Be smart and you can keep racing. Reduced run mileage on soft ground. Hokas or like. Consider clinical prp and an unloader brace. The best thing you can do is thoroughly inform yourself. Good luck.

---

Swim - ( x ) All good ( ) In the shop
Bike - ( x ) All good ( ) In the shop
Run - ( ) All good ( x ) In the shop

At age 56 had meniscus tear in right medial posterior horn. Doc says he removed 60% of it. And thar i should quit running as sure to get oa there. At 67 no major issues. I cut back on mileage and watched diet to reduce inflamatory foods.

Unfortunately i developed tears and oa in the left good knee over time (think it carried more load to compensate for surgically repaired right knee). At age 65 went back to doc for possible surgery, but he said that it was degenerative ( no big tear) and surgery was not the way to go. So quit running he said. Several months later Emory healthcare started doing stem cells for oa. So i did it with follow up prp injection and my knee has so far responded very favorably. I had to give it time for the stemcells to take hold (about 8 months), but i am back doing tris and while run conditioning not back yet as i only run about 9 miles a week, i have not had any big setbacks and my training and racing going pretty well. Stem cell not covered by insurance and results not conclusive but i am glad i did it.

My guess is over time improvements in this area should come. So stem cell/prp + better diet + better run mechanis/ strength could keep you in the game. Good luck.

John, how bad are your symptoms? Did they xray the knee? How much space is left? Eventually the spacing will close to bone on bone and that's pretty much the end of your running career. Now, how to delay that time. First, as mentioned above; Hoka shoes and not the new lightweight ones. Get the Stinsen's, Bondi's or Maffate Speed. You need extreme cushioning. Also mentioned, only train on soft surfaces; trail, grass or cushioned track. Shorten you race distance; Olympic or sprint. And swim more run less.

Also, investigate Orthovisc, Synvisc or similar injections in the knee. Your joints are lubricated with synovial fluid. With arthritis the fluid goes away. Orthovisc will really help and should get you back running again.

Try to make it last as long as you can. All of this will help and keep you in the game.

---

---------------------------
''Sweeney - you can both crush your AG *and* cruise in dead last!! 😂 '' Murphy's Law

I have an appointment to see Doc re: PRP, and Stem cell. Bottom line, I'm ok not racing much if at all or running very little, yes, Hoka's have been my go to shoe for a couple years already. Main thing I want to be able to do is a.) avoid a future knee replacement or have weakness on involved leg lead to hip issues etc. I really do plan to swim more, and resume cycling at a slightly less intense degree. Thanks for your input.

I need to know a bit more information about you and your knee to give you any useful information.
What is your height and weight?
In 1992 did they comment on the status of the articular cartilage in your knee?
Is the OA in the medial compartment of your knee only? Is there any involvement of the lateral compartment or the patella femoral compartment?
What are your symptoms like today?

You sound very reasonable. Much more reasonable than some of the people who will undoubtedly respond telling you that you'll be able to continue to train and race. You may be able to, but the intelligent choice is activity modification- which you clearly realize based on your post. So, kudos for that.

Occasional corticosteroid injections have been shown to be very safe if done approximately every 3+ months on an as needed basis.

Viscosupplementation has been falling out of favor more and more every year. It seems at each Hip and Knee conference, more and more data is being presented showing lack of efficacy. That said, I still offer it and inject about 20 or so patients a week with it.

Unloader/offloader bracing is an option if you have isolated medial or lateral compartment disease.

Then the more obvious stuff...NSAIDs/Tylenol.

If I'm you...I'm cycling and swimming. I'd do weights to offset the running loss.

Just my 2 cents if you're looking to avoid a knee replacement.

"Shallow and deep partial thickness fissuring is present on weight bearing portion of lateral femoral condyle"
"Grade 2 Chondrolmalcia of weight bearing portion of lateral tibial plateau". Medial, lateral and middle osteoarthritis. So, basically throughout the knee.
All ACL/MCL repair work from '92 intact.

Everyone is different for sure, so what I have experienced may be different than your situation. But since I'm your age and have had a similar experience with my right knee I thought it would be helpful to share my experience.

I've been a runner since my late teens. OA and torn medial meniscus diagnosed by MRI in 2007 (I was 53 then). The MRI reported a litany of issues in my knee, including a partial tear in the posterior cruciate ligament, some strained ligaments....a shopping list of issues, not unlike what you would see if you took an old car in for a condition assessment! I opted for arthroscopic repair which fixed the meniscus and allowed me to run normally...for about 18 months and then I was right back into problems. Another MRI, another torn meniscus, another scope...this one did not yield a cure...hurt enough to keep me from running. This MRI also showed two small areas of loss of articular cartilage which means 'bone on bone'. I tried Synvisc injections but that did not seem to make a big difference.

I asked my surgeon about whether I should continue running and he told me that the osteoarthritis will progress regardless of whether I run or not, so ('at your age') keep on going if you enjoy it and use your judgement based on symptomatic experience (pain, swelling if any). So I did. I worked hard in the gym at strengthening the knee area and had to adapt my run gait radically to protect that knee...I had a noticeable lope and unevenness in my stride and I went through a lot of compensatory injuries (back, hip flexor etc). Eventually, my run gait smoothed out, I still compensate some (land more on my right forefoot and still heel strike on my left) but you would be hard pressed to notice anything unusual. My run is not as economic and I still have trouble descending steep grades as the footfall on the bad knee has to be carefully managed. If I get it wrong, I am reminded that all is not normal in that knee.

But the key is that I am still going strong, still running competitively, injury free for long stretches of time, still doing tris at an FOP level for the old farts and my knee has stabilized and has not deteriorated for the past 7 years of activity. I limit my distance to half marathon/half ironman or less but that is more related to my background vs issues with my knee. The two keys for me are: consistent strengthening work focused on the knee area as well as overall core work, and relentless pursuit of a once-again efficient run gait.

Good luck to you as you pursue a path, hopefully back to good running.

What exercises are you focusing on?

 - Single leg squat on bosu ball is the primary knee-focussed exercise. Other leg extended behind you and resting on an elevated platform (weight bench, chair etc). Start with no weights then work your way up to holding dumbbells in each hand as you do the squats. (Edit: these are called Bulgarian split squats or rear foot elevated split squat. I do it with the bosu ball right side up so your foot is on the hemisphere cushion).
- I also do deadlift, regular squat, leg extensions on a machine and lots of big gear, slow cadence riding.

From what you have quoted I don't see anything that says the OA is throught the knee. It seems that most of the cartilage wear is in the lateral compartment of your knee. From a mechanical/ alignment perspective this is not the typical wear pattern.
Be very careful if you try an "unloader" brace because most "unloading braces" will unload the medial compartment and put the majority of your body weight through lateral compartment of your knee.

I would have to look at your MRI to know for certain but from the snippets of the report you quoted it sounds like most of the wear is lateral. IF THIS IS THE CASE (ie your medial compartment is healthy), I would get a custom lateral unloading brace so that most of your body weight is going through the healthy medial compartment. If, however, the medial compartment also has significant wear, then that is not a reasonable thing to do.

In general focus on:
1) Body composition- the less weight you are carrying, the happier your knees will be
2) Strengthening- glutes,quads, hamstrings. If you haven't done much strength training learn how to squat, deadlift with perfect form. Then get after some serious strength gains.
3) Focus on cycling, swimming, XC skiing (if you are near snow), swimming
4) Minimize pounding (running, ball sports like soccer, basketball, etc)

I am the heaviest I've ever been right now at just over 180#+. Normal is around 175-178, will keep weight down. Tone down the Beer.
Am doing some strength work and have for years, but will be even more consistent. Was told to watch active knee bending for a while until joint calms down.
I love to ride, on and off road. XC ski and swim, yes.
Will run Hokas only soft even surfaces maybe 2-3 times a wk. if tolerated and not more than 30 min. I'm good with that.

Arthritis is pretty much throughout the knee, so bracing does not sound like the best option.

What about the attitude, expressed above that you are going to have OA anyway, so run a little if tolerated rather than totally shut it down? I do NOT, however want to go through a knee replacement in my late 60's or whenever. Obviously, IM's or Marathons are silly, I get that, but is 30 minutes on soft surfaces a couple times a week going to markedly hurry the decline? Not saying, just asking.

I would say #1strength and #2 get the body weight down if your knee has settled and you want to run then yes MAX cushioned shoes and soft surfaces would be the way to go.

You really should listen to how the knee responds. If you are running 20-30min a few times a week and no pain during or after with minimal swelling then carry on.
If however you are having to grimace during the running and having to change your gait to compensate for the pain...then back off the running.
Interestingly I have several patients who are in your situation who can't tolerate running on the flats and are able to run 30-40min on a 3-5% uphill grade without problems. If you can tolerate the treadmill that might also be an option.

Interesting feedback on uphill treadmill.

I agree with 95% of what you recommend as that has been my experience as well. The only part that has differed for me is the gait change. When your knee cartilage deteriorates to the level that mine is (articular cartilage loss), there is no way to run without pain UNLESS you change your foot fall. You will naturally land forefoot on your bad knee (to protect it) and rotate the foot inwards to spread out the shock load and to enable other parts of your knee structure to absorb the load.
However, I fully agree with your comments on the swelling and also if pain gets worse as you work on the return to running, it is likely that this path is not going to work for you. I've been lucky enough to be able to adapt my gait to enable protection of my bad knee joint. It took a long time and running was not pretty. But if I try to run like I used to (normal heel strike), I would not be able to run at all. Reading the symptoms is key...if you can try running and it is not increasing damage to the knee, then you may be able to work through it and adapt. So....how do you know? I guess a mixture of experience, common sense, good judgement and good, sport-oriented professional medical advice is essential to having the best chance of getting through this without ending up in an area where neither one of us wants to be...not able to run and a candidate for a knee replacement.

Lots of good feedback here. I don't have much in the way of advice, but posted my story a month or so ago and thought I'd share it again as it's much like yours, but I'm only 40yo. Long story short I played soccer in college, had a couple of knee surgeries to repair my ACL and torn cartilage, and for the past 12 - 15 years have been doing LD triathlons, marathons (Boston this April), ultras (50k in May), and the like without any real issues, just some minor swelling here and there in my knee. That was up until about a month ago...which incidentally is just a few months after I turned 40! I started having a lot of swelling and aching (no real acute pain) in my right knee that just wouldn't go away, particularly after running. A few weeks ago I went to my ortho and he said I'm bone on bone in my right knee as the lateral side of my meniscus is gone. It wasn't a total surprise as I knew it was coming I just thought it'd be farther down the road given I'd been doing so well.

My doc recommended an Ossur Unloader One brace. I just received it today so will try biking and running in it and see if this helps with the swelling (and report back here with an update). As of right now, I'm still planning on doing IMAZ this November as I can swim and bike with minimal issues, but do realize I will likely have to walk much of the marathon. I'm also investigating stem cell options. I would love to continue doing triathlon, but most of all just want to be somewhat active without the chronic pain and swelling I have now and hopefully avoid a knee replacement anytime soon.

I am bone on bone in my left knee. I am 45 years old, MOP swimmer/cyclist... BOP (if that) "runner". I have had issues for years, stemming from a L knee dislocation in 1992.

I have been swimming and biking without issue for 12 years, running with pain and swelling. Everything got sharply worse after a haphazard fall I had in 2012, which dislocated the knee cap and tore my ACL. I didn't realize it was torn at the time, because I was used to a certain amount of pain and swelling anyway. I continued to swim and bike and run/walk for as long as I could. It took about a year before I went to my HMO ortho who told me my Xrays were the worst he's ever seen. He didn't do any manual testing on me, saying "Your ligaments and other tissues don't matter, you need a knee replacement, now." But, in an effort to hold that off, he gave me a cortisone injection, which helped for a while.

I continued with the swimming and the biking, and attempted strength training with the help of a Physical Therapist. My condition continued to deteriorate, until I couldn't get into and out of my car without manually lifting my leg into the driver's seat.

Decided it was time to get serious, so I got myself an appt @ Midwest Ortho @ Rush (IMO, best ortho outfit in Chicago). I explained my situation to the doctors there. They shook their collective heads and concluded that I had an ACL tear (very unstable) bone spurs, end stage osteoarthritis in all compartments, and probably some other stuff. They went in in February with the intention of cleaning me out and attempting the ACL repair if possible. The condition was too deteriorated to replace the ACL, so they cut what was left of it out, smoothed off my bone spurs, trimmed what was left of my meniscus, and smoothed my ragged cartilage. I still need a knee replacement, but this fixed me up enough to do IMWI last weekend. (My third and final IMWI)

I did all of the swim/bike training without issue. I trained to walk the marathon. And I did. I'm not going to lie, it was a long lonely walk. I'm not able to run at all. The mechanics of my knee are so messed up that the knee doesn't straighten out all the way, so running is an awkward and painful endeavor so I don't even bother trying to run/walk.

Doctor said there was really nothing I could do to make it worse. So... I did an Ironman. You can do it. It can be done. You will have to swallow your pride and walk.

For me, it's the training that I love... long bike rides, open water swims with my friends... those are the things I love and would miss. So I did them anyway. The walking training? I did that alone. That's 100% mental.

I still need a knee replacement, but I'm no worse for the wear than I was after my February surgery. Now. Onto Aquabikes and TT racing.

I'm curious about your opinion of the Ossur and any feedback you are willing to provide, also if you have the fit or the one. I'm waiting until Oct. 1, 90 days out from surgery for synvisc injection and would like to talk to my doc about getting the Ossur at that time if it will help. Thanks

I have the One as I wanted to be able to run it in and was told the Fit doesn't hold up to that kind of abuse very well. Also, my doc wanted me to pay him $1000 for it, but after a few minutes online I found a guy selling the exact model I needed brand new on eBay for $790, but with the option to make him an offer. I ended up buying it for $450! I'll keep you posted and if I don't remind me in a few weeks!

So I've been running in the Ossur Unloader One for a few weeks now....probably about 50-60 miles total. I watched their online video to make sure I got the fit right...really easy to do. Cut a few of the straps down to size and was ready to go. It fits as well as a brace like this can and is relatively light weight for what it does.

Overall, it really helps prevent the swelling and post-running pain I was having vs. running normally on my bone on bone knee. I did a 15mi run @ 7:50 pace last week in NYC and prior to the brace couldn't have fathomed being able to do that type of distance (or pace) so I'm very pleased. I do get some chaffing where the two support straps cross behind by knee. I've been using Rock Tape to try to prevent this which has helped, but on long runs the Rock Tape still works off and I just run through it...not that big of a deal. The brace does slip down slightly after I start sweating...sometimes it's worse than others and I haven't really figured out why...maybe it's just my sensitivity to it or maybe I'm not adjusting it the same every time even though I think I am. I've also learned it's a fine balance between being comfortable enough to run at pace and having it tight enough to keep the brace in place.

Bottom line, I'm happy with it and it's been well worth the $450 I spent for it via eBay. I plan to run IMAZ in it in 6-weeks and just a few months ago I thought I'd be walking most all of the mary.

I have a similar problem... I will try with the diet and reduce inflamatory foods.

I went low carb/ high fat which given past carbo loading habits is tuff. No sugar no grains helps a lot but it to is tuff initially. Learn about ketogenic diets too. Primal endurance podcasts may help too. Better mechanics probably just as important and I learned a lot from mobilitywod website. Sitting all the time is killing us. But with little effort I would venture things would go better. What's really crazy is in retirement my swimming is still strong as ever for 1500 meters. And my biking is nearly as good as in my 40's with better bike and di shifting. I have not cut it loose on the run yet holding out hope for kona next year in age 70 age group. Good luck.