tag:blogger.com,1999:blog-6193043695356712843.post2914391809533651866..comments2023-09-02T23:55:45.583+10:00Comments on Doctor Skeptic: Knee arthroscopy for a torn meniscusDr Skeptichttp://www.blogger.com/profile/09376469049519802493noreply@blogger.comBlogger10125tag:blogger.com,1999:blog-6193043695356712843.post-56621012071305296502015-02-12T19:34:14.953+11:002015-02-12T19:34:14.953+11:00I am not aware of any controlled trials of these d...I am not aware of any controlled trials of these devices. They would need to pass that test before I believed that they were helpful. There are too many similar things being used that have not been adequately tested, and either persist or are later shown to be ineffective.Dr Skeptichttps://www.blogger.com/profile/09376469049519802493noreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-82137376831061801962015-02-05T02:27:04.026+11:002015-02-05T02:27:04.026+11:00Dear Dr Skeptic, what is your opinion on meniscus ...Dear Dr Skeptic, what is your opinion on meniscus scaffolds (Menaflex or Actifit) and meniscus transplants?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-60730806147050098832014-07-26T21:21:16.927+10:002014-07-26T21:21:16.927+10:00Yes, but having seen hundreds of meniscectomies, t...Yes, but having seen hundreds of meniscectomies, the true bucket handle tear and locked knee is uncommon, and I have seen many of these as chronic, with full range of knee movement. Most meniscectomies done are for very minor tears that are unlikely to be symptomatic.Dr Skeptichttps://www.blogger.com/profile/09376469049519802493noreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-84909676350692909722014-07-26T01:00:12.383+10:002014-07-26T01:00:12.383+10:00It certainly seems plausible that removing a twist...It certainly seems plausible that removing a twisted piece of meniscus would prevent pain and locking.<br /><br />Having seen hundreds of menisectomies, it was always quite obvious when a mechanical blockage was removed and range of motion was immediately restored.<br /><br />I can see how a small tear may improve over time and even experienced it myself, however when your knee locks or gets sudden sharp pains from a piece of meniscus getting caught in the knee joint, surgery still makes sense to remove the flapping piece of cartildge. I've had three partial menisectomies under local, and was back to competing in a few weeks. Prior to one of my surgeries, I was hobbling on and off for 3 months while waiting for surgery. I was back to work within 3 days and competing within 3 weeks of my surgery. (Anecdotal, I know) <br /><br />It would be interesting to repeat the study and compare local anesthesia vs general anesthesia results as well. -Some general anesthesia agents such as ketamine, or alpha-2 agonists, may affect post operative pain.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-67089050143834221002014-07-20T08:05:33.340+10:002014-07-20T08:05:33.340+10:00An "uptick" is an understatement. About ...An "uptick" is an understatement. About 2/3 of joint replacements done these days are knees and the rate has been increasing for the last decade or two. I can't explain all of the reasons (ageing, obesity, demand, supply, lower thresholds, lack of alternatives) but I can tell you that the results are not as good as hip replacements. We are currently doing some research into the 'unhappy knee' and hope to have some insights into this problem in the next few years.Dr Skeptichttps://www.blogger.com/profile/09376469049519802493noreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-26925596072417353372014-07-20T07:24:23.414+10:002014-07-20T07:24:23.414+10:00Very interesting, thanks. It may be my ageing dem...Very interesting, thanks. It may be my ageing demographic (mid 50s) but I have noticed an uptick in knee replacement surgery - is this the 'new' arthroscopy? Four friends have undergone knee replacement with very disparate recovery/success outcomes. Do you have a general view?<br /><br />Thanks again for an enlightening site.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-54388038628103861582014-01-05T18:22:18.140+11:002014-01-05T18:22:18.140+11:00There are many things to do, including nothing (ma...There are many things to do, including nothing (many people have difficulty with the concept of NOT treating conditions). It is easy for me to tell you what doesn't work, and sometimes, apart from simple analgesics and maintaining regular exercise, nothing else is effective. This means the patient might have to accept that the knee is no longer normal.<br />I can't comment too much on specific cases without seeing the patient or the images, but many patients have difficulty accepting a knee that is less than normal as they age. This is what drives many people to have a joint replacement with only mild or moderate degenerative changes in the knee, because they get pain after volleyball or waterskiing. Those patients will not be happy with a knee replacement, as it provides a knee that is much worse than "normal". <br />Other people cope well with the limitations that result from degenerative changes in the body.Dr Skeptichttps://www.blogger.com/profile/09376469049519802493noreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-33868247304613200592014-01-05T17:25:09.843+11:002014-01-05T17:25:09.843+11:00So what should he do?So what should he do?Laurahttps://www.blogger.com/profile/01872391264241870260noreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-62786533653344415212014-01-04T07:44:45.812+11:002014-01-04T07:44:45.812+11:00Although this is snot an advice column, I can'...Although this is snot an advice column, I can't help myself. I can tell you pretty clearly that collagen injections and PRP will not provide you with any significant benefit. Furthermore, NOT having the injections will benefit your bank account.Dr Skeptichttps://www.blogger.com/profile/09376469049519802493noreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-83185482162983700522014-01-04T01:18:54.045+11:002014-01-04T01:18:54.045+11:00Thank you for the enlightening post, Dr. S. I had ...Thank you for the enlightening post, Dr. S. I had a knee injury from dancing, couple months ago and it spontaneously healed (pain subsided) but got reactivated when I resumed my dance classes. I got an MRI and it showed a medial meniscus tear. My doctor put me on diclofenax which (is pretty much the most horrible painkiller ever. worst three days for my GI) i discontinued soon after. He advised surgery.<br /><br />I got a second opinion from a different doctor who also advised surgery but asked me to do Contrast therapy for a week and also Rx trypsin/chymotrypsin for a week. I'm completely convinced by the study results (and the quality of studies) that surgery will not help me. My question is, would collagen injections/PRP injections have any effect on the rate of healing? To what extent does physiotherapy help in such cases?<br /><br />I realize I'm asking you advice on a specific case and I understand if you refuse to answer for legal reasons. Either ways, your blog and efforts are much appreciated! Thank you!<br /><br />Regards,<br /><br />PrajPrajnoreply@blogger.com