyone permanently crippled after hurting their knee?” Seems unlikely, says I. So I do some more reading, and I find that contrary to conventional wisdom, there are other things I can try. Like a cold compression brace, and electrical stimulation to bring blood flow to the area, thus encouraging healing.

So that’s what I’m going to try. I’m really, really tired of limping.

4 thoughts on “What to do?

  1. My Ex had a torn meniscus repaired arthroscopically and had very positive results, minimally invasive and short, short recovery. Had nothing but praise to say for the procedure. If you haven’t already, you might want to give it a look.

  2. Everything in medicine is always a great big “It depends.”

    If it’s a big enough tear, then, like Ron says, surgery is your best bet. The physiotherapy afterward is absolutely essential. Don’t skimp on it. And continue doing the exercises on your own for long after our stupid “health” system ceases to pay for professional help.

    Physiotherapy is an excellent choice also without surgery, if there’s a snowball’s chance they’ll pay for it. The other treatments you mention can also help, and won’t hurt (I think!). A brace is a good idea in any case. And then there’s some major “depends”: depending on your weight and fitness levels, there’s more or less strain on the joint and more or less support from the tendons and muscles. The RIGHT KIND of exercise helps the most, but finding out what that is *in your case* really takes a visit to a physiotherapist. The web isn’t good enough for that 🙂 . A good physio is so useful, my suggestion would be pay for a consultation or two yourself if your insurance refuses to cover that without surgery.

    (Why do I have so much to say about this? My significant other tore a meniscus six years ago, and wound up right as rain after about three months of physio and a year of exercise. No surgery, it was a smallish tear.)

  3. It’s not just the $650 I’d have to come up with for physical therapy. It’s also that the surgery carries a high risk of deep vein thrombosis.

  4. Yeah, one always has to think long and hard about any surgery. Depending how big the tear is and depending on the other factors and depending on how strongly surgery is indicated from a purely medical/anatomical standpoint, I’d try everything else first too. (I mean, if it’s a bad tear and I’d just be fooling myself if I thought anything but surgery would do any good, then I would not wait, but it’s hardly ever that clear cut.) Since you’ve been walking on it for years (is that right?) it’s probably a small enough tear to make not-surgery worth working on.

    Re DVT after surgery. Eg here it says the risk is about 1% in older women. That’s not nothing, and 0.001% would be better, but, again depending on how strongly surgery is indicated, it’s not awful either.

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