Training & Nutrition - knee surgery woes

Been putting it off for months but there's no putting it off any longer. I have a torn meniscus (cartilege) in my right knee. The doc told me early in the spring that if I strengthened the supporting ligaments and muscles, I may be able to postpone the surgery to repair or remove it. He recommended a stationary bike and I said no to the stationary part and yes to the bike.

The past few days I've been experiencing painful locking episodes while on the upstroke of my pedal. They're becoming more frequent. Today I didn't even make it down the block before it locked up and I was riding on the middle chainring, low gear. I'm throwing in the towel and I made the call to schedule the surgery. Recovery is around 3 weeks for normal activities and 6 weeks for recreational sports. Would riding 30 miles fall into that category? I'm looking at probably at least 7 weeks from today before I can get back on the bike. What will I do between now and then? My first charity ride was supposed to be this Sunday too. This sucks.

I would consider light to moderate weight training to strenghten these areas before I would consider surgery.Squats,leg presses,leg extensions,lunges etc.

You may already know all about this procedure, but I'll shoot you some information just in case. I had surgery on 4/5/02 to REPAIR a torn medial meniscus in my right leg. I am now an expert on the physiology of the knee! Here are a few thoughts that I hope will make you @ least more educated regarding this surgery.

REPAIR vs. PARTIAL MENISECTOMY

There is a blood supply in the menisco-capsular junction of the meniscus. The menisco-capsular junction is in the outer 1/3 or so periphery of the meniscus, which is also called the red zone. Capillaries feed the blood supply in this red zone. Luckily, my tear was a peripheral menisco-capsular tear that was longitudinal and smaller than 3cm. This is some of the criteria for doing a repair as opposed to a partial menisectomy. The doctor also considers the patients age and future athletic needs. He also considers whether or not this is a degenerative tear, or an acute tear. Degenerative tears do not meet the criteria for this surgery – even if they are in the right area, as they do not heal well. Only about 10-20% of patients qualify for a repair.

Repairing menisci gives the patient a better long-terms outcome, as the patient is able to keep 100% of the cartilage. This allows the shock-absorbing capacity of the menisci to do their job in terms of spreading out the cushion over the entire meniscus. Also, keeping the entire meniscus lessons the chance of degenerative arthritis as the articular cartilage of the femur and the tibia continues to have the meniscular cartilage buffer – so it (the articular cartilage) doesn’t rub together.

Of course, this all comes @ a price – that price is a much longer recovery period. If all goes well, a REPAIR will land you on crutches for 4 weeks, and you won’t be able to resume full athletic activities for about 6 months. You'll also be cranking out some serious PT for about a month.

The only ugly potential downside (other than the extended recovery) in terms of a repair vs. a partial removal is that there is a chance that the repair will not work. In that case you'll need another operation – either another repair or a partial menisectomy. The failure rate of the initial repair varies depending on whom you believe. However, it’s generally thought that the success rate is about 80%.

I’m about 3 months into by rehab now and all is well. However, I’m just now beginning to ride my bike on the road. I won’t be able to mountain bike until October – argh. I’ve been swimming laps for the past 2 ½ months, and this has truly been the magic pill in terms of getting the knee back into shape.

Anywho – sorry for the GIANT reply, and good luck!! :D

4 weeks on crutches, 6 months before resuming full steam?? WHAT???

I had this same surgery on my left knee a couple years ago. I don't think it was a repair because I was off crutches after a week or so and back to full activities in about a month. But full activities back then wasn't riding a bike or doing anything athletic. Thank you for the education. I really had no idea. All I was told was that the doctor basically goes in and cleans up and smooths out any ragged or torn edges. The tear I have is a horizontal one and the MRI didn't specify how big. This really is a last resort. Cycling and swimming were considered the best and really the only exercise recommended since weight bearing tended to tear up the meniscus even more.

Hope you're up and back on the road very soon and thanks for the info.

There is also pain in my knees nowadays when I'm climbing the stairs.

Anyone wants to help me out by telling me what to do? I don't get problems like locking, but it just hurts when I am walking up the stairs. Please help! THANKS!

Hi

I too have knee problems (pain up stairs etc.) and have seen some physiotherapist type person.

Summary is I have overuse and unbalanced leg muscles from cycling leading to tendon trouble. The recommended initial treatment is stretching and various exercises to strengthen less-used muscles, especially straight-leg type exercises that don't bend the knee. I was told to avoid leg extensions and squats as they stress the knee too much.

Here are a coulple of links to start with, there's loads of stuff out there
http://www.kneeguru.co.uk/index.html

http://www.physsportsmed.com/issues/1996/05_96/jensen.htm

Knees bear more stress than just about any other joint in the body so it's no surprise that they are the first joints to show signs of wear. My knees have given me a terrible time and the surgeon tells me I'm a candidate for replacement in the future. Argh!!

Wouldn't you know, it's a gorgeous morning. The first gorgeous morning we've had in something like two weeks and I'm stuck inside weaving a tapestry when I'd rather be sweating my buns off in the saddle or running on the beach and swimming with my two year old grand daughter. Best get used to it for a while and pull out the sewing machines. At least I have my needlework and sewing to get me through this.

Knee pain is pretty common and might not be a big deal unless you're an athlete or serious recreational weekend warrior in which case, you'd want to get your knees checked out at the first sign of trouble by an orthopedist who understands you depend on your knees more than Joe Blow the couch potato. Sometimes people take these problems into their own hands and wind up with overuse injuries making the problem worse.

Squats and even leg ext won't stress the knee if you avoid locking out at full ext and focus on the middle 2/3 of the range of motion.Of course start light or no weight and gradually work up and learn how to do the exercize correctly. Strengthening the supporting muscles,tendons etc is the key to avoiding imbalances that cause knee problems and I also find long bike rides tend to somewhat stree my knees.oceanrider I suggest you start such a program once healed and cleared to avoid future problems.

Originally posted by oceanrider
Thank you for the education. I really had no idea. All I was told was that the doctor basically goes in and cleans up and smooths out any ragged or torn edges.

Yup, that's what my surgeon told me prior to my surgery also. However, after getting a better look with the scope, he decided to do a repair. It came as a BIG shock to learn of the change of plans as I came out of anesthesia!

It doesn't sound as if you'll be a candidate for a repair. However, you may want to @ least discuss this with your doc prior to your surgery.

Good luck!! :D

Originally posted by oxologic
There is also pain in my knees nowadays when I'm climbing the stairs.

Anyone wants to help me out by telling me what to do? I don't get problems like locking, but it just hurts when I am walking up the stairs. Please help! THANKS!

I hate to say it, but you had better see your doc on this one. The knee is a very complicated joint - a whole lot of stuff can go wrong causing a myriad of symptoms. You can do some research on the web also - that's what I did prior to my visit with the doc. It really helps to be an educated patient.

Good luck!

Thanks for the websites BAC. And Carl, you're right about strengthening. Thanks for the concern. The surgery is scheduled for Wed next week and the medical assistant told me I'd be back on my bike in a couple of weeks. I think she's being a bit optimistic. If I heal like last time, I give it a month before I'm doing anything beyond around the block.

From my wife's recent ather bad experiences with meniscus repair, pre-physical therapy to prapare the body and subsequent post physical therapy are absolutely essential, especially in a more mature person.

Most ortho's are pretty uninformed about physical therapy, generally run a knee surgery mill, and son't really want to see any of the problems associated with the negative side of their surgery. Get them in, operate, out the door, goodbye - Wham, Bam, Thank you maam.

Because of lack of PT, her knee problem developed into a severe back problem (SI joint pain) which knocked her out for almost a year. She is only now about 90% recovered. Took a tear of excellent PT (the first rwo therpaists did exactly the wrong thing) coordinated by a Physiatrist (physical medicine specialist) and, for the crap associated with the intense pain, a psychologist.

All avoidable with proper pre physical therapy and post therapy. We caught ours too late.

I would spend your time off the bike doing a whole body weight routine including unilateral leg movements to strenghten the other leg.I am not a trainer or physical therapist but I can refer you to a yahoogroup on weight training where you can search the archives or ask questions of such qualified individuals.One indivdual in particular is very good at answering these types of questions and could tell you what to look for in a psy. therapist in your area.I agree totally with DnvrFox that you should take the rehab /thrrapy into your own hands and realize the surgean views your knees as a profit center.

Be very wary of removing the mensicus, go for the repair!!! Get a second opinion. I lost my meniscus a long time ago, and I've regretted it ever since.

Ride Whole
Pat

I don't think it can be repaired. The left knee was scoped and the same thing was done around 3 years back. There have been minor problems since the surgery and this year it even filled up with fluid when I began favoring it because of the problem with the right knee. I assume the same procedure is going to be done here. I know there is condromalacia and some arthritis too. That's what was found in the other knee. Overall I'm satisfied so far with the results on the left knee though it's not perfect by any means. I'm going to be better about rehabbing this time. Last time I think I got lucky.

DnvrFox, your wife sure had a rough time. I've never heard of such a nightmarish result from arthroscopic surgery. Glad she's up and around and back in the saddle and thanks for the warning and advice. I know my surgeon's office runs like a mill and I wouldn't trust him for PT advice.

If you're having locking episodes you probably have what's called a "bucket handle" tear. That's a flap of meniscus that flips up and down with movement. When it flips up and gets caught, that's when your knee locks. Getting it fixed (either repaired or removed depending on the size and location of the flap) early rather than later is better. The longer you wait, the larger the flap becomes, the harder it is to fix.

Well, it's done. I had the surgery on Wednesday... 4 days ago. The doc said I have a 3 out of 4 arthritis and I'll have to be careful not to bring my knee up too high on the pedal upstroke. There was a lot of debris in there from the degenerating cartilage. Anyway, I miss the bike. Maybe in about a week I can start on a wind trainer.

Glad to hear the surgery went OK.How long is it going to put you out of action for?

Originally posted by oceanrider
Well, it's done. I had the surgery on Wednesday... 4 days ago. The doc said I have a 3 out of 4 arthritis and I'll have to be careful not to bring my knee up too high on the pedal upstroke. There was a lot of debris in there from the degenerating cartilage. Anyway, I miss the bike. Maybe in about a week I can start on a wind trainer.

Good luck on the recovery!!! :D

Thanks for the good wishes everyone. It's been 5 days and I'm still in recovery mode. There were several problems the surgeon found once he got in there. One of them is a degenerative condition that produces crystal rods that form in the joint and get in the way. It also saps substance from the cartilage. It's usually found in the elderly but lucky me. I'm just asking when can I get back on the bike. They're just sitting there patiently waiting for us to get out and have a good time again. The camelbak is also very thirsty. The doc and I will discuss therapy on Thursday. For now I'm still laying in bed most of the time watching the idiot box. Not enough cycling on tv.

A couple weeks ago my wife went to LBS for fitting adjustments because of knee pain. They refitted her seat and suggested she test ride making certain that balls of her feet were centered on the pedal.

Using the parking lot, she was looking down at her feet when she ran into a newly installed cable fence at the end of the lot. Short story - tore up her knee real good.

She's real testy about not being able to ride for a couple weeks. And, PO'd at herself for not seeing the new fence.

Those with knee problems have my sympathy as do those living with foks with knee problems.

Carl

Ouch! I hope she didn't do any internal damage to her knee. Tell her to email me and we can cry in our soup together. :( I really do feel out of sorts. Nothing seems normal and my body feels suddenly old.

I saw the surgeon yesterday and he gave me a good idea of what bad shape he found the knee in. There was a chipped bone from a previous injury that I don't remember. Now how I don't remember an injury that was so traumatic that I chipped a good size piece of knee bone off, I just don't know. Then there were around 150 small non-cancerous joint tumors that replaced and destroyed healthy cartilage. Something called synovial chondromatosis. Unlike true cancer, it is self limiting and burns itself out although occasionally it is part of a cancerous process. This is obviously not something I wanted to hear. Of course there's arthritis and the connective tissue was pretty worn and the torn meniscus... part of that injury process I don't remember. There's still quite a bit of pain on working on my gait. There's an area that's bone on bone that he messed with to try to build some scar tissue which is a good thing I guess.

Today I start physical therapy. He told me I'm really not a candidate for home therapy but maybe I can learn the techniques and take it home. Insurance doesn't cover the whole thing. A couple days ago I started riding again, if you want to call it that:p Just 10 minute rides at a snail's pace in almost granny gears. It wasn't bad but the knee did slightly lock up once. Maybe it's the swelling.

I guess I'm pretty bummed and a little scared I'll have to give serious riding up. No. No way. I'm going to work at my PT. I've got a tour in the fall with my Florida Bike Forums friends. Gotta get back in the saddle.

OK, where's my care package??? After whining and pouring my heart out (*****ing) about not being able to get out and ride for near on 3 weeks, I was looking for some tea and sympathy. Ok, maybe chocolate instead of tea. Today I did a whopping 2.44 miles at an average of 10 mph. Hey, it's an improvement!! :D

The knee is feeling much better and there's a big difference just in the last 48 hours. I'm limping only occasionally and was able to push mid gears. This is the Florida off season. July and August are brutal. If I had to take time away from the bike, this was the best time to do it.

Oceanrider, good luck with recovery... but take it easy. DON'T overdo it. Just take it slow, and be patient... it's tough now, but, it's better to be safe.
If it makes you feel any better, and I hope it does... I have had BOTH knees fully opened up for cartiledge removal and ligament repairs (left in 1976, right in 1981), and the most important thing was for me to be able to get back on the bike. The surgeon highly recommended cycling for the rest of my life to keep the surrounding muscles strong to aid support to the knees... I ride 4500 miles a year, and can do centuries frequently. I'm not pain free, but when I get an ache I take a few days to rest, and I'm good to go.
So, don't fret. Take it easy, and you will be fine.
Again, good luck.:)

I had my first knee operation at 21 and my second at 24. These operations are the main reason that I am a cyclist. Before that, I was a soccer player, lacrosse player, and runner. All of the wear and tear resulted in arthritic knees before age 35. Here are my suggestions for anyone struggling with knee pain. Before any of this, see a doctor to rule out any serious injury like the ones that have been discussed in this thread.

1) Strengthen the quads with straight leg lifts (add ankle weights when these get easy). From there you can graduate to short arc quad extensions and half squats.

2) Raise your seat as high as you can while not having to rock your hips when pedaling.

3) Spin like Lance! Don't mash gears.

4) Get the book called the "Arthritis Cure."

5) Take a glucosamine supplement (which is suggested in the book). I have yet to speak with a doctor who is an athlete who does not take this nutritional supplement. Note: The success varies with the individual and it usually takes about 3 months of taking it religiously to notice a difference.

6) Stretch - especially the ilio-tibial band on the outside of the knee.

I could not get out of a chair or go up steps without knee pain. By following the above, I now do almost anything I want pain free.

Good luck!:D

Thanks for the insight into the future. I know I'll get back to my previous abilities again and hopefully beyond. It's just the here and now person that's staring back at me in the mirror I'm not too happy with. See, swimming is my alternate form of working out and that's been denied me also. These past 3 weeks I've probably put on 10 lbs but no way am I going to step on the scale to add to this pitiful pity party that's thankfully coming to an end. Wednesday I'll be ok'd for swimming again and I'll also be ok'd for 20 minute easy mile rides on my ATB as I come to the two week post-surgery mark. No bridges or inclines yet but I can work around that. I've been doing straight leg extensions and range of motion exercises and the doc has recommended a cortisone injection in two weeks. I think I'll probably be getting them regularly like a two or three times a year. Those things give me the heebeejeebees with those long needles. Last time the dude hit something and I had to be peeled off the ceiling.

I've been cautioned about the future use of road bikes because of the knee bend required on the pedal upstroke as there is an area of bone on bone arthritis. Glucosamine chondoitin might be a big help here and I'll be using that stuff religiously.

Anyone else been cautioned about the type of bike?

Post surgery 17 days. After logging around 15 miles last week, this week I logged 30. Got back on the road bike for the first time on Friday. It felt great. This morning was the best so far at 11 miles probably averaging 13mph. I took one break but it was due to the heat, not the knee. Next week I'm going for 45.

The knee is much more functional with less pain than before I had surgery but it clicks often where the meniscus was excised. It doesn't hurt but I know it's not a good thing.

FWIW I had a similar clicking in one knee some time ago sustained from sprinting down mountains on foot.I never checked it out with a doctor but if I properly warmed up the knee including taking it through a range of motion in the air(so called clicking it out)it would be ok but after to much stress it would get tight againand start the clicking.I very rarely experience this now which I credit to strengthening my knees and leg since then.From my limited medical knowledge I understand this to be some sort of rubbing which others have said is not harmful but as I stated above in my case seemed to indicate the knee was tight.

Gadzooks! When I joined this forum I had no idea the most commonly occurring word would be 'knee'. It's been fascinating reading through your story, oceanrider (we've compared scars over in the Training section [Edit - hey, this IS the Training section!]), but I feel compelled to add a general point about leg extensions, by which I mean those machines found in most gyms. I've met physios who believe they should be banned and I tend to agree on the basis that I'm fairly certain the use of them contributed to my own knee catastrophe. Everyone's physiology is unique, but the stress on the patella tendon caused by these things is far too great. Avoid. Incidentally, since I resumed cycling my knees have never felt better, I even think the 'crunching' sound I hear when I walk up stairs has lessened. Done right, I don't think there's a better way to recover from a knee op. Or seven.

OR
I tore (Ruptured) my left patella tendon the end of February 01. Grimm predictions of a summer on crutches. I was riding by May. In the mean time was therapy and yes it included stationary bikes as well as weights etc. What you are talking about is a much simpler proceedure. My daughter had it done in high school and has run a coupe of marithons since and is a marine.

Get it done and good luck.

Joe
:beer:

Can't keep someone who's determined down. Good job Joe getting back up when you did. BTW, how did you blow your tendon?

Still less than a month since the surgery. No limp at all anymore but there's still some tenderness if I try to kneel on it therefore no kneeling yet. I can pray better from a sitting position in the saddle LOL. Last week I aimed for 45 miles which I attained. The clicking is lessening by quite a bit. This week my goal is only a modest 55 miles due to the exessive dog days heat. I need a better light system to do any serious night riding and I already spent my monthly cycling addiction allotment on tires, tubes and pedals for my new street machine previously known as the comfort bike.

Walking is much less painful now. I didn't realize how much pain I was enduring before I had this procedure. As for leg extensions, I do them but with no weight. My squats are half squats and I brace my back against the wall when I do them. I imagine it will be a full six weeks before I enjoy the total benefits.

Originally posted by oceanrider
Can't keep someone who's determined down. Good job Joe getting back up when you did. BTW, how did you blow your tendon?

Just walking down stairs - I sliped and caught myself with too much gusto.


Still less than a month since the surgery. No limp at all anymore but there's still some tenderness if I try to kneel on it therefore no kneeling yet. I can pray better from a sitting position in the saddle LOL. Last week I aimed for 45 miles which I attained. The clicking is lessening by quite a bit. This week my goal is only a modest 55 miles due to the exessive dog days heat. I need a better light system to do any serious night riding and I already spent my monthly cycling addiction allotment on tires, tubes and pedals for my new street machine previously known as the comfort bike.

Walking is much less painful now. I didn't realize how much pain I was enduring before I had this procedure. As for leg extensions, I do them but with no weight. My squats are half squats and I brace my back against the wall when I do them. I imagine it will be a full six weeks before I enjoy the total benefits.


Sounds like you're doing great keep it up!

Joe
:beer:

For a cheap lighting system start with one of those clipon rear blinkers they are as cheap as $3(at Walmart) and are more important safety wise than a front light(I clip mine onto the belt of my fannypack.For a front light I just keep a maglite in my hand wedged on the handlebar that way if a car is in an intersection I can aim it at the car so it will definately see me (much better flexibility this way) and if no traffic I can leave the light off to save the battery and instantly click on if needed.Still be cautious at night and if uncomfortable dont hesitate to take the sidewalk.Evening is a great time to ride in Fl. in Aug.(man was it hot this afternoon)

I've got a good blinker already. It's the headlight that's kind of worthless. What's a maglite? Are you referring to a flashlight? I think I'm going to take a 3AM ride this morning to catch the Persoids (sp whatever) meteor shower. I'll ride as long as I feel comfortable. A1A is lit where I ride.

A minimaglite would be one of those small powerful metallic flashlights with spot to flood (recommend AA not AAA ). If well lit like that is when I save the battery .A minimag is useful for camping due to size,weight and strong beam.The headlamps like Pretzel etc are also useful for biking and camping but are more expensive.I have used other small flashlights on the bike as well.Three is a little early for me unless im touring lol.I heard the shower was suppose to be a bust probably hard to see anything in SoFl anyway with all the light pollution.