Chronic ACL deficiency w/meniscus tear

[volleyballguy]

OK, So I was diagnosed with a meniscus tear some time ago; I know it's basically a waiting game with surgery - wait until you can't stand the pain anymore. Last time I got it checked out, I found out that I have an ACL deficiency on both knees, likely inherited - which is probably what lead to the meniscus tear. But the doc said the greater concern was the ACL. My other knee feels fine.

The pain comes and goes. Some days it doesn't hurt at all, some days it hurts a lot. I want to stall surgery and play vball as long as I can (I know people will say "just stop playing volleyball", but I'll just say no). Doctor says to get on the bike a lot and get an ACL brace for vball. ACL brace is mucho expensive and I have the health savings thing, so if I were to get it, I'd rather wait until surgery so it's only one fat deductible... any advice from people out there? Any other exercises besides just biking?

[feeny]

I have to disagree wtih you vbguy -
Meniscal surgery should NOT be a waiting game until you cant take the pain anymore.
There are LOTS of diferent kinds of tears. Think of it like this - you put a small puncture in your tire - you an repair it when its small... OR... you can instead just fill the tire with air and keep driving - sure youll need to fill it with air quite often, drive easy on it etc - but yeh, you can keep driving - except you risk making that small puncture a much bigger one as long as you are driving around on it unrepaired... and worst of all - the big punctures - they usually cant be repaired anywhere near as well - if at all.

Also - a meniscal tear can lead to an "unstable meniscus" - that means that the whole mensicus moves during activity - think of your knee as a big walnut crusher - and that meniscal cushion has to be precisely positioned to do its job... little bit of movement - and crush - new tear....

So, my advice is - if you know you have a tear and its causing you grief - what are you waiting for? More tears? More damage?
Get it fixed ASAP and then start the full rehab on your new knee - rather than wearing this one possibly to the point of not being as repairable as it might have been.

I dont believe a brace will help you with meniscal issues at all.... if you need a new ACL - you need a new ACL.
My main advice - train for injury prevention - that is muscle strength. proprioception, balance exercises - all things designed to maximise the use of your muscles and reflexes - and minimise the need for your ACL at all. But - I wouldnt be doing this sort of training with a torn mensicus.

[volleyballguy]

thanks for the feedback... yep, I definitely know I risk injuring it more by waiting, but it has more to do with insurance, and also the fact that knee repair seems to be getting better every year. So I don't want to get surgery unless I absolutely have to; wait until I know it's time. I still am unsure if it's time yet. Plus if it's the ACL too I want to just do it all in one straight shot. I also am kind of scared of surgery to be honest. I don't want to go in feeling OK and then making things worse, which I have read can happen.

Anyway, I will probably do it at some point; I guess I was just looking for options in the meantime. :-)

[Kaputt_Knee]

volleyballguy, you don't have any options, especially if you want to continue playing volleyball at any kind of decent standard. You need to get it fixed and NOW!

I played volleyball in the National Leagues in France, UK and Germany - you cannot train and play to a halfway decent level with a messed up knee, you're a liability to yourself as well as others in your team. I now coach to college standard and I would not allow a player with your knee instabilities to even collect balls around the training sessions!

The surgery is a piece of cake, it's the rehab that sorts out the men from the boys - if you don't rehab properly you will have problems. If you do you'll be able to return to your sports. The number of complications is exaggerated here because this is a place where people come for answers when things have gone wrong for whatever reason.

So in plains words your options are: find a good surgeon and get it sorted now! What is a season lost now to a lifetime of pain and problems caused by waiting too long?

[pt_striker]

Hey V-ball guy,

Well, personally, I think you are wise not to leap into ACL surgery without first giving the conservative route a good go, especially if you've still got a half-functional ACL and decent stability. To quote my own surgeon, "ACL surgery is not a slam dunk." And the trauma to the knee is real and lasting, or has been for me. In addition to biking, there's plenty of gym stuff you can do to strengthen the muscles that support your knees (stairmaster, leg press, hamstring curls, plyometrics--see the thread at the top of the list for details). Personally I don't think braces are worth beans; take the money you were gonna spend on that and buy a good bike or a gym membership.

But Feeny is right about the meniscus--there are many different ways to tear that, and a small surgery to fix a small meniscus tear now could spare you a BIG surgery to remove all or part of it later. Find out more about exactly where and how big the tear is. Depending on location and size, some tears can heal themselves, some cannot. (Meniscus gets more blood flow toward the periphery, so tears there tend to heal better.)

Good luck!

pt

[volleyballguy]

thanks PT, I am trying conservative options first, without a costly surgery. I know my knees better than anyone and my instinct is telling me it's not time yet. ("You'll know" is the common expression I hear). Glad to know others are in my camp. Having a medical savings plan changes perspectives on things...!