Articular Cartilage Damage (Medial)

[Gee034]

Hoping for advice from someone who possibly has had the same injury as me.

I had knee surgery in February to trim my meniscus which was successful. During the operation the surgeon noticed the articular cartilage was also damaged and tidied that up but said it could cause me problems, he went on to say if that was the case there would be no more surgery but maybe 'injections'.

3 months later after rehab/physio I managed to play football a few times pain-free but since then my knee is painful after running 100-200 yards. If feels fine to walk, but the impact when running is painful. It's frustrating as for 2-3 games of football it was fine but I cant seem to get back to that point even after 2 months of resting it.

I have booked an appointment with my surgeon to see if there is anything that can be done. It 'clicks' a lot generally but only painful when running. I am wondering what is the next step? Would they offer an injection to help with this kind of problem? I am 34, would the NHS give injections to ease running pain or is it a case of being happy that I can walk/cycle fine and just get on with it?

I understand the injections only last a few months so if my articular cartilage is damaged, I'm thinking injections will just be delaying the inevitable so do the NHS actually fund someone going back a few times a year to help with pain for running with someone my age (34).

[Vickster]

The NHS will cover steroid injections, however, cortisone has been shown to damage articular cartilage so unless your joint is completely trashed, they are best avoided. And mustn't be given multiple times.

Non cartilage damaging injections of hyaluronic acid, platelet rich plasma or stem cells are not covered on the NHS and will be several hundred if not several thousand pounds

To be honest, in your situation, I'd give up running, football and any other high impact activity. Having had your meniscus trimmed has unfortunateky potentially set your knee up for more deterioration as that shock absorption has gone.  So stick to physio exercises (pay a good sports physio if you can to optimise rehab), swimming, cycling (with correct gearing and bike set up, spinning not grinding), walking for weight bearing.

Managing weight is important too if you're overweight at all. Vitamin D, fish oils, glucosamine/chondroitin can be helpful. Also,  icing after activity as inflammation is the killer to cartilage.

I knackered my knee aged 37 and it's just deteriorated more and more (my issues started lateral and are now moving medial too).

Good luck

[PwordsB]

Hey. Unfortunately I agree with Vickster. You're at a point where you can choose to keep running and you may even just about manage it for a few years, but if you choose to do that, you'll be very likely to find yourself in a situation a few years down the line where you're going to need surgery just to keep you walking. Once you've had that surgery, you'll be in a situation where you won't be able to run again as well. Not to mention the ever growing waiting times on the NHS. I read an article today that says NHS bosses are planning to give up the idea of an 18 week maximum waiting time for elective surgery because it is unachievable. I just spent around 42 weeks waiting for an operation and I'm a 28 year old guy out of work at home slipping into madness. It's important that you realise if you do need surgery at some point it will be considered elective, routine surgery. It may be causing your world to crumble away and drowning you in sorrow, but unless your knee is physically killing you, you're probably going to the back of an awfully long list. You want to avoid being anywhere near that path.

I'm trying not to ramble on too much, but I think your options are to stop running for fun now, try to find hobbies and ways to exercise that your knees can cope with for thirty more years, knowing that you then could run when you need to, or keep running now and find yourself in a horrible situation within a few years. If I had been given that option before a snowboarding accident took it from me... Well, with hindsight we would all do the right thing.

I'm sorry, I know how horrible it is to give up things that are important to you. Good luck.

[SuspectDevice]

Hey. Unfortunately I agree with Vickster. You're at a point where you can choose to keep running and you may even just about manage it for a few years, but if you choose to do that, you'll be very likely to find yourself in a situation a few years down the line where you're going to need surgery just to keep you walking. Once you've had that surgery, you'll be in a situation where you won't be able to run again as well. Not to mention the ever growing waiting times on the NHS. I read an article today that says NHS bosses are planning to give up the idea of an 18 week maximum waiting time for elective surgery because it is unachievable. I just spent around 42 weeks waiting for an operation and I'm a 28 year old guy out of work at home slipping into madness. It's important that you realise if you do need surgery at some point it will be considered elective, routine surgery. It may be causing your world to crumble away and drowning you in sorrow, but unless your knee is physically killing you, you're probably going to the back of an awfully long list. You want to avoid being anywhere near that path.

I'm trying not to ramble on too much, but I think your options are to stop running for fun now, try to find hobbies and ways to exercise that your knees can cope with for thirty more years, knowing that you then could run when you need to, or keep running now and find yourself in a horrible situation within a few years. If I had been given that option before a snowboarding accident took it from me... Well, with hindsight we would all do the right thing.

I'm sorry, I know how horrible it is to give up things that are important to you. Good luck.

Yeah, I tend to agree with this.  When my medial meniscus tore in April 2012, I could no longer run on it, but kept up hard cycling.  The loose flap of meniscus chaffed the cartilage on the end of my femur in one little spot (is that what you mean by articular cartilage - the cartilage that coats the end of your femur?).

Anyhow, I had the meniscus trimmed a month or two after tearing it, but that damaged femur cartilage spot gave me grief for another 5 yrs, especially if I ran.  In fact it's only in the last 3-4mths I've stopped feeling that damaged femur spot and I'm now back into a little running and finally that spot seems to have healed, but I'm never going back to the volume of running I used to do (e.g. 20km/2hr runs).  4-5kms will probably be my limit now, and much of my running is done as 1-3min run/1-2min walk.

So that articular cartilage can heal, but is is a very very slow process, and really, running on it too much is just asking for future trouble.  I'm going to attempt to build up as little running, but if I feel that spot again, I'll call it quits & just stick to cycling, swimming & gym work.

[Torao]

Have you had your gait analyzed? When I was returning to high impact sports after having new cartilage implanted, I had developed some odd habits due to needing to protect the knee post-surgery that I had to unlearn. You could have something that is making you run in a slightly different fashion that can be corrected. But also you may just need to build up the endurance/muscle memory. Start by running shorter distances where it doesn't hurt, but doing reps of it to reinforce the right way and that it doesn't have to hurt. Focus on making sure your technique is proper and dial back when the technique starts to falter rather than trying to push through.

I know nothing about how the NHS works, but I would also suggest getting a second opinion. The first doctor I went to about the full fissures in my cartilage said I needed to stop doing things because of the damage. I walked out while he was finishing the sentence and found a different doctor. It's your body, it's your life. Nobody else has more invested in you than you do. If being able to play football is important to you (for me it's capoeira and parkour), then find a doctor who will work to get you back to that. I'm four years out from ACI surgery for patella and trochlear groove and I'm running, jumping, kicking etc better than I ever was before surgery. Yes I have to ice and do a fair bit of prehab, but some of that is just that I'm still spending more than 15 hours a week doing impact training in my late 30s.