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I received a call from a dear friend of mine regarding his knee injury. I get lots of these. He had some anterior knee pain during his long runs over 10 miles with minimal swelling. As an Ironman triathlete, this guy is a machine. He swims, bikes and runs….almost every day! That is not a typo.
Needless to say, my friend “Tom” is not your typical weekend warrior and his pain tolerance is quite impressive. With this being said, when Tom complains of pain, it’s not taken lightly.
Tom had already been evaluated by an orthopedic surgeon and an MRI was ordered. The MRI revealed a kneecap stress fracture, a knee cartilage injury and a knee scope was schedule. Tom’s question to me was simple: “Do you think I need a knee surgery for a torn meniscus?”
I get lots of knee torn meniscus management questions on MikeRyanFitness.com. I think Tom’s knee injury is a perfect opportunity to help many of my readers by sharing my thoughts on knee cartilage injuries.
Tom’s Knee Cartilage Injury Facts
No Known Mechanism – No falls, no twists and no knee injury history.
Knee Pain – Anterior pain only after 10+ miles running. No joint-line pain over the medial or lateral menisci.
Symptoms – Patella soreness after long runs only. No catching, no joint locking, no giving way and no swelling inside or outside the joint.
Torn Meniscus Management
If It’s Not Broke, Don’t Fix It – If there is no mechanical signs or concerns related to a knee meniscus tear, I’m a firm believer in not bothering it. There’s an old saying in sports medicine: “Don’t do surgery on an x-ray or MRI.” In other words, trust you evaluation and what the patient is telling you not just what the film looks like.
Common Findings – A great deal of individuals, athletes and couch potatoes alike, are walking around with pain-free meniscal tears, myself included. It’s very common and not a reason to do a surgery compared to so many more serious knee injuries.
Location, Location, Location – The knee cartilage is a valuable piece of real estate. Where the tear is located will have a huge impact on the person’s symptoms and the need for surgery.
Lateral vs Medial – A tearing of the lateral or outside meniscus is more concerning than a medical or inside meniscus tear. This is because the outer compartment of the knee bears more weight and is much more prone to knee arthritis.
Happy Knee? – If there is no inner “locking” or “catching” of the knee, no pain over the inner or outer joint lines and no significant swelling within the joint, a scope is probably not necessary. In most cases, scoping a happy and asymptomatic knee will simply create problems for the athlete.
Ice + Strength – Controlling swelling by applying 15 minutes of ice every hour and increasing quad strength with limited range of motion (ROM) leg exercises are crucially important sports medicine tricks to help avoid surgery for a torn cartilage.
In Summary
My recommendation to Tom: To pass on the knee scope, avoid running until the doctor clear him to do so, get aggressive with his pain-free leg exercises to keep his legs strong, utilize Russian electrical stimulation to assist with this quad and hamstring strength, focus on his swimming, use a bone-growth stimulator to help speed the healing of the patella and to be consistent with his knee icing.
What did Tom do? He had the scope to trim his meniscal tear. It’s been about 2 month since the knee surgery, he’s now has joint-line symptoms where his meniscus was cut during the scope and he’s still trying very hard to regain the quad strength he had before the scope. He recently return to running. He’s a great person and we all hope to see him back to competing aggressively at a very high level.