Monday 12 January 2009

Knee surgery required

Rather than tell you about the training I haven't been able to do in the last week, I'll update about my knee.

I saw an orthopedic surgeon today who examined me, and asked me various questions about my exercise routine and goals etc.

The prognosis is as follows. I do have a lateral meniscus tear of the left knee. It's not a massive tear, but neither will it repair itself. Further to that, a repair attempt on the cartilage (effectively stitching it) is unlikely to work (and could possible result in a tear in the same location again) due to both my age and the location of the tear itself. So, the surgeon advised that the damaged cartilage is removed during arthroscopic surgery.

The Patellar Tendinosis was shown to me on the MRI. Right below the knee cap, a bone spur is rubbing against the Patellar tendon, causing me pain. I get this pain all the time, all day long. It's not a crippling pain, but it's constant. The surgeon proposes that a small piece of the bone be removed and, and to use his words "the area be roughed up a little" to promote inflammation and healing. The recovery period for this procedure is three months.

My next fear is a general anaesthetic. I just have the same irrational fear as most other people in that I think I won't wake up afterwards. I asked if the procedures could be carried out under a local anaesthetic instead. The short answer is yes, but the effectiveness of the operation is compromised. First, I would not be as relaxed, and second a tourniquet could not be applied because it is too painful. Apparently, there is a fair bit of blood loss for the Patellar procedure, which is kept down by the tourniquet application under a general anaesthetic. So, that particular decision I have got to make myself, but I'm still erring towards a local.

Finally, the most critical question. If I deferred the operation under I got back from the Atacama Crossing, what are the risks. The answer was that if I felt I could do the event, then no further significant damage is likely to occur. If I ripped the cartilage even more, it wouldn't really matter since some of it is already going to have to be removed. Ref the Tendinosis then he advised that I cut back my mileage, and especially speedwork, and try and make the event off my current fitness. He even went as far as to suggest I should stop training totally, and just rely on my current levels.

So, I'll try and defer the surgery until after the race, unless it becomes apparent over the next few weeks that I won't be able to make any decent attempt to complete the race at all.

What I am probably going to do is continue to get sports massage, ultrasound and short-wave heat treatment on the Patellar Teninosis to get rid of the acute pain. I am even half hopeful that it might go away on it's own, with enough attention and a reduced program. What I am not prepared to do is quit training, but I do have to accept that I am not going to be in anyway contending for a half decent place in Chile. I will have to settle for a 'finish' regardless of position, even last. I will have to cut out the speedwork straight away, and reduce my mileage down. I have no idea what to yet, but I am hoping I might be able to maintain about 20-25 miles through to the start of the event. I am likely to incorporate more walking into my program. I will have to start to use my walking poles again, as much for my knee benefit as for practice for the salt-flats of the Atacama Crossing.

I am very much in damage limitation mode. Better this than sit at home miserable after a knee operation and have to watch the race on the Internet. At least I'd rather try and fail, than have to withdraw now (likely lose all my money).

So, there's no good news here at the moment, hope you are having better luck than me.

I'll post up again, when I've something more positive to say.


  1. richard,

    i had the same surgery reg. similar problem in 2000 and can tell you following:
    1. I also had general anestheasis fear but there is really little to worry about. (I know this doesn't help your case, knowing what my thoughts were back then)
    2. It took well over 6 months to get my knee back to shape, mind you, I didn't you any special exercises as such, no particular 'speed up recovery' treatment
    3. If i were you I would go for the race nonetheless, just keep the knee and yourself in decent shape and simply go and enjoy yourself! At least the pressure of finishing in good place won't be there and you will just take it easy and gather experience.
    This is MUCH better than wallowing in self pity back at home with bandaged knee.
    Injuries like this you can't really prevent, unless you gave up sport completely :))
    Even if you have to walk all the way (unlikely)...
    good luck!


  2. Rich, thanks for your comments, the MdS is coming around so fast, it always seemed so far in the future but now it's nearly here!
    I think the training is going ok, I'm just having those 'have I done enough' thoughts... I have been concentrating on the quality rather than quantity.
    Really sorry to hear about your knee, but at least a recovery sounds very hopeful and hasn't necessarily ruled out the Atacama. Like Matt said, just go, relax and enjoy it, your fitness levels are excellent and I'm sure you'll be fine.