when this conversation shifts to surgery, does anyone know what type?
i had arthroscopic micro fracture surgery for my meniscus seven years ago (can’t remember if i had a tear or had just worn it down from too much running), and i was back to full time running in six weeks with no issues.
is this an option for rob or is “surgery” referencing something more invasive?
I suspect it would depend on the type of tear but meniscus surgery, whether it's repair or menisectomy is usually arthroscopic. All depends on the type of tear and whether they decide to sew it or remove part of it to improve the stability of the joint. The initial arthroscopy will help them decide what they need to do because they need to see what the tear looks like, they can't really tell that from just an MRI.
I understand the basics of this, but do you have any idea of the long-term affects of repair vs. removal? Is full removal what leads to the dreaded "bone on bone"?
Yes, people who have total menisectomies usually become candidates for osteoarthritis, because the purpose of the meniscus (as with most cartilage in the body) is to reduce the friction when the joint articulates (rotates or flexes). When it tears it causes pain and reduces knee stability and range of motion.
Menisectomy can remove part of all of the meniscus, depending on what type of tear it is and where it is. Most menisectomies would be partial where they would trim away the part of the meniscus that is torn because there is no prospect of it healing (usually for medial meniscus tears where there's no blood flow to that part of the joint). The preferred option would still be to sew it but depending on where it is it may not be easy to do so via arthroscopy and they may just decide to trim.
Total menisectomies almost always lead to osteoarthritis, because then the friction is the articular cartilage (at the bottom of the patella, that would normally rub against the meniscus) is rubbing against the top of the tibia when you flex and rotate your knee. Over years that articular cartilage wears down (like a brake pad) and when it wears out you get the is the bone-on-bone that can cause bone spurs to develop which then causes significant pain. Then you are a candidate for a knee arthroplasty (replacement). Like my dad, he has had lots of little meniscus tears in his left knee, which was never stable to begin with because he suffered a broken patella slipping on the ice in Philly 20 years ago so he may be looking at one in the next 5-10 years or so if his osteoarthritis continues to develop.
That's very unlikely for Rob - it's usually something that would be done in older patients as part of a knee arthroplasty (replacement). But even partial menisectomies increase the risk of osteoarthritis, as does suffering a tear and leaving it untreated. The risk factor is a bit lower than total though. But Rob, like a lot of basketball players that rely on explosiveness, will always be at risk of osteoarthritis when he gets older.
If it is indeed a lateral meniscus tear, the chance of having to do a menisectomy is more minimal than if it was a medial tear, because a) blood flow to the lateral part of the meniscus means it has a great chance to heal on its own; and b) it's easier for orthopods to get to the meniscus to repair it. So assuming that is indeed the case he's got a great chance at a full and quick recovery (though given his other knee issues in the past they may decide to play it safe with him and hold him out longer than needed to make sure he has max stability in his knee when he returns).
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