Guest: Dr. C. David Geier Jr. - Orthopedic Surgery

Host: Dr. Linda Austin – Psychiatrist

Announcer: Welcome to an MUSC Health Podcast.

Dr. Linda Austin: I am Dr. Linda Austin. I am interviewing Dr. David Geier, who is Assistant Professor of Orthopedics and Director of MUSC Sports Medicine Clinic. Dr. Geier, what are some of the common procedures that you do?

Dr. C. David Geier Jr.: Mainly, I do arthroscopic surgery meaning surgery through small little stab incisions, and I mainly do the shoulder and the knee, although I do some arthroscopic surgery of the elbow and the ankle. The most common ones I probably do are when it comes to the knee meniscal surgeries people with meniscal tears or ACL reconstruction people that tear their anterior cruciate ligament. In the shoulder, I do arthroscopic surgery for repairing rotator cuff tears and for repairing labral tear such as when someone dislocates their shoulder.

Dr. Linda Austin: So, let’s talk about the meniscal tears. First of all, what is the meniscus of a knee?

Dr. C. David Geier Jr.: The meniscus is a C-shaped cartilaginous structure, piece of cartilage. You have one on the inside of your knee and one on the outside of your knee on each knee, and essentially they are shock absorbers between your femur, your thigh bone, your tibia, and your shin bone, and essentially that’s exactly what they are. They are shaped like the letter C? and they are shock absorbers. They don’t have much of a blood supply, so with a twisting injury to your knee or deep squatting injury, you can tear this meniscus, tear the shock absorber.

Dr. Linda Austin: So, when you go ahead then and repair it, how do you do that?

Dr. C. David Geier Jr.: Well, it really depends on what you find when you get in there. Most of the time when someone comes to the office for knee pain and I am suspicious of a meniscus tear, they have got, say, pain on the inside of their knee and pain with twisting and turning; a lot of times, I order an MRI because the x-rays that we get in the office just show bones. The meniscus tear will show up on an MRI and that’s when we start talking about surgical treatments, and in response to your question that gets then, in terms of surgical treatment, you are talking about either repairing it meaning, through those little stab incisions fixing it with sutures or what’s more commonly done, you trim out the inner part of the tear and that really depends on what you find when you get in there. Even an MRI is not very good in predicting whether or not it’s is going to be one you can fix with stitches versus one that you trim out. Both have their pros and con that if you can repair it meaning fix it with stitches that is clearly what you want to do because you preserve that shock absorbing tissue; the chance of that is not all that likely, that only happens, you only find that about 15% of the time, and that’s honestly more common in the younger athletes, you are 15 or 16, you old up to may be 30, and is usually traumatic in nature, but again it’s related to the type of tear you find when you get in there. About 85% of the time, you find a tear just based on its orientation, the quality of the tissue or that type of thing that you trim out the inner part of the tear. The good thing, if you trim it out ?yes? you do lose some of the shock absorber, but the rehab is much, much quicker. I can let you put all your weight on it right away. You are walking around the house, walking around the town within a couple of days; you are back doing most normal activities at most within a week or two. The meniscal repair, by the nature of trying to get that to heal with stitches, I have to limit you and make you nonweightbearing for three or four weeks. So, they are very different surgeries, although it’s the same structure and through the same two or three stab incisions.

Dr. Linda Austin: So, then is open repair a thing of the past? Is this always done now arthroscopically?

Dr. C. David Geier Jr.: For the most part pretty much, the open surgeries are a thing of the past. You still will see sometimes done, a surgery, where you place the needles through the two little stab incisions from the front, but there may be an incision in the back in a repair setting, but almost everybody has gone to just doing it through small little or two or three little stab incisions. There are really the breakthroughs with arthroscopic surgery over the last 10-15 years that many of these procedures, not just with the meniscus but especially with shoulder stabilizations and rotator cuff repairs, and ACL reconstructions; we can really do these through minimal incisions now.

Dr. Linda Austin: Dr. David Geier, thank so much for talking with us today.

Dr. C. David Geier Jr.: Thank you.

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