The verdict
I can’t say I didn’t expect this, but the worst case scenario has come to pass.
The MRI revealed the following: My left knee cap is tilted due to tightness in the tissues surrounding the knee (specifically the lateral retinaculum). This tilt has caused my kneecap to be misaligned in the groove of my femur, where it should slide smoothly when I bend my knee. Instead of sliding smoothly, the underside of the kneecap grinds across the head of the femur. The condition is known as Lateral Patellar Compression Syndrome. The result of this misalignment is that I have now significent bone marrow edema (bone bruising) on the underside of the kneecap (patella) and the head of the femur. I also have a flap of torn cartilage under my patella where the grinding is occurring. The pressure on the cartilage has also caused some fluid to be released causing a small cyst near my posterior cruciate ligament (PCL). My anterior cruciate ligament (ACL) also appears to be thin, but otherwise intact and normal.
So…where do I go from here?
The bottom line is I really have 4 available courses of action.
The ‘I Give Up’ Approach – Do nothing and stop running…since the pain and condition is aggravated primarily by the stress of running, I could certainly live a pretty full and active life with no further action on my part. However, the wear under my knee cap would more than likely result in some form of arthritic condition of the knee when I get older.
The ‘Pretend Nothing Is Really Wrong’ Approach – Do nothing, but continue to run and use RICE, medication and massage to minimize inflammation and pain. Likely result is eventual breakdown of the cartilage and an earlier onset of arthritis in my knee. A side effect is that knee pain will probably continue to cause some biomechanical adjustments that may lead to other problems.
The ‘Keep My Fingers Crossed’ Approach – Pursue an aggressive regimen of soft-tissue work to loosen the lateral retinaculum and strengthing exercises to attempt to realign the patella. This does not address the cartilage damage already present under the knee. Since the rough surfaces will continue to wear on one another….the likelihood of the development of arthritis is still high.
The ‘Deal With It’ Approach - Arthoscopic surgery. The most extreme option, obviously. The first priority of surgery would be to perform a lateral release (a small incision in the lateral retinaculum) to relieve the tension on that side of the knee and allow the patella to return to a healthier position. Second, chrondoplasty to remove the loose cartilage flap and smooth out the damaged cartilage tissue under the kneecap. Following this, physical therapy to strengthen the knee and insure that the knee cap stays in proper alignment.
My thoughts on the various options.
- Option 1 is not an option. Period.
- Option 2. Ostrich, please remove head from sand.
- Option 3. A half-measure. Only addresses one of the two issues.
- Option 4. Drastic, but the only option that gives me a fighting chance to get my knee working correctly so I can continue to run.
My surgery is scheduled for next Tuesday. This is an outpatient procedure and involves the surgeon going in with 2 small incisions on either side of my knee. The work is done with arthoscope (light and tiny camera) and some small instruments. According to my doctor, I should expect to be on crutches for 2-3 days. I can start swimming as soon as the incisions are healed (within a week) and should be able to ride a stationary bike within 2 weeks. If all goes well, I’ll be running within 4-6 weeks.
I’m pretty nervous about the whole thing, but I am relieved as well. First, I’m glad that all of the discomfort I’m feeling is not in my head. I’m also excited at the prospect of being able to run without the tightness and pain that has just been something I assumed always would be there.
One funny thing is that I’m not sure what to do about training the next few days if I”m going to be laid up for a few weeks after the surgery anyway. Hmm, not sure.
Wish me luck.
Man, arthroscopic has come a LONG way… You will be fine and fixed up in no time. I know lots of people who have had this done. No big deal. Now my reconstruction project on my own knee….that was fun!
I’m really sorry to hear about that, but I will pass along this advice.
“Success is the ability to move from one failure to the next without losing positivity.” – Winston Churchill
Never give up on yourself. See this as an opportunity to grow as an athlete and a person. The process of overcoming this injury will be worth far more to you than any race results the injury may preclude.
Best of luck.
getting scoped is like a rite of passage.
like the flatman said, it’s come a looooong way!
i’m glad you have such a definitive diagnosis, and corrective course of treatment… i was hoping you would say Option 4… actually, i knew it would be 4.
I’ve been scoped twice. TRAIN YOUR BRAINS OUT BEFORE IT! The better conditioned you are when you go under anethesia, the easier you come out, plus you’ll have a fresh memory of wanting to work out. Although in your case, don’t run.
Key during your PT will be ensuring you are given exercises to do, FOR THE REST OF YOUR LIFE, that focus on that strength imbalance around your knee so that things don’t revert to how they were.
I have no ACL in my left knee, and for years I have been religiously doing PT exercises to keep the muscles around that knee (and I do them for my “good” knee, too, just in case) strong and balanced. I may still have to give up running someday, but that’s why I took up triathlon, so I would have 2 other sports that I can probably safely do for many, many years.
You made the right choice. Heal up well, and be thankful you know what the root cause is and can address it.
I think you definitely made the right choice, and the fact that you are getting done so soon is even better. Atheletes bounce back from this stuff all the time. I’am sure you will be ready to rock come next triathlon season.
Good luck!
Wow. I’m sorry. It sounds like you made the right decision. How sure are they that the surgery will help your knee? I’m sure the surgery will go stellar. Try and use the time off to relax a bit and give yourself a break.
Good luck with your surgery. I agree with you on your choice of options. The other choices are not solutions, just postponing the inevitable, or watching things become worse.
I will be looking forward to reading about your recovery out the other end of this temporary setback.
Good luck JP. I think you made the right decision. My season and first race just hit the shelf due to a hip diagnosis. It sucks, but at least this way we get a good shot at rehabbing back to full fitness and function. The longest route, but definitely the best.
well you made the decision best for you. Hopefully you did not have to rearrange you race schedule other than not being able to train. With knee surgery today you should be back to measured non-impact stuff like biking and swimming within a month.
Heck I met a guy last month that was back in the gym with his trainer one week after hip replacement surgery.
Hi JP
I was glad to find you post while searching for data on Lateral Patellar Retinaculum issues. My MRI shows thickening of it, causing my knee to track/catch lateral. I am an active athlete having done 9 Ironmans. I have AZ on the schedule and am freaking out about the prognosis. I haven’t discussed with my ortho the results yet. I am sure surgery to release it is another option. What was your result after surgery? I appreciate any input you may have on this. Thank you.