I hurt my knee running downhill in Sept and it just hasnt felt right since. Just had an MRI and met with the sports doc … the report shows a 7mm x 7mm pothole at the bottom of the medial condyle. Waiting to see an ortho to get their thoughts but the wait is about 2 months here in Canada. Any knee experts with thoughts on this? I’ve read microfracture doesnt work on weight bearing cartilage?
I’m not a doctor, but I am a biomechanics final year undergrad specialising in the knee, so I do know somewhat about knee cartilige problems.
I have bad news for you. cartilige, once worn out completely , is really really difficult to replace. stem cells might change that, but that is still under research. the ‘pothole’ you described seems sort of a strange way for the cartilige to wear. may be due to some knee deformity or some biomechanical anomaly. most cartilige wear that I study is fairly even across the entire condyle. the small tear should heal in time if you take care of it. the 7mm section which has complete cartilige loss, is a different matter though. you might give it some time to see if it heals itself, but I’m not optimistic.
I think your best bet right now for continuing to lead an active lifestyle may be for unicompartmental knee replacement. consult your physician for this.
I don’t understand much of the medicalese but wanted to send ((((hugs)))). Get some glucosamine/chondroitin; it’s a supplement that may help with joints and cartilage. It’s not going to fix your issue but it could help and won’t hurt.
Can you still swim? Bike?
I’m not an expert but have had a similar injury and want to urge you not to give up hope. I had a significantly larger osteochondral fracture (1.3 cm by 1.3 cm was the size given on the MRI report) on what I was told was a partially weight-bearing area. I did the microfracture procedure, rehabbed diligently, and have since returned to running (did an IM last fall) with few complications (and actually running as well as i ever have). Perhaps it’s foolhardy or bad for the long term health of my knee, but I had my own cost-benefit analysis that led me to the decision to make the return to running. Your situation may be different, but I will say that there are plenty others who have had this injury out there, some of whom have returned to triathlon in full, it’s just not as easy to find the success stories as the horror stories. I know I’ve seen stories of people dealing with full-weight bearing defects as well, and if not microfracture, there are other options (like grafts). Good luck and keep your head up!
Graham,
First of all, sorry to hear. I assume it is OK for cycling? What about snowshoe running, classic and skate skiing and perhaps even “uphill only” running?
Dev
I don’t understand much of the medicalese but wanted to send ((((hugs)))). Get some glucosamine/chondroitin; it’s a supplement that may help with joints and cartilage. It’s not going to fix your issue but it could help and won’t hurt.
Can you still swim? Bike?
a common misconception for supplements-they will help you if you have ‘some’ cartilage left, but they will not ‘re-grow’ entirely worn out cartilage. still, like you said, it wouldnt hurt taking care of what is left.
I think the OP could probably still swim and cycle without issue. ( probably not anything requiring sprinting or heavy load bearing, though.) running, though, might be tricky.
Back in 2008 I had a torn piece of cartilage removed about the size of a quarter, inch in diameter from the top of the tibia; the doctor then performed microfracture on the tibia. It never really worked for me even with all the therapy etc. but it is not to say it can’t work everyone is different. I did get back to some running but nothing like I used to, what I tended to do was spread out my running maybe 3 to 4 times a week but nothing over 6 miles. Could I have run further probably but I didn’t want it to ruin my knee and not be able to walk in years to come. Check out the microfracture with the doctor to see if that is an option and good luck. Cheers LA Rob
Thanks for the kind words Dev and Ali. I’m still in shock frankly after a great summer of training and plans to race IM Whistler. I was just in Kona just 2 months ago and (foolishly) volunteered two shifts at the race and ran about 100km in total on Alii / at the volcano on this knee believing my PT that it was poplitial strain…yeah right. Anyway, I’m glad I went against my family doctor’s advice and paid for a private MRI (equal to a nice set of race wheels). So at least I can limit further damage and assess my options. I really don’t want to give up riding as a minimum. I’ve sent a few of the orthos on this board private PMs for their thoughts so hopefully I get some informed opinions. Unfortunately, I might have to wait about three months to see the ortho here in Canada so I am qucikly becoming an expert in all things related to this injury and its recovery.
Location regarding weight bearing and patellar forces are key here. I had/have OCD on my left knee. Otho held up piece of removed fragment to my face during surgery (I was awake to watch) and told me “to never run again”. I cycled, hiked, swam, walked all my tri “races” for 10 yrs. I grew tired of this and slowly started to progress back to running. I have been running now for 14 yrs with no pain or signs of dysfunction in my knee (knock wood).
I realize this is s case study of one and I am sad to not have kept better records. It does tell you that all is not lost. Be patient and let your body heal.
Cheers!!
LP
Don’t give up hope! I had the same injury, roughly the same size as yours, a few years ago. I had the microfracture surgery and after a looonnnnggg rehab I’m back to 100%. I was initially told my running days were over and that I should not think about triathlons any longer. They were wrong, very wrong. I’m running more now than I had in the past.
Do a search, there are a few threads about this. Good luck!
There are several options available besides microfracture. Osteochondral autograft or allograft and autologous cultured chondrocyte implantation.
I work in the allograft (cadaveric donor) transplantation field and have seen a lot of success with osteochondral allograft repairs.
Thanks so much to everyone for all of the information and hope. I really hope it’s not the end but am also trying to be realistic in case it is. I really want to be able to at least ride after this. Ironically, I hate swimming of all three sports and love running best.
I had a microfracture procedure on my ankle. I was told to stop running and did for ten years. Finally decided to start running again in 2005. I am no where near as competitive as I was but I am enjoying myself.
I would suggest if you do try running again to try the Hokas. They have allowed me to run virtually pain free.
Dave
Agree with some previous posts. You may be o.k. with OAT (osteochondral allograft/autograft transplant) with a 70 % success rate for zones less than 10-20 mm .This is pretty specialized Rx, though- not sure how available it is in B.C.
Good idea to have a physio or podiatrist assess your gait for muscle imbalance/patellar tracking.
Don’t give up hope though!
You may benefit from an OATs procedure, Carticel or DeNovo procedure. I’ve seen some good results for DeNovo. In laymans terms it is taking immature cartilage cells and implanting them into a well circumscribed defect. Something to look into. Good luck.
E
Again, don’t give up hope.
I have two ‘fissures’ in my cartilage in 2008. After surgery to clean out the area and smooth the edges I did a six month rehab and was back running. I take supplements (that probably only help my head space) and am happy with my injury management. It will never be as good as new, and I am probably on borrowed time, but I am still racing at my normal level.
I am hoping for stem cell therapy in the next decade!
Graham - No, your career is not over. Adnama’s story is my story, too. I didn’t run for a long time and slowly got back into it. I still have some pain but it is manageable. Be patient. Remember the 10% rule. Start by walking. Run on soft surfaces. Run on uneven surfaces (for my long runs, I just run through the woods, off road and off trail). Go to the gym. Build strength all around your knee. This strength maintenance should be disciplined and constant. Really, it becomes easy because the more you do it the better your knee feels. I, also run 6 days a week but my off days are REALLY easy, just to get the “healing juices flowing”. I’m glad I didn’t give up.
Similar to a meniscus tear I had in 2004 from hyper extending it in a mountain bike crash…lost about a third of it…I was told by my orthopod that running of any distance would be out of the question…I focused on swimming and cycling, and waited a good 4 weeks before running (against the PTs advice)…it took a while to come back…and I’ve never gotten back to 100% (but I’m old too)…I’ve been able to be competitive at everything from Oly Nats to a pretty good sized regional 50k (top masters)…don’t give up…the body has an amazing ability to heal…I occasionally see the guy that scoped my knee and he just shakes his head…
Hey one Graham to another!!
Post my big bike crash in IM Canada - I ripped off 10 Square CM of Articular cart from my R Femur - so the only option was ACI – my doc in Denver said this is like Jello- goes in soft and over time hardens - up to two years - but now am pain free and run on trails and race Tiris again .
if you would like to chat about this procedure please contact me back channel - good luck.
Graham
Graham, thanks for the offer … email sent to you.
Best!