Ok not a doctor (student physical therapist assistant) But we just covered this in orthopedic management

The problem is the Arthritis. If it was just the meniscus you would probably be a good candidate for a meniscus replacement. (due to your age and activity level) When there is arthritis present it is generally a waiting game until you need a total knee arthroplasty (when this is the case look into oxford knee replacements... some runners have reported the ability to return to running even though it is contraindicated)

There is a clinic in San Francisco that does do meniscus replacements and has a help line to determine candidacy.
http://www.stoneclinic.com/meniscuslinkspage



Good Luck

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Sabrina

Missing your meniscus is one thing. Missing articular cartilage is also one thing. But when you put the two defects together, you've got more than the sum of its (missing) parts. Are you missing both your lateral and medial meniscii? How big are your articular cartilage defects? Small and localized? Or diffuse and full-compartment?

If your AC defects are still small and fairly localized, you could look into a microfracture (first line of treatment) or ACI or OATS (Autologous Chondrocyte Implantation or Osteoarticular Transplants...both typically used later on) coupled with a meniscal transplant. Both of which may POSSIBLY allow a return to running in limited amounts (how much depends on you, your doc, and the shape of your knee).

If your AC defects are too large (or your alignment is really bad), there's really not much they will do for you as far as repairing the cartiliage. Your next step would be an osteotomy (distal femoral or high tibial, depending on which side of the joint is problematic). Femoral osteotomies are rare in adults, so there really isn't much research on them out there if you are looking to read up on the procedure. Tibial are more common. But neither will allow you to run, really. Both are preferable to an arthoplasty, however, and in a young patient, docs would probably look to that before a replacement. They are, however, major surgery with a long recovery time as they involve breaking the bone, and inserting metal screws and plates in to hold stuff in place for up to a year to allow the bones to heal.

The final option is arthoplasty, or joint replacement. But most orthopods will steer you clear of that when you are young and active.

You should definitely see an orthopedic surgeon and get an mri or mr-arthrgoram to determine the extent of the damage (or an investigative scope), esp. if you are missing your meniscus and have AC wear and tear already. There's a fine line between when the first set of procedures (MF and ACI/OATS with a transplant) are viable options and when the damage gets too extensive. And it's a line that can be crossed quickly--even if you are regularly monitoring your condition.

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mmm-mmm-Momo Charms
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I was 32 when I had meniscus surgery. Never recovered right. A year later went to a real specialist, had surgery to find out I had no meniscus left, and no articular cartilage. Dr. said he did the highest success rate surgery for the problem (microfracture) and that he and his team had developed another procedure that they could do on me if it didn't pan out. I'm doing my first IM this week, but I do have pain and I cannot run as fast or as much as I used to. Advil works, but I do not like using it unless it is absolutely necessary. I didn't want to push the issue for other options yet because many professional athletes had still remained successful with this procedure. Some days its great, others, not. I do want to say that it is the arthritis in my knee that causes a lot of my pain. Sucks being 34 and knowing what I could be doing. But at least I found a Dr. that understood my desire within reason because of my age. Its okay, but in 10 years I'll be looking for something else to be done for sure and hopefully there will be better options than the ones listed here because they are about 25% success rate procedures (carticel procedures and the like) with over a year of recovery time (like no weight bearing and a machine that you must use to keep your range of motion). I can't stomach that right now with work, 2 kids (one on the way) and coaching. So when the dust settles, I'll investigate more. The important thing was finding a specialist who empathizes, not discourages unless your knee is a complete wreck, but they still will find a way. Cohen and Orlin and Associates are who I went to on Long Island in NY. Good luck.

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The Rat Snake:
A Tribute Race at Gilbert Lake State Park, Laurens, NY May 16 2015
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Get other opinions. They may be the same, but do it anyway. Meniscus can generally be dealt with but as said if you truly have articular degeneration now I'd be careful running now, because it is a waiting game.

So what is keeping you from running/triathlons?

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Ride Scoozy Electric Bicycles
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Sounds like I have the same problem. My surgeon told me no more running. Went for a second opinion. This Dr. did say I had oesteoarthritis. She prescribed me celebrex and sent me to a therapist who fitted me with an osteoarthritis knee brace. Works wonderful. Did IM USA and Florida last year . Not running as fast as I did before, but, hey, I'm there. And I'll be there in Placid again, next week. Check out www.ossur.com for the oesteoarthritis knee brace. Look for the unloader one. It fits most of your leg. It does the job for me. Hope this helps out. If you're in Placid, look for the little stocky old fart with a knee brace on the left knee.

Good luck..

the brace looks nice indeed, sorry to ask but the bone to bone reaction when all of the meniscus plus the cartillage are all gone equates to pain even when walking or only when you running? tore up my knee back in `88 and only pain i get from time to time is when i bend too much or when i ramp up my mileage to fast

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"Pain is NOT temporary,you remember every bit of it"

No surgery? Celebrex forever? Brace looks cool, does it leave sores or anything? Comfortable for 26 huh? How much if you don't mind me asking? Thanks and good luck, maybe I will see you this weekend, I'll be there for my first. (hopefully not last!)

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The Rat Snake:
A Tribute Race at Gilbert Lake State Park, Laurens, NY May 16 2015
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I also have an unloader brace--it basically does the work of an osteotomy, without the surgical procedure. Many of them can be custom made to your leg, AND you get to pick out the color (and they are carbon, for all you weight weinies :p). I don't have an ossur, I have a Twonsend Custom.

Honestly, although they are designed to be worn during sports...I don't wear mine for tri stuff (although I do for hiking, backpacking, and post race stuff). Because of my alignment, I hit one leg on the other and the brace gets in the way in running. And really, it isn't UNDOING anything, it merely helps with the pain...wearing it while running isn't necessary for me if you can stand the pain.

My brace was about $2100 or so, I think...insurance covered about 85%.

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mmm-mmm-Momo Charms
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Can't speak for the OP, but for me, my left knee is nocticeably larger than my right due to swelling even at rest. Activity makes it worse. And yes, mine hurts all the time.

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mmm-mmm-Momo Charms
Handmade beverage charms, jewelry, and miscellanea
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In reply to dforbes: I had surgery about 3 yrs ago. They scraped the meniscus and I guess with wear and tear, that's why I'm bone on bone. Surgeon said the only thing he could do was to replace the knee. Not for me, yet.... I've been on celebrex ever since and my physician checks me out every once in a while. Where the straps comes in contact with the skin, I simply put some body glide so that it doesn't leave any sores. It's not the most comfortable thing to have but, if I want to keep running, it does the job. I simply nhave to re-adjust the straps once in a while during the race.
It cost me around the $1400.00 cnd.
I'm not advertising for this company, I'm simply glad I found a fix for now. These are only my opinions.

I had my MRI today to confirm a torn lateral meniscus and cyst. I had my other knee scoped 7 or so years ago.

I've never heard anything about articular degeneration, is that something I should ask my doctor about? Or will they say OH MAN, are you screwed?

The xrays of the knee seemed to show good spacing between the bones.

Just ask if the surrounding AC looks healthy and normal. If it isn't, they'll mention it in the report.

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

That's amazing you can handle the bone on bone. Mine was totally that to the point I could feel it scrape when I bent it, but there was no way I could run on it. There was a half dollar size legion where there was supposed to be articular cartilage. Glad you can do it without invasive procedures. Good luck.

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The Rat Snake:
A Tribute Race at Gilbert Lake State Park, Laurens, NY May 16 2015
Follow the Rat Snake on Twitter

Can't speak for the OP, but for me, my left knee is nocticeably larger than my right due to swelling even at rest. Activity makes it worse. And yes, mine hurts all the time.

Yikes, luckily no symptoms like that just yet on my 21 yr old injury, hopefully that the injury healed itself but they say tears in this part of the knee will not really heal on its own.

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"Pain is NOT temporary,you remember every bit of it"