Have a torn meniscus? So what can you do? Should you do surgery? Try to let it heal or what?
Before you jump to a conclusion like I sometimes do I would keep in mind while doing your research that everyone is biased to some extent and that definitely includes your doctor.
I just tore my meniscus about 2 months ago (for the second time) so I’ve done a lot of research and in this post I’ll share with you some of the things I have learned.
I tore mine in judo/bjj two times or so…
And I hobbled around for a good 6 weeks before I began to see some improvement likely because of some of the things I did below.
Things you can do.
- Surgery (partial men. or stitch)
- PRP or stem cell injections
- Wait for it to heal
- Peptides and lesser known options (below)
There is risk to doing everything including nothing, but probably less risk if you wait for some time like a month before giving anything a go.
I was close to signing up for a surgery, but…
My bias is that I don’t really trust doctors and I don’t like the uncertainty of knowing what the doctor will do. Or having to put my health in his hands.
All the info out there on failed surgeries, second surgeries, etc. has me not convinced, but to be self-deprecating that could be to my detriment too.
And it might also have been that nose surgery I got in Taiwan to correct my deviated septum.
That was frightening.
I remember being tied down to a stretcher totally wrapped up in sheets with my whole face covered except for a small place for my nose and mouth.
I couldn’t see and I couldn’t move.
Then during surgery he dropped a piece of cartilage that he cut out from my nose into my mouth.
After that I had to stay in the hospital for a day or two in an uncomfortable position and then I couldn’t breath through my nose at all for like a month and to top it off I don’t think it improved anything.
So you’ve read about the red and white zones right?
Conventional medicine says that if your tear is in the red zone it can heal (or be repaired) and if it is in the white zone it can’t heal.
Is that completely true?
Before I tell you about that…
Here’s one thing you can do.
1. SURGERY (stitch it or cut some out)?
You have 2 basic options for surgery (depending on the surgeon).
Here’s the first.
Shall we ‘trim’ your meniscus?
I wouldn’t do a partial meniscectomy.
This is where they remove the torn bit. It can reduce your symptoms very quickly, but…
I read very little good about this. And this is the more likely thing a surgeon will do.
Although some people can quickly return to sport and feel fine (see the Reddit thread link below), but the chance of early onset arthritis years later is high.
I remember one study that said that there was no better outcome between partial meniscectomies and sham surgeries.
If you cut it out (even a little) you alter the biomechanics of the knee. And one source said even cutting out as little as 10% increases risk of OA.
That was a Regennex (kind of PRP) video I think so they may have some self interests to say so, but other studies still said the more you cut out the greater your risk of arthritis.
If you cut it out you’ll have less cartilage where you are supposed to have it.
The other option for surgery…
Shall we try to ‘stitch’ it back together?
There seems to be a shift towards stitches when possible since the studies show that partial meniscectomy often leads to arthritis.
But it depends on the doctor.
Repair does sound better.
But it’s still not without risk.
Some doctors say that stitches and repair won’t work if the tear is in the white zone (non-vascular part) of the meniscus.
I would avoid these doctors as there are techniques out there…
Others say it can work and there are different techniques to encourage bleeding to help it heal.
I saw one Youtube video (sorry can’t remember which one) of a before and after stitch (1 year later) in the ‘white zone’ that healed.
You could see a scar of the stitch mark in the healed part (scoped).
And this also suggests (to be mentioned below) that the non-vascularized part of the meniscus does have some healing potential.
Which goes against popular opinion.
I read that in one study there is still a chance of 25% of failure or second op with repair. I saw two surgeons here in Fukuoka. One said he would go in and try to stitch it, but if the condition was bad cut it out.
I didn’t like that.
But I think a lot of surgeons will say that.
I saw a second one and he seemed against partial men. and pro stitches. But repair is like 5 months out and like 6 weeks on crutches.
And you are still placing a lot of trust in someone.
Both surgeons said PRP was like the 2nd best option but remember they are orthopedic surgeons.
Ask a surgeon what you should do he will probably say, “surgery” because that’s what he does.
There are some surgeons who will use stitches that don’t dissolve and even one guy in the linked-to thread below said he has anchors left in his knee from the surgeon that he can feel when he walks around.
I met one guy (Absenceofgoodnames) in this thread I started that had multiple surgeries on his knees and suggested that I wait. That might have affected me as there were some in that thread that had bad experiences with surgery and a fewer number not.
So I would do thorough research (and on your doctor and his methods) before trying any surgery.
Because different doctors have different methods and beliefs about what works and doesn’t.
Based on what I learned…
Maybe consider surgery especially if:
- the tear is unstable
- there is catching or locking
But maybe consider some other options first despite your pain and desire to ‘fix it’ now because it might not actually fix it and it could make it worse.
Yet, if you don’t do anything there is a chance that you will get arthritis too.
Unfortunately, there are 800,000 meniscus tears in the US annually, but only 10% are repaired. Source.
2. PRP (inject your own blood into the knee) or stem cells
I would try this first before any surgery and I can now say that I have done something like this.
I withdrew my own blood and injected it in my knee 2 times successfully and failed two other times.
Probably not something you want to try, but I did since…
The price is high here in Japan at $1000 for one shot which may help but one shot may not be enough. Some recommend 3-4 shots.
PRP is not usually covered by insurance.
I injected my own blood into my knee (DIY PRP?)
Is whole blood as good as PRP?
I can tell you that your whole blood probably has plenty of platelets in it as one of the times that I failed injecting it was because the blood coagulated in the syringe and wouldn’t come out.
PRP or whole blood makes sense cause think about it…
If you do your research you’ll read that only 1/3 of your meniscus gets blood so the other part can’t heal.
This is everywhere on the web.
That’s what all the orthopedics will say.
Like I said everyone is biased including doctors because it’s in their interests to do surgery as that’s how they get paid (usually).
Sometimes they may get paid regardless like here in Japan with public healthcare, but it’s still their training.
Some people (including doctors) are more conventional in their beliefs and others lesser so.
Convention is likely old medicine and that’s likely what your average doctor is practicing.
Your synovial fluid has some blood cells in it and STEM CELLS.
So I am a little skeptical when orthopedics say… “your meniscus can’t heal because there is no blood flow”.
There is some truth to it, but…
It’s not a dead thing inside of you.
Based on my research I think it probably does have some healing abilities since there are blood cells in it, but maybe not a lot.
One thing I have been wondering is…
WHY THE F*CK DON’T THEY JUST INJECT BLOOD INTO YOUR KNEE?
Yeah, PRP, but just blood would help too.
I don’t get that.
Some doctors do do it, but it is not common.
Maybe it’s because this is medicine and like education or government these institutions are slow moving and slow to change despite evidence…
Can PRP help treat old meniscus tears?
IDK. But I talked with one surgeon here in Japan who said that he thought it helps with new tears but not old tears.
I am sure it won’t hurt and in my experience injecting whole blood into my knees it actually increased pain for a few days and I’ve read that is the same with PRP despite the fact that they say it is anti-inflammatory.
You can expect it to cause more pain in the short term.
As injecting a fair amount of fluid in there will increase pressure in the joint too.
And one thing that I learned that some surgeons do in the case of repair (sutures) for an old tear is they rough the edges of the tear up before stitching to stimulate healing.
Kind of like if you glue two smooth surfaces together the seal will be less likely to hold than if you scratch it up a bit.
Which also reminds me that prolotherapy (mentioned below) is said to cause healing by inflammation.
So used in conjunction with PRP it may help, but more on that and peptides later.
Better than PRP or whole blood would be ‘STEM CELLS’
But those are going to cost you more. Like maybe 2-5 times as much as PRP.
Joe Rogan had them injected in his knee (mentioned in his podcast with David Sinclair) and Conor McGregor had them done for his ACL.
3. WAIT (stay off it and let your body try to heal it without surgery)
When it hurts you don’t want to wait, but chances are it will get better… if you wait. If you go back too soon you will make it worse and then you are going backwards.
Just stay off it.
Maybe even get some crutches for a while.
When it hurts more sit down or lie down and wait and rest.
Don’t push through it.
But your doctor may tell you it won’t heal…
The first tear I had in 2015.
I stopped bjj/judo for 2 months. It healed about 90% it’s original…
Then starting about 9 months ago (2019) I think I might have torn it again mildly.
Then there was a slow downward progression with it getting worse with occasional popping and a little pain probably cause I didn’t stop and let it heal.
Then one night POP, POP, POP trying a reverse triangle choke.
I went to the doctor. Got radiated with an X-Ray and then an MRI which said a medial meniscus tear.
The same spot as the first.
So perhaps that spot was weakened from the first or it didn’t completely heal the first time or I just re-tore it again in the same spot.
I think it probably didn’t completely heal.
Will it heal on it’s own?
I think that depends on the tear type. From what I’ve gathered it doesn’t necessarily mean it won’t heal on its own if it’s in the ‘white zone’.
But if the tear is big and open then maybe that’s harder to heal on its own.
And unfortunately I don’t think there is any way of knowing the true condition of the tear without going in with a scope.
And your doctor probably won’t go in and let you look at it to decide what to do even though that might be best.
THINGS YOU CAN DO WHILE YOU WAIT (what I am doing)
These are some things I am doing and whether or not you have surgery they will help.
- Fasting because it boosts stem cells (24 hours or more). Then eat really healthy. The first time I tore my meniscus I did a 3 day fast.
- Drinking lots of green tea (especially matcha) because studies show it increases stem cells in skin, helps form bone and cartilage, and reduce inflammation.
- Taking lots of spirulina (amino acids). It’s an anti-inflammatory and good for your bones. I’ve been taking like a small handful of tablets a day recently. If I had to chose 2 survival foods it would be spirulina and sweet potatoes. Also chlorella has some growth factor in it CGF which helped grow some chickens in Korea faster.
- Cacao improves vascularity (nitric oxide), may release growth hormone and like green tea and the algae above helps reduce inflammation. High amounts of epicatechins (in tea and cacao) may also reduce weight and increase strength.
- Colostrum (10+ grams) increases IGF-1.
- Go to a sauna or steam room regularly because a sauna increases growth hormone. It’s like lazy man’s exercise.
A science backed injury diet combined with fasting to boost stem cells and heal your injuries
Studies of the nutraceutical formulation NT-020 (a combination of blueberry extract, green tea extract, carnosine, and vitamin D3) has demonstrated that NT-020 is beneficial in supporting repair mechanisms following an injury. – Source
- Drink tons of green tea (especially matcha) and/or get a green tea extract
- Eat loads of blueberries and/or get a blueberry extract
- Eat turkey, beef, chicken or pork for carnosine and/or if you don’t like meat…
- Eat loads of spirulina. Actually it will get stuck in your teeth like crazy so you might not want to do that, but you can just swallow them or I just let them dissolve in my mouth as I like the taste.
- Vitamin D3: oily fish, eggs, fortified milk, + mushrooms AND put them in the sun for up to 14 hours
Most studies show that it improves healing.
- Fasting promotes healing.
- One study showed that fasting for as little as 24 hours or 2-3 days can boost stem cells (intestinal stem cells in mice).
- Fasting increases growth hormone, yet also lowers IGF-1.
- Food restriction increased TGF-B3. TGF-B3 is “one of the most potent stimulators of matrix deposition in meniscal cells.” – Source
An odd sounding exercise that sounds like it could help?
What about intermitting fasting?
I started doing some of that maybe 5 years ago. For the last year I’ve been usually eating from about 4-10pm.
I noticed a difference when I fasted for almost 3 days during my injury. But 16-20 hours isn’t going to make a difference I don’t think.
I didn’t notice.
I mean it might help some, but if you want results you should periodically do at least 24 hours…
And don’t overeat.
Honestly in the past even when I ate in a window with just 4 hours in a day I still ate the same amount of food as I usually eat (or close to it) which might not be so good.
Or… calorie restrict
When mice were fed a diet reduced in calories by 40 percent from normal, the researchers observed that reserve intestinal stem cells expanded five-fold. Source
There are studies out there that show that this extends lifespan and there are studies out there that show that this effects skeletal muscle and increases stem cells.
So if eating nothing sounds too difficult try eating half as much as you normally do for an extended period of time.
So if fasting or calorie restriction stimulates stem cells in mouse intestines, lungs and stimulates stem cells in muscles and humans have increased stem cells in their synovial fluid following an injury then I am going to jump to the conclusion that fasting or calorie restriction is going to help you heal your meniscus.
Yet for how long? Or how often? IDK. But those mice were calorie restricted for weeks.
A one day fast will help, but maybe a one day fast once a week for a month will help more.
And sleep more.
You need to rest before the rehab so don’t push it too soon.
You can do some basic leg lifts to the front, side and back. A lot of reps and work your muscles without stressing your knees like you would in a squat.
Here’s one I have been doing. I think this has helped too because it is not high impact on the knees and I’ve noticed how it’s strengthened my foot and calf muscles.
Think it’s a pretty good whole leg exercise and maybe even abdomen some.
Also a good idea to work on what you can because that will increase your own growth hormone and circulating hormones in the body.
Like for example…
You may not be able to do much for your legs now, but can you work on your stomach? Upperbody? Back?
Do what you can.
Even though I stopped doing squats and box jumps I still could do these one leg exercises in the video above and I could work on my stomach and do some isometric exercises for my upper body.
Also have a shoulder injury (re-injured old injury) so couldn’t consistently do pushups or pull-ups, but I could do some muscle contractions, wall pushes or pulls.
So do what you can.
And you might need to let it rest before you can do anything.
Here’s a good gentle one…
Do this exercise as it helps lubricate the knees and helps transport nutrients in the knee. I did this daily for a year after I tore my meniscus the 1st time. And just got a reminder to do it again.
How does the meniscus get its nutrition?
So I looked at a few papers. And what I gathered is that it gets it from synovial fluid, possibly the underlying bone and peripheral part that gets blood flow.
And I read one source that says there are blood cells in synovial fluid and another that said only minimal blood cells.
The transport of solute from the joint cavity into the cartilage can take place by two mechanisms:
(1) pure diffusion due to solute concentration gradient and (2) by mechanical pumping action. Source
…vascular recession does not significantly alter nutrient levels in the meniscus, reducing at most 5% of the nutrient content in the central portion of the tissue. Therefore, our analysis suggests that reduced vascularity is not likely a primary initiating source in tissue degeneration. However, it does feasibly play a key role in inability for self-repair, as seen clinically. Source
And remember those stem cell shots mentioned above?
Well, guess what you actually have some there right now.
So that suggests that even though there is no blood flow the synovial fluid does contain nutrients although lower in number.
Although relatively uncommon, spontaneous healing from a meniscus injury has been observed even within the avascular area. Source
Also… I am looking into…
5. Peptides (BPC 157 and TB500) to name a few
As of now I haven’t made a post about this yet, but I will.
Peptides are one of the cheaper options and in my research possibly better than PRP, surgery, stem cells, etc. But there is not many studies on them with humans.
TB500 and BPC 157 as well as others have shown in animal studies that they can repair and regenerate cartilage, ligaments and bone.
I’ve been using the peptide BPC 157 and injecting it in my knee or around my knee.
It’s a peptide that is in your stomach acid originally, but is made in a lab and has 15 amino acids. I read quite a few favorable stories about this and cartilage repair.
My experience has been…
Like I said I hobbled around for about 6 weeks before I noticed much improvement.
Around the 6 week mark I did my first DIY blood injection mentioned above. And then around 7 weeks I started BPC.
I have seen improvement with a decrease in pain later in the day. Previously I had more pain standing and walking later in the day after 3 or 4 pm.
Before walking felt more sketchy. Like if I wasn’t careful I could twist it a certain way and re-injure it.
It’s feeling more stable and strong. As of now I’ve been using it for about 3 weeks. Mostly injecting it 3 times a day (short half life of 4-6 hours), but recently I’ve been squirting it in my mouth.
It’s not as strong orally so you should double the dose. I had no side effects really see the post I made on BPC 157 (coming soon).
TB500 is in the mail
I haven’t tried this one yet but soon will.
- TB500 (7 amino acids) is the muscular skeletal fragment of Thymosin beta 4 (43 amino acids). Source and additional info as there is some confusing info out there on these two.
- Ipamorelin is a growth hormone secretagogue as well as CJC-1295. It stimulates your pituitary gland to secret more growth hormone which may help heal cartilage injuries.
- GHK. I also ordered this one, but haven’t tried yet.
- Pentosan is not a peptide, but also sounds like it may help. I think studies show it’s beneficial for arthritis.
Read Kareem Abdul jabeer regrew part of his meniscus that was mostly gone. I probably won’t mess with this one. Read it was pricey and has side effects.
I would try a peptide that is a growth hormone secretagogue before straight HGH.
But you can look it up.
Read some about injecting this at injury site.
It’s like a mix of saline or sugar injection that causes inflammation and then maybe healing. Not sure about it. Haven’t read much about this, but one doc was talking about combining it with testosterone and another with PRP.
Sounds less convincing than most other injections to me although better than something like cortisone or hyaluronic acid as the later are temporary fixes.
WHAT DOES A MENISCUS TEAR FEEL LIKE?
It effin hurts.
It feels a bit like a big cut and bruise in your knee.
Imagine if you sliced your foot open and then you walked around on barefoot on it.
That’s what it feels like.
Some people get catching and locking. Recently when I re-injured it I got some catching I think in certain positions. Although I haven’t experienced that lately that was closer to the time of injury.
Often on the ground and in newaza and BJJ sometimes. I would feel something hitting or snapping in there. It didn’t ever lock and I don’t want to push it there.
So we are chilling out until 100%. I hope I can get back to 100%.
I’ve had so I am being more cautious with this and feel like I have to intervene and do something. So I’ve so far done 2 blood injections and many injections of BPC 157.
I haven’t been training in almost 9 weeks.
What should you do?
I wouldn’t rush and I wouldn’t do a partial meniscectomy or if you do that definitely follow up with stem cells or peptides.
I would probably only do surgery if you can’t move your leg or it’s locked, but look for a doctor that will stitch it and make sure you clear that with your doctor.
Because maybe they will say that they will try that, but if they can’t stitch they will remove the torn part.
I don’t know about you but I don’t like that uncertainty.
You don’t want to wake up without a meniscus.
It’s up to you.
I don’t know what’s best.
As I write this my knee starts to hurt more, lol maybe cause I over did the standing and rehab today. It’s been 2 months and I think it’s getting better definitely in the last few weeks (peptides and blood??)
And I will try some more peptides and maybe more blood, but I wonder still about surgery or fear that I could re-injure it again.
It’s hard to know what’s best.
I thought about giving all these things a try that I am planning on and then going back to get another MRI ($70 here in Japan) to see if it healed the tear.
And then I could rub it in the face of conventional medicine.
Some studies show that some people have tears in their knees, but manage fine and have no symptoms. Although some surgeons say they may be more likely to re-tear if untreated.
That’s why they cut it out or stitch it.
And I would also look into PRP, stem cells or peptides to help it heal.
Also waiting and resting will likely help some.
And if you are considering surgery I’d see the Reddit thread for possible outcomes.
Oh yeah think that’s where I first heard of BPC 157.
P.S. Are you a grappler?
Both tears happened with big fat careless f*&@! (YES, I AM BITTER ABOUT IT) who tried jumping moves:
- Jumping guard
- Kani basami (scissors throw)
Both have a history of knee injuries. Very dangerous and stupid to do. Now illegal in judo for that reason.
Don’t experiment on your partner.
Do you want someone to try their flying moves on you?
If you are bigger than your opponent or partner then effin respect the difference.
RESPECT YOUR PARTNER.
Big or small.
Get out of your head.
Play the game, but play smart.