Tweaked my knee at my kid's soccer practice a few weeks ago, and the pain wasn't getting better. A couple doctor visits resulted in an MRI and the following report:

MRI KNEE RIGHT WO CONTRAST
Results
Result Impression

1. No discrete meniscal tear.
2. No acute ligament sprain. Old injury to the medial collateral ligament with thickening. Mild degeneration of the anterior cruciate ligament. No acute contusion or fracture.
3. There is moderate areas of grade 3/4 cartilage fissuring with delamination centered in the median ridge of the patella but mildly extending into the medial and lateral facet with moderate subchondral edema and cystic change. Small area of garde 3/4 cartilage fissuring with subchondral edema and cystic change in the inferior aspect of the lateral facet of the patella. Mild fraying in the trochlea. Small area of grade 3/4 cartilage fissuring with subchondral edema in the posterior aspect of the lateral tibial plateau. Mild grade 1/2 chondrosis elsewhere.
4. Small joint effusion. Tiny Baker's cyst. Mild subcutaneous edema.
5. Mild extensor tendinosis with low-grade interstitial tearing. Mild lateral patellar subluxation and tilting. Minimal edema in the superolateral Hoffa's fat suggesting minimal impingement.


So it basically sounds like I'll never be a runner again. What I really don't understand is this issue seems recent, and I've only been on a Peloton for the past few years. Pretty shocking result, as I figured at worst it would be getting a meniscus cleaned up. I'm 41 with two young and very active kids, and I'm having a hard time coming to grips with the idea of arthritis. A PT several years ago diagnosed me with patellar tendinosis in the same knee, and now I'm wondering if that misalignment was more significant than I thought.

Doc recommended the gel injections to manage the pain, but said I'd be looking at knee replacement within a few years if I try to run at all.

So a couple questions, all opinions welcome.
1. Is the doc being overly conservative, or is this a pretty significant diagnosis? I assume some of the jargon in there is pretty common at my age anyway
2. What would you do? I've already gotten in the list for a new Peloton fit to make sure I'm still well aligned.
3. What sort of PT can or would help in this?
4. Am I generally screwed?

Avoid steroids in your knees. I think a trial of something like Synvisc is reasonable. Would also look into PRP injections. Not sure what the data currently shows, but last I checked it seemed pretty promising. I think some people are doing something newer called platelet rich fibrin. These have high concentrations of growth factors that may help your body repair things in ways it wouldn't be able to do by itself.

Either way, do whatever you can to avoid having a knee replacement for at least another 15-20 years. Switch to swimming, minimize your running to just occasionally playing with the kids, whatever.

Might be worth seeing a non-operative sports medicine doc or physiatrist.

Who did you see? This isn't nothing but it isn't you will need a knee replacement in a few years if you keep running.

aggiederelict said:

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Who did you see? This isn't nothing but it isn't you will need a knee replacement in a few years if you keep running.

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Thanks y'all, just exploring all options right now.

I saw Steve Morgan at Total Orthopedic Sports and Spine in Allen on recommendation from a friend.

Any harm in getting the Hyaluronan injection to just manage the pain while I look into getting mechanics in order and resetting the plan? Some days it's really bad, and I'm starting a log for pain level, daily activities, shoes worn, etc. My hesitation would be losing the pain as feedback for any mechanical adjustments or PT work.

Also I'm very open to seeking a second opinion if anyone has a referral in the North Dallas area

Go see Paschal at Texas Orthopedic Associates for a second opinion. He has worked on my right knee and my dad's shoulder.

https://www.txorthopaedic.com/provider/scott-o-paschal-md/

Get a second opinion.

I learned a fair bit about knees with my ACL/Meniscus blowout. Definitely find a good PT that works with athletes or fitness types. Might try switching to more cycling or rowing for cardio to reduce knee impact.

90% of that was already there. Sounds like you have a little swelling in the joint that may be where the discomfort is coming from.
Step 1: get a second opinion
Step 2: if you have 5-10lbs (or more?) to loose I would make that a priority. The single best way to decrease the force on your knees is to literally decrease the amount of weight they handle each step.

Hey there. I'm a PT and I've seen many knee MRIs. Honestly the grade 3/4 cartilage fissures are the main thing. Your report is otherwise not that bad. Also, it's hard to read a report and know how bad the size of the areas of concern are. I would put knee replacement off the table due to your age unless it's really bad. I would consider other conservative measures such as PT, PRP, synvisc, etc. I would also consider a second opinion if the ortho is not recommending some of these conservative options. Are you in Fort Worth by chance?

Edit to add. I didn't see your other post. I don't know docs in North Dallas unfortunately. Yes I would consider the injection.

Thanks all. I appreciate the feedback, still looking for a more conservative doc in my area. I also have the MRI scan on a CD if anyone is willing to take a look.

Also a good point about losing weight. I'm 5'9" and usually hover between 160-165. Not huge, but getting safely under 160 would probably go a long way. I'm almost done eating my feelings after the results.

No more stouffer's lasagna buddy!

I know our situations are different but in 2020 I wasn't sure I'd be able to run again. Alot of PT and a mobility program got me back on track. I still have pain from time to time, but its manageable.

You went deep into the Wayback Machine with that one.


I appreciate the encouragement. Truthfully, I've done enough cool stuff and had enough adventures that I don't need another shot at an Ironman, though doing one where I'm not pooping my pants the entire run would be nice. God's given me an awesome life so far, and all I really want is to enjoy the rest of it with my kids and be reasonably fit and healthy along the way.

I know several people that go to Kashal Patel from orthopedic specialist of Dallas in Wylie. They also have a PT business next door. I haven't gotten surgery from him but know several various age athletes that have.

I thought you were going to say no more unplanned and untrained 100 mile or whatever kayak races

That is an epic story that will live in infamy!

Which is shocking after all that paddling. Patel just got done with one of our bjj professors knees that has been giving him issues for years. Quick scope and back on the mats teaching in 2 weeks

Chris Miller at Legacy Orthopedics & Sports Medicine (on 121 in Allen). He did my ACL reconstruction in 2018. I don't know how conservative he is, as I had no choice but to have surgery. But he's an avid runner and I think he would listen to you and understand your concerns.

Fwiw, 5'9" 160 isn't overweight. It's in the good BMI range. Losing 5 more might be fairly difficult unless you have a slight build already.

Deadlifts. Seriously.

I've torn both of my ACLs and deadlifts have always felt as if they provided relief to my knee pain. Squats not so much.

Turns out, it wasn't all in my head.

High intensity resistance training as intervention method to knee osteoarthritis

I really like single-leg deadlifts as well.

I have to be judicious with the amount of trail running that I do but last season I was good up to about 21k.

The main takeaway of this thread is you have regular PT and surgeons who will get you back to normal and tell you that you will never run again and be thankful for what you have. Those surgeons will probably have 3-4 surgerys scheduled that day and will be forced to do the bare minium allowed to get you back to normal.

Then you have specialized sports PT and surgeons who's goal is to get you back to the exact shape you were before the injury.

Go to the sports group. So many ways to get you back to your fighting shape.

Good news / Bad news time

Good News

- Got my peloton refit in Friday and it's a massive improvement. I was in a very aggressive position that put a lot of strain on my knees. Sacrificing power for comfort, but I'll take it. I did a ride and felt way better than I have in a long time.

Bad News
- I had a DEXA Scan today, and the results were just this side of humiliating. I've never been one for strength training, but it appears it's no longer optional. I really need to clean up my diet and do more than justthe bike a few times a week.



I still haven't gotten the injection, as I want to do some PT work on my own without any feedback being masked.

Appreciate all the insight on this thread. I agree with the above that picking a reasonable course of treatment versus throwing injections or surgery at it is the smartest way to go long term.

I'm gonna jump in on this thread and post my MRI results and maybe some of you smarter folks or PT's could help me out here

Quote:

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COMPARISON: None.

TECHNIQUE: Routine MRI of the left knee was performed without contrast.

FINDINGS:

MEDIAL COMPARTMENT: Focal 2.0 x 0.5 cm full-thickness cartilage defect along the posterior weightbearing surface of the medial femoral condyle. No underlying subchondral edema. The medial meniscus is normal without evidence of tear.

LATERAL COMPARTMENT: Small zone of high-grade and full thickness cartilage fissuring along the posterior aspect of the tibial plateau without underlying subchondral edema. The lateral meniscus is normal without evidence of tear.

PATELLOFEMORAL JOINT: Full-thickness cartilage fissure at the patellar apex with trace underlying subchondral edema. Small joint effusion and popliteal cyst. No osteocartilaginous bodies are identified.

LIGAMENTS AND TENDONS: The anterior and posterior cruciate ligaments, medial collateral ligament, iliotibial band, fibular collateral ligament and biceps femoris tendons are intact. The popliteus muscle and tendons are normal. There is no evidence of injury to the posterolateral corner supporting structures.

EXTENSOR MECHANISM: The quadriceps and patellar tendons are normal. The medial retinaculum, medial patellofemoral ligament, and lateral retinaculum are normal.

MARROW AND SOFT TISSUES: There is no abnormal signal or evidence of soft tissue mass.

IMPRESSION:
1. 2.0 x 0.5 cm area of full-thickness cartilage loss along the posterior weightbearing surface of the medial femoral condyle.
2. Mild chondromalacia in the lateral and patellofemoral compartment.
3. Small joint effusion and popliteal cyst.
4. Intact ligaments and menisci.

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What I interpret here is you are bordering on arthritis due to cartilage wear. Time to take up more swimming and cycling and paddle sports and less running/jumping?

I can't swim for crap

I love mountain/gravel biking

Tennis no, pickleball sure

I still love volleyball (actually doesn't bother me too much)

Golf will be fine

Paddle as in paddle boarding or kayaking.

I do have a Concept2 at home