KNEES – A WARNING
At the AGM we touched on medical issues but there is one problem area in the club that appears again and again – knees. The case of Werner is a case in point. He’s been off running for over a year due to persistent knee trouble which goes back twenty years or more and a hill-walking injury – turning around with his foot fixed in deep snow.
For new members who have never met Werner, in his prime he was a handy club runner with a marathon pb of 2:55, (Dublin, 1986) and a 7-hills pb of 1:49 in 1987.
Werner at the 7 Hills in 2007Werner has already had 2 arthroscopies on his right knee – where the knee joint is probed by a tiny camera and bits of loose cartilage are cut off and flushed out. He returned to running after both procedures but was still in pain so in November of last year he opted for the nuclear option of remedial knee surgery called “open wedge osteotomy.” This was performed in a specialist sports clinic in Cologne where Werner graduated in sport science and English – after the NHS consultant more or less said: “put up with the pain as long as you can and then have a joint replacement.”
First take a look at the series of images taken within the knee joint during arthroscopy:
“Gleitlager” means “sliding bearing”
“ Knorpelschaden” means “cartilage damage”
“Aussenmeniscus” means “outer meniscus”
The upper left photo in Figure 1 shows shredded cartilage at the centre of the joint; the image on the top right is the outer meniscus or cartilage, which is beginning to peel away.
The bottom left image shows a grey area of exposed bone, contrasting with the white cartilage. The small white patches are pads of cartilage encouraged to grow in a previous operation by drilling tiny holes into the surface of the bone – this is what the surgeon is doing in figure 2 below, the bottom left image.
The other views show aspects of a totally shagged knee joint, to use the correct medical terminology.
Here’s Werner’s story:
“Running became too painful 3 years ago. Just as painful was the transition from running to cycling which took a full two years. After that the yearning to experience the hills on two legs rather than two wheels finally subsided, extinguished to a mere flicker of a flame that used to be part of my life. It took equally long to come to a decision over the route to take with the knee problem, and perhaps unsurprisingly I opted for the osteotomy.
The rationale behind this intervention is to create a new load-bearing axis between hip joint and heel, which in my case currently runs through the medial compartment of the knee. By shifting this axis further towards the good meniscus, more of the load would be carried by healthy tissue, reducing pain and stress on the knee. A further benefit would be to leave the knee joint intact, and essentially buy time before any knee replacement would be considered.
The operation involves a cut through almost the entire tibia head from the medial side towards the lateral part where the fibula joins, leaving just a little bone to act as a kind of hinge. The surgeon then opens up this cut with a chisel and a spreader, to create an wedge-shaped opening of, in my case, 12mm. What was a bandy leg is now a straight leg (and standing up straight the right foot is now 6cm over to the right!) The gap is then fixed with the help of an anatomically shaped titanium plate and seven screws, which is stable at all angles and does not require a cast. Over time, the gap fills with new bone tissue. Ten days in hospital follow, I left after seven - couldn’t take the snoring of my room mate.
Back to Scotland, with the follow-up, supposedly, to be done by the NHS. Through my GP I asked for a control x-ray (6 weeks post-op) to check whether anything has moved, I did make it onto the waiting list but 7 weeks post-op I have not been given a date as yet. So, nothing new there...I have now been out of hospital for 6 weeks, just binned the crutches. I am still hobbling but have been to West Linton and back on the bike. Being able to read 20 books in those weeks of inactivity was brilliant but the fresh air and the view of the Pentlands in deep snow is better. Movement in the knee feels ok – whether the open-wedge option was the right choice will become apparent in about 6 months’ time, when the knee is either better than before (i.e. with less pain) or similar or worse. Can’t wait to see whether the Royal Infirmary was right with their advice or not...”
Werner is not the only club member with knee trouble. About two months ago Heather had a knee operation that went slightly wrong resulting in a haematoma, leading to another operation – she’s not been at the club since the spring. Tom Harley had an knee op last week and is resting up. Gordon is waiting for his second arthroscopy on his other knee, which points to the fact that many, especially tall or heavy people, may have a genetic disposition to knee problems if they run. Others suffer knee injuries playing football – like Willie recently, and overtraining can also do the trick – Jacqui after her first attempt at the New York marathon springs to mind.
Many, if not most runners, will suffer knee injury at some point and it is essential that care is taken to rest and recover and if problems persist to get them checked out by a specialist doctor. As Werner has discovered, having to give up running altogether is a hard call, but not as hard as having to give up walking.
Douglas / Werner
