13 March 2014

Is it possible to run in the mountains with a torn lateral meniscus in the knee?


It has the past few weeks been incredibly warm in Uppsala and the spring is almost exactly two months ahead of last year when the snow lingered into the beginning of May. There is certainly no snow now and you can find plenty of coltsfoot, snowdrops and crocus already in bloom in the parks. The conditions are perfect for running and I have started to add hill repeats and longer weekend runs to my daily commuting runs to and from work. In particular the hill repeats have been though as my aerobic capacity has decreased during the winter with slow-distance volume training and my legs have lost much of their speed and quickness. However, this morning I had a great run in the local hill, where Uppsala Castle is situated, within a stone’s throw from my home.

Spring run up the hill to Uppsala Castle
Compared to last year, when I had some persistent early season pain in my calves and Achilles tendons, my body feel much better and stronger. The only worrisome thing is of course my right knee after the accident in the beginning of January when I was hit by a snowboarder from behind when I was skiing. I still can feel pain and stiffness in the knee when rising after having been sitting too long in a meeting. I have also felt some pain when riding my bike - running actually works much better than biking which is strange. I have however not really tested the knee when running in high speed and, more importantly, not when running in non-level terrain. It was therefore really great that I did not feel much when really testing the knee in this morning’s training run.

I am actually quite surprised that it feels so good. I finally got my diagnosis of my knee injury last week after having waited, as you regretfully have to do for most medical procedures in Sweden, for many weeks on an MRI. I was quite depressed when I got the verdict “Lateral Meniscus Tear”. The MRI showed specifically according to the radiologist’s statement: “Collateral and cruciate ligaments are intact. Medical meniscus is intact. In the lateral meniscus there is a central dorsolateral  rupture which probably extend to the upper meniscus surface. Moderately increased amount of fluid in the suprapatellar bursa”. 
 
MR images of my right knee showing the torn lateral meniscus
Really bad according to this and the season could be over before it begun. Worse, it could mean an end to running in the mountains forever as the menisci really play an important role in load transmission and shock absorption, joint stability, joint nutrition and lubrication and proprioception (reviewed in Fox et al The basic science of human knee menisci: structure, composition, and function” Sports Health 2012; 4: 340-351). The orthopedic surgeon I consulted recommended an arthroscopic operation to further assess the extent of damage and to treat the injury through partial meniscectomy.

However, as I am already now a short period after the accident having only minor problems with my knee when running I opt for leaving the meniscus in situ and continue with conservative treatment with increased strength training and physiotherapy. I am also afraid of the increased risk of osteoarthritis after meniscectomy (see for instance Katz et al Surgery versus physical therapy for a meniscal tear and osteoarthritis in N Engl J Med 2013; 368: 1675-84) and would like to try to avoid surgery by all means if possible. Having performed arthroscopic knee operations myself I know how traumatic these could be for the structures in the knee and it is only natural that this cause problems both in a short and in a longer perspective. It is also interesting that if I had not got the results of the MRI I would most likely just have continued my training as before. Now I will have to push myself harder with regards to strength training for my quadriceps and other knee supporting muscles and also run more tougher hill and trail runs. It is still 165 days to PTL so I am not worried and based on the run this morning I need not be. So, yes, I think it possible to run in the mountains with a torn lateral meniscus.  

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