I’ve posted before about my knee. 6 years ago I have major ACL/MCL reconstruction along with radial meniscectomy and medial meniscus repair. In October, the medial meniscus tore again. Not sure if it never healed completely, or if it’s because of the run volume I’ve put on in the last 6 years (I started triathlon after knee surgery and had no background whatsoever). I’ve completed multiple 70.3’s, half marathons and 30-35 Olympic and sprints.
Yesterday, I had another partial meniscectomy on the medial meniscus as well as some “clean up work”. Follow up visit to doc is in a week.
Doc suggest finding a new sport that does not involve running (or so much running). He’s a sports guy, so he’s not a dummy in this area. However, my plan all along was to do a 140.6 at least once. 2017 is my window and, provided I get doc approval, I intend to train for a fall 140.6 (Moo, Choo or Lou probably).
I plan to use the Trainer Road Full Distance Plan. I am FOBOP to MOP athlete. Run is already my weakness. I’m wondering what approach some of you would recommend to baby this knee so I can achieve my goal of completing my 1-and-done 140.6. Presumably, after this race, I’ll move to shorter distances and possibly bike racing and reduce my run load.
The TR plan generally prescribes 3 runs per week: a long base run, a specialty run (such as hills) and a base+strides type of workout.
Would you stick to these plans or reduce the running? Shorten some runs? Other?
My goal is to finish to the best of my ability and to preserve knee as much as I can.
I’ve posted before about my knee. 6 years ago I have major ACL/MCL reconstruction along with radial meniscectomy and medial meniscus repair. In October, the medial meniscus tore again. Not sure if it never healed completely, or if it’s because of the run volume I’ve put on in the last 6 years (I started triathlon after knee surgery and had no background whatsoever). I’ve completed multiple 70.3’s, half marathons and 30-35 Olympic and sprints.
Yesterday, I had another partial meniscectomy on the medial meniscus as well as some “clean up work”. Follow up visit to doc is in a week.
Doc suggest finding a new sport that does not involve running (or so much running). He’s a sports guy, so he’s not a dummy in this area. However, my plan all along was to do a 140.6 at least once. 2017 is my window and, provided I get doc approval, I intend to train for a fall 140.6 (Moo, Choo or Lou probably).
I plan to use the Trainer Road Full Distance Plan. I am FOBOP to MOP athlete. Run is already my weakness. I’m wondering what approach some of you would recommend to baby this knee so I can achieve my goal of completing my 1-and-done 140.6. Presumably, after this race, I’ll move to shorter distances and possibly bike racing and reduce my run load.
The TR plan generally prescribes 3 runs per week: a long base run, a specialty run (such as hills) and a base+strides type of workout.
Would you stick to these plans or reduce the running? Shorten some runs? Other?
My goal is to finish to the best of my ability and to preserve knee as much as I can.
or maybe just follow your doc’s advice and accept that your body does not want to do what your brain wants. find something else that is low-impact. or, as jimatbeyond suggested, reduce your ambition to (power) walking.
Although I understand the desire to be obsessive about your training plan the day after your knee surgery (I would be the same way), I would be patient and see how your rehab goes before planning any major events. I dislocated my kneecap and tore my MPFL a couple winters ago, I had surgery in May and did one sprint that I was not well prepared (particularly the run) for in September of that year.
My question is, how do you incorporate that into a plan? On run days just walk/power walk?
Pre-surg, I was walking daily and was walking about 13:00 min miles. Pretty brisk walking. I don’t know that is actually less impact on the knee. In order to finish an IM, I would need to run at least some of it. But I’m prepared to do alot of walking and know that I’ll never be able to run a long race again, at what I was once capable of.
Until I talk to doc again, I don’t know that the recent medial repair was caused by load or because of failure of the previous repair, or both. The initial injury was a nasty football injury.
My question is, how do you incorporate that into a plan? On run days just walk/power walk?
Pre-surg, I was walking daily and was walking about 13:00 min miles. Pretty brisk walking. I don’t know that is actually less impact on the knee. In order to finish an IM, I would need to run at least some of it. But I’m prepared to do alot of walking and know that I’ll never be able to run a long race again, at what I was once capable of.
maybe consider aqua jogging as part of your training plan to reduce the stress on your knee. About 5 weeks out from a HIM I had a slight groin injury and running would aggravate it so to keep at least somewhat still running I replaced my run workouts with aqua jogging. Not great but it worked well enough and might help you.
Alright, I’m not a doctor but I work for one(ortho surgeon) and do orthopedic device design as my daily grind. Take what I say with a grain of salt, as it is a mixture of both anecdotal knowledge from the industry and stuff I’ve asked my boss over the years.
Without knowing where your tear was, it’s hard to say if it re-tore, or the doc missed a little bit of frayed tissue during the procedure and it snagged again. It’s common to miss some torn material with deep posterior tears, especially on younger and more athletic patients. Disregard this if it was a bucket handle tear that was sutured.
There have been tons of advancements with knee replacements. In your situation, if your lateral compartment is mostly fine, then your should be a good candidate for a UKA (Unicompartmental Knee Arthroplasty). This is sometimes a better approach than trying to keep saving the medial meniscus. Properly implanted UNIs commonly have a 91% success rate at 15 years out. Some evidence shows them lasting even longer under the right circumstances. This would allow you keep running, albeit with a decreased training load. Your current capacity might be off the table, but running should still be fine. This is according to the doc I work for, and was said off record at a lunch meeting because I’ve already asked him about options to continue running once my right knee finally gets bad.
After about 20 years, you can move over to a CR (cruciate retaining) knee implant system. This would likely give you another 20+ years, depending on the surgeon who implanted it and your own pathology. I’ve also been told you can run on these, but probably not the same training load as a guy in his late 20’s with good knees.
To close, this is the basic plan that I’ll be following once it’s time. I fully intend to be in my mid to late 70’s and still doing triathlon, so this is my long game : )
What I would do is find a PT who knows running mechanics very well. And by “well” I mean
A) Very thorough orthopedic exam of the whole chain (foot, ankle, knee, hip, spine). Including a shoe assessment for your mechanics.
B) Detailed video analysis that can slow the mechanics down
C) Put A and B together and guide you from there.
Running store analysis won’t be adequate enough, they aren’t medical professionals (unless the one doing the run analysis at the running store is a licensed medical professional who knows runners. Run coach would be a possible step AFTER you’ve had the above completed but “Run Coach” is a broad topic.
Even if your initial knee injury was an old football injury, you’d want to find out if you are excessively loading the medial knee as you return to running. I would say you can get back to IM level running…but there is right way and wrong way to do it.
What I would do is find a PT who knows running mechanics very well. And by “well” I mean
A) Very thorough orthopedic exam of the whole chain (foot, ankle, knee, hip, spine). Including a shoe assessment for your mechanics.
B) Detailed video analysis that can slow the mechanics down
C) Put A and B together and guide you from there.
Running store analysis won’t be adequate enough, they aren’t medical professionals (unless the one doing the run analysis at the running store is a licensed medical professional who knows runners. Run coach would be a possible step AFTER you’ve had the above completed but “Run Coach” is a broad topic.
Even if your initial knee injury was an old football injury, you’d want to find out if you are excessively loading the medial knee as you return to running. I would say you can get back to IM level running…but there is right way and wrong way to do it.
I’m tracking what you’re saying. I’m a bit hesitant because I don’t know exactly what qualifications to look for. It seems there are a lot of “running coaches” that turn out to be chiropractors. I don’t know if they know their stuff or not. Perhaps my Ortho surgeon (who is also the surgeon for an NFL team) would be able to offer a referral? I guess I’m not sure where to guy to find my go-to person. I don’t want to waste time and money on someone who’s not good at this.
My question is, how do you incorporate that into a plan? On run days just walk/power walk?
Pre-surg, I was walking daily and was walking about 13:00 min miles. Pretty brisk walking. I don’t know that is actually less impact on the knee. In order to finish an IM, I would need to run at least some of it. But I’m prepared to do alot of walking and know that I’ll never be able to run a long race again, at what I was once capable of.
even if you power walk at a 13:00 pace, you can finish at the bike cutoff and still finish easily. why would you need to run some of it ?
My question is, how do you incorporate that into a plan? On run days just walk/power walk?
Pre-surg, I was walking daily and was walking about 13:00 min miles. Pretty brisk walking. I don’t know that is actually less impact on the knee. In order to finish an IM, I would need to run at least some of it. But I’m prepared to do alot of walking and know that I’ll never be able to run a long race again, at what I was once capable of.
even if you power walk at a 13:00 pace, you can finish at the bike cutoff and still finish easily. why would you need to run some of it ?
Yeah for perspective, 13m/mi = 5:40 marathon. That still leaves you room for a 2 hour swim and 8 hour bike. Given your race history I’d guess you are way faster than that.
Maybe it’s best to sit down with your doc to fully understand the degree of articular cartilage disease you have. He/she will also be able to tell you about how much of the medial meniscus remains, and importantly, how stable your knee is under anesthesia. In other words, from an ACL reconstruction perspective, how is the stability of this knee compared to the non-operative side? This would be important as you and the doc try to predict the long and short term future.
There’s a lot more to life than triathlon. It would be nice to have the best functioning knee you can to play with your kids, do your job, vacation with the family in the Catskills. The more of this you can do without further surgery, the better off you’ll be. I have done all three operations mentioned in this thread and if you can live your life without the need for orthopedic involvement for as long as possible, on one plane, you win. Best of luck.
