Apologies in advance for the essay! Hopefully it's not TOO boring, and thanks for reading.
If you're a recent TPF sufferer and are just interested to know what your long term prognosis is, please scroll to the bottom where I will give a brief summary of mine**!
In 1997 I fractured my left tibial plateau sprinting and vaulting off a picnic bench, and landing badly. It's a ridiculous way to sustain such a massive injury, and I would see the funny side if it hadn't had such a big impact on my life!
The fracture was slightly displaced and there was some hesitancy over whether to operate or not. In the end the hospital decided, with my consent, to insert 2 screws to repair the break. I had also ruptured my PCL, which wasn't really discussed much at the time and was not operated on, but has meant that my knee now hyperextends, maybe 3/4 inch past where it should.
I was on crutches for around 6 weeks and did a bit of physio - TBH I didn't really take it that seriously, I was doing exams at the time, and figured when I was told 'you will have problems with this knee in later life' that was just a true of lots of bone breaks, and issues would maybe start telling when I was, I don't know, maybe 50 or 60.
Anyway, after coming off crutches I didn't do anything in particular to get the leg back to full strength, I was always aware that it wasn't as good as the right one, but it was good enough - over the years I went to the gym, ran cross country long distances, did pretty much what I wanted with it without it giving me too much grief. It was always very slightly weaker looking than the other one and I was always aware it was my 'bad leg', but it wasn't especially painful.
Between 2007-2010 I trained semi-seriously in MMA - for those that don't know this is a tough sport that involves wrestling and kickboxing. In 2010 however (funnily enough just after my 30th birthday) I was finding that my bad knee was aching quite a lot when sitting with it bent at work, some pains when walking, it just didn't feel great. I went to a very good physio who told me I have a kneecap alignment problem, and that I would need to do quad strengthening exercises to pull it across slightly. I worked hard at this but to no avail.
Over the next year I kept seeing physios, who gave me stretches, different exercises and so on, but nothing really helped. Whereas at the start of this I was keen to get back into MMA as soon as possible, I had now given up on this idea and just wanted to be able to walk and sit pain free, and maybe do a bit of running. Being an athlete seemed like a distant memory and something which I would never feel again. The pain had been getting slowly worse if anything - when sitting with it bent, the lateral side ached from mid-thigh to mid calf, also I now had an audible tearing sound when going from a weight-bearing full squat to a standing position (I just avoid this now and tend to go down on my other knee if needs be).
I saw a musculoskeletal specialist and had an MRI scan. Knowing that I had an imperfection on the surface of the Tibia, I expected to see the cartilage worn away to some extent. Encouragingly, the meniscus and other mid-knee cartilage actually looked pretty good. He said though that I had some wear and tear behind the kneecap. I asked 'no arthritis though?' to which he looked at me grimly and replied 'this is how it starts.'
That was about 18 months ago. He reiterated that I should strengthen the muscles around the knee, in particulate the quad and the teardrop muscle (I forget the latin). I have worked quite hard to do this but noticed no real improvement in the muscle size, or in my symptoms.
Around 6 months ago I saw one of the UK's leading knee surgeons, a Dr Fares Haddad of the The Wellington Knee unit in London. He took new X-rays and also looked at my old MRI scan. He listened to my story, pretty much as above, after which he was somewhat dismissive - not in a rude or unprofessional way, but just in a 'there's not really much I can do for you' kind of way. I think his attitude was actually to try and make me realise that there was no sense in worrying about this now. There would be probably more harm than good in any operating, the knee certainly isn't bad enough to be replaced, so 'keep it strong, avoid impact exercises'. He said the knee should be good for doing basic stuff for about 20 years, at which point TKR surgery may be well ahead of how it is now. Going by how much more pain I'm in now than 2 years ago though, I can't see it lasting all that long…but I guess he knows better than me.
What I had not realised before was that due to my now extended PCL, all my running and MMA (kicking heavy bags for hours on end with my shin) had been causing my Femur to bash against the patello-femoral cartilage, causing that to erode. I'm still not sure if this is the source of my pain however. The Dr also told me I'd had a wasted operation back in 97 as the chunk of TP had not been screwed in particularly straight - there's now like a 1mm or so step in my TP, which doesn't bode well.
The doctor reassured me that he saw a lot of worse knees in younger patients, and I'm sure this is true. There is always someone worse out there, and one of the reasons that forums like this are great, is that they allow you to put things into perspective, by helping you understand your problem and giving you a sense of unity with your fellow sufferers, for better or worse. I know I don't have the worst knee on this forum by a long shot, but still - I'm 32, I don't yet have a family, and I'm sad to say that now, rather than looking forward to the rest of my life, I'm quite apprehensive about it. I've always relied on my self-image as physically strong and capable - I guess everyone does to a certain extent so maybe that's a moot point. But I do worry about my ability to function normally in 5 or so years time - how this will affect my relationships, my career and so on. I feel like I had it all, ruined it in an instant, and am now powerless to put it right.
Anyway I'm pretty sure I DO have OA in the knee to some extent - it aches, it burns, it feels stiff and swollen, there's more fluid on it than the other one. It also clicks sometimes when standing, turning etc, and if I put my hand on the kneecap I can feel quite a bit of creaking compared to the other one. I can still walk without a limp (though long walks are getting a little painful), I still mountain bike quite a bit, and I do shallow squats and other leg exercises in the gym. I have just started taking painkillers when I want to do something enjoyable, like go out for a nice meal or the cinema, without it bugging me so much. I'm considering the painkillers every day option but I feel I need to put this off as long as possible. I'm also taking a few natural remedies which seem to do nothing, and I'm considering trying weed, though it tends to make me a bit anxious these days.
So I suppose I'm just looking for some general advice, support maybe, I dunno! I do have a few questions:
- I've heard cycling is good for OA in knees, but I get a 'click' on every downstroke of my bad leg, on any but a very light gear. Is this doing more damage, do you think?
- A physio recommended leg raises on a machine for quad strength, with feet at different angles to target the teardrop muscle. A rugby player friend of mine however since told me (he also had a PCL tear) this can cause friction on the back of the kneecap if you have an elongated PCL - anyone got an opinion on this?
- Is it good for me to really work on getting more muscular legs (they're ok ATM, bit skinny maybe) - I squat maybe 120 KG not down to 90 degrees…I feel I could build my legs more, but I'm worried I'm just going to damage the cartilage further while doing it, which surely defeats the object…but could this be the answer to my problems?
- Anyone recommend drugs which will take the pain away but wont cause me drowsiness or other health problems long term? Furthermore, if you use Marijuana for pain relief, does it provide some lasting relief? I heard this may be the case as the active chemical in it has a long half-life. I can't be getting stoned every morning before work!
- Is there any way of permanently just killing all the nerves in the knee? If it didn't hurt, I wouldn't go mad on it and start doing gymnastics, but at least before it starts properly falling to bits I can live without the constant distraction of pain?!
- Any other hope (eg 'hang around for 5 years and stem cells will sort you out') gratefully received.
Thanks for looking in and sorry it was so long. I guess it helps to talk about it, and if anyone can offer any helpful advice, I'll be really grateful.
**If you're recovering from TPF, I would say get a lot of advice from doctors and physios on what activities you need to be doing. I didn't do my post-op PT properly, and then without consultation, as I was pain-free I picked sports completely unsuitable for my knee, now I'm paying the price. Get your knee strong as quickly as possible and get good advice on what amount of impact-activity is suitable for your situation.
Keir (32, male, 6ft, 185lbs)