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-   -   Knee osteoarthritis question. (http://tt.tennis-warehouse.com/showthread.php?t=445620)

Raul_SJ 11-13-2012 04:40 AM

Knee osteoarthritis question.
 
x-ray and mri shows "mild osteoarthritic changes" in both knees, and small
tear in posterior horn of medial meniscus of right knee.

My knees feel stiff when I run. Very little pain, but I can only jog slowly due to the stiffness.

After completing a jog of 5 miles, the knees begin to hurt a few hours after and it gets worse by the next day.

I have to rest for a day or two before I can jog again.

Question:

Why does rest decrease the knee pain?

i.e., If the cartilage that cushions the knee is worn down, shouldn't the knees hurt every time I try to run?

maggmaster 11-13-2012 05:40 AM

Normally I am all for working through some pain but in this case, find another way to get your cardio in. Bike, use the eliptical, row, find something that doesn't cause your knees to stiffen up. Your body will thank you in the long run.

Raul_SJ 11-13-2012 06:01 AM

The doctor has given me clearance to jog. He says exercise will strengthen the bones. And I don't run regularly, 10 miles a week on average.

Although there is controversy in the medical community as to whether running exacerbates OS, many doctors feel that it does not and it's beneficial to be active.

Chas Tennis 11-13-2012 06:38 AM

I believe that there is osteoarthritis, posture issues and many other issues. If a long-time posture issue is aggravating your osteoarthritis, especially when running, would you and your Dr catch it?

Distinguish between two locations of knee pain. First, in the knee joint with the meniscus, etc. and, second, under the knee cap/patella - patellar-femoral joint. Where is your pain?

Patellar Chondromalacia
http://www.nlm.nih.gov/medlineplus/e...cle/000452.htm

I believe that I have patellar-femoral pain because my rectus femorus is short/tight and it causes my patella to ride poorly in the femoral grove. Other quad muscles can cause the patella to ride poorly, even turn from the femoral grove. The pressures on the patellar-femoral cartilage are very dependent on knee angle - hurts on steps, etc. - so an activity like running might aggravate that cartilage. ?

These recent knee injury threads have discussions including the rectus femorus issue that I believe people should be aware of.

http://tt.tennis-warehouse.com/showthread.php?t=437802

See reply #6 - How Tight is Your Rectus Femorus?
http://tt.tennis-warehouse.com/showthread.php?t=435344

http://tt.tennis-warehouse.com/showthread.php?t=414073

maggmaster 11-13-2012 07:11 AM

Ok then if I were going to keep running, I would start an extensive strengthening protocol for my legs as well as a self massage session every day with a foam roller. Pay particular attention to your IT bands along the side of your leg.

ollinger 11-13-2012 08:53 AM

Your MRI findings suggest you should give up running entirely. The combination of arthritis and a meniscus tear means you're on the slippery slope that may lead to joint replacement. Arthritis in the knee means there are little jagged edges that can shred your meniscus until it's of no value. The past few years have seen studies like the highly regarded "MeTeOR" (meniscus tear in osteoarthritis) study (multi center study at top institutions such as Mayo Clinic, Brigham and Women's Hospital, Hospital for Special Surgery, and 3 or 4 others) examining this issue. The emerging consensus seems to be that meniscus surgery in the presence of arthritis does nothing to alter the course of the problem. Stregthening muscles does not alter the vertical pounding the menicus and joint surfaces take when you run; muscles do not support weight. Take up non-impact forms of exercise and keep the running to an absolute minimum.

Chas Tennis 11-13-2012 09:05 AM

Quote:

Originally Posted by Raul_SJ (Post 7013859)
x-ray and mri shows "mild osteoarthritic changes" in both knees, and small
tear in posterior horn of medial meniscus of right knee.
..............................

Do you have the MRI report written by the imaging lab specialist? The MRI reports that I have read always contain a detailed check list of the conditions of most of the joint's structures. It is really necessary to locate the structure and its condition. Your Dr or the imaging lab will supply you with a copy.

WildVolley 11-13-2012 09:22 AM

I second the advice from those who say to replace jogging (impact) with no impact exercise. In your situation, walking should be superior to jogging.

Weight bearing exercises will help strengthen your bones, but you can always do weight lifting to stress the skeletal structure.

sureshs 11-13-2012 09:40 AM

Swimming is good

Ronaldo 11-13-2012 09:56 AM

Quote:

Originally Posted by sureshs (Post 7014289)
Swimming is good

Try deep-water running

charliefedererer 11-13-2012 04:25 PM

Quote:

Originally Posted by Raul_SJ (Post 7013859)
x-ray and mri shows "mild osteoarthritic changes" in both knees, and small
tear in posterior horn of medial meniscus of right knee.

My knees feel stiff when I run. Very little pain, but I can only jog slowly due to the stiffness.

After completing a jog of 5 miles, the knees begin to hurt a few hours after and it gets worse by the next day.

I have to rest for a day or two before I can jog again.

Question:

Why does rest decrease the knee pain?

i.e., If the cartilage that cushions the knee is worn down, shouldn't the knees hurt every time I try to run?


On your MRI how mild was "mild"?
Depending on your age, is the "mild" so small, that your knees have less arthritic changes than seen on most knee MRI's?


How small is "small"?
Small like in so tiny only a sharp eyed radiologist could even possibly think there is a tear there? Or is it something that is really a potential problem?




Too few realize that MRI's are open to much interpretation. What might be "small" to one radiologist interpreting the images might be "moderate" to another. Or he could use the word "small" when it is really miniscule.


If I were you, I would visit an experienced sports medicine specialist with a special interest in knees and have him examine you and review the MRI (bring it with you) and give an honest opinion of what is going on, and what he would recommend.

Raul_SJ 11-25-2012 02:07 AM

Quote:

Originally Posted by Chas Tennis (Post 7014229)
Do you have the MRI report written by the imaging lab specialist? The MRI reports that I have read always contain a detailed check list of the conditions of most of the joint's structures. It is really necessary to locate the structure and its condition. Your Dr or the imaging lab will supply you with a copy.

Knee x-ray report.
Narrowing of knee joint joint and patellofemoral joint space is seen more so in the medial tibiofemur space.

Osteophytes seen from the condyles of tibia, femur and patellar margins.

Impression.
Early osteoarthritis of both knee joints.

MRI Right knee
Findings:

Osteoarthritic changes noted as evidenced by Marginal Osteophytes from the condyles of Tibia, Femur with mild narrowing of Knee Joint spaces and altered signal intensity.

Minimal fluid noted in the knee joint and suprapatellar bursal spaces appearing hyperintense on T2, PDFS and hypointense on T1W sequences.

No synovial hypertrophy.

ACL and PCL are normal in size and alignment, however minimum irregularity and signal changes noted at the margins.

Lateral menisci is normal in size, shape and signal intensity.

Medial and lateral collateral ligaments are normal.

Muscles, Tendons and Neuro Vascular Structures around the knee joint are normal.

Patella and Patello Femoral Articulations are normal.

Hoffa's Fat Pad is normal.

Posterior horn of the Medial meniscus show small focus of altered signal intensity extending up to Capsular surface and it appears Iso to hyperintense on all sequences.

Impression:

Osteoarthritic changes of knee joint.

Grade II degeneration involving the posterior horn of medial meniscus.

Minimal knee joint effusion.

Raul_SJ 11-25-2012 05:37 AM

I am particularly wondering about the mri report:
Posterior horn of the Medial meniscus show small focus of altered signal intensity extending up to Capsular surface and it appears Iso to hyperintense on all sequences.
Does this indicate the size of the meniscal tear?

I am getting conflicting opinions on whether the tear will heal. One doctor has told me that the meniscal tear will heal . Another doctor has told me that the tear will not heal...

I have heard that meniscal tears close to the blood supply stand a better chance of healing, but I am not clear where the location of my tear is...

One doctor has recommended exploratory arthoascopic surgery. He said he will take a look inside and then make any necessary repairs or cleaning... I am not clear if the *entire* meniscus is worn out due to wear and tear, in which case the surgery results will not be as good... It sounds like the Doctor needs to take a look inside to see the condition because the MRI does not give the complete picture?

Other advice from Doctors:

Strengthen the quadracepp.

Hamstrings are too tight. The range of motion is too narrow...Do exercise to loosen them.

Chas Tennis 11-25-2012 05:53 AM

Quote:

Originally Posted by Raul_SJ (Post 7031662)
Knee x-ray report.
Narrowing of knee joint joint and patellofemoral joint space is seen more so in the medial tibiofemur space.

Osteophytes seen from the condyles of tibia, femur and patellar margins.

Impression.
Early osteoarthritis of both knee joints.

MRI Right knee
Findings:

Osteoarthritic changes noted as evidenced by Marginal Osteophytes from the condyles of Tibia, Femur with mild narrowing of Knee Joint spaces and altered signal intensity.

Minimal fluid noted in the knee joint and suprapatellar bursal spaces appearing hyperintense on T2, PDFS and hypointense on T1W sequences.

No synovial hypertrophy.

ACL and PCL are normal in size and alignment, however minimum irregularity and signal changes noted at the margins.

Lateral menisci is normal in size, shape and signal intensity.

Medial and lateral collateral ligaments are normal.

Muscles, Tendons and Neuro Vascular Structures around the knee joint are normal.

Patella and Patello Femoral Articulations are normal.

Hoffa's Fat Pad is normal.

Posterior horn of the Medial meniscus show small focus of altered signal intensity extending up to Capsular surface and it appears Iso to hyperintense on all sequences.

Impression:

Osteoarthritic changes of knee joint.

Grade II degeneration involving the posterior horn of medial meniscus.

Minimal knee joint effusion.

I am not qualified or capable of evaluating a report like this. What I do is search each term and also entire phrases to find information.

Briefly searched and found information on

Marginal Osteophytes - found pictures, lots of material

"Grade II degeneration involving the posterior horn of medial meniscus." Any tear found? or degeneration?
http://www.ncbi.nlm.nih.gov/pubmed/15875232

(Last year my injury was
"LATERAL COMPARTMENT: There is some degenerate signal within the lateral meniscus as well as a focal intermediate-grade, partial thickness tear at the posterior root attachment."
The Dr thought that the injury probably was not that bad. I took off tennis for 3 months and resumed playing very gradually. That knee injury is OK now. )

When an MRI says "normal" for a structure that is as good as it gets - but MRI's miss things so always keep them in mind as possibilities. The many "normal"s in your report are one very good result.

Study the anatomy of the knee structures. Study your knee results until you understand them.

Injury Location and Posture Issues. Does the location of any of the injury sites on the front (anterior), back (posterior), inside (medial) or outside (lateral) have any relation to your posture? For example, if all your Marginal Osteophytes are on the inside (medial) part of the knee, are you slightly bow legged? Or "Narrowing of knee joint joint and patellofemoral joint space is seen more so in the medial tibiofemur space." - hip muscle posture affects joint cartilage pressure and quad muscle imbalances can cause patella tracking problems.? Complex, subtle issues for a specialist. You need injury location information that may not be in your MRI report. Similar questions.

Technical reference researching the location of Marginal Osteophytes. For illustration only.
http://***.bmj.com/content/61/4/319.full

Articular Cartilage. In addition to the more mobile meniscus and lateral cartilages the knees have articular cartilages that are part of the ends of the bones. Advanced arthritis often/always? involves damage to the articular cartilages and finally the bones. What was the Dr's prognosis?
http://en.wikipedia.org/wiki/Articular_cartilage_damage

Interesting paper just found, I believe it deals mostly with articular cartilage
http://rheumatology.oxfordjournals.o....full.pdf+html

Lyme disease arthritis is not rare. What are its characteristics? Familiarize yourself with it and discuss with your Dr to rule it out.

Ask yourself what your goals are?

Frequently run 5 miles/distance.
Play tennis.
Cardiac-respiratory conditioning.
Maintain leg muscle.

Is running distance keeping your knees inflammed? Tennis? Dropping things that we really want to do is very tough. Take off for a few months and see how your knees feel? Find alternate exercises.

Raul_SJ 11-25-2012 09:58 AM

Thanks. I will study this... am wondering if my tear is a good candidate for
arthroscopic surgery.


http://www.ncbi.nlm.nih.gov/pubmed/15875232
MR imaging has emerged as an important modality in the non-invasive evaluation of osseous and soft-tissue structures in the post-traumatic knee.

However, it is sometimes impossible to determine with confidence if a focus of high signal intensity in the meniscus is confined to the substance of the meniscus or if it extends to involve the joint surface.

This is a critical differentiation because the latter represents meniscal tears that can be found and treated arthroscopically, whereas the former represents degeneration, intrasubstance tears or perhaps normal variants that are not amenable to arthroscopic intervention
I notice that the MRI report says:
Posterior horn of the Medial meniscus show small focus of altered signal intensity extending up to Capsular surface

If "capsular surface" = "joint surface" it appears that my tear is amenable to surgical repair.

But on the other hand, the MRI says it's a "Grade II degeneration" and degenerative tears don't respond well to surgery...

I'll have to keep studying...

Chas Tennis 11-25-2012 10:39 AM

Quote:

Originally Posted by Raul_SJ (Post 7032076)
................. am wondering if my tear is a good candidate for
arthroscopic surgery.


http://www.ncbi.nlm.nih.gov/pubmed/15875232
MR imaging has emerged as an important modality in the non-invasive evaluation of osseous and soft-tissue structures in the post-traumatic knee.

However, it is sometimes impossible to determine with confidence if a focus of high signal intensity in the meniscus is confined to the substance of the meniscus or if it extends to involve the joint surface.


This is a critical differentiation because the latter represents meniscal tears that can be found and treated arthroscopically, whereas the former represents degeneration, intrasubstance tears or perhaps normal variants that are not amenable to arthroscopic intervention
.................................................. ............

If "capsular surface" = "joint surface" it appears that my tear is amenable to surgical repair.

But on the other hand, the MRI says it's a "Grade II degeneration" and degenerative tears don't respond well to surgery...

I'll have to keep studying...

What is the capsular surface? (The joint has several surfaces.)

Does the "Grade II degeneration" refer to the articular cartilage?

Does the MRI report describe a clear tear? Are your symptoms consistent with a meniscus injury?

The MRI for my first 1999 knee injury did not clearly show the meniscus tear. It only showed a slight shadowing where the meniscus is thin and hard to image. The slight shadowing was 'consistent' with the Dr's diagnosis of a medial meniscus tear. There was no definitive MRI observation unlike my 2011 injury of the other knee.

In 1999, I asked the Dr the probability that my knee would heal without surgery. He guessed that without surgery I might have a 25% chance of healing and said it was OK for me to try and heal. I gave it 3-4 months to heal, no running, and it did not improve. I got the arthroscopic surgery in Jan 2000 and the knee recovered. However, your symptoms are not like those of my first meniscus injury. I was afraid to run feeling very insecure and uncomfortable about knee motion.

ollinger 11-25-2012 02:03 PM

Arthroscopy for the tear would not be of value. As I noted above, studies that have been published earlier this year and also widely reported in the popular press indicate that meniscus surgery repair is not worthwhile if there is arthritis in the joint.

Raul_SJ 11-25-2012 02:25 PM

Quote:

Originally Posted by ollinger (Post 7014212)
Stregthening muscles does not alter the vertical pounding the menicus and joint surfaces take when you run; muscles do not support weight. Take up non-impact forms of exercise and keep the running to an absolute minimum.

The Doctor said that strengthening the quadriceps muscles reduces the
impact on the knees.

Isn't that true?

ollinger 11-25-2012 04:56 PM

Not true. One is always reminded in anatomy class in med school that muscles have no weight supporting function. If anything, more developed muscles add weight that increase the load on the joints.

Chas Tennis 11-25-2012 06:54 PM

I wore a Donjoy brace for the first 3 years after my 1999 meniscus operation. Then I lost about 20 lbs and started doing leg exercises, presses, etc. at the gym. When the bigger leg muscles do heavier exercises the muscles hypertrophy. Exercise magazines and books say that the support structures, secondary muscles, ligaments, tendons, etc., also all build up. From my experience it felt and looked as if everything built up, same with arms. These support structures tend to make the joint tighter so that it probably moves in a more controlled way, less lateral wobble, etc. I also stopped using the brace at that time although I probably could have done so earlier.

For effects other than on the main muscle exercised, see second paragraph, -
http://en.wikipedia.org/wiki/Strength_training

With arthritis I am not sure that heavier leg exercises don't do harm. ? With acutely injured joints I have read that isometric exercises are sometimes used to maintain muscle while healing.

A Dr's advice and perhaps a prescription for some physical therapy for safe exercises would be best.


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