Federer Comeback in Trouble?

[stotty]

So you are existing with two knees both of which have torn menisci? Really. Why no surgery yet? I am a physician and to be considering a knee replacement before surgically dealing with this is not reasonable. Usually the meniscus surgery is quick, less than an hour, and I have gone to lunch after two of them. I have been cleared to "advance as tolerated" after 7 weeks. Physical therapy started one week post op. I am hitting on the court for the last three weeks. Not aggressively, but each time is better than the previous one.

Yes you can wait and hope, but meniscus do not heal up usually. Poor blood supply. Let me know if you would like any more discussion.

Interesting. So what about my situation? I am very close to bone on bone in my left knee and cannot bend it easily during rallies without pain. In normal day to day life outside of tennis I am not really impaired. Can I avoid surgery if I go on an extensive strengthening routine and keep my weight as lean as possible? I would like to avoid surgery altogether if it were at all possible.

[jschaff]

Of course every situation is unique so it is difficult to give a medical opinion without knowing all of the details. But I am happy to talk with you about it if you like. I do this routinely with my tennis team, friends, family, etc. If you want just email me and I will give you my contact information to discuss privately and as long as you need. jschaff112@gmail.com. Jeff Schaffer, MD

[jimlosaltos]

I am a decent case study. My formative junior years, and up until the age of thirty, were played on red shale, which is similar to clay. I never had a single problem on that surface, but of course I was young back then. Since then I have played on Astro Turf, and more latterly, on hard courts. Astro Turf is easy on the legs. Hard courts are what really do the damage in my view. There is no give on a hard court. One brakes and then slides on Astro and clay courts whereas on hard courts you brake and come to an abrupt halt...that's jarring. Today, it's hard courts that kill my knees whereas on Astro I have far less pain.

God knows what Novak's knees are gonna be like at 60. I imagine not good.

It took me a while to realize what you are (I believe) referring to.

Are you playing on Omnicourt surfaces? I think it's name changed when Jack Kramer bought the product. Basically, lots of sand underneath and between blades of synthetic grass, if it's the same thing I'm thinking about. {When I read "AstroTurf" I immediately though to the extremely hard surfaces my amateur soccer friends (and the NFL players' union) hate, hate, hate. Hard as a rock, give carpet burns on every fall, and has rubber "tire crumbs" that are highly carcinogenic and get in players noses, pockets and everywhere else. But that's another story).

That's an interesting one. A teaching pro friend of mine installed those on some courts in Atherton (a tony neighborhood south of San Francisco) long, long ago. Drains immediately after rain. As you say very soft on the feet. I found it difficult to play on because the sand was so dead, yet the ball could slide on the synthetic grass. I imagine it would be very good in terms of keeping one's joints and limbs intact. It is soft, (more so than clay), but chunks don't come up under your feet causing traumatic injury.

Sidebar: Most unusual court I played on was on a hotel roof in Hawaii. Tiles with holes to let the rain that fell for short periods seemingly every day go through. But it was so slick playing on that surface was more like being a hockey goalie than a tennis player. Reminded me of playing on wood, basketball courts back in college in Michigan. Anyone returning serve should be given a face mask <g>.

[stotty]

It took me a while to realize what you are (I believe) referring to.

Are you playing on Omnicourt surfaces? I think it's name changed when Jack Kramer bought the product. Basically, lots of sand underneath and between blades of synthetic grass, if it's the same thing I'm thinking about. {When I read "AstroTurf" I immediately though to the extremely hard surfaces my amateur soccer friends (and the NFL players' union) hate, hate, hate. Hard as a rock, give carpet burns on every fall, and has rubber "tire crumbs" that are highly carcinogenic and get in players noses, pockets and everywhere else. But that's another story).

That's an interesting one. A teaching pro friend of mine installed those on some courts in Atherton (a tony neighborhood south of San Francisco) long, long ago. Drains immediately after rain. As you say very soft on the feet. I found it difficult to play on because the sand was so dead, yet the ball could slide on the synthetic grass. I imagine it would be very good in terms of keeping one's joints and limbs intact. It is soft, (more so than clay), but chunks don't come up under your feet causing traumatic injury.

Sidebar: Most unusual court I played on was on a hotel roof in Hawaii. Tiles with holes to let the rain that fell for short periods seemingly every day go through. But it was so slick playing on that surface was more like being a hockey goalie than a tennis player. Reminded me of playing on wood, basketball courts back in college in Michigan. Anyone returning serve should be given a face mask <g>.

Astro is a loose term. It's actually this stuff : https://tigerturf.com/uk/product/advantage-pro/

Artificial grass surfaces have improve immeasurably over the years. They used to be poor but not now. It's an extremely popular surface over this side of the pond because clubs are dominated by players middle aged and upwards who want a forgiving surface to play on. Tiger Turf certainly provides that and is the market leader over here.

It isn't deemed a surface that performance players can be developed on so the LTA have been very reluctant to promote artificial grass, and they won't give interest free loans to clubs who install them, whereas they will give loans, and even grants, to clubs who install hardcourt surfaces.

[jimlosaltos]

Astro is a loose term. It's actually this stuff : https://tigerturf.com/uk/product/advantage-pro/

Artificial grass surfaces have improve immeasurably over the years. They used to be poor but not now. It's an extremely popular surface over this side of the pond because clubs are dominated by players middle aged and upwards who want a forgiving surface to play on. Tiger Turf certainly provides that and is the market leader over here.

It isn't deemed a surface that performance players can be developed on so the LTA have been very reluctant to promote artificial grass, and they won't give interest free loans to clubs who install them, whereas they will give loans, and even grants, to clubs who install hardcourt surfaces.

Very interesting. Thanks for sharing. And good look with the limbs

[glacierguy]

Sidebar: Most unusual court I played on was on a hotel roof in Hawaii. Tiles with holes to let the rain that fell for short periods seemingly every day go through. But it was so slick playing on that surface was more like being a hockey goalie than a tennis player. Reminded me of playing on wood, basketball courts back in college in Michigan. Anyone returning serve should be given a face mask <g>.

I've played on the plastic tiles too! The British Embassy in Tokyo had a single court where the plastic tiles had been laid over an older tarmac surface. Drains immediately in the rainy season, but as you say - slick.

[doctorhl]

I love everyone’s court stories. I played on an asphalt court In the 60’s that the university apparently got the highway department to install. The knap on the ball lasted half a set. The most miserable court experience I ever had was on a singular court that apparently was an early sanded, artificial turf court at a Misssippi state college where the humidity was so high that the wet sand slowed the ball down slower than clay. I did get to play on carpet in the late 70’s at a few British halls.

[arturohernandez]

So you are existing with two knees both of which have torn menisci? Really. Why no surgery yet? I am a physician and to be considering a knee replacement before surgically dealing with this is not reasonable. Usually the meniscus surgery is quick, less than an hour, and I have gone to lunch after two of them. I have been cleared to "advance as tolerated" after 7 weeks. Physical therapy started one week post op. I am hitting on the court for the last three weeks. Not aggressively, but each time is better than the previous one.

Yes you can wait and hope, but meniscus do not heal up usually. Poor blood supply. Let me know if you would like any more discussion.

My knees both feel great these days. Yes, I cannot run on hard courts as much as I used to. But I can walk for miles and have little pain in my day to day activities. The orthopedic surgeon is okay with me using a brace on the left one for exercise.

I am also doing strengthening exercises for my entire body. I switched to gut string. All of these things have made my tennis much less effortful than before. Not sure that surgery is warranted on either knee right now. I can get a second opinion but the doctor I see works with athletes on professional teams. So she has seen the whole range of good and bad with regard to joints.

[arturohernandez]

My knees both feel great these days. Yes, I cannot run on hard courts as much as I used to. But I can walk for miles and have little pain in my day to day activities. The orthopedic surgeon is okay with me using a brace on the left one for exercise.

I am also doing strengthening exercises for my entire body. I switched to gut string. All of these things have made my tennis much less effortful than before. Not sure that surgery is warranted on either knee right now. I can get a second opinion but the doctor I see works with athletes on professional teams. So she has seen the whole range of good and bad with regard to joints.

Looks like I missed the thread and now see that I might be Stotty in a few years. I will keep your advice in mind as I get older and the knee gets more fragile and worn.

[jimlosaltos]

My knees both feel great these days. Yes, I cannot run on hard courts as much as I used to. But I can walk for miles and have little pain in my day to day activities. The orthopedic surgeon is okay with me using a brace on the left one for exercise.

I am also doing strengthening exercises for my entire body. I switched to gut string. All of these things have made my tennis much less effortful than before. Not sure that surgery is warranted on either knee right now. I can get a second opinion but the doctor I see works with athletes on professional teams. So she has seen the whole range of good and bad with regard to joints.

I strongly urge you to get multiple opinions.

I know a whole lot of people with knee surgeries and many different outcomes. Some got surgery when recommended procedure now is to do exercise as you are and avoid the knife. Others' got great surgery, some not.

From the experience of people close to me, having a professional sports pedigree is not necessarily a meaningful credential for MDs.

My SO had micro-fracture surgery on her knee, early on for that procedure, from a local doctor that worked for the 49ers football team, had Steve Young's autograph on his wall. He forgot to tell her that after micro-fracture you had to stay off that knee for an extended period to allow the blood from the deliberate fractures to congeal and replace the cartilage. She didn't and ended up with no cushion in her knee.

Second surgeon with similar resume' removed too much meniscus, leading to her getting a knee replacement. { Which worked extremely well. Back on the courts. Took nearly a year to truly get mobility back. }

Good luck !

[arturohernandez]

I strongly urge you to get multiple opinions.

I know a whole lot of people with knee surgeries and many different outcomes. Some got surgery when recommended procedure now is to do exercise as you are and avoid the knife. Others' got great surgery, some not.

From the experience of people close to me, having a professional sports pedigree is not necessarily a meaningful credential for MDs.

My SO had micro-fracture surgery on her knee, early on for that procedure, from a local doctor that worked for the 49ers football team, had Steve Young's autograph on his wall. He forgot to tell her that after micro-fracture you had to stay off that knee for an extended period to allow the blood from the deliberate fractures to congeal and replace the cartilage. She didn't and ended up with no cushion in her knee.

Second surgeon with similar resume' removed too much meniscus, leading to her getting a knee replacement. { Which worked extremely well. Back on the courts. Took nearly a year to truly get mobility back. }

Good luck !

That is what is so encouraging to me. The doctor told me "I am a surgeon. I would love to fix this but I think I will do more harm than good if I try to fix it. If it were a ligament, I could replace it." She is surgeon who told me to avoid surgery. The brace is doing the trick. It feels MUCH better. I used to be in constant pain. I can now run in my yard and chase the dog with no pain and no brace.

A doctor who goes against what would make them more money and is their specialty is rare thing. I know I am being a bit stubborn here but I LOVE people who go against what should be done for monetary and convenience reasons.

But I will seek out a second opinion. I did so for my cholesterol in two different countries and both recommended Crestor.

Hopefully, I won't end up having to go to a third doctor to break a tie.

Thanks!

[jimlosaltos]

That is what is so encouraging to me. The doctor told me "I am a surgeon. I would love to fix this but I think I will do more harm than good if I try to fix it. If it were a ligament, I could replace it." She is surgeon who told me to avoid surgery. The brace is doing the trick. It feels MUCH better. I used to be in constant pain. I can now run in my yard and chase the dog with no pain and no brace.

A doctor who goes against what would make them more money and is their specialty is rare thing. I know I am being a bit stubborn here but I LOVE people who go against what should be done for monetary and convenience reasons.

But I will seek out a second opinion. I did so for my cholesterol in two different countries and both recommended Crestor.

Hopefully, I won't end up having to go to a third doctor to break a tie.

Thanks!

You're right, that's a very good sign.

Good luck!