Some background first – 46 years old, runner for 30+ of those years, triathlons for the last 15 years (running my strongest leg) culminating with my first IM in 2005. Somehow tore my meniscus in 2006? (minor tear) and while waiting for the surgery managed to get T-boned by a truck, tossed to the curb, emergency room, etc. Fun fun fun…
During surgery for the meniscus, discovered that the accident took a chunk out of the articular cartilage at the end of my femur in a load bearing area. Surgeon tried the microfracture procedure to fill the hole, trimmed up the meniscus and into rehab.
Now it’s two years later and I still have knee pain. Recent MRI showed that the hole is only partially filled, so the microfracture didn’t do the trick. Opinion of several docs is that it’s the cartilage damage (not the meniscus) causing the pain and the recommendation is not to run (or do any impact sport). Chances are that this is the right recommendation since it doesn’t hurt unless I run or do some heavy work in the yard, etc.
I’ve tried the route of exercising to stay fit, but miss the competition and racing and am trying to figure out how to get back to some level without doing more damage to my knee. The most appealing plan at the moment is to train for a tri without doing any running, but then “run” the run portion during the race. I won’t be as fast as I used to be, but it would be more than a jog so it would still feel like a race.
Finally my questions –
One doc suggested an unloader brace to transfer the impact elsewhere – does anyone have any good/bad experience with one?
Do you think shifting my running mechanics would make a difference? Seems unlikely, but maybe worth looking into the barefoot/pose schools of thought…
There are other surgical treatments, besides a mircrofracture, that you may want to investigate. What you are eligible for and what may be successful for you depends on a ton of factors… including size and depth and location of your lesion, what the rest of the joint space is like etc.
Yes, you can run on AC defects–but many people WILL have pain. Permanantly. I haven’t been pain free since I was 12. Eventually, you get used to it, I guess. It’s a choice you have to make. You also have to know where and when it’s time to draw the line.
EVERY case is a study of one. Two people can present with identical damage, and have radically different levels of functioning and/or response to treatment.
From what I’ve been told, the rest of the joint area is in pretty good shape – except for the lesion of course. One factor that doesn’t help me is that I’m a bit bow-legged – didn’t bother one surgeon, but the other suggested that if we were to do something, we’d also need to “re-align” me by straightening out my legs. Seemed like a big deal and not too appealing!
The pain is something I can deal with, it’s the additional damage that I’m trying to avoid.
I’ll have to give the brace a shot – seems like a good, non-invasive thing to try.
I am assuming your defect is on the medial side? (I’m basing that on the fact that your surgeon said he’d want to address your bowleggedness) He probably is thinking of doing something along the lines of a cartilage restoration procedure and then an osteotomy to unload the area.
I am the opposite–I had an osteotomy to unload my lateral compartment (knock-kneed, rather than bowlegged). Unfortunately, my cartilage damage is too widespread in the lateral side for me to have any sort of restoration, and I now lack my meniscus over there as well, so all they can do is unload the compartment to slow the progression.
The recovery is long, indeed, and it wouldn’t be my first choice of procedures…but I am hoping it buys me some time.
Definitely look into a custom unloader. Mine is by Townsend, and I even got to choose the color (Mine is carbon fiber with a blaze orange finish :-)) It is quite a nice device. They can be spendy, though, so make sure your insurance covers part or all of it unless you want to fork over $2500.
Yes, I believe you’re right about the location. Interesting that we’ve got the opposite situation… I’ll certainly look into the unloader. I believe at least some of it will be carried by the insurance, but will check.
MR-there are lots of options for the athlete with medial compartment degenerative change. Many are dependent on the size, location and thickness of the lesion. If, for example, you lived in Chicago, you’d go see Brian Cole, MD (I think at Rush) an Orthopedist who’s practice (and life) revolves around cartilage restoration procedures. Or Tom Minas, MD at Harvard. At 46 you have a lot of years left, not just to train and race but to hopefully forestall something major like a joint replacement. Although you may already know from your doc that there’s little that can be done, you may not and simply continuing your search could prove quite beneficial.
no brace can do what your muscles are designed to do – absorb and generate forces, br acing may help pain, but your will always have to use it with weakness futher developing in limb. This may be worth it to you, but just be aware.
Good running mechanics can help everyone, both from a pain standpoint and a performance one. It does not guarantee it will help you run pain free, but it almost always helps and the worse your technique is, the more good technique will help
no brace can do what your muscles are designed to do – absorb and generate forces, br acing may help pain, but your will always have to use it with weakness futher developing in limb. This may be worth it to you, but just be aware.
An unloader brace is not a musculature support. It is designed to realign the leg to off-load a damaged joint compartment. It’s not a support system in as much as it is a that mechanical device redistributes the force like an osteotomy would.
Thanks John, I’m in the Boston area so I may look up Dr. Minas. This is something I’ll keep pursuing since I think there will continue to be advancements that I can take advantage of. All those aging baby boomers can only help!
I was told the same thing due to thin cartilage on lateral condyle. I am looking for options. I use the elliptical hoping to help with cross training. Any recommendations for Orthopedic surgeon in the Denver area that would be able to due cartilage “regeneration” options?
I know Im bumping a really old thread here but this came up when I searched for articular cartilage injuries.
Any of you guys on here get back to tri/running after your knee injuries?
I am 11 months post op, been biking and swimming and hope to get back to running too. I had stem cell surgery to repair and graft new cartilage in my knee
Be interested to hear from anyone else with similar experience.
I think I got lucky, my articular cartilage damage turned out to be in non-weight bearing spots and I got some spontaneous fill in of fibrocartilage. My doc didn’t think returning to running would be a problem. I’m about a year and a half postop and I’ve been running conservatively and thus far things have been fine. I think a lot it depends on where the injury is. What does your doc think?
I think I got lucky, my articular cartilage damage turned out to be in non-weight bearing spots and I got some spontaneous fill in of fibrocartilage. My doc didn’t think returning to running would be a problem. I’m about a year and a half postop and I’ve been running conservatively and thus far things have been fine. I think a lot it depends on where the injury is. What does your doc think?
That’s good news for you. I am going back to my surgeon in a few weeks for a 12 month MRI to see the progress & check the quality and quantity of the graft. He says I should be able to run. I will see how the knee reacts & will build it up very very gradually.
The one thing the surgeon has told me to avoid all year since the op was any impact or any exercise like a squat etc
best of luck! I know it’s nerve wracking. I spent a long time searching the knee injury threads here and on letsrun.
Thanks a lot…yes it is nerve racking. It’s the unknown that makes it worse
Look into Ossur One Unloader with Smart Dosing. I have one, and my medial left knee has stage 3-4 articular cartilage defect and a torn meniscus. The Ossur brace works great, you can do marathons in them. Practice good form.
Here’s the best kept secret in medicine- Your physician doesn’t actually know what is causing your knee pain and is only making assumptions. There is plenty of research to show that “bad” MRIs don’t correlate with pain. As well, one can have tremendous pain with “good” MRIs. Have you ever run without knee pain in the last year or so? If so, it is quite possible that your articular defect is just there and not causing pain. Stressing this area can actually help the defect fill in over time anyhow. Unloading your knee can reduce pain temporarily. However, your knee doesn’t exist in an unloaded environment, it requires loading for proper function. As well, long term brace usage is not conducive to typical life. And it is quite possible that your knee requires a different type of loading to reduce pain and improve function.
There are all sorts of pain generating structures in the knee… subchondral bone, outer third of the meniscus, MCL, PFJ, tendons, etc. Cartilage can’t actually hurt because it is aneural.
I recommend you find an experienced physical therapist who is comfortable treating you without the prospect of surgical intervention in the future. You will definitely benefit from a mechanical approach that doesn’t try to isolate the pain generating structure(s), but rather understands the function of the knee. The simplest way to put this is to stretch what is tightened, strengthen was is weak, correct adopted gait deviations, etc. Because this has been going on for an extended period. It will likely take an extended period to resolve… at least 3 months to stretch adaptively shortened structures. Cartilage repairs truly don’t work well as we age… think over 20 years old. Good luck!!
(Mine is carbon fiber with a blaze orange finish :-)) It is quite a nice device. They can be spendy, though, so make sure your insurance covers part or all of it unless you want to fork over $2500.