11 replies to this topic

[Also Ran]

Firstly is degenerative joint disease in the knee the same thing as osteo-arthritis?

I'm a 45 yo male. 185cm currently 85kg. I got a an arthroscopy report dated Feb 2010 which says I've got degenerative joint disease and it describes in some detail the state of the knee. The surgeon at the time told me to stop running, take up cycling & swimming and don't ever get overweight.

My knee aches briefly a couple of times a week but is otherwise pain-free. I recently showed my physio the report and asked about doing some running. I told him I don't want to speed up the degenerative process. After reading the report he said 'don't run' (I believe he'd generally have a pro-running attitude).

So, medical professionals on here, I'm happy to show the full contents of the report but first I'd like to hear in general terms what it would take for you to recommend someone to retire from running due to knee osteo arthritis issues.

[TheRuns]

How about the recommendation from both your orthopod and your physiotherapist? I'm not going to disagree with them as I don't know the inside of your knee. I would think their comments are all the evidence you need to change physical activities.

[NeillS]

Continuing to run will probably accelerate the rate of wear of your knee joint. It will degrade faster than it otherwise would have (probably). Therefore your pain will be more severe, more early. How much is anybody's guess. It may never get any worse than it currently is. It may be terrible in 3 year's time. It is very hard to tell, there are too many factors in play here that we don't fully understand yet. There are no absolutes, no black - and - white here.

Whether or not you continue to run will depend on how much you love running, how much you love your knee and how much you love not being in pain. If you are happy to cycle and swim, do that instead, it will almost certainly last longer than it otherwise would have.

[run2work]

Also Ran, on 17 August 2011 - 10:35 AM, said:

Firstly is degenerative joint disease in the knee the same thing as osteo-arthritis?

I'm a 45 yo male. 185cm currently 85kg. I got a an arthroscopy report dated Feb 2010 which says I've got degenerative joint disease and it describes in some detail the state of the knee. The surgeon at the time told me to stop running, take up cycling & swimming and don't ever get overweight.

My knee aches briefly a couple of times a week but is otherwise pain-free. I recently showed my physio the report and asked about doing some running. I told him I don't want to speed up the degenerative process. After reading the report he said 'don't run' (I believe he'd generally have a pro-running attitude).

So, medical professionals on here, I'm happy to show the full contents of the report but first I'd like to hear in general terms what it would take for you to recommend someone to retire from running due to knee osteo arthritis issues.

can you type out the report here?

r2w

[DrJH]

It's easy to say 'stop running'. It's the safe option. However, any tissue will respond to the load you place on it, even the cartilage in a degenerative joint. Running helps circulate synovial fluid (part of the role of this is to supply nutrients to articular cartilage). It helps maintain proprioception and muscle power around the joint.

There are also many individual factors to take into account. How advanced is the degenerative process? Is it localised to a particular compartment? Do you have any glaring biomechanical abnormalities that may be exacerbating things? Have you injured that joint in the past?

We know running doesn't cause osteoarthritis, but does it make it worse once it is present?

My advice generally to people in this situation is to avoid runs where you get a lot of fatigue, like marathons or other long, tough, rugged events. Try to run on grass. Develop a running action where you're lighter and more on your toes and avoid pounding.

I think some weight bearing exercise is essential. I doubt anyone will be able to tell you exactly what and how much.

Edited by DrJH, 20 August 2011 - 06:37 AM.

[Also Ran]

The history with this knee (left) is ACL reconstruction and part meniscus removal 21 years ago (done arthroscopically).  Further arthroscope done 18 months ago to remove more loose meniscus.

I’ve been wearing a pedometer for the last couple of mths and do 10,000 steps most days.  I’d love to get back to a bit of running.  3 x 5km runs on grass per week would be so much better than 0.  However I’m concerned that if got to that point, in the longer term the running could unknowingly speed up the degeneration even though it’s pain-free.  I guess I was hoping to be pointed to a study indicating how people who have knee osteoarthritis and run pain-free fare in the long term compared to those with knee osteoarthritis that don’t run.

I’ll post up the contents of the surgeon’s report next week.



PS: My r leg has history too…. I got into cycling after last year’s arthroscope & was riding 250-300  ks/week but then a truck swerved into a bike lane & took me down.  Among other injuries, my knee cap on the right knee was fractured and I needed fasciotomies on my r calf due to acute compartment syndrome. Maximum bend on my r knee is 115 deg due to scar tissue around the knee cap.  I can’t ride on roads anymore, too much stress for my wife….  

[Pharmlou]

Hey Also Ran,
sorry to hear about your predicament. You probably won't find a study that will provide you with the answers you are looking for because everyone's knee injury will be different, not to mention the differences in biomechanics of each person (i.e running style, efficiency, weight etc). Most of the studies you will see are anecdotal anyway and will only provide you with the rough guide that your physician and Physio have already provided. You already have early stage osteoarthritis in your knees ( asymptomatic possibly ) in addition to the injuries you have inflicted and it is only a matter of time before the knees get worse. Preserve them for as long as you can. Is swimming that bad?

[JeShannah]

DrJH, on 18 August 2011 - 09:02 PM, said:

ITry to run on grass. Develop a running action where you're lighter and more on your toes and avoid pounding.

Agreed.  The stress that goes through your joints is significantly less when running on a soft surface as opposed to bitumen.  It is one of the reasons that 21km runners who go for speed are absolutely shattered at the end of a race while 50km trail runners (many of them 50+ years old) who go at a more leisurely pace are darn sore but otherwise okay (personal & clinical observation, not based on a specific study).

What was the cause of the left ACL reconstruction?  (I would be surprised if it was running as you do now).  As far as arthritis goes, it is not possible to conclude that  the problem will deteriorate from running alone.  Also, arthritis itself does not always correlate with pain:  decreased movement and susceptibility to injury, yes.  But not always debilitating pain

Do you continue to perform an activity that may accelerate the degeneration?  Or do you modify the nature of the activity so that you can continue?  Or do you throw in the towel?  

Ultimately, the choice is yours.  Are the professionals with whom you have consulted runners?  If so, and if you do want to continue to run without causing damage, I would ask the question, "How can I run without causing further damage?"

Don't despair unless you try and exhaust all options.  And there are always more options.

[Also Ran]

The ACL injury was not from running. It was a jumping/twisting motion playing squash.  After the ACL I played competitive squash for many years with little trouble.


I do do a bit of swimming and currently have a 3 month gym membership.

During my regular walking I might throw in some 1 min jogs on grass & see how that feels.  Is there anything in the report that says absolutely no don’t do this?:

This is what the surgery report says:

Operative diagnosis: Degenerate joint disease, loose chondral fragments left knee

Operation performed: Left knee arthroscopy, partial medial meniscectomy, extensive chondroplasty medial femoral condyle.

Operative findings:

Arthroscopic examination revealed large areas of full thickness chondral loss over virtually most of the weight bearing area of the medial femoral condyle. There were exceptionally loose areas at the posterior margin as depicted on the MRI scan. There was some degenerate extensive tearing of the remaining medial meniscus tissue.

Surgery consisted of removal of chondral loose bodies, extensive further chondroplasty and partial medial meniscectomy surgery.

Intercondylar notch revealed intact graft. Lateral compartment revealed grade 1 change on both sides of the joint as did patellofemoral examination.

In summary: Significant medial compartment degeneration. There was certainly some reversible mechanical features of this arthroscopy which should improve him.

[Colin]

JeShannah, on 22 August 2011 - 05:15 PM, said:

Agreed.  The stress that goes through your joints is significantly less when running on a soft surface as opposed to bitumen.  It is one of the reasons that 21km runners who go for speed are absolutely shattered at the end of a race while 50km trail runners (many of them 50+ years old) who go at a more leisurely pace are darn sore but otherwise okay (personal & clinical observation, not based on a specific study).

That difference is more to do with the speed at which you run than the contact force difference on a shod foot, which is not as big as people believe. Against that slight advantage is the fact that the contact force is 'better spread' on a smooth hard surface.

Also running style/gait etc has a much bigger influence on the amount of G- force at contact. The spread is quite wide amongst runners of similar speed.

cheers

[TheRuns]

Also Ran, on 23 August 2011 - 12:44 PM, said:

In summary: Significant medial compartment degeneration. There was certainly some reversible mechanical features of this arthroscopy which should improve him.

First up, let me declare that I am not an orthopaedic surgeon. I am a doctor, however, and so I can make some (educated) comments about the report you enclosed. What was the remainder of the last line? I'm not sure I understand what "should improve him" means.

Anyway, if I had that report, and I was also told by my surgeon to avoid running, I would do so. The report above indicates extensive damage to your knee, in particular there is a virtual absence of cartilage where it is needed most: on the articular surfaces. To run on this would be akin to driving a car without smooth bearings and the results are obvious. Your surgeon sounds like they debrided the area and removed the parts of cartilage that were floating around and resected part of your meniscus too. The meaning of grade I is difficult to explain without the classification system being used. There is more information here: The Arthritic Knee

I'm sorry to read your report as you obviously want some good news about what you can/can't/should/shouldn't do.

[NeillS]

I would tend to lean towards agreeing with that. This line particularly: "Arthroscopic examination revealed large areas of full thickness chondral loss over virtually most of the weight bearing area of the medial femoral condyle."

is not particularly confidence - inspiring. Full thickness chondral loss means exactly that, TheRuns has got it. There is no cartilage left. Not meniscus, that is already gone. The actual articular cartilage is almost fully gone on the medial condyle. After the cartilage goes, you only have bone left. I wouldn't take the risk of running on that, you will possibly be having knee replacements within 5-10 years with that level of damage.