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Running after chondroplasty
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Running after chondroplasty - December 1, 2007 7:34:00 AM
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JSPT
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I went in a for a meniscus repair about 1 month ago, and the surgeon ended up shaving down 2 tears in the cartilage of the femoral condyles. He said that he did not have to go down to the bone.
I have been a runner for the past 10 years and find myself really missing it. I asked the surgeon, and he gave me the "well, if you have 75,000 miles on your knees, you're down to about 20,000 now, and running will only speed that up" answer.
The research I'm familiar with states that if you have muscle imbalances after injury and then run again, you will break down the cartilage and eventually need a replacement. If I stay strong and only run 10-15 miles/week, is there a chance I can run without accelerating the damage? Is anyone familiar with any studies in this area?
Thanks for any thoughts.
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RE: Running after chondroplasty - December 1, 2007 9:25:04 AM
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SJBird55
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general activity and structural changes: http://www.medscape.com/viewarticle/555018_1
For middle aged and elderly: http://www.medscape.com/viewarticle/551521
I haven't seen any studies post-chondroplasty with regard to running.
You could look at it this way... what you really want to know is the prognosis for your future. If you don't run, what's the likelihood you'll need surgery (for example a TKA) in the future? If you do run, what's the likelihood you'll need surgery (for example a TKA) in the future?
I assume you are younger (in your late 20's to mid 30's), well, you obviously already have issues with your knees and I would highly doubt that those issues are just going to go away because you had surgery. Look at the risk/benefits of running. The main risk with running is that in the future, maybe, potentially sooner than later, you'll require further surgery (and no one really knows). Look at ALL the benefits of running and higher level activities. Running is healthy and running has so many positive effects across a large spectrum of variables: cardiac, cancer, stress reduction, maintenance of weight... So, if you give up running what happens to the big picture future for yourself?
Obviously, there are other alternatives for running... it is highly unlikely that you'd stick with them because you obviously enjoy running. The APTA has the "couch potato" exercises... just kidding. What I would do instead is focus on the healing process after a chondroplasty. If I recall Mike Reinhold and probably Kevin Wilks and maybe Steve George would have some work or articles in that area. Know the healing process and focus on the activities recommended by those guys within the time frames they recommend. Their work may not be the best in regard to randomized controlled trials, but I highly doubt that you're going to find that kind of level of evidence for rehab at this point in time anyways. If I were in your shoes and I wanted to run, I'd make darn sure that that a good healing process was allowed to happen and scarring occurred. I'd also do as you mentioned and make sure you are engaged in a strength training program and at some point it would probably turn into a maintenance program, but definitely, that should be part of your life.
After whatever time period that it is deemed the cartilage and tissues are healed, then I'd begin to ramp up into the running stage. There are things you can control that would probably help out your situation: shoes, control pronation, running surface, distance. Most of all, use common sense.
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RE: Running after chondroplasty - December 1, 2007 12:52:18 PM
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jlharris
Posts: 478
Joined: April 12, 2006
From: Nebraska
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Felson DT, Niu J, Clancy M, Sack B, Aliabadi P, Zhang Y. Effect of recreational physical activities on the development of knee osteoarthritis in older adults of different weights: the Framingham Study. Arthritis Rheum. 2007 Feb 15;57(1):6-12.
The above study was commented on by the authors at Advanced Physical Theray Education. The conclude:
quote:
This noteworthy study involved 1,279 subjects, over a 9-year period! Their aim was demonstrate the effects of recreational exercise such as walking, jogging, cycling, aerobics etc. on the development of knee OA in older, overweight or obese adults.
In a Nutshell: After adjusting for age, sex, body mass index (BMI), they concluded that recreational walking, jogging, frequent working up a sweat, were NOT associated with a decrease or increase in risk of OA progression.
Clinical Relevance: Considering the unquestionable benefits of exercise especially for obese individuals, it would be justifiable if we told our patients, "Studies show that exercises will not increase the progression of your knee OA!" Re-assure them!
You're are not an obese adult, but it may allows us to question the belief continued weightbearing exercise will accelerate knee OA.
_____________________________
Jason L. Harris, PT, DPT
My PT Blog
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RE: Running after chondroplasty - December 1, 2007 2:26:48 PM
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jma
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Interesting article. Agree with the posts above
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RE: Running after chondroplasty - December 1, 2007 8:43:54 PM
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JSPT
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From: Michigan
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Thanks for the response; I appreciate the time you all took to respond. SJ, I agree with what you said, but I know the jury is really mixed. As you correctly stated, I COULD row, bike, elliptical, etc., but none of those really "do it" for me.
It would be nice if I knew how the chondral lesions got there in the first place, but I don't think they were caused by running. I think my happy medium will be to run a few miles 1-2 times/week and do other stuff the rest of my workouts. I'll look up the articles cited and read about the healing time, etc.
Again, I appreciate the input.
< Message edited by JSPT -- December 1, 2007 8:47:37 PM >
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RE: Running after chondroplasty - December 3, 2007 11:49:46 AM
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Bournephysio
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Did they repair the meniscus or remove some of it? The healing time takes a while for a repaired meniscus. The meniscus is very important for protecting cartilage. Even more than just increasing surface area and cushioning.
The cartilage on the femoral condyle will not heal. You have lost at least the superficial zone of the cartilage and likely the middle as well and are likely down to the deep zone. Its ability to respond to loading will be decreased.
It is fairly clear in the basic science literature that too much loading will accelerate OA changes but intermittent loading is very important for the health of cartilage. Unfortunately we do not know how much is too much clinically. I would suggest that the level that you were running before was likely too much for you. The study Jason quoted was about OA risk not progression (at least according to the abstract). Cartilage is a very robust tissue until it starts to deteriorate.
Was cartilage shaved from both condyles or just one? have you injured your knee before? Do you have any of the signs of benign hypermobility syndrome? do you have a family history of knee OA?
Doug
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RE: Running after chondroplasty - December 3, 2007 1:23:23 PM
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JSPT
Posts: 289
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From: Michigan
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The surgery was for a small tear of the inner rim of the R medial meniscus, which was removed.
Was cartilage shaved from both condyles or just one? There was a 1x1 cm lesion of the lateral tibial plateau and a 1x2 cm lesion of the medial femoral condyle. Both of these were shaved down, but did not reach the bone.
Have you injured your knee before? No.
Do you have any of the signs of benign hypermobility syndrome? Yes. Uninvolved ROM is 10 degrees of hyperextension to 145. Involved was the same pre-injury.
Do you have a family history of knee OA? My dad had a similar surgery when he was 28, which is my age. He currently has some mild OA both knees.
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RE: Running after chondroplasty - December 5, 2007 7:00:51 AM
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SJBird55
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From: Michigan
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JSPT... snag the October 2006 JOSPT. Everything you probably ever wanted to known about chondral lesions.
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