Saturday, August 10, 2013

Update: Knee Surgery

It has been a while since I blogged, because I really don't have much to say other than injury updates. I have been battling what I thought was ITB since March. Finally, last Wednesday, I had my knee arthroscopy and the surgeon repaired my lateral meniscus. (The fact that it was a repair is significant, more on that later.) 

I am not clear where I hurt it. There was a moment in the OP50 that I distinctly remember twisting my leg (along the AZ trail). After that, my IT Band began hurting, but I am not sure if that is when it tore my meniscus. Some meniscal tears are a result of overuse, so it is possible that I just overdid it. In any case, I returned home from Arizona and tried running, possibly too soon. And I had what seemed like a definite case of ITB -- all the classic symptoms. I treated the ITB aggressively with no success. Then, after a few successful long runs, I DNF'd my first race in mid-April. At that point, I decided shutting down was the best thing. My buddy Tony tried to convince me to get a shot before I shutdown, I assume to allow the shot to really take effect. Instead, I shut down for 2 weeks and skipped the shot, feeling guilty about always going for the easy solution. Immediately after returning to run, the pain returned. I gave in and got a cortisone shot in early May.

During the customary three days after I shot, I did some bike riding and then I began slowly testing my leg. It felt great. And I did probably the dumbest thing and immediately resumed hard training (50 mile weeks with 10k of vertical gain). After a long weekend in Leadville training, my knee had finally had enough. Less than a month after the cortisone shot, I was back on the sidelines. I don't know that it would have helped, but if I had it to do again, I would get the shot and then take the two week recovery, sort of doubling my efforts to be conservative over that period.

Despite already being a long and costly injury, I broke down in the middle of June I began getting dry needled and had an MRI done. The dry needling did magic for the ITB symptoms along my hip, glute, and quads. (I now swear by dry needling as the best release technique available to runners.) That was the good news. The bad news was that the MRI was quite clean and I was still in lots of pain. Despite those that insist running is bad for your knees, mine look very good. There was significant bruising on the lateral side of my knee and fluid around the joint, both symptoms of my injury, but no real evidence of the cause. The surgeon's theory was that there is a small tear in my lateral meniscus, which is why the bruising was so pronounced on the lateral side. I went back and forth with friends and family discussing my options. Naturally, there were many of them. In the mean time, simple things like bike riding, walking my dog, and hiking became extremely painful. Things far outside the scope of ITB (typically). Instead of the Leadville Silver Rush 50 run, I switched to the MTB race because running was too painful. Not long after that point, I decided to go ahead and let the surgeon go in and see what was going on.

When I woke from surgery, the surgeon (Dr. Andy Motz) explained that he had found exactly as he expected, a small tear. He repaired the tear with a couple of anchors. In many menisectomies, surgeons will just remove part of a torn/frayed meniscus. In the case that they just "clean up", the risks post-surgery are mostly just inflammation, which we runner folks are used to battling! However, in the case of a repair, there is a risk that the stitch comes undone. Thus, I need to be a bit more cautious over the next 4-6 weeks. And, if you follow my blog, or even just this post, cautious is not how I normally work. 

The left is before and the right is after. I don't see much on the right, but I see the tear on the left.

Car ride home from surgery.

Nice and swollen with three incisions to show for it! Notice my note to the doctor that my left knee was the correct one to operate on.

I am four days post surgery now and quite stiff and sore. However, the soreness is pretty tolerable. In fact, I have been in much more pain in my life, like the last 13 miles at LT100. I have started a small PT regimen just to keep things "firing" and to try and avoid too much stiffness and atrophy. I am not sure yet what the next few weeks hold, but I am probably already doing too much. September 18th is officially 6 weeks post-surgery and I hope to try a run on or near that date (short of course).

In closing, I really don't know what has gone wrong. I am starting to believe more and more that I had two injuries. The ITB symptoms were too perfect and the remedies I tried there were working well for that to be a phantom injury. My guess is that this meniscus tear happened in March at OP50 (or possibly during my fall back in November) and that it just took enough miles and time for the bruising to rear it's ugly head, essentially creating a second injury that had similar symptoms as the first. And the cortisone shot provided the catalyst for me to push hard enough to make that happen. Hopefully, both are gone when with a long layoff over the next several weeks.