Can it really be time to call it quits?

I'm a 54-year-old male, 6', 190 lbs. I tore my meniscus and had a repair two years ago. I continue to have a lot of pain in the front middle of the knee, and it is a significant detriment to my running. I feel the pain while swimming a mile a day later, as well. I have no locking or swelling, but the pain makes me wonder if I will eventually have to give up running all together, as one doctor suggested. Is that sometimes the case with meniscus tear repairs?

David Vallea

Sacramento, CA

Most arthroscopic meniscal surgeries that are performed are menisectomies (removing a portion of the meniscus), because most of the tears encountered are not amenable to repair. This leaves the athlete with less of the protective cushion and may allow for early degenerative changes to occur with impact loading sports such as running.

It is difficult to know in this case whether a true repair was done, where the tear was, and if in fact it is healed. The other issue is whether there was damage to the articular cartilage visualized at the time of arthroscopy. Articular cartilage is different from meniscal cartilage; it is the firm, white cartilage that coats the ends of the bones that make up the joint. It is what is damaged in arthritis.

The real issue in this case is to determine whether the disability and pain are due to the deficient meniscus or to other issues, such as muscle imbalance/weakness, patellofemoral problems, gait-related issues (foot position, etc.), or arthritis. One thought is to be evaluated by a physical therapist/athletic trainer who has experience with runners. It is very common to experience kneecap issues and weak quads as the result of knee surgery. Sometimes formal gait analysis may be helpful. If a correctable condition is found, running may improve. If the pain is due to the abnormal meniscus or arthritis then you may need to alter your running regimen. I would not advise running through the pain.

Jonathan L. Glashow, MD

New York, NY

Without knowing many more details. I can only give you a generic answer. I am sure that your surgeon told you that there are many factors which affect the success rate of meniscus repairs. Statistically speaking, 80 to 90% of meniscus repairs done for proper indications are successful. However, even if the repair is successful, if there is significant anterior knee pain (as from damage to the articular cartilage under the kneecap, or chondromalacia), you may have residual symptoms from it independent of whether or not the repair was successful.

Did your surgeon tell you that you have significant chondromalacia of the weight-bearing surfaces or of the patellofemoral joint? Did you have an ACL reconstruction at the same time? Perhaps some of your symptoms are due to residual ligament laxity. Unfortunately, MRIs are notoriously difficult if not impossible to determining success or failure when it comes to meniscus repairs. Based upon your history, if a short course of anti-inflammatory medication or a cortisone injection do not provide adequate relief, then your only realistic options are to quit running or undergo another arthroscopy to determine the integrity of the meniscus repair and/or the integrity of the articular cartilage.

Klaud Miller MD

Evanston, IL

You should check with your surgeon. He can ascertain how the meniscus has healed. It is very common to develop anterior knee pain after an internal derangement of the knee. There are exercises to correct this. You may need an MRI of the joint. However your first effort should be to have your surgeon make sure the knee is working properly. Then have him refer you to a sports physical therapist/trainer.

At 6', 190 lbs. you also need to have shock-absorbing running shoes. Be sure you obtain the best shoes on the market for cushioning.

Robert Erickson, MD

Canton, OH