Anyone back to kiting after lateral meniscus tear in knee?

[Orangutan21]

I’m a 45 yr old male w a medial meniscectomy on 2/5. I went kiting on 2/11-6 days later. Not my wisest decision but I was fine although swollen afterwards. As a PT the recovery time with meniscectomies are highly variable. Swelling after surgery is going to affect your recovery time significantly-as this varies quite a bit from Patient to Pt-hard fast time lines for return to sport are impossible to predict. Swelling and joint injury cause arthrogenic muscle inhibition-ie-your quads and hamstrings around the knee joint literally aren’t responding to nerve impulses and won’t contract as desired. I was walking on a flexed knee 2 days after surgery as my quads couldn’t support my body weight. Had therapy on the morning of day 3 and was able to walk with a near normal gait and even perform a partial squat. The therapy forces the quads and hamstrings to start firing again and will speed your recovery dramatically. The guidelines I would set for for return to kiting would be a return to near normal knee range of motion (at least 120 degrees) as it may take up to 3 months before full range returns. Squat to at least 90 degrees with tolerable or no knee pain, perform a partial single leg squat to 40-50 degrees of knee flex, and be able to perform lateral/ant/post/diagonal jumps of 18-24” without increase in operative knee pain. Note if you’re favoring the operative leg and this is where an objective eye of a therapist will help you. Quad and hamstring endurance are also a factor, also- is the operative leg your front foot or back foot-I find I put significantly more torque on my back knee-of course if your on a twin top this will vary. I ride surfboards which absorb a lot of the chatter that occurs on a twin tip and riding a twin tip will require significantly more quad and hs endurance. Additionally-straps really place the knee at risk from rotational forces (torque) as the foot is fixed and the knee must absorb all rotation that occurs. If you have the option-a strapless surfboard is the least stressful for the knee. Additionally-the gluteals are a primary stabilizer of the knee-do not neglect them in your rehab-doesn’t have to be fancy-simple squats within pain free range-then progress to single leg squats also pain free. I was able to do a partial single leg squat on a bosu board on the operative knee on day 4 to 5. Bosu boards are great for mimicking the chatter/surf you’ll deal with on the water. Try and simulate the posture you assume with riding during rehab. Respect fatigue and stop before the knee musculature fatigues-this is how injuries occur. Atrophy begins in 48-72 hrs- the sooner you activate the knee musculature the sooner you’ll be kiting. While I wouldn’t recommend kiting on day 6- I’ve proved it can be done without detriment. Talk with your Therapist about what u need to be doing for return to kiting and plan the steps you need to get there.

[RickI]

I just tore mine up about two weeks ago in a nasty wipeout in high wind. Before that time both knees were in good shape unlike quite a few other areas which had been dinged by kiting, skiing and life. If I behave myself and am not particularly unlucky, I don't anticipate needing a surgery. Things should heal on their own with proper care and PT I have been told. I am 60 and have been impressed with the speed of healing in the short amount of time to date. After about 6 to 8 weeks, I hope to be able to get back on the water. I plan to wear a DonJoy Armor knee brace while things continue to heal. Once the knee is stabilized again on its own, I will wear one of these Rhino Skin braces routinely to try to protect things. I am not up for knee deterioration or surgeries, if I can help it.. It was designed by Dr. Steve Arculeo, DC who has been kiting since 2001. I used it a few days after the injury on a routine basis to avoid enlarging the tear and really like the comfort and support for just walking around. http://amzn.to/2o8IxaX Good luck out there and if you can avoid tearing your knees up, don't!

[Orangutan21]

Tears on the inner 70-80% of the menisci are poorly vascularized and are notorious for not healing. Meniscus injuries are tricky in that the torn flap can move back into place in which case you’ll have no pain or symptoms. When the tear is on the inner portion it will not adhere back to the surface of the tibia- because of poor circulation- so any rotational force at the knee will pull the torn flap back up and you’ll be at square one again. Tears on the outer rim of the menisci have much better vascularization and are much more likely to heal. Get an MRI-know where the tear is before you conclude whether to rehab or have it repaired surgically. Surgeons will not do meniscal repairs (in which the tear is tacked back down onto the tibia as opposed to a meniscectomy in which the torn flap is removed completely) on tears on the inner 2/3s of the meniscus because they will not heal. Even if the tear is on that outer third and you’re over 25 they’ll likely not opt for a repair (rather they do a meniscectomy) as vascularization and age have opposite slopes-older=poorer blood flow. For a brace to work it has to prevent any torque on the knee-while that maybe possible on an extended knee-I doubt it will help prevent rotation on a flexed knee as the joint surfaces of the knee are less congruent when flexed and therefore have a lot of inherent instabilty. Not saying it can’t help but my knees tend to be flexed when riding-so the femoral condyle contact on the tibial plateau is minimal compared to an extended knee which leads to more force on the meniscus as the load isn’t distributed across the entire meniscus. I suppose we could all ride with straight stick legs. Most of the studies on knee braces indicate that it’s not the stability of the brace that prevents the injury-but rather the increased proprioception or joint awareness that lets you know you’re approaching a zone where injury is more likely. In which case a neoprene sleeve will do you as much good as a sturdy titanium brace. To prevent torque that brace would have to be so rigid and fixated it would be impractical to wear for sport.

[Orangutan21]

Let me try and word that a bit better- meniscal tears are typically due to rotational and sheer forces. The femur rotating on the tibia creates a sheering force on the meniscus tearing it. To stop rotional force at the knee the brace would have to be so rigid above and below the knee joint line that you’d hardly be able to flex the knee to any degree at all. Medial and lateral knee stabilizing braces are a bit more effective in stabilizing the knee but lose much of that stability when the knee is flexed-that’s the whole trick is stabilizing the knee throughout its range of motion and I’ve seen many braces but have yet to see one that stabilizes the knee throughout the entire range. The best stabilizers of the knee are intrinsic ones-your muscles. I recently took a course on knee biomechanics which illustrated how important the gluteals are in stabilizing the knee joint. If you think you need a knee brace your knee is probably not strong enough to kite.
As far as rehab vs surgery-it’s imperative you know where the tear is before you make that decision as I’ve said before all meniscal tears aren’t equal. Outer rim tears might heal while inner tears will not. I made the mistake of thinking that with a rigorous rehab program I could boost the circulation at the meniscus and heal it regardless of where the tear was-I spun my wheels for 18 months-I had moments of the knee feeling great but almost every kiting session left me right back with that searing pain of a tear. My tear was roughly midway into the diameter of the meniscus and had little chance of healing. Kiting puts a lot of torque and sheer on the knee joint as our feet are fixed with straps-while the ankle can absorb some of that force-it’s he knee that takes up the brunt of it. I’ve gone back to playing with the cant of my straps so as to minimize these forces. Nothing is going to be as effective as strengthening the quads, hamstrings and gluteals in all ranges of motion.

[Dave K]

Has anyone here tried stem cell prolotherapy?

[url]ps://www.caringmedical.com/prolotherapy-news ... irate-knee[/url]

[markchatwin]

Since the original post in 2009 that particular knee has never swelled or given me much of any issue. I would say in the last 2 years I can sometimes notice pain at the area where the cartilage is missing but it is mitigated by a little rest and ibuprofen. Keeping body weight down is key as well. I have had the other knee done (Dec. '16) but that one being more a "smooth out under the kneecap" sort of thing. It too was chronically swelling and I opted for the surgery. Same doctor, same good results.

Both knees required a solid 8 weeks to resume activities, though on a smaller scale. i.e. - skiing on smooth runs, kiting in lighter winds without jumping. Seems that the mark for full power comes after one year...