Having sharp pains in your knee every which way you turn is neither fun nor sustainable. If you enjoy being active, having a knee that’s painful, but otherwise stable, is really annoying. You just want the damn pain to go away! Most people would go to their GP who would then recommend them to a surgeon and they would recommend that they “clean your knee out,” otherwise known as an arthroscope. Now you have a decision to make. Do I do the surgery and tidy up whatever it is in there that’s giving me pain? Or do I ride it out and maintain my knee cartilage? This is actually a bigger decision than you might think.
Arthroscopic knee surgery is usually performed so as to clean and tidy up the internal knee joint. Nothing is actually repaired. Meaning that they will generally cut out bits of the knee cartilage that are suspected of causing the knee pain. A good surgeon will be able to clean and tidy the cartilage and keep as much of the cartilage as he can.
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We find that the evidence is usually 10-15years (at minimum) behind what we are seeing in the clinic. We see real people, with real problems, and we’ve made a great living out of offering real solutions.
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The cartilage that we are discussing here is meniscal cartilage. It’s the cushioning cartilage in your knee. It’s softer and more prone to cuts and tears from compressive and rotational forces. We call it the Meniscus. There are two kidney-shaped menisci in each knee, a medial and lateral meniscus.
They absorb the shock in your knee and protect the articular cartilage, the shiny lining on top of your bones inside the joint. Once your articular cartilage wears out, you generally need a knee replacement, which is why we like to keep the meniscus as intact as possible.
The surgery is actually quite simple when you think about it. They open two 1cm holes at the front of your knee. They insert a mini camera in one hole, and a shaver or scraper instrument through the other hole. The skill with the surgeon lies in how they can use those tools to tidy up the tearing with removing as little meniscus as possible.
The whole process usually lasts about 30 minutes, then you wake up and they give you a sandwich and juice. Hopefully, the surgeon visits you once you wake up and gives you the all-clear to go home the same day. Done well, you should be able to hobble out of there on some crutches, and you should be walking around more comfortably within a couple of days.
The rehabilitation process is not complicated:
- Follow the surgeon’s guidelines for wound healing. Ice and elevate if necessary. You want to regain full knee extension as quickly as possible, and return to a normal walking pattern as quickly as possible, whilst respecting the healing process. This is best done in partnership with your Osteopath so they can guide you.
- Get onto an exercise bike and start moving the knee through a full range of motion. Keep getting your quadriceps and hamstrings worked on by your therapist. You can begin engaging your knee within the squat and deadlift movements (done correctly), provided there is no pain.
- Keep engaging those movements until they are full range and pain-free. Now you can start loading them. You should be at about the 6-week mark post-op. Once you’ve regained sufficient strength in your knee that resembles pre-op strength, you can start doing some straight-line running, if that is your desire. Anything extra from here on would require specific programming based on your specific goals.
So you’ve just read about the process of cleaning out your knee. A fairly routine surgical process these days. What is more important is the decision you need to make about whether you should actually get it done or not. This decision has become easier given recent evidence. The evidence suggests that a cleanout of your knee does not have any long term benefits and that it will actually accelerate your need for a knee replacement.
So then why do people still get them, and why do surgeons still do them? Well, some surgeons will do them when there is acute locking of the knee. This is an undesirable scenario where the knee locks and inflames. It can lead to a whole myriad of complications, including serious ones like blood clots. Some surgeons will also do them for specific people who have specific goals. Like if you’re a football player earning $50 million dollars a year, you’d probably take a jackhammer to the knee if it means getting you back out on the pitch in the short term. These athletes suffer into their older adult life, but who cares when you have $500 million in the bank. And then you get some surgeons who do them because they’re butchers, stay away from them.
Usually, the surgery helps in the short term, but the pain comes back. And as you get older….arthritis and degeneration speed up and you’re now looking at a knee replacement. Fortunately we now know better. We don’t recommend these surgeries unless absolutely necessary.
So if you’re just an average Joe or Jane, and you have some knee pain from a torn meniscus, don’t get the surgery done. Get it looked at by your Osteopath because they will have some tricks up their sleeve to help you. Get the knee stronger, build some muscle around it. It will slow the arthritic process and hopefully you may not need it replaced. And if you do need it replaced, you won’t need it done as soon.
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