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Author Topic: Knee problems, but need to run  (Read 1489 times)

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Offline Gnomon

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Knee problems, but need to run
« on: October 14, 2009, 11:33:42 PM »
Hi,

I'm applying for a law enforcement position that requires me to be able to run.  I'm 55, and have been trying to train for my evaluation, but my right knee started giving me problems around the beginning of the summer.  I had MRIs done of both knees, and the radiologist who read my film said an Orthopedic consultation would be in order. 

I booked an appointment with a doctor at a clinic who, although I was under the impression he was an Orthopedic Surgeon, turned out to be a Sports Medicine specialist.  A very nice and knowledgeable guy.  He suggested I try a knee treatment called Durolane (I think it's similar to synvisc).  The treatment worked for close to a month, and then my knee pain recurred.  My physiologist then told me that this doctor was not an Ortho.  So to continue, a week ago, he told me that for my problem knee surgery doesn't do much, and so he drained the knee and gave me a Cortisone injection.  Then, as he left the room, he said "that's the best we can do for you". 

So, since my career depends on me having a functional knee, I need to find out all my options.  Tomorrow I'm seeing an actual Orthopedic Surgeon.  I'm interested in getting some feedback here as well, so I'm going to transcribe the MRI report.  Hopefully there's a solution to this issue.

Clinical History: Bilateral knee pain left greater than right.  Medial compartment/joint line tenderness

Technique: Multiplanar multisequence unenhanced MR imaging of the knee was performed.

Findings: 
A small amount of joint fluid is present. There is no frank effusion.  There is some edema along the anterior aspect of the knee at and below the level of the patella.

The anterior aspect of the medial femoral condyle and trochlear groove are quite abnormal.  In these regions there is full thickness irregular cartilage loss and seemingly some regional osteophyte formation.  There is also signal change within the subchondral bone suggesting both imbitation of fluid and edema.  Evolving subchondral cysts are suspected.  Curiously the patella appears normal.  A sine linear loose body is present within the patellofemoral compartment anterior to the trochlear groove.  This spans 7 mm transverse by 8 mm craniocaudal by 2 mm AP.  It is best appreciated on the sagittal T2 weighted sequence, image 21 and the axial T2 weighted sequence, image 31.

The medial and lateral collateral ligament complexes are intact.  Trace signal change within the proximal most aspect of the lateral collateral ligament may or may not reflect a slight strain injury.

There is some signal change along the undersurface of the posterior horn of the medial meniscus.  The apex in this region is minimally blunted.  The lateral meniscus is unremarkable.  The anterior and posterior cruciate ligaments are intact.  The ACL has a rather distinct thin anterolateral bundle.  The extensor tendon mechanism is unremarkable.

Interpretation:

Abnormality is predominantly limited to the distal femur anteriorly.  An osteochnodral fracture is suspected.  There is a tiny flake-like loose body within the patellofemoral compartment of the knee.  There are fairly severe focal degenerative changes affecting the anterior aspect of the medial femoral condyle and trochlear groove.  The patella is spared and appears normal.

There is perhaps slight fraying of the undersurface and apex of the posterior horn of the medial meniscus.

An orthopedic consultation is recommended.


Thank you for looking at this!  If the MRI images are useful I could post them.

Offline derek320

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Re: Knee problems, but need to run
« Reply #1 on: October 15, 2009, 02:33:42 AM »
The sports medicine specialist wasn't a surgeon? Sports medicine is usually a sub-specialty of an orthopedic surgeon, they go through additional training in order to become a sports-medicine specialist, this is the type of surgeon that I see for my knee.

Anyways, based on your MRI, it seems as though you are missing a bit of cartilage on your medial femoral condoyle. That means that the cartilage lining your femur is beginning to wear thin in some areas and may even have completely worn down to the bone in some areas. This is probably something that the surgeon is going to want to fix, when the cartilage wears down to the bone it is very painful and becomes even harder to fix because the bone begins to get damaged. Cartilage defects have a variety of surgeries that attempt to repair them, yet most of them act as temporary fixes such as a microfracture which I recently had and was told to only expect it to last around 7-10 years (I'm only 17).

It also looks as though your medial meniscus has a small tear, this might be something that the surgeon doesn't even want to bother fixing depending on how damaged it is or he may want to scrape off the damaged part of the meniscus, this is a more minor surgery than cartilage repair, you can usually walk out a meniscus repair.

As for running, I'm not sure how beneficial that will be for your knee. Running is a high impact exercise and is usually more wearing on your cartilage and meniscus. Also, if you end up needing a cartilage repair surgery, they all come with a long recovery. My microfracture surgery came with 8 weeks of non weight bearing and around 2-3 weeks of partial weight bearing. Therapy is going to come to a grand total of around 4 months of therapy, and I'm not allowed to run, jump, twist, or anything else high impact for 6 months post-op.


Hopefully everything turns out all right for you, sometimes those MRI reports make everything look worse than they really are. Best of luck to you at the orthopedics tomorrow!
-Left knee history-
Oct 06- injured knee, MRI shows torn meniscus, no action
June 09- knee begins popping, MRI shows large OCD lesion
Aug 09- OCD lesion removed, microfracture surgery, partial meniscectomy
Jan 19- biopsy for MACI, partial meniscectomy
Apr 19- MACI implantantion, meniscus allograft

Offline Gnomon

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Re: Knee problems, but need to run
« Reply #2 on: October 15, 2009, 10:58:46 PM »
Thank you! The OS said that scoping is an option that he'd be willing to do at any point, but agreed with the following program:

1) Lose 40 pounds.
2) While in the process of losing the weight, do a non-loading cardio like biking.
3) In a month I can get a repeat of the Durolane injection.

Then, with the modified biomechanics that weight-loss will bring, see how things go.  If all else fails, then we could try scoping.


Offline Jessyca

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Re: Knee problems, but need to run
« Reply #3 on: October 16, 2009, 03:51:31 AM »
Hello, I'm in a similar position.

For me, using a brace has allowed me to run (for the first time in 3 years) until my surgery this winter.  So, that may be something to look into.

Good luck!
February 9, 2006 Fell skiing, knee twisted.
July 12, 2006 Arthroscopic surgery
October 23, 2006 Possible reinjury
January 10, 2007 Arthroscopic surgery
August 13, 2009 Bracing my knee until surgery in January
January 29, 2010 Arthroscopic surgery - LR/debridement

Offline Gnomon

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Re: Knee problems, but need to run
« Reply #4 on: October 16, 2009, 04:00:33 AM »
Quote from: Jessyca
Hello, I'm in a similar position.

For me, using a brace has allowed me to run (for the first time in 3 years) until my surgery this winter.  So, that may be something to look into.

Good luck!

What kind of brace are you using?  Are you in law enforcement?

« Last Edit: October 16, 2009, 04:02:44 AM by Gnomon »

Offline madel23

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Re: Knee problems, but need to run
« Reply #5 on: October 16, 2009, 02:52:21 PM »
I'd be interested to know what brace you're using too!  And where in your knee the problem was.

Offline Jessyca

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Re: Knee problems, but need to run
« Reply #6 on: October 16, 2009, 04:31:19 PM »
I am currently interning for a federal law enforcement agency, with plans to apply there as soon as I graduate college this summer (keeping my fingers crossed that they have an opening then......).

I first started having knee problems nearly 4 years ago.  The first surgeon I went to misdiagnosed the problem as a meniscus tear and did 2 surgeries trying to correct that  ::) The past year and a half things were getting worse, and I've seen three surgeons in that time. Two of them basically said to forget about running and give up on a career in law enforcement  :o Not gonna happen, so I went to my current OS (point there being its ok to shop around until you find a great surgeon).  Anyway, this one determined that the problems result from patellar tilt and misalignment.  In February I'll have a lateral release and cauterized debridement.

In the meantime, I'm wearing a DonJoy Tru-Pull Lite brace.  (My internship ends the day before my surgery  ;) )  For me, its worked really well.

Good luck!
February 9, 2006 Fell skiing, knee twisted.
July 12, 2006 Arthroscopic surgery
October 23, 2006 Possible reinjury
January 10, 2007 Arthroscopic surgery
August 13, 2009 Bracing my knee until surgery in January
January 29, 2010 Arthroscopic surgery - LR/debridement

Offline Clarkey

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  • Neil TheElephant knee packed up carrying his trunk
Re: Knee problems, but need to run
« Reply #7 on: October 17, 2009, 10:48:16 AM »
Hi there,

My 2nd anniversary since I felll onto pavement is coming up on Monday and have not been able to run since then. Friday 19th October 2007 is a day I never forgot as its changed my life as I can no longer compete in sporting activities and can no longer go jogging with my mate.

I am fairly lucky as I work as a Greenkeeper at my local golf club so dont need to be able to run but cant walk as fast as I would like to due to falling onto my right knee. The only form of excercise I can do at the moment is going to the gym 3 times a week and use the exercise bike and cross trainer, using the cross trainer is the closest I can get to running but its not the same as being able to run outdoors in the fresh air.

I was suppose to have my right knee scoped this month but been told by another member can take up to 26 weeks on the NHS which is a disgrace as they should be able to fit you in sooner. If it takes that amount of time then it would take me into the New Year at the beginning of January which I dont want as I like it done before Christmas if possible. Have been waiting since 30th June so was expecting a surgery date by now.

I hope members posting on here can start to run again one day once the OS's have sorted out our knee problems. There are alot of jobs that require you to run and must be a worry for those that rely on running when they are at work but cannot so have to go a sick pay or office duties.

Nick :) {2009} :)

RK: PFPS, Arthrofibrosis, Tendinopathy, Five cortisone injections
16/01/18 Anterior interval release, distal patella excision, lateral meniscal repair
18/07/14 Anterior interval release  
16/11/09 Medial plica excision, fat pad trimming















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