I have been having some minor knee pain for some weeks now. It isn't too bad while running but mainly hurt up and down stairs. Now the pain up and down stairs has for the most part gone away. I get some cracking of the joint from time to time and on some days do get some pain but it seems to be improving. I am a lifetime runner and aside from a week off 3 weeks ago have been running through it. I had an MRI of the knee and it showed a "focal full thickness chondral defect which appears acute at the angle of apex of the patella". It isn't too bad at the moment and I am running with it. My sports med doctor suggested trying some glucosamine and managing my running by pain. He also suggested an optional arthroscopy to clean it up. I was wondering if anyone has had any experience with this kind of injury and whether they have continued to run with it longer term and whether or not they found an arthroscopy helpful.
You should ask your surgeon about "repair" rather than "clean up". Depending on your age, size, shape of chondral defect there maybe a surigical option that involves repair. This kind of surgery takes a lot longer to recover from. In my experience not all orthopedic surgeons feel comfortable performing procedures designed to repair or regenerate cartilage, it is alot easier to trim the damage. In the meantime consider biking more. Take a look at this short article Osteoarthritis - Cartilage and Exercise.
Damien Howell PT, DPT, OCS
That's really helpful Damien. It is inline with what I am feeling. The other day when I went for a run it seemed to improve the knee. My pain isn't great - hasn't been since the outset. I can generally walk and run fine and freely. My concern is in understanding if I just cut back on mileage and leave it whether in the long run this is worse than looking at having surgery now. I guess if I can achieve the zone your article refers to whether there is a need to consider surgical alternatives. I did do more running than usual in December/January and have now cut back down to my previous norm. My sports med doctor was not pushing seeing a surgeon particularly hard but said he would refer me if I wanted.
This defect does not appear to be on a load-bearing surface, which means that running should not be contraindicated. While you may have recently felt pain leading to a scan and diagnosis, there is a chance you've had the chondral defect much longer than you know. A study subjecting willing participants to MRI scans showed that a large proportion of subjects without chronic pain have visible "defects" normally associated with chronic pain, throwing a bad light on the association. In other words, the fact that something doesn't look pretty on a scan means nothing in itself. Moreover, many chronic pain patients have no visible defects at all.
I'm willing to bet your December/January push had more to do with throwing your quads out of whack, tightening the muscles and possibly inducing some temporary tracking errors, evidenced by your report of lessening rather than increasing pain over the time since. In light of this outcome, your doc would have difficulty pressing for any major surgery, as it appears he is understandably reluctant to do. They often relent when the patient presses too hard, but I'll give you credit for letting it play out and not demanding surgery.
Arthroscopic "cleanup" surgery is fairly common and uneventful for the general population, but its success for runners is not guaranteed. I've seen it fail and end running careers, although the original damage is partly to blame. If you read up on articular cartilage repairs, you will find that some procedures are still in the experimental phase. There are other procedures to rebuild cartilage that sometimes result in the production of non-load-bearing fibrocartilage that is an unsuitable replacement for load-bearing hyaline cartilage. Caveat Emptor.
Glucosamine has been shown by some - but not all - studies to help, particularly in combination with chondroitin. Hylauronic acid (only of high quality), MSM and SAM-e are also recommended. There have been supplements that include all of these, but I can't vouch for quality or efficacy, since absorption of supplements is difficult to guarantee. Putting something in a pill does not mean it will wind up where you want it to go. Again, caveat emptor.
One recommendation that cannot fail, is to look into an anti-inflammatory diet, avoiding foods tied to infl and chronic pain, including most refined foods, fried foods, many grains, starches, sugars, and ammationomega 6 nut/seed oils that are common in the average diet. There is growing evidence that high quality omega-3 oils, some herbs, and ginger family roots such as ginger and turmeric, are powerful preventatives to painful inflammatory conditions such as joint pain, when incorporated into your regular diet. Ginger contains cox-2 inhibiting substances, without the side-effects of concentrated pain drugs, and has even been found effective for arthritis.
Really appreciate you taking the time to write such a detailed response. What you are saying seems to fall in line with my symptoms. Today I did a long run, didn't feel any pain the whole time and am feeling pain free now some hours later. Will read up a bit more about some of the supplements and also further enhance my diet. My physio also said to me that he has patients that come in and have terrible knee pain and the scan will only show something minor and others who come in with no knee pain but the scan shows they should be in major pain. This seems in line with what you are saying about scans. Once again thanks for the detailed response.