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Just left the orthopedic surgeon: I'm not rational, help me with my post-visit analysis
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First of all, about me. Fat guy, MOP, turning 40 in Feb. 5 years of triathlon experience. 5 70.3's but no 140.6.


I have always thought that 140.6 would be in my future someday, but probably a 1-and-done'er. I'm more than "just finish" category, but I'm not chasing KQ or anything like that at all. I race against myself.


My wife just did IMLou and after spectating her, I definitely felt the bug bite. I want to do this.


I got into this sport after knee reconstruction 5 years ago: ACL reconstruction, MCL repair, medial meniscus repair.


I just left my orthopedic dr. after having an MRI from my knee flaring up. I have consequential medial meniscus tear again. It can be repaired/trimmed with a scope. I also have some surface meniscus damage and arthritis in that knee.


When I ask the doctor: "after surgery when can I start running long distance again?" he explained that running is never going to be good for this patched together knee. That long term, I will continue to see damage. He did not say that I can't run, but rather explained (quite reasonably) that I need to weigh my love for running against the long term consequences. (What I am also thinking is: what are the long term ramifications of not running to the rest of my body? I'm already a big guy and I do love the sport of triathlon. Even though I'm not very good at it, I enjoy the lifestyle of training for events and putting forth my best effort.


My question is this: how realistic is it to have this surgery, recover and begin running again with a target of competing in my one and only 140.6 at the end of 2017. At that point, shut down the running significantly and only do short distances.


Part of my thinking is that if I wait 2-3 years, is my body ever going to be "more" ready than it is today (? My meniscus/cartilage is not going to grow back. It's only going to deteriorate more ove time.


I know of several people that did their first IM on long runs that didn't exceed 14-15 miles. It seems that if upped my bike training and baby'd the running....maybe I could manage it with some grace?


Or, am I just being an idiot and just need to forget about running altogether?
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Re: Just left the orthopedic surgeon: I'm not rational, help me with my post-visit analysis [dprocket] [ In reply to ]
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My .02 worth: Meniscus removal vs repair is an easier and faster recovery-I have had 3 knee surgeries all meniscus based, repairs and removals. My last one was 3 yrs ago, I went into surgery in good shape minus the banged up stump, and was cleared to play full check hockey 2 weeks later. I was late 40's at the time, biggest game changer for me was running in Hoka's...good luck.

Pots
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Re: Just left the orthopedic surgeon: I'm not rational, help me with my post-visit analysis [pots4] [ In reply to ]
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Become a good swimmer and biker and you can walk the whole run easily.
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Re: Just left the orthopedic surgeon: I'm not rational, help me with my post-visit analysis [dprocket] [ In reply to ]
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Switch to bike racing, it is more fun anyway.

If you really want to do a 140.6 then you just need to decide how much of the knee you are willing to give up for the time you want to race. I am a one and done-er when it comes to IM, I bike race now. Running has never agreed with me and I like the bike. When training for the IM I tore my right calf, I gave it time off, babied it back in, did all the treatments, but it still always bothered me and the more I ran the worse it got. So I said screw it and trained swim and bike and kept my runs short and easy.

Of course my run/walk was slow, but I finished the day and met my goal time (which was not particularly ambitious).

If you are okay with a 14-15 hour IM then don't worry about training the run, do the IM and quit running. If a fast time is a big deal to you then you need to decide how much damage it is worth. Personally I wouldn't accept the long term damage in exchange for a faster time, I'd get the race done as best I could and then stick to just swimming and cycling. I plan to still be cycling when I am an old dude, so not willing to damage things now.
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Re: Just left the orthopedic surgeon: I'm not rational, help me with my post-visit analysis [aarondb4] [ In reply to ]
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if you're really dedicated, do your knee a favor and get down to <15% body fat.
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Re: Just left the orthopedic surgeon: I'm not rational, help me with my post-visit analysis [dprocket] [ In reply to ]
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Well i had a miniscus repair ten years ago and do ultra's. Have tear in other knee and possible small tendon tear. Have to ice after long runs. Did two 50ks, one 100 mile this year in mountains.
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Re: Just left the orthopedic surgeon: I'm not rational, help me with my post-visit analysis [dprocket] [ In reply to ]
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When you say "fat", how much do you weigh? Height? Body fat %? Losing weight could be the best thing for your knee if you are significantly overweight. Think of 5 lbs overweight like your knees have to carry around a bag of potatoes during your run. Lose a few bags of potatoes and your knees will feel a difference.
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Re: Just left the orthopedic surgeon: I'm not rational, help me with my post-visit analysis [treyedr] [ In reply to ]
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treyedr wrote:
When you say "fat", how much do you weigh? Height? Body fat %? Losing weight could be the best thing for your knee if you are significantly overweight. Think of 5 lbs overweight like your knees have to carry around a bag of potatoes during your run. Lose a few bags of potatoes and your knees will feel a difference.

Yep. Definitely true. I am 6' 190#. I agree that dropping quite a bit of weight is a requisite for pursuing it further. I've always been heavier and my thought was to spend the off season (pre surgery when I can't run anyway) focused on dropping weight. That will be even harder since I can't run. That is the hardest thing for me and that will test my resolve. I'm one of those guys that has to have eating on-point plus burn alot of calories (versus some buddies that eat whatever they want and stay lean).
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Re: Just left the orthopedic surgeon: I'm not rational, help me with my post-visit analysis [dprocket] [ In reply to ]
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Yes, definitely weight loss will be your friend to your knees, no doubt about. And your going to feel so much better running at a lighter weight. Losing weight has a huge diet component (80% diet, 20% exercise). Yes, as in less calories. What you eat is just as important. Stay off the processed foods and carbs. Good luck.

Now's the time to embrace long hard swims and bikes. You can lose plenty of weight just doing these. Get some serious intensity into those trainer rides. Not just lollygagging. The Sufferfest lives up to its name. Running, get thee on dirt if possible and do as much running on dirt and stay off the pavement. You can do this, just be smart about taking care of your knee.
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Re: Just left the orthopedic surgeon: I'm not rational, help me with my post-visit analysis [sto] [ In reply to ]
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I had ~1/2 the meniscus in my right knee removed in 1998. I was 22 & was having my ACL redone. The doctor (who was great) advised me to not run again as I would have a high risk of arthritis.

So I spent the next 10-12 years falling in love with racing my bike. When I started to think about running again, I think I had strengthened my quads significantly.

I don't pretend to be a super fast runner now but my 5k times are nearly as close to what they were in high school, & I finished my first Ironman this past summer with several weeks of 50 mile plus training. No knee issues whatsoever!

I thought 18 yrs ago I would never be able to do an ironman. 40 is still young, take a few years to strengthen the muscles that support the joint & then revisit running. Tackle it slowly, & smartly & you can certainly do it!
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Re: Just left the orthopedic surgeon: I'm not rational, help me with my post-visit analysis [dprocket] [ In reply to ]
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dprocket, I hear you - I'm 50, about a stone overweight, had a knee reco in 2005, also before that (because of same injury) had some meniscus removed.

Just to beat myself up a little bit, I went through some old results this week - I did a 2:30 Oly dist in '91, a 4:58 half and then a 12:59 IM in '95. A long time ago, much slower now.

Anyway, I'm rabbiting on. But I'm telling you all this because I still run and I still dream of being faster.

A few observations:

* As has been noted already several times on this thread, get your s..t together in regards to nutrition. There will be one or two really bad habits that you can start changing right now, guaranteed (a colleague dropped a serious lump of weight, over a couple of months, simply by cutting out all soft drinks. Full stop. Coke, diet stuff, didn't matter - gone. My huge downfall is night eating)
* One thing I don't think has been mentioned is you need to find a good physio. By that, preferably someone who specialises in sports. If the physio knows all about running/tris, even better. When you start seeing this physio, he/she will probably give you some exercises. Do them. Religiously (but you've had a reco, so you probably already know this)
* Patience, patience, patience (but you've had a reco, so you probably already know this).
* Maximise your strengths, work on your weaknesses - so ramp up the swimming and biking. If you have a gym membership, spin classes are awesome for burning off lard. Be Elmer Fudd (ie verrrrrrrrrrrrry careful) about your running - for me, it's only three times a week, and soft surfaces (treadmill, gravel tracks) whenever possible.

Good luck. Go get 'em.

"Find a way, not an excuse". Goony, Kona, 2009
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Re: Just left the orthopedic surgeon: I'm not rational, help me with my post-visit analysis [dprocket] [ In reply to ]
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dprocket wrote:
First of all, about me. Fat guy, MOP, turning 40 in Feb. 5 years of triathlon experience. 5 70.3's but no 140.6.


I have always thought that 140.6 would be in my future someday, but probably a 1-and-done'er. I'm more than "just finish" category, but I'm not chasing KQ or anything like that at all. I race against myself.


My wife just did IMLou and after spectating her, I definitely felt the bug bite. I want to do this.


I got into this sport after knee reconstruction 5 years ago: ACL reconstruction, MCL repair, medial meniscus repair.


I just left my orthopedic dr. after having an MRI from my knee flaring up. I have consequential medial meniscus tear again. It can be repaired/trimmed with a scope. I also have some surface meniscus damage and arthritis in that knee.


When I ask the doctor: "after surgery when can I start running long distance again?" he explained that running is never going to be good for this patched together knee. That long term, I will continue to see damage. He did not say that I can't run, but rather explained (quite reasonably) that I need to weigh my love for running against the long term consequences. (What I am also thinking is: what are the long term ramifications of not running to the rest of my body? I'm already a big guy and I do love the sport of triathlon. Even though I'm not very good at it, I enjoy the lifestyle of training for events and putting forth my best effort.


My question is this: how realistic is it to have this surgery, recover and begin running again with a target of competing in my one and only 140.6 at the end of 2017. At that point, shut down the running significantly and only do short distances.


Part of my thinking is that if I wait 2-3 years, is my body ever going to be "more" ready than it is today (? My meniscus/cartilage is not going to grow back. It's only going to deteriorate more ove time.


I know of several people that did their first IM on long runs that didn't exceed 14-15 miles. It seems that if upped my bike training and baby'd the running....maybe I could manage it with some grace?


Or, am I just being an idiot and just need to forget about running altogether?

you're not done. you've just been doing it wrong. i've worked with countless patients over the years who thought they were done running. or felt they were near the end of their days. i'm about to wrap up treatment with a mid to late 40's female who still puts down 50-60 miles a week while injured and was clipping off sub 3 marathons just as short as 5 years ago.

you'll be surprised what simple adjustments can do for you.

for starters, fix that diet and drop the weight. there is no reason you can't be 40 years old and 10% body fat. work on strength, build up the milage slowly.

look, if you keep course, you're going to need a knee replacement eventually. the worst case scenario is you need it by 50 if you gun for the 140.6. the best case scenario is that you learn to care for your body better and go the rest of your life without knee issues.

i remember when i was 22 and my ortho told me i was never going to run again and needed surgery. i opted not to, finished school, took care of my knee insanely well and have since run dozens of marathons and a half dozen ironman.

john
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Re: Just left the orthopedic surgeon: I'm not rational, help me with my post-visit analysis [dprocket] [ In reply to ]
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You might think about a 2nd opinion, see if it's a consensus or just this docs opinion.
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Re: Just left the orthopedic surgeon: I'm not rational, help me with my post-visit analysis [dprocket] [ In reply to ]
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This stuff is nuts. Once you reach the age of 30 at least half of people have meniscus tears. There is also plenty of research to show that physical therapy and partial menisectomies have the same outcomes after 1 year. Knee pain comes and goes and running can make it worse if you have pain. However, it is entirely possible that you can run pain free without making yourself worse. Degeneration is normal, degeneration doesn't equal pain. Find a PT (stop flexing your knee to end range), manage your condition and continue to compete.
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Re: Just left the orthopedic surgeon: I'm not rational, help me with my post-visit analysis [Calvinbal6] [ In reply to ]
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+1.
Disclaimer: I am in the medical field.
I am on the other side of 50, I have meniscus tears in both knees. Since my 30s and 40s (soccer, volleyball).
OK, deep squats and fancy lateral movements (soccer, hoops, hockey) are out...so what?

I can walk, dance, run, ride, potty-squat without pain and issues and my knees behave if I pay them their respect.....

No way any knife comes near my menisci until the tears are so bad that they result in irreconcilable daily pain.
They are there for a VERY good reason, and there is no alternative as good as the originals.

YMMV.

Calvinbal6 wrote:
This stuff is nuts. Once you reach the age of 30 at least half of people have meniscus tears. There is also plenty of research to show that physical therapy and partial menisectomies have the same outcomes after 1 year. Knee pain comes and goes and running can make it worse if you have pain. However, it is entirely possible that you can run pain free without making yourself worse. Degeneration is normal, degeneration doesn't equal pain. Find a PT (stop flexing your knee to end range), manage your condition and continue to compete.
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david [ In reply to ]
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windschatten wrote:
+1.
Disclaimer: I am in the medical field.
I am on the other side of 50, I have meniscus tears in both knees. Since my 30s and 40s (soccer, volleyball).
OK, deep squats and fancy lateral movements (soccer, hoops, hockey) are out...so what?

I can walk, dance, run, ride, potty-squat without pain and issues and my knees behave if I pay them their respect.....

No way any knife comes near my menisci until the tears are so bad that they result in irreconcilable daily pain.
They are there for a VERY good reason, and there is no alternative as good as the originals.

YMMV.

Calvinbal6 wrote:
This stuff is nuts. Once you reach the age of 30 at least half of people have meniscus tears. There is also plenty of research to show that physical therapy and partial menisectomies have the same outcomes after 1 year. Knee pain comes and goes and running can make it worse if you have pain. However, it is entirely possible that you can run pain free without making yourself worse. Degeneration is normal, degeneration doesn't equal pain. Find a PT (stop flexing your knee to end range), manage your condition and continue to compete.


Original post may not have been clear. This is not 'normal wear and tear' meniscus damage. I have that in the other knee. The current medial meniscus is reinjured from the original trauma of the first knee injury. When the ACL was rebuilt and the Mcl was repaired, the medial meniscus was also patched up.

In Reply To:
Doc says that the same tear that was repaired is reinjured. If I could run right now without pain, I would be. This is an injury that has abruptly me from stopped running for the time being.
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Re: david [dprocket] [ In reply to ]
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Is this a regular ortho or one who is a sports Med based ortho? The ones who have worked with athletes can have a pretty different view on how to treat and what to do. The ortho I have in Colorado who did my knee and elbow did his fellowship in California and worked with the Kings, Dodgers etc. There wasn't even a thought about not being able to do the same things I had been, it was all about getting me back to 100 percent.

On the flip side you need to take care of yourself too. Not because you may need surgery later, since quite frankly anyone may need something fixed in the future. But because coming out of surgery when in shape is explnentionally easier to recover from. If you're willing to have someone do surgery on you just to do an event, dropping weight and getting in better shape shouldn't be a second thought.
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Re: Just left the orthopedic surgeon: I'm not rational, help me with my post-visit analysis [dprocket] [ In reply to ]
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Look at your knee this way. You all ready have arthritis in the injured knee. We have no viable way at this time of regrowing cartilage (stem cell therapy has not yet come to fruition). You are 40. You will most likely live to at least 85. Destroy your knee now. Get a knee replacement. A knee replacement will not last 45 years. Talk to a ortho joint guy about having to do a redo knee replacement. Understand how challenging and difficult these are.

Come to the most reasonable conclusion. Bike and swim.

Sure you will find anecdotes about how people have been able to run ultramarathons with degenerated knees just like you will find people that talk about how they were a 3 pack a day smoker and never got sick so smoking is "safe".

Understand that by undergoing the injury that you had i.e. having a acl repair, mcl repair, and medial meniscal repair. You probably had a pretty good mechanical injury to the articular surface of your knee. People don't quite understand that meniscal repairs are varible depending on degree, location, etc. So one meniscal tear is not the same as another. If an orthopod is telling you to stay away from running...i'd take that seriously. A bunch of yahoos on the internet without having seen your imaging studies really don't know what they are talking about in terms of your prognosis ( me included since I'm not privy to that info).

However, given the fact that you are young and have a lot of years ahead of you...why would you risk chronic pain for a short term result? Risk benefit just doesn't seem worth it.

Another way of looking at this is this. If your orthopod is wrong and you could run long distance with your knee: what have you lost? The ability to do a 140.3. But you still have a good functional knee.

If those telling you that you can run on the knee are wrong: what have you lost? You now have a long term degenerated knee that will give you chronic pain..limit mobility...necessitating knee replacement that likely won't last your entire lifespan. Necessitating another knee replacement which is not an easy surgery...that often does not lead to a satisfactory result.
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Re: Just left the orthopedic surgeon: I'm not rational, help me with my post-visit analysis [aarondb4] [ In reply to ]
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aarondb4 wrote:

Switch to bike racing, it is more fun anyway.

This was my first though reading the OP's post. Plus for the cost of 1 IM entry you can race a full season of road or mountain. Road racing is some great fun and is really easy except when it is hard, and when it is hard it is taste blood and suffer like none other hard. Mountain biking is a time trial with a mass start and the marathon races can be a ton of fun and it is only as hard as you are willing to make it, not like road racing where if you get dropped you may as well call it a day.

I just had ACL, LCL and popliteus reconstructed, luckily the MCL was only sprained and the meniscus is in good shape, but I don't know how much running is in my future, almost made it to 30 before having a knee problem...

Pactimo brand ambassador, ask me about promo codes
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Re: david [Grant.Reuter] [ In reply to ]
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Grant.Reuter wrote:
Is this a regular ortho or one who is a sports Med based ortho?

This ortho happens to be the trainer/Ortho for an NFL team that plays in the AFC West.

Grant.Reuter wrote:
If you're willing to have someone do surgery on you just to do an event, dropping weight and getting in better shape shouldn't be a second thought.

Agreed. This is a pre-requisite that I would set for myself as a condition for signing up...which would also have to come after a successful surgery.
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Re: Just left the orthopedic surgeon: I'm not rational, help me with my post-visit analysis [gasman] [ In reply to ]
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I get your advice, I really do. However, most of us over fifty have found out this basic fact from most Doc's, they tell you not to run. They have no idea of the average runner and give the same advice that they do to most of the sedentary clientele they have.
Yes, not smart to base decisions based on internet responses. Over the past twenty years every time I have seen a Doc I was told to bike not run. I went in once knowing I may have a stress fracture, the advice given was do NO exercise for 6 months. If pain not gone then he would do a bone scan. . Another time a young Doc told me " at your age running is bad for you, just bike, you will thank me later" So, again, I get your advice, but for him at best needs to find a sport Doc who knows what he is doing before he quits something he enjoys......my 2 cents
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Re: Just left the orthopedic surgeon: I'm not rational, help me with my post-visit analysis [dprocket] [ In reply to ]
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I had an ACL/MCL repair (middle third patellar tendon graft) in 1992, many IM's and lots of other races since, I had another surgery on the same knee in Feb. this year at age 60. I had meniscus removal in a couple parts of the joint as well as cartilage "clean up" and smoothing. FWIW, I did not run for 7 months post op. Was biking and swimming though. Resumed very light soft surface runs in Hokas following a disciplined run/walk routine beginning in Sep. Now two months later, so far so good. But, I'm very conservative and am going to take it slow. My PT (and Doc) both said, if I have no pain and no major swelling, then to continue with this routine. I bike and swim unlimited BTW. I think pain and swelling ought to be your indicator. Oddly enough, I actually feel better after these little outings. I think it may be simply due to joint movement and blood flow, but I ice religiously. I do NOT want a knee replacement, and I often ask myself if this is accelerating me towards that possibility. Don't know, and I hope not. Good luck, but pay attention to what your body tells you. BTW, I am unusually sensitive to weather changes, my knee will swell when low pressure systems approach, or if I am sedentary too long. Like driving in a car or flying on a plane.
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Re: david [dprocket] [ In reply to ]
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dprocket wrote:
Grant.Reuter wrote:
Is this a regular ortho or one who is a sports Med based ortho?

This ortho happens to be the trainer/Ortho for an NFL team that plays in the AFC West.

Grant.Reuter wrote:
If you're willing to have someone do surgery on you just to do an event, dropping weight and getting in better shape shouldn't be a second thought.

Agreed. This is a pre-requisite that I would set for myself as a condition for signing up...which would also have to come after a successful surgery.

Just peaked at your profile. One of your doc's partners put my knee back together in 2003. ACL, MCL, meniscus repair and some bone damage. I'm fortunate in that I have virtually no issues with the repaired knee to this point, (45 yo), and have run everything from 5k--50M and 140.6 since the surgery. Those guys are a quality group. My wife is in the medical community here and would even consider having anyone else look after me.
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Re: Just left the orthopedic surgeon: I'm not rational, help me with my post-visit analysis [dprocket] [ In reply to ]
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As a bit of back ground. I'm an orthopaedic surgeon who specializes in sports medicine knee (no other joints). I've been in practice 30 years and have done over 5000 ACL reconstructions. I have had both my ACL's reconstructed, left in '96 and right in '99. I have some osteoarthritis in both my knees. I just did Kona, albeit with a bad cold.
First thing first, the most important thing to make a diagnosis of your knee problem is a good history and a thorough physical examination by an experienced surgeon. The MRI is helpful only if the findings are 100% consistent with the clinical presentation. So having said that, where is your pain?, what is it like?, what makes the pain worst (i.e. squatting, stairs, twisting, running etc)? How bad is the pain at it's worst on a scale of 1 to 10 where 10 is the worst pain you can imagine. How bad is the pain on a daily basis. Any locking, giving way of your knee? Any new noises; clicking, cracking or grinding?
What do you standing X-rays show? (they have to be standing and are more important than the MRI in most cases).
I need all that information to give you an educated response but I can say in the interim that the best thing you can do to start with is to lose 10 pounds like many of the other posters have said. Many studies show huge improvements in symptoms with a simple 10 pound weight loss. I can also affirm this as a runner myself with two bad knees. My other thought is that if you want to do an IM you should avoid surgery if at all possible and entertain biological options like HA or PRP.
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