You may have already been here, but if you haven't it may be worth a try.

http://www.orthop.washington.edu/...t-care/hip-knee.html

http://www.orthop.washington.edu/...-patients-guide.html

Don't know about the knee - but I have a friend who stopped running due to Pf - had problem for years - now after getting rid of orthotics etc - pf is ok.

 Not being active is the wrong answer. Have you tried some easy spinning on the stationary bike? And way less sitting at work? I find my knee really hurts if I stand too long. Standing is much worse than walking. And even sitting too long is not good too.

Good luck. I know how you feel.

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clm
Nashville, TN
https://twitter.com/ironclm | http://ironclm.typepad.com

Hi Jen,

I had three RT knee arthroscopies on the medial side and had nickel size holes in the femoral and tibial cartilage, I couldn't hardly walk up stairs let alone run. I consulted with a few orthopedic surgeons and decided to get a high tibial osteotomy, which moved my weight from the medial side of my knee to the center of my knee. Had the surgery November 2013 and consisted of cutting my tibia 80% across, moving my lower leg out 11deg, inserting a cadaver bone wedge and a plate and four screws to hold everything together. Was on crutches for three months, but well worth it. I signed up for a marathon this fall and can do 70.3's again. It is a long road, but better than a dead end. If you want more info, feel free to PM me if you would like more info. I don't know how to add pics in a post, but I added two pics of my knee in my profile.

Wow - that is a pretty amazing surgery. The back of my kneecap is where the worse of mine is. My Dr talked through what is currently available for surgical treatment and said I am past the point where much of the options are available to me. I should get in and talk to someone else.

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Jen

"In order to keep a true perspective on one's importance, everyone should have a dog that worships him and a cat that will ignore him." - Dereke Bruce

I get up at least hourly at work and walk around. I've always been antsy :-) Standing for me is a no-no as well. That might be why I have PF on the left, from putting my weight on it when I do stand for too long.

I haven't done a bike spin but it would be interesting to see what happens with it. Everything else I've tried has caused pain. The knee flexion with swimming bothers me for crying out loud. Endlessly frustrating.

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Jen

"In order to keep a true perspective on one's importance, everyone should have a dog that worships him and a cat that will ignore him." - Dereke Bruce

Have you see someone there specifically?

I've seen 2 of the most recommended Drs and both have said the same thing. I suppose trying the UW isn't a bad idea. My insurance sucks so who knows how much they'll cover but a third opinion never hurts.

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Jen

"In order to keep a true perspective on one's importance, everyone should have a dog that worships him and a cat that will ignore him." - Dereke Bruce

I have terrible knee DNA, mom, aunt, grandmother all have new knees, it is in my cards. I'm 47 and was to the point of pain from any physical activity more than walking. I had resigned to not doing tri anymore until I found my latest sport medicine doc.

Currently I'm using rooster cartilage injections ( every 6 mos) and mobic (7.5 mg per day) combination with good results. I'm able to run and bike again, currently training for a half. I also wear a PT runners knee band below my kneecaps, the combination is working for me.

When that combo stops working I intend to try stem cell therapy - regrow knee cartilage! This looks pretty promising as a stop gap before knee replacement. Doc says the new cartilage is not as hard as your original, but it is cartilage.

For PF, I had to stop wearing flip flops, that fixed mine permanently. Although I have very flat feet I also stopped wearing my custom orthodontics and now wear Altra zero drop shoes. Feet have never been better.

I feel your pain...

Larry

One thing you could do for swimming is use a pull buoy and band. Just let your legs drag. You still get a good workout with no leg strain. (Just be very careful pushing off the wall...) I just use ROKA Sim shorts for the same effect, but with them I can't drop the buoy.

.

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Remember Luddites are people too...

Thanks for the info. I'm 46 now.

I did a series of 3 Eufflexa shots (the synthetic version of the shot you are doing) and relief lasted for about a month. My current doc said I'm not a candidate for the stem cell. Apparently you need a certain amount of cartilage left in order for it to work and I'm past that point. So depressing.

I never hurts to see another Dr though. Maybe something has come up in the last 18 months.

I dropped some big cash in very supportive shoes, running and casual. That helps my pf a bit. I can put weight on it at the end of the day at least.

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Jen

"In order to keep a true perspective on one's importance, everyone should have a dog that worships him and a cat that will ignore him." - Dereke Bruce

Is your osteoarthritis isolated to the patellofemoral joint? If so, there are orthopedic surgeons out there that do PF resurfacings. One of the joint guys in our practice does them occasionally. My boss won't, but it's out there.

I had surgery at a clinic in Vancouver, BC to repair a torn meniscus in 2012, but I read and researched various sites for opinions and general information. I just wanted to suggest another option. I would hope that there is a better answer for you, even if it is just to walk pain free. Forty-six is still very young. I sincerely hope you can find some better news.

Good luck.


Jim

I'm in the same boat. Articular cartilage defect grade 4, trochlear groove (bone on bone) from getting hit by car while biking. Find a better PT. Stretching and rolling the ITB have helped me quite a bit-helps the knee track better. I'm not running but can bike and swim ok, both gave me pain before the PT and some time off. I am stretching and rolling every day. Aqua bike is my new sport and on a much more limited basis. I agree on the standing, standing is worse than anything.

For the PF, find some good off the shelf orthotics -- go to a New balance store and get a foot scan. I found an ultra runner who worked at the store, he recommended some orthotics with a met pad and the problem was fixed -- this after lots of doctors, PT, custom orthotics, etc..

I am grade IV (full-thickness, exposed subchondral bone) over the entirety of my lateral femoral condyle and most of my tib plateau. (Also pat fem joint space, although that doesn't bother me as much and is largely a by-product of my osteotomy/realignment (mine was femoral, open wedge)). I also had my lateral meniscus completely resected. I've had...mmmm...8 or 9 surgeries? I've been grade IV since I was a kid--posttraumatic OA as a result of an accident. If there's anything I've learned, it's get as many opinions as possible, and stay as active as you can.

Patellofemoral OA is tricky, b/c there's a lot of things that could cause it (together or in isolation)...knee in relation to pelvis, fem/tib alignment, rotational variances, patellar tilt, soft tissue wonkiness, etc. etc., etc., etc. Like I said, lots and lots of causitive factors.

If you've tried the main non-surgical interventions (e.g. quad strengthening exercises, stretching of the lateral patellar retinaculum, ROM work, NSAIDS, injections, taping, bracing, etc.), then I'd start soliciting surgical opinions.

Debridement/clean out (is it for sure the OA causing the pain? Or could it be plica, impingement, etc. Have you had a diagnostic arthroscopy?), soft tissue realignment (which includes lateral release (<--danger, danger, will robinson...used to be way over done and cause more harm than good, but some people DO benefit from it)), osteotomy--tibial tubercle, or...there comes a point when a replacement IS your best option--age be damned. If your quality of life is ruined, and you have no other options...then you shouldn't have to wait. Have you investigated a partial? Like the stryker pat fem resurfacing? If your damage is unicompartental, it migght be something to investigate.

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mmm-mmm-Momo Charms
Handmade beverage charms, jewelry, and miscellanea
http://momocharms.wordpress.com

Fwiw, I developed PF now 1.5 years ago. I am 100% positive that it was because my roomate's gf was bringing over her dog and I was allergic so I started wearing shoes in the house. Then once I got PF I started to wear shoes even more often and more supportive ones to help ease the pain. Problem is, the body decides to stop supporting itself with so much support so it kept getting worse and worse. It wasn't until I was at PT (proactively not for PF) that I talked to a guy who gave me analogy with the St Louis arch and the keystone - the fact that pushing on the top of the keystone makes the arch strong (ie weight from above). Whereas pushing from below the keystone (arch supports, supportive shoes) made it weaker. I now walk barefoot every chance I get and I feel like I have never walked, ran better in my entire life. There are a lot of schools of thought on PF, but IMO orthotics and additional shoe support are simply to treat the symptoms of PF, they do no treat the root cause.

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Rocker is right. There comes a point where knee replacement is your best option. Quality of life is very important. I shattered my knee cap 10 yrs ago and my OA has gotten progressively worse. I can run with a brace real slow (8 min/miles), but it hurts real bad. The Donjoy AO Reaction Knee brace is the only one that works for me. I'm 46 and my doctor is ready to replace the knee when I feel it is time. I'd rather get the knee and keep happy by working out than sit on the couch and get fat and depressed. Good luck. My day is near.

I'm 52 now; was 48 when my left knee (which had always been my good one) started hurting during an easy run. I laid off running for several weeks, but it never improved, so I went to a knee doc to see what was wrong. They took xrays and were shocked I wasn't there for my right knee, which had always been my problem knee but for whatever reason wasn't hurting when I went in. Long story short: both of my kneecaps are in the wrong place, way too far to the outside. Over time, because I've run my whole life, I've worn away the cartilage behind both kneecaps. I will eventually need to have both knees replaced. The right knee looks horrible on x-rays and has been problematic for me since I first hurt it skiing in 1988, but for reasons unknown to any of the knee docs I've seen, it's generally behaving itself. It was the left knee that would swell mercilessly whenever I did anything that stressed the kneecap, was hurting me constantly, and was the reason I was seeking out help from knee docs.

In 2012, after I realized that rooster comb goop didn't work and that cortisone injections I was getting were having very little positive effect, I sought out different surgical opinions for my left knee. One knee surgeon told me I had no options. Another knee surgeon offered me a partial knee replacement (patello femoral and medial compartments) and told me I'd be back running in six months. I went back to the first knee surgeon and told him another knee surgeon had offered me a partial knee replacement. When he heard that, he offered me a tibial tubercle osteotomy. He told me it would require an incredibly long recovery, but that it might delay my need for a knee replacement. I did a lot of research and ultimately went for the osteotomy in July of 2013. He called it salvage surgery and told me I should never, EVER run again. Before my surgery, both swimming and cycling hurt a ton; walking on flat surfaces was okay, but any downhill incline was horribly painful, and forget about stairs, either up or down. I told him I wanted to be able to swim and bike hard (albeit on flats, not hills), and that I understood my running days were behind me. He said I'd be able to after I completely recovered.

I was religious about my recovery from the osteotomy, and I've been thrilled with the results. To be clear, I cannot swim hard anymore; kicking kills my knees, as does pushing off the wall with anything more than a very light touch. So, I'm slower on the swim, but I can still swim; I use a sort of modified pull. I cannot ride hills without paying for it for many days. For that reason, it's just easier to stick to flat and rolling terrain. But, I can still ride long, and I can still ride hard. I can walk long distances (though sometimes my right knee will get very upset when I do). I can even shuffle (no one who has ever run would call it running, but it is not walking; it's sort of a cross between a shuffle and a jog). I swear by my Hokas. I still compete (though many on this forum would call it participation and not competition; the point is, I still race, even though I'm a lot slower than I used to be; I just love competition too much to not do it).

So yeah, I found relief from a similar diagnosis. Are your running days over? I hate to say so, but yes, if we're talking about actual running, they probably are. Do you have to live a sedentary lifestyle? Hell no! I was miserable and in a lot of pain after a knee surgeon told me I had no other options. A friend set me straight and convinced me to seek out a second opinion. That led to several different consultations, which eventually led to an osteotomy, which eventually led to a LOT less knee pain. I think the key is that you can't go into a knee surgeon's office and say "I'm an ultra runner, my knee hurts, can you fix me?" You have to go into a knee surgeon's office and say, "I am an active person whose lifestyle is being significantly curtailed by my knee pain. I'm coming to you asking for a way to return to being active, without constant pain. Can you help me?"

Jen sorry to hear about your knee condition. I am going through something very similar and soon I will be having my 3rd arthroscopy on my left knee. I am 39 years old and was an elite, sponsored cyclist. I have a badly torn medial meniscus (radial root tear) and a leason on my weight bearing MFC. I also have very bad patella tracking, catching etc and very bad pain under my kneecap. PRP offers temporary relief but it isn't a long term solution, more so something to help improve my quality of life a bit. Hang in there

Tim

I had bad oa and got stem cell/prp injections at Emory in Atlanta and after giving chance for healing, about 9 mos., I am now running fairly well at age 67. Mine was degenerative not absolute bone on none, more like potholes, especially on medial side of knee. I coupled that with treatment experimentation using primarily the mobility wod website.

Hey Jen .... How about an update on this thread. Hows your recovery going?

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

Ugh.

Still having PF problems. I don't even know if my knee will bother me because I can't get active enough to find out.

Thanks for asking, I appreciate it.

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Jen

"In order to keep a true perspective on one's importance, everyone should have a dog that worships him and a cat that will ignore him." - Dereke Bruce

Just for giggles I did a search for "knee replacement" and my own thread popped up :-)

The latest:

For my PF:

I got shockwave treatment and holy cow, it worked! The treatment was incredibly painful but quick. I'm not really active yet but I have had little to no pain since getting treated.

For my knee:

I was so tired of not being able to walk comfortably and I'm getting fat because I can't be active at all. I went in to see my Dr in November and asked what we could do next. He said "OK, let's get in there and look around!" I had arthroscopic surgery on my knee on 12/22. The intention was clean-up. I had a general and was in and out the same afternoon. I remember him coming over to the bed when I was waking up in recovery. The keyword I remember is "shocked." Um. That's not what you want to hear from your surgeon. The next words were "full knee replacement." Crap.

At my follow-up he said he thought he was looking at the knee of someone 20 years older than me. Severe arthritis in 3 compartments so a partial isn't even worth it. He said there are 4 (or 5) areas where the bone is completely exposed. He gave me pictures. He used the word shocked again. I was far worse off than he anticipated.

Now I'm in the waiting game. He said it is up to me when I get it. So far my knee feels OK after the arthroscopy and I really don't want to be out of commission for the summer so I'll probably get it done in the Fall.

Yippee.

I asked if I'd be able to run again with a new knee and he said no. I'm pretty sure he's lying.

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Jen

"In order to keep a true perspective on one's importance, everyone should have a dog that worships him and a cat that will ignore him." - Dereke Bruce

Is your knee bone on bone on both medial and lateral sides? If it is on both sides HTO will not be an option. Around here in Boston not many ortho surgeons do them as it is a specific subset of people who qualify....athletes, to young to have knee replacement, and one sided cartilage loss.

I had a HTO and a TTO like others who have posted have had. Mine was not as successful as theirs. I did an IM the month before my big surgery in '11. Now I can't keep up with college tours and get dropped from the group. I did all the PT and worked hard then pain decreased but my knee hurts every day. Last summer my knee started locking up and I had a scope to see what's going on, grind down three bone spurs and take out my hardware so in the future when I need knee replacement I have less chance of infection. Despite removing a pinky top joint sized bone spur, my knee continues to lock 2-3x per week. It is frustrating not to know if on any given day I can walk. I bring crutches in the car with me at all times and another pair in the house. Going to see another ortho surgeon (I think #5 or 6) and trying PT yet again.

I'm on my 6th year of major knee issues. It's caused me to loss my sport that I love, gain weight and struggle with finding exercise that I can participate in a way I enjoy.

Good Luck!

Sure do, but much less than it was now that I don't participate in high impact activites that's one of the reasons I'm in the pool only permanently. I have spent enough time with surgeons in my life. My articular cartilage issues won't heal on their own and I'll still probably have to get that done, but I'm truly 90% less day to day pain now that I don't run. A lot of my knee pain was structural and bone on bone you can only get bucket handle tears shaved down so many times b/f there isn't anything left.

I will say one of the things I know that helped me was getting Rolfed for about a year b/c there were 'issues in the tissues' causing me pain as well. My hips down to the floor were a disaster and if you saw my flexibility b/f and after you'd not believe it. Honestly from mid thoracic down to the floor I'm the most flexible person I know over 40.