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Mountaineering/long treks after partial meniscectomy

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Paul Jakob · · Unknown Hometown · Joined Dec 2014 · Points: 0

Dear all,

I would like some experience from people who might have had knee injuries, and how they dealt with the return to mountaineering and trekking. I do classical alpine climbing and a whole lot of walking with heavy packs. I had the unfortunate experience of sustaining a bucket handle meniscal tear on the medial meniscus of my left leg doing a "drop knee" move in the climbing gym. I underwent an arthroscopy, and the surgeon told me it was not repairable, so he removed the torn piece. I am 34, the knee is otherwise fine, but I am now scared that I will develop osteoarthritis, given the repetitive load I put on my knees during mountaineering and trekking.

A couple of mountain buddies told me to "chill", one of them has OA and works as a UIAGM guide. The other is also a guide and to my surprise, never reconstructed an ACL tear. I guess guides are just that tough. The doctor also told me to just go back to the mountains and worry about OA when it arrives.

But anyone out there have sustained similar injuries and does long heavy walks and climbs to share their thoughts and experiences.

Benjamin Chapman · · Small Town, USA · Joined Jan 2007 · Points: 18,818

Paul...1st point is to use ski/trekking poles. The tip alone should save your knees lots of wear and tear. Next, lose the heavy pack. We've lugged monster packs up and down mountains for years and the simple truth is that it's damaging your knees. Simplify, economize, go without, but stop carrying so much crap. Finally, hit the weight room. Build up those quadriceps and strengthen those supporting muscles around the knee.
Good luck...my ACLs feel your pain.

Old lady H · · Boise, ID · Joined Aug 2015 · Points: 1,374

^^^ edit to +1 above. :-)

Doc's right. Just go for it.

First, arthritis isn't a given, and, symptoms aren't a given even if you have arthritis. Some can have almost normal joints and lots of pain, others can have terrible x-rays and not have any noticeable symptoms. Go figure.

Second, the most effective treatment for arthritis? Lose weight and exercise.

I'm close to 60, and my knees only became an issue within the last year, from arthritis I never knew I had until then.

Best treatment? Watch the Christmas cookies and get out and exercise!

I would only add to stay on top of the muscles you don't use regularly, and get to the gym for that. In my case, everything that's used for riding a bike or walking is great, the rest not so great, and one knee doesn't bend very well. So, PT is to strengthen all that up.

Best, Helen

Paul Jakob · · Unknown Hometown · Joined Dec 2014 · Points: 0
Benjamin Chapman wrote:Paul...1st point is to use ski/trekking poles. The tip alone should save your knees lots of wear and tear. Next, lose the heavy pack. We've lugged monster packs up and down mountains for years and the simple truth is that it's damaging your knees. Simplify, economize, go without, but stop carrying so much crap. Finally, hit the weight room. Build up those quadriceps and strengthen those supporting muscles around the knee. Good luck...my ACLs feel your pain.
You've had ACL reconstruction? Did you recover fine for the outdoors? The packs can be lighter, but when I camp, it's hard to carry a light load.

Did you manage to go back to what you used to do before your operations? I wonder what the descents will be like from now on....
Paul Jakob · · Unknown Hometown · Joined Dec 2014 · Points: 0
Old lady H wrote:^^^ edit to +1 above. :-) Doc's right. Just go for it. First, arthritis isn't a given, and, symptoms aren't a given even if you have arthritis. Some can have almost normal joints and lots of pain, others can have terrible x-rays and not have any noticeable symptoms. Go figure. Second, the most effective treatment for arthritis? Lose weight and exercise. I'm close to 60, and my knees only became an issue within the last year, from arthritis I never knew I had until then. Best treatment? Watch the Christmas cookies and get out and exercise! I would only add to stay on top of the muscles you don't use regularly, and get to the gym for that. In my case, everything that's used for riding a bike or walking is great, the rest not so great, and one knee doesn't bend very well. So, PT is to strengthen all that up. Best, Helen
Thank you Helen. Yes, the doctor told me to completely forget this OA ghost, that it's "multifactorial" and if it arrives, it's in 15-20 years.

I had the procedure last week, I did exaggerate on the cookies. I now have a very good reason to be as lean as possible. I will pay more respect to the weight room. I was one of those people who only did sports outdoors and so on. But I think I will need the gym.

Do you get to do long treks, heavy descents and so on? I go up big mountains....I have a trip to south america booked for the next summer and so on. That's why I'm worried. But people told me to forget about it, live the mountains and worry later.

Thank you.
Lee Green · · Edmonton, Alberta · Joined Nov 2011 · Points: 51

Speaking as both a pushing-60 physician and the owner of a couple of pretty bad knees (ah, my misspent youth...), your doc, Benjamin, and Old Lady H have it right. Keep active, maximize movement, minimize impact loading, definitely go with two trekking poles, and minimize cookies. (Unless they contain high-quality chocolate, in which case take no prisoners.) Deal with the arthritis if and when it comes, and take a very conservative approach to surgical intervention.

rgold · · Poughkeepsie, NY · Joined Feb 2008 · Points: 526

I had ACL reconstruction and partial dissection of the lateral meniscus about five years ago at age 68. I don't carry a heavy pack a lot but do on occasion. I do lots of gym and rock climbing and periodic hilly slow trail-running. I use poles for hiking and trail-running. I get occasional aches and pains---nothing debilitating---and no more in the repaired knee then in the good knee. Arthriitis does not seem to be an issue yet in either knee. When trail running and hiking on unstable ground, I wear neoprene knee braces with some lateral stiffening. I doubt they provide much in the way of structural assistance, but the warmth they generate feels good.

My one side effect from the operation is the loss of a bit of range of motion in the repaired knee. I can't, for example, "sit" on my heel as one does when rocking over on a high step. Occasionally, this makes certain high-step climbing moves harder for me than they used to be.

Of course, I'm 73 and you are 34, so you have a lot more time to grind your knee down now that there is cartilage missing. All I can say is, looking back at 60 years and counting of climbing, my recommendation is---at every stage---do what you can when you can do it. That said, the recommendations already made to keep your legs strong are now more important than before your injury, and you should definitely use poles as much as possible from now on.

Benjamin Brooke · · San Pedro, CA · Joined Apr 2012 · Points: 1,050

hey paul,

i had a similar operation (arthroscopic?) on my left medial meniscus when i was 30. i tore mine doing sprints while kicking my leg back...although years of wear and tear hiking the adirondacks didnt help. im now 35 with no pain whatsoever. i do not notice any difference while climbing or hiking, even on fifteen plus mile days with monster packs. only when i occasionally take a yoga class do i notice a slightly lessened range of motion when i fold the knee (it straightens fine).

i do remember the pain lingering for a few months post op. i threw the cane they gave me aside on day one and began hiking after ten days. like others have said i used trekking poles and took it slow. i also started road biking instead of running. at some point the mild swelling and lingering pain just stopped. i believe blood supply to the meniscus is limited and that plays a role in slow healing.

we will both probably have shot knees when we're old men. surgery will be a semi annual event for us by then. my best advice is drive it til the wheels fall off. all the best in your recovery.

Old lady H · · Boise, ID · Joined Aug 2015 · Points: 1,374
Paul Jakob wrote: Thank you Helen. Yes, the doctor told me to completely forget this OA ghost, that it's "multifactorial" and if it arrives, it's in 15-20 years. I had the procedure last week, I did exaggerate on the cookies. I now have a very good reason to be as lean as possible. I will pay more respect to the weight room. I was one of those people who only did sports outdoors and so on. But I think I will need the gym. Do you get to do long treks, heavy descents and so on? I go up big mountains....I have a trip to south america booked for the next summer and so on. That's why I'm worried. But people told me to forget about it, live the mountains and worry later. Thank you.
No mountaineering, I confess. Yet. :-)

I am a bike/walk/bus commuter, no car at all, so I do a lot of not very hard stuff all the time. I also try to do foothills hike/bikes now and then, and need to add a lot more of that in when the weather allows, and, be faithful to the treadmill forevermore in the winter. Last winter, I lost so much cardio from not biking, walking to the bus instead, I though I had a heart problem in the spring!

The trips I have got out on are two-fifteen miles, the longer ones including some biking. No problems.

Exercise, the stuff you don't use is what you need to go after. Personally, I don't think I'll talk myself into it, but skate style skiing would be good. Swimming, too. Lots of breast stroking. That was fun to type! Anyway, that side stuff and hips are probably going to put you in resistance bands, yoga, tai chi, something like that.

So, weight, I do notice grocery bags hanging on the bad side, my climbing backpack doesn't bother me at all. That suggests get the gear and pack dialed as optimal as possible.

Descents, including stairs, were... interesting. One mistake I made was favoring the gimpy one, which made my gait wrong, and contributed to making it worse. I'm only three weeks into it with the PT, but, I've been concentrating on keeping my feet pointed straight ahead, not using a hand rail, etc. Normalizing as much as possible.

Walking, I could go all day long. Ditto biking. BUT, the stuff that wasn't getting used, because I favored the leg, is all shot.

Coming down climbing approaches, I'm still pretty slow and cautious, and make sure one foot is good before the other does something. Ditto our iced in City.

I would suggest getting in with a really good PT right off. I would also be straight up with partners, so they know you might be slow. Most people are very kind about this. If they aren't, don't waste time with them.

Youngest meniscus surgery in my crowd? 20! He's 21 now, surgery ended up just removing some, no repair possible. And, he's crushing hard, at that age when guys are just really starting to muscle up.

Bottom line, for me: until something actually falls off or explodes, go for it!

Best, OLH (60 really soon. I'm taking up lead climbing this year!)
Old lady H · · Boise, ID · Joined Aug 2015 · Points: 1,374

Plus one on high quality cookies. Excellent medical advice!!

Paul Jakob · · Unknown Hometown · Joined Dec 2014 · Points: 0
Old lady H wrote: No mountaineering, I confess. Yet. :-) I am a bike/walk/bus commuter, no car at all, so I do a lot of not very hard stuff all the time. I also try to do foothills hike/bikes now and then, and need to add a lot more of that in when the weather allows, and, be faithful to the treadmill forevermore in the winter. Last winter, I lost so much cardio from not biking, walking to the bus instead, I though I had a heart problem in the spring! The trips I have got out on are two-fifteen miles, the longer ones including some biking. No problems. Exercise, the stuff you don't use is what you need to go after. Personally, I don't think I'll talk myself into it, but skate style skiing would be good. Swimming, too. Lots of breast stroking. That was fun to type! Anyway, that side stuff and hips are probably going to put you in resistance bands, yoga, tai chi, something like that. So, weight, I do notice grocery bags hanging on the bad side, my climbing backpack doesn't bother me at all. That suggests get the gear and pack dialed as optimal as possible. Descents, including stairs, were... interesting. One mistake I made was favoring the gimpy one, which made my gait wrong, and contributed to making it worse. I'm only three weeks into it with the PT, but, I've been concentrating on keeping my feet pointed straight ahead, not using a hand rail, etc. Normalizing as much as possible. Walking, I could go all day long. Ditto biking. BUT, the stuff that wasn't getting used, because I favored the leg, is all shot. Coming down climbing approaches, I'm still pretty slow and cautious, and make sure one foot is good before the other does something. Ditto our iced in City. I would suggest getting in with a really good PT right off. I would also be straight up with partners, so they know you might be slow. Most people are very kind about this. If they aren't, don't waste time with them. Youngest meniscus surgery in my crowd? 20! He's 21 now, surgery ended up just removing some, no repair possible. And, he's crushing hard, at that age when guys are just really starting to muscle up. Bottom line, for me: until something actually falls off or explodes, go for it! Best, OLH (60 really soon. I'm taking up lead climbing this year!)
Thank you for all your input. I am seeing the same PT that helped me recover from a shoulder surgery. I think it will be fine on that end. I just wanted to know how people have dealt with knee problems, I'm happy you shared all this experience with me.

I do rather long and demanding outings. I climb mountains between europe and south america. In south america, just the approaches and ups and downs to carry materials are too much. Sometimes I go down more than 3000m in a day, and I always feel my knees tired. Without part of the meniscus, I just got terrified it will be wrecked by my type of activity.

In any case, the surgeon himself told me "do your activities as before, worry about arthritis if and when it comes". I do have a solid excuse to stay leaner now, which I will try. I'm not a small guy. At least I will be able to climb a bit harder.

thank you so much.
john strand · · southern colo · Joined May 2008 · Points: 1,640

Arthritis has many facets, no one can predict when it will spring up or even if it will. You may be fine or it may hit next years.

You can do a lot of stuff with a partial meiscus or maybe not, depends on the individual. I had mine cut at 35, several types of arthritis diagnosed around the same time.

My joint started going by early 40's and now 3 implants later, I'm doing reasonable I guess

Ibrahim Cetindemir · · Ashford, WA · Joined Nov 2012 · Points: 5

In 2015, on my way down from Muir I completely shot my right meniscus, took a normal step and the whole bloody thing just buckled; couldn't put any weight on that knee for around 2 weeks, extremely painful. Thankfully I was less than a mile from the parking lot and the rangers got me down on a wheal chair. I knew I had to take care of that knee asap so I got the surgery the following year, after getting health insurance.

I had my meniscus repaired last march. 5 months after the surgery I climbed ElDorado in the North Cascades. My knee performed well, a little pain on the way down but thats it. My head wasn't all there tho, after 5 months of REALLY taking care of the knee I wasnt mentally prepared for the downhill part and I tired myself out big time trying to be extremely careful during the descent.

Shortly after my surgery I told my doc that the other knee felt as if it was moving around a bit whenever I would walk downhill, although it had never given me any issues I still wanted my doctor to take a peak, specially after my out of pocket max had already been met and my insurance was covering everything. He set me up with an mri and lo and behold, my acl was completely missing. I honestly couldnt believe him, that knee always felt bomber aside from the unusual and rare instability episodes.

I got my acl reconstructed along a partial menisectomy 5 months ago and I was just discharged from PT 2 weeks ago. The acl knee feels amazing right now, my only current issue is a bit of patellofemoral pain on my other knee. I work as a busboy so I am always on my feet, plus I have been getting ready for a Denali trip and have stepped up with the training since early January. That has amped the pain a bit but still very very tolerable. Regarding OA I already have it on that same knee, the doc told me it was extremely mild and it would take at least 10 years before it really start bothering me.

Paul Jakob · · Unknown Hometown · Joined Dec 2014 · Points: 0
Ain't That Rich wrote:How big is "partial"? One of the biggest challenges you face is fearing future damage, and somehow favoring your "damaged" knee in such a way that a whole new series of minor injuries begins to pop up.
I think about 60% of the medial meniscus is gone. I still have 4 PT sessions, I will try to just use it as normally as possible. Many people just told me to not worry about it. I even got to know, after this operation, that two mountain guides I know have really bad knees. One doesn't have his ACL at all, and won't bother repairing. The other has arthritis since his 20s because of a different accident. If I do 5% of what those guys do, I'm happy.
Jimmy Downhillinthesnow · · Fort Collins, CO / Seattle, WA · Joined Mar 2013 · Points: 10

When I read the topic of this post, my brain switched some letters around and I saw "martial penisectomy." Which could definitely make mountaineering difficult.

Since I guess I should say something helpful...just keep going what you love. Don't let it hold you back--as someone else mentioned, keeping weight off and exercise are some of the best treatments and preventive measures for OA anyway. And the cardio benefits will definitely be good for you. Deal with the arthritis IF it comes--which it very well may not.

skik2000 · · Boulder · Joined Jun 2013 · Points: 5

Can you guys that have had torn meniscus problems talk a little about the symptoms you had post tear? I've had some knee pain for the past two weeks and while playing on the internet have convinced myself I everything from a damaged meniscus, strained tendon or just some gnarly trigger points in my adductor.

The knee pain was the first thing to come. There wasn't any particular motion/movement/event that made it hurt. I've continued to train through it and now the majority of my leg muscles have tightened up significantly and it somewhat hurts to walk (not necessarily the knee). Foam rolling helps but is somewhat temporary. I've got an appointment with an ortho on Friday so I'll get some answers then but 2 days is a long time!

My knee doesn't want to fully extend but I really think that's more because of the super tight muscles at this point. I can extend the leg fully if I consciously try to do so and can also stand only on the affected leg w/o knee pain.

carla rosa · · CA · Joined Mar 2016 · Points: 269
Skik2000 wrote:Can you guys that have had torn meniscus problems talk a little about the symptoms you had post tear? I've had some knee pain for the past two weeks and while playing on the internet have convinced myself I everything from a damaged meniscus, strained tendon or just some gnarly trigger points in my adductor. The knee pain was the first thing to come. There wasn't any particular motion/movement/event that made it hurt. I've continued to train through it and now the majority of my leg muscles have tightened up significantly and it somewhat hurts to walk (not necessarily the knee). Foam rolling helps but is somewhat temporary. I've got an appointment with an ortho on Friday so I'll get some answers then but 2 days is a long time! My knee doesn't want to fully extend but I really think that's more because of the super tight muscles at this point. I can extend the leg fully if I consciously try to do so and can also stand only on the affected leg w/o knee pain.
could be lack of strength in glutes/hips compared to your quads.... go to the doctor/PT and try to loosen those muscles! tight leg muscles, esp. above the knee, will pull everything else out of wack.

Good luck.
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