It all began in the Fall of 2002. Persistent left knee pain that took the fun out of the run. On longer runs the knee would on occasion give out for a split second. I ran the Tucson Marathon in 2001 and 2002 looking for a PR on the mostly downhill course. Both times my left knee started causing me issues around mile 16-18. I finished but never bested my PR from Portland Marathon.
During the Winter of 2002 I underwent physical therapy, with little change. During this time, I'd notice pain in the knee during sleep. I would often wake up a night and wince to try and straighten my leg. This is, apparently, a classic symptom of a meniscal tear.
Finally, in early 2003 I went to Oregon Sports Medicine and met with a surgeon. He predicted a torn meniscus and scheduled an MRI to confirm. The MRI itself was a strange experience - 30 minutes of laying partway into a long tube, a humongous, loud electromagnet that (I presume) reorients the water molecules in your body. The results of the MRI seemed to confirm a medial meniscus tear and the surgeon recommended athroscopy with intent to repair if necessary.
We scheduled surgery and in February of 2003 I underwent an ectomy of the meniscus (menisectomy). I elected to have a general anesthetic. I'd heard arguments both ways and finally decided that it would be peaceful to just pass out while surgery was performed. The doctor found tears (shreds really) in both the medial and lateral menisci. Before and after shots. In the before (left) image you can see the shredded tissue. In the after image you can see where this tissue has been nibbled away and cleaned up.
Recovery was extremely fast. I had surgery on a Thursday, rested on Friday and was back at work on Monday using crutches for assistance. By the second week I was on the stationary bike...though really slowly! After that I transitioned to swimming and harder cycling. I was back to light running within 5 weeks of surgery.
Summary, and some thought-provoking points:
During the Winter of 2002 I underwent physical therapy, with little change. During this time, I'd notice pain in the knee during sleep. I would often wake up a night and wince to try and straighten my leg. This is, apparently, a classic symptom of a meniscal tear.
Finally, in early 2003 I went to Oregon Sports Medicine and met with a surgeon. He predicted a torn meniscus and scheduled an MRI to confirm. The MRI itself was a strange experience - 30 minutes of laying partway into a long tube, a humongous, loud electromagnet that (I presume) reorients the water molecules in your body. The results of the MRI seemed to confirm a medial meniscus tear and the surgeon recommended athroscopy with intent to repair if necessary.
We scheduled surgery and in February of 2003 I underwent an ectomy of the meniscus (menisectomy). I elected to have a general anesthetic. I'd heard arguments both ways and finally decided that it would be peaceful to just pass out while surgery was performed. The doctor found tears (shreds really) in both the medial and lateral menisci. Before and after shots. In the before (left) image you can see the shredded tissue. In the after image you can see where this tissue has been nibbled away and cleaned up.
Recovery was extremely fast. I had surgery on a Thursday, rested on Friday and was back at work on Monday using crutches for assistance. By the second week I was on the stationary bike...though really slowly! After that I transitioned to swimming and harder cycling. I was back to light running within 5 weeks of surgery.
Summary, and some thought-provoking points:
- In some cases meniscus repairs prevent further damage to the meniscus. This is particularly true when the meniscal tear interferes with joint range of motion.
- In other cases the torn meniscus is simply a "pain generator" but may not require repair. In these cases it is up to the athlete, along with their doctor, to decide if surgery is appropriate or not.
- It's worth noting too that meniscus tears (and cartilage damage in general) can be asymptomatic. In other words, you may visit the doctor for knee pain, the diagnosis may be a torn meniscus, a menisectomy performed, and the root cause of your pain not addressed.
- Contrary to what you often hear from runners, having the meniscus repaired does not mean that you are "good as new". Damaged meniscus, repaired or not, means that the knee joint has less surface area; less cushiony goodness. Continuation of impactful activities greatly increases the risk of further meniscus damage and possible arthritis later on. My surgeon recommended easing up on the ultrarunning, and putting greater emphasis on swimming and cycling.
- The use of the MRI as a tool for diagnosing a torn meniscus should be carefully considered. It is an expensive procedure and may not show enough detail to make a solid diagnosis. Most likely the surgeon will recommend exploratory arthoscopy anyway if the symptoms indicate a meniscal tear. If you do choose an MRI, seek out a relatively powerful unit (currently 2 tesla is considered reasonably powerful for human-subject, generally available imaging). Often the small, open units used in-situ in doctor's offices are not powerful enough to resolve smaller tears or other damage.
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