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Facebook Live: Dr. Paul Thomas on Meniscus Tears

Dr. Thomas, tell us a little bit about yourself and what specialties you see here at Bone and Joint Institute:

I was born in Nashville so I’m a local Tennessee boy. That’s kind of rare these days but born in Nashville, grew up in Columbia and Lawrenceburg; my dad was an engineer at Union Carbide in Columbia. I went to school at Lawrence County High School, graduated and then went to medical school at the University of Tennessee in Memphis. I stayed at the prestigious Campbell Clinic and did my residency in orthopaedic surgery, and now I live in Leiper’s Fork and have been for about the last 30 years. Dr. Craig Ferrell recruited me to come back here to my home area. I miss Dr. Ferrell, but it’s all because of him I’m here. I’m married now 45 years to my wife Janice and we have six children together, all raised here in Middle Tennessee.

I have two parts to my practice. Half of it is joint reconstruction, total hips and total knees, and the other half is sports medicine mainly the treatment of shoulder and hip pathology.

What is a meniscus tear?

The meniscus, I describe it as the cushion of the knee joint. It’s called fibrous cartilage but it’s just between the joints and it’s kind of the shock absorber when you bear weight on your knee or ankle or even to the hip. It’s just the shock absorber so it cushions your knee joint and that’s it’s role.

It’s commonly torn in two different scenarios. One would be an acute tear – that’s usually a sports medicine sort of injury – when someone is loading the knee or twisting their knee or bending their knee. Then there’s chronic tears, which is kind of the wear and tear when people come in for some reason just saying “for some reason my knee is bothering me.” Each of them are different and treated differently. For an acute tear, that is commonly a surgical intervention because the meniscus for an acute tear, the blood supply on the outside could have good blood supply but the inside doesn’t. Still, in someone younger with an acute tear, we usually try to repair the meniscus. In the chronic tears, that’s more of a conservative treatment where we would maybe do a partial meniscectomy or trim out the pieces torn when it doesn’t have the potential for healing like an acute tear. Generally though, we try to be conservative. A lot of times we’ll give them a cortisone shot, try some physical therapy or give it some time. Each of them are treated differently.

Is there any certain technology you use, especially while you’re in the operating room?

It’s come a long way. In the old days back when I was doing my residency, we used to have to open up the knee, repair the meniscus or trim out the meniscus or sometimes even had to take out the entire meniscus. But that’s never done these days. The biggest technology is arthroscopic surgery so whether we trim out the meniscus or repair it, we’re going to do that arthroscopically. To that, there’s a lot of new technology as far as repairing the meniscus. We can do what’s called an Inside-Inside technique where you don’t have to make an incision on the outside part of the knee but we can repair the meniscus and suture it back together. That’s the biggest technology that’s changed through the years.

What is the recovery like from a torn meniscus?

It depends if it’s an acute tear versus a chronic tear. For an acute tear and a repair of the meniscus, we’ll repair it and stitch it back together but then we have to be very careful about disrupting that repair. We usually will put them on crutches for about four weeks and not bear much weight on the knee. We’ll start physical therapy immediately to keep the muscles and the ligaments good and strong but as far as weight bearing, we’ll take the weight off of the meniscus and let it heal up. That’s only if we repair it.

If it’s a chronic tear or one that we just trim out the meniscus, we let them resume activities almost immediately based on pain. They can put weight on it, they can bend their knee, and we also put them in physical therapy to restore their motion and to restore the strength of the knee. So they’re very different as far as recovery goes but each of them are very successful.

What can you do to prevent a meniscus tear?

Things like overall conditioning, staying in shape, keeping muscles good and strong, stretching before you do activity, keeping your weight down and again, conditioning is really the biggest part of preventing a meniscus tear. 

Describe some of the comprehensive care we offer here at Bone and Joint Institute for the community:

That’s the best part about the Bone and Joint Institute and our affiliation with Williamson Medical Center. We can do it all right here from the moment the patient comes into our office and they see one of the surgeons. Then we start their treatment, we’ll set them up for an MRI and we can do that right here in this facility. If we scheduled their surgery, we can do it downstairs most of the time in our surgery center. Then it’s the same thing with physical therapy, we have PT on site as well so it really is comprehensive that we can offer the patient everything they’d need to come here and get everything they need as far as treatment to rehabilitation to eventually back to doing the things they love to do.

To watch the full segment with Dr. Thomas from Facebook Live, click here.