Another Worn Meniscus

Hi,

I have been running for around 10 years or so, now 42, and in the last year following a lot of constant pain in my knees I was diagnosed by a consultant at the Bristol Sports Injury Clinic with worn meniscus in both knees.  They suggested that my running days were over and that I should take up a new method of keeping fit.

In the last 6 months I have stopped running totally and have been going to the gym throwing around a few weights and doing a bit of light work on the cross trainer.  Not only is this tedious, boring and quite frankly depressing the blinking knee pain is still there!  Grrrr.

Are there any runners out there that have managed this condition and continued some form of running?  I would be happy just going out once a week for a 10km Sunday morning plod, but I really can't do with any more pain.  Any thoughts or comments are most welcome.

Paul.

Hello Paul

I am not too sure what the difference is between a worn meniscus and a torn meniscus. 

I am 50 and have been running for just over 7 years.  But last April I had arthroscopy to repair a torn meniscus to my left knee.  I had a lot of trouble with this knee prior to tearing it.  And probably think that it was torn for quite a while.  But of course, I did not want to stop running so just carried on.  But only to make the tear worse.  In my case it was to make the tear larger.  So eventually I went along to my doctors and she referred to see a private consultant as I am insured with BUPA.  He was also a keen runner and advised me to go ahead and have surgery.  If I wanted to carry on running.  So I took his advice and this is just what I did. 

I had an MRI scan so  he could see how bad the tear was.  I had day surgery which was no problem at all.  Within 6 weeks of sugery I was running again.  I would not know that I have now had this done. 

It really is a miracle.    So I have gone from not being able to run at all.  To now running around 20 to 30 miles a week.

Arthroscopy is extremely successful.  Maybe go along to see your doctor and he or she can have you referred.

 Good Luck.

Good Evening Cat2661,

Thanks very much for the reply. 

Yes I was also lucky enough to be able to use my company BUPA policy to get referred to the consultant at the Bristol Clinic.  I had a MRI scan and then they gave me the diagnosis of a worn or age related degenerative meniscus cartilage.  They suggested that a conservative approach would be the most appropriate course of treatment at this stage and that was no running or any other activity that aggravated the condition.  Unfortunately even with the cessation of running they appear to be aggravated most the time and perhaps it is time to get a second opinion to see if anything can be done.

Regards,

Paul

Hi Cat and Paul,

Interested to hear both your stories, very relevant to my current problem.  I haven't run since the end of July -GRR.  Its my left knee.  My physio, who I paid for privately to find out what my problem was, is convinced that I have worn/torn miniscus damage, and urged me to ask my GP for a referral to othopeadics (NHS - I have no private medical insurance unfortunately).

 My GP was very good, and referred me on 4 August, and I have an appointment for the 'knee clinic' on 20 October, this is the usual waiting time! 

 I am unsure - but expect - as this will be the first appointment there, I am unlikely to get a diagnosis, but I do hope he will refer me for an MRI, as that is the only way they will know for sure.  I will be totally gutted he just says its wear and tear and stop runnine.  I might be in my early 50s but far too young to give up my running and triathlon career!

 CAt - I am hoping, in a funny way, that they do think I need an op.  Paul, I would be gutted if I got the same response as you!  I would ask for a second opinion, especially as you have private insurance.

 Good luck....LL

Paul,

I work at the Sport and Orthopaedic Clinic in Bristol (different form the description you give above). If it was here you saw a Consultant (I know it was not me) I would be happy to provide a second opinion regarding your cause of knee pain. If it has persisted and it is interfering with your running and the meniscus is not torn then in my experience something can be done to improve your symptoms. Most importantly to get you running again.

My standard for providing a second opinion is to take a full history, examine your knees and hips make a working diagnosis as to the cause of the pain.  Compare your symptoms and signs with available special investigations and recommend further investigations if necessary. I explain the cause of the symptoms and the options, prognosis of each and the evidence for treatments available.

Best not to name names by the way.

John Hardy

Good Afternoon John,

Thank you for replying and giving a suggested course of action.  A second opinion I believe would be very useful in trying to get to the bottom of the pain that I am experiencing.  I will start the ball rolling my end and will get myself referred to you, hopefully in near future.

Best Regards,

Paul

Fellow knee sufferers...not sure how you have got on with your recent referrals?

 I had my orthopaedics appointment last week, and they x-rayed my knee.  The Registrar went over the xrays with me, and said I have osteoarthritis, this was clear (to him) because of bone spurs on the x-ray, so can't argue with that :0(.  Although it wasn't good news, I was impressed that they actually x-rayed it there and then and were able to provide a pretty unequivocal diagnosis, and I didn't have to wait another 12 weeks for that!

 I was hoping I had something that was fixable, but as it stands, I will have to wait until I'm 75 to get a new knee, as its not bad enough, and NHS can't do anything about it.  So, that's twenty odd years away....

The suggestion from him was that I 'modify' my activity.....so I guess I will just need to manage the symptoms and see how I get on.  I don't know much if anything about this disease, so will have to do a bit of research...but hopefully I can still run to a certain extent.....may have to rule out another Ironman though!

LL

Lindie,

It is rare I offer advice to an individual but here goes.  First do not accept the results of a a registrar and an x-ray alone. Second, in the modern NHS you may not be talking to a registrar at all.  Third the reason for the osteoarthritis is not explained by a bone spur. Bone spurs, if that is what is was, are not a sign of osteoarthritis. Osteophytes on the other hand are just one of the four features of osteoarthritis:

1. Joint space narrowing
2. Osteophytes
3. Subchondral sclerosis
4. Subchondral Cysts

Without these you have not got osteoarthritis.

You may have degenerate change. What any patient wants to know is:

1. What is causing the degenerate change?
2. What can be done to stop it progressing or reverse it?

The commonests thing I see that cause degenerate changes leading to osteoarthritis of the knee are:

1. Meniscal tears
2. Hoffa's posterior fat pad impingement
3. Plica syndrome
4. Loose bodies
5. Trauma

Four out of 5 of these things can be corrected. Therefore, go back to the consultant and ask the 2 questions above. You have the right to see the consultant in Orthopaedics and Trauma. Do not accept anyone less on this occasion. To roll over and accept osteoarthritis is not acceptable.

Hope this stirs things up a bit.

 John Hardy

Let us know how you get on.

Hi John,

 Many thanks for your response, all I can say is I felt all along that it all seemed a bit too final, too soon.  I need more answers, as you rightly say.  I am not sure how to go about it to be honest, just ring them up?  Do I need to go back to my GP?

 I do feel more strongly now,  that I may have been fobbed off - he didn't quite tell me to take up knitting instead but he might as well have!

 Watch this space....I will report back!

 Thanks for taking the time to respond.

Lindie

Well, I emailed the consultant, and he has said he will see me, so just waiting for an appointment now. At least I will get an other chance to discuss it in more detail, and raise questions...

LL

Good Morning Everyone,

Just a quick update on this post.   Went to see John Hardy at the Bristol Sport and Orthopaedic Clinic, he had a thorough examination of my knees and we had a long discussion about my symptoms etc.  I was very impressed.  Looking at my last MRI scans John could tell that picked up something called Plica Syndrome (a tear of the ligamentum mucosum )and that arthroscopy of both knees and partial excision Plica could help.  That was great news, a diagnosis and a potential treatment, a really positive outcome!

Unfortunately while discussing the treatment with my insurers they were unable to provide the funds to meet the the full costs of the treatment to get it done right away.  Hey ho, so I believe I am on the wating list for the procedure, but I'm feeling positive that someday soon I may be able to get out for a little plod again.

Cheers

 PK

Good Afternoon Everyone,

This is a short post to give you a progress update with my knee problems.

Well, I have been very fortunate enough to be able to go ahead with the arthroscopy operation, which was completed on both knees last Tuesday.  It would appear I was suffering from plica syndrome and Hoffa's syndrome (fat pad impingement).

All went well, the hospital staff, anesthetist and the John Hardy were great.  I am currently recovering at home and of course following the physio's exercise regime to the letter!    After a two days with my feet up I am now walking around (tentatively).

After six weeks I will post another update on the results.

PK

Hello Paul

I wish you a real speedy recovery,  Keep us all informed of your progress.  And try to be patient.  I know how difficult it is.   But if you do try to to do too much to soon.  It can really set you back.

Take care

Hey  Cat2661,

I hope all is going well with you.

Thanks for the advice.   I certainly will not be doing too much and luckily enough my job involves sitting at a desk so not too much strain on my knees.  I can be patient if I put my mind to it!  I am currently lying on the sofa with my feet up drinking a cup of tea while watching Ray Mears eating woodland fauna

Have a great Christmas and New Year.

Regards,

 PK

Hello again Paul

Everything is fine with my knee now.  I would not know that I ever had the op.  I have had no more problems with knee at all. 

I know that arthroscopy is is extremely successful.   It just takes a little to time to get back to normal.  It's all worth it in the end.

You too have a lovely Christmas and a Happy New year.

Best wishes

Jackie

> doing a bit of light work on the cross trainer

For what it's worth, I find the x-trainer harder on my knees than running! I do hope your medical consultants realise you use it. 

This is probably totally unhelpful, but I read a few weeks back that the anti-gravity treadmill (Google it if you don't know it) had come down in price to an "affordable" £27K. I believe these can be used with certain knee injuries. That's *if* you know of a gym with one, or have 27K down the back of the sofa.

Best of luck to all of you.

Paul, pleased to hear your op went well, wishing you a speedy recovery! 

Just a quick update.....I finally got to see the consultant!   He said that although he agrees the original diagnosis - ie. osteoarthritis, he wants to be able to rule out any other issues, so is referring me for an MRI scan.  He also said he has a few things he can try regarding the Baker's cyst, and talked about injections etc.  I do feel it was well worth pursuing, so at least I will feel I have explored every avenue.  So thanks to John for suggesting I follow it up!

Not sure how long I will have to wait for the scan, will let you know the outcome of that.

 LL

Lindie Loo,

I was pleased to hear you went back and have got an MRI in the future to look and see what is causing your osteoarthritis.  Considering the following cause degenerate change and then osteoarthritis in the knee it is important to exclude these and deal with each rather than let the degenerate changes to progress:

1. Unstable meniscal tear
2. Hoffa's posterior fat pad impingement syndrome
3. Osteochondritis dessicans (caused by 2 above)
4. Plica syndrome
5. Torn plica
6. Loose bodies
7. Traumatic chondral injury
8. Partial or full ACl tear
9. A host of other rarer conditions

Do not let your Consultant in Orthopaedics and Trauma fob you off with an MRI report only. These are written by a radiologist looking at the scan in isolation. You consultant has the oppertunity to check you symptoms against the MRI images that should now be available to him/her at the time of consultation. Ask him to show you the scan and explain why he thinks you are developing degenerate change. If you get short time then look for a Consultant with the time to deal with you properly.

Also, in the NHS look out for the "Extended Scope Practitioner". This is not a trained doctor or specialist and the advice you get will not be up to the standard of a trained O&T consultant.

Best of luck for Christmas to all and Happy running in the New Year.

While it is icy dry and cold do not forget:

1. Hydrate before running to protect the knees.
2. Do not run on icy paths. (stick to the grass).
3. Wear shoes with a good tread ( ask Santa for some new shoes if necessary or get to the sales before the 4th Jan).

Hope this helps.

John Hardy

Thanks John for the helpful advice regarding my MRI scan and follow up consultation.

Happy christmas to everyone too!

LL