Clocks, Clouds, and Meniscus Tears

In 1966, scientist / philosopher Karl Popper wrote an essay entitled, “Of Clouds and Clocks”.  He believed that studying physical systems could be divided into two categories: clocks or clouds.

Clocks are structured, predictable, repeatable by nature. The internal workings of a clock are precise and each component serves a purpose such that if you alter a part, you can predict the outcome.

An engineer’s dream.

Clouds are just the opposite. Clouds are irregular, disorderly and unpredictable. You can’t alter the make up of a cloud to force it into a specific shape for example. You could tamper with it’s temperature but what precisely will happen is unknown.

Of course, life is, ummm, cloudy at best. We can do our best to make life work like a clock but life is played out on a spectrum. On one end we have appointments and calendars and checklists, and all the wonderful things that have structure and predictability.

On the other end, we have “sh*t happens”. Uncontrollable, unpredictable, irrational.

Some of us are happiest living more of a “clock” style life: to-do lists, schedules, rules, policies, processes, and all forms of structure. Me? My head is in the clouds (sorry, it was there – I had to take it 🙂

When you hurt, have an injury, or are coming back from a surgery, it’s tempting to treat the problem with only a “clock” approach: find out what’s wrong, broken, not working and fix it. Consult Dr. Google and get the protocol. Simple.

Why Treating a Meniscus Tear is More Like a Cloud Than a Clock

A torn meniscus in your knee just begs to be treated with a “clock” approach. It’s a thing, a structural thing, that’s damaged. Your knee hurts because of this damaged thing so just go fix it. Clip it, tie it, replace it, yell at it, do something to it and bingo, all will be well.

But when you treat something using a “clock” approach that is permeated with “cloud” features, you run into problems.

In people over the age of 40, osteoarthritis (OA) of the knee is common. And meniscus tears in this age group are usually not from trauma, like playing football, but from a degenerative process that weakens the cartilage placing you at risk of a tear. So something routine, like stepping off a curb just the wrong way, can tear your meniscus.

But it may not be just the meniscus tear that causes the pain. It could also be that the OA, in response to the tear, becomes more active; more symptomatic.

Just when you thought the knee was a clock, a damn cloud rolls in.

If your knee hurts, you’re over the age of 40, and you’ve had no traumatic injury to your knee, your pain may not be from a meniscus tear even if you find a tear on MRI.

In one study of 991 people (age 50 to 90),  in those who had OA, about 63 percent with knee pain had meniscal tears and 60 percent who were pain-free had tears. In people with no arthritis, 32 percent with pain had tears and 23 percent without pain had tears.

So, in other words, a meniscal tear, by itself, is not enough to justify surgery for knee pain. Surgery for the tear in the presence of OA will not yield a predictable result; your knee and your body’s function are not simple mechanical things. They are complex biological things.

What to Do

I had surgery for a meniscus tear in my left knee about 20 years ago. At the time, I was under the age of 40, the tear was from a traumatic event, I had a knee that would not straighten, it locked up on me frequently, my knee gave-way when walking down a flight of stairs, and I couldn’t walk normally. And there were not many other treatment alternatives at that time either.

About 18 years later, I developed a tear in my right knee. It was a large, unstable, posterior-medial tear. My knee locked, gave-way, wouldn’t straighten. I had all of the symptoms that my right knee had 18 years prior.

But this time, I chose Platelet Rich Plasma (PRP) injections followed by a special form of rehab. Why? It was far less risky than surgery, I had some evidence of OA in the knee, I had the time to devote to the rehab, and if the procedure failed, I could always opt for a surgical solution.

In my case, the PRP and rehab worked. The tear healed and my function returned to normal. It took many months and wasn’t a smooth process. I had plenty of “speed bumps” along the way.

Each situation is unique. Your practitioner / surgeon / therapist should recognize that you are a wonderful bundle of clouds and clocks so the two of you can discuss your options and discover what suits you best.

When you face a physical problem, keep in mind that most have several factors that have to be addressed. While it’s tempting to boil it all down to just one thing, one mechanical thing, the human body resists being treated like a “clock”.