In the winter of 2007 I was training for the CDA Ironman, doing a long trail run in Tryon Creek. On the flats things felt fine but I degraded to literally a walk on the uphills. My left knee hurt. And not the kind of hurt you can run through; more like there was a very sharp pain and then it just gave out. Didn't work.
In the three years since I tried everything. Accupuncture. Physical therapy. Abstinence. Stretching. Orthotics. Then, I resorted to surgery. First a lateral release. No change. My doctors at Rebound recommended a Fulkerson osteotomy and ACI. Scared the crap out of me. Particularly after reading related postes under Knee Guru. So I delayed and debated. Got second opinions. Got scoped and had a cartilage sample taken for the ACI. I was awake so that I could guide the surgeons to the spot that hurt. I recall seeing him sweep an instrument over normal, white cartilage, then he tapped a spot that looked normal and the instrument sunk in - like wet sheetrock. Bingo. They took a plug of cartilage to culture for the ACI; I can still recall the thump of the mallet before they turned up the anesthetic and I drifted off.
Then, skiing in Deer Valley in spring 2009, my knee hurt so much that I hardly enjoyed skiing - even on the groomers. I decided then to schedule surgery. No easy decision as it meant crutches and a brace for weeks.
Fast forward to September 2010. My cultured cartilage sample was ready to go in some storage area at Carticel Labs, and they coordinated a courier to bring the sample just in time for my surgery. My leg was washed, shaved and washed again, then I was covered with warm blankets and wheeled into the operatory. Got hooked up with a Game Ready ice cuff (amazing) afterwards and began recovery.
The scariest part? Showering. A giant black trash bag duct taped over my brace and the careful shuffle into the shower. So easy to imagine a slip and a fall, and the potential to cock up all the work they'd done - maybe for good.
I had surgery on a Thursday, took Friday off and worked from home on Monday. Couldn't bear to take more vacation, nor could I bear working from home for the entire week. So I packed the Family Truckster up with the Game Ready and the crutches and drove our only automatic to work.
Pain was very manageable. I took partial doses of prescription narcotics on the first two nights so that I could sleep more soundly. Regardless of any pain, it's crazy trying to sleep with a huge brace on. When you want to roll over and have to orchestrate this 1-2-3-Heave to throw the Frankenstein leg one direction or the other.
A few weeks later a range of motion machine arrived. I learned to take off the brace and swing my leg into the machine. Laying in bed while the machine slowly extended and flexed my knee. Week by week the flexion increased - following the guidelines.
The worst part? Not having any real options for exercise. I still hobbled my crutches over to Bally's and went through the motions, but it just wasn't very satisfying not being able to be really aerobic.
So now it's May, about eight months post-surgery. The results are encouraging so far.
On the athletics front, obviously less volume than before my injury, but I've tried to keep active and set non-running goals. I rode Seattle to Portland again (maybe my fourth time?) but sadly just crapped out at about mile 170 outside of Portland on the one day ride. I think just not fully recovered from surgery. It frustrated me enough that I drove out the next day and rode the distance to finish as a two day rider - dammit.
Did Cycle Oregon in 2008. Not an ultra event, or maybe even a heavily athletic event, but an awesome week of riding culminating in two nights at Wallowa Lake - gorgeous. In 2009 I did the Vineman Aquabike; essentially the Iron distance swim/bike events without the run. And I tried my hand at a couple of OBRA (Oregon Bike Racing Association) time trials along the beautiful upper Clackamas river.
In 2010 I plan to do at least six different OBRA TT events. Trying hard to convince friends to join me in Race Across Oregon (RAO) as a 2-4 person event. Depending upon the route may do Cycle Oregon again. There is also an amazing looking rando from Portland to Whitefish, MT. Here's a pointer
I am also looking at long distance swim events, which are unfortunately scarce locally. There's a very compelling 10km swim in Bonaire, NA that I would love to do (I say that now). Have done some diving down there and a distance swim would be awesome over those sites.
So...I still aspire. Miss the running to be sure - particularly now that my son is 16 and running x-country. So ironic that after 16 years of waiting for him to run with me, I'm grounded and he's running 5 minute miles. Shit.
So, an update two years after my lateral release. Well, I've continued to investigate options - mostly with the doctors at the Rebound Clinic. A couple MRIs and a handful of x-rays. Lots of consultations about options. A bit more PT, although I think I probably do just as well on my own without it.
The primary line of thinking in the last two years is that I've worn a groove in the cartilage of the femoral trochlea. The MRI shows it clearly. It's not huge; probably half a centimeter wide and a centimeter long. And it's not full-thickness. Up until recently the doctors have correlated this with my knee pain and dysfunction. Their recommendation has been a Mickelson osteotomy to essentially relieve the pressure of the patella on the lateral chondral surface and provide more leverage for the knee.
I've hesitated (for two years obviously) hoping to find an alternative that's not so dramatic. And, I've been hesitant to agree with the diagnosis because my pain is on the lateral side of the knee - not the center where the cartilage damage is located.
I've opted to have two of the doctors scope me next month in an effort to understand what's causing the dysfunction.
I do believe that my problem is the result of poor bio-mechanics and over-use. Even in 2006, when training for the Haute Route run, I noticed a tick, a twinge of pain at about 20 degrees of flexion when stepping up. I also know that I have compensated for this secretly for a long time, letting the left knee go slack coming down stairs and using my right leg to push myself through a step up on a steep climb. Looking back further, it is certainly that my knee pain in 2002 was symptomatic of something other than meniscus damage. Some studies do suggest that meniscus/cartilage damage can often be asymptomatic, and that knee pain often has other root causes.
There is some promise in autologous (self-sourced) stem cell injections, I think. www.regenexx.com
is one example. In animal models, and anecdotal examples with humans, the procedure does seem to produce replacement cartilage and improve healing in bone. In the procedure, stem cells are taken from the pelvis, cultured to increase their numbers, and reinjected at the injury site. Unfortunately, there are no real scientific, randomized, double-blind trials to test this procedure. Nonetheless, it does seem a likely early start at something that will someday be commonplace. These procedures typically cost around $7,000, and seem like a relatively benign thing to try. So...maybe. Here's another, similar clinic doing the procedure in Europe: www.xcell-center.com
In the winter of 2007 I was starting to ramp my running in preparation for the 2007 CDA Ironman. I ran the Hagg Lake 25km, which is usually a complete mud-fest. I post-holed in a couple of mud puddles that were much deeper than I anticipated, hyperextending my knee and then slamming hard. The following weekend I went out for a 12-14 mile run in Tryon Creek park and could barely jog the hills. My left knee hurt like hell going up any incline. It wasn't something I could run through and if pushed it would just give out completely. For several weeks thereafter anything that engaged my left quads was extremely painful.
I did the usual ice, elevation and rest, but nothing calmed it down. Finally booked an appointment at Sports Medicine Oregon in Tualatin, and in just a few minutes the doctor looked at the lack of 'float' in my patella and recommended a lateral release. I wanted to be as conservative as possible, and if you've read some of the forums such as kneeguru.com about lateral releases, you find all kinds of horror stories. People that are having difficulty walking after a lateral release. This scared the shit out of me and I was hugely hesitant to go ahead with it, so.
I went through probably 4-5 rounds of PT, some chiropractic, even acupuncture. Nothing helped.
So, for nearly a year I debated. Doctors at Rebound Clinic in Portland, OR, concurred that a lateral release was my best option. In March 2008 I went in for surgery. Normally I am not troubled by such things, but this time my heart rate was high, blood pressure high - I was stressed about the procedure.
Good news/bad news, the lateral release was pretty uneventful. I was on the bike shortly after surgery (stationary and probably 20 rpm) and recovery was pretty quick. There was some relief in my symptoms but even after recovery I found that it was challenging to break into a run across a busy street.
After 30 years of distance running, I realized that I had to put it on the shelf. Since that time I've had dreams of being on the trails, running with my ultra friends, and then losing them, watching them run off without me. Depressing!
After my meniscus repair I decided to do fewer ultrarunning events and to incorporate triathlons. I did do a handful of ultras those years, notably the Zane Grey 50 Mile in 2005. I did Coeur d'Alene Ironman in 2004 and the Canada Ironman in 2005.
The knee felt pretty close to normal although it still did not feel 100% on marathon distance runs.
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:
Note: I am not a doctor, nor do I presume to be in a position to pass on medical advice. I pass along my own experiences to those that may be interested or looking, as I was, for benchmark data from others in order to contribute to a decision on their own situation.
- 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.