Injured?--Think correction and prevention. (The Clinic).

It is always a good idea to determine why your injury occurred in the first place. Make sure that a sports medicine professional evaluates your gait, your feet and running shoes, and considers leg length discrepancy. Properly fitted orthotics might help you avoid another similar injury. Solve the problems that contributed to your injury before you start to train again.

Mitch Goldflies, MD.

Chicago, IL

If your pain is due to tightness around the arthroscopic portals (surgical incisions), the adherent tissue can sometimes be loosened by specific scar massage techniques, best provided by a sports-oriented physical therapist. However, this tissue may gradually loosen up over time. There's less concern about your pain as long as it is not pain within your knee joint. Any recurrence of swelling, patellar pain, or any tendency for your knee to "give-out," should prompt re-evaluation by you orthopedist.

As to a full return to distance running, the prognosis is less encouraging. In general, once damage to a weight-bearing joint, such as the knee, has occurred, running, especially long distances, is usually advised against. The cumulative trauma from the repetitive impact of running is likely to cause further joint damage and can set the stage for future osteoarthritis.

The loose bodies that were removed were most likely fragments of cartilage, meaning you now have less cartilage to cushion your joint. The lateral release may result in a better balance of forces across your kneecap, reducing the chances of further loose body formation. A search for any biomechanical factors that may have contributed to your original problem would be very worthwhile, again to reduce the chances of future problems. These factors might include a leg length discrepancy, which can be either structural or functional (for example, always running on the same side of a banked surface), over-pronation, or imbalances in muscle strength or flexibility. Your orthopedist or a sports-oriented physical therapist would be able to evaluate these conditions.

If you decide to return to running, do so cautiously. Do not ignore any knee joint pain or swelling (as opposed to incision pain). Make all increases in distance very gradually, warm up thoroughly, stretch, run no more than every other day to allow recovery, minimize hills and banked surfaces, get a professional recommendation for shoes appropriate for your specific conditions, and make sure you replace them before they wear out.

Brian Bowyer, M.D.

Columbus, OH

Beware of doing leg presses and knee extensions with resistance--it is easy to overload the knee with too much stress after surgery. As you return to running, stick to flat surfaces such as a local track. Begin with walking up to five miles a day and gradually introduce jogging intervals. Over a period of at least three months, gradually increase the jogging intervals while decreasing the walking intervals if you remain symptom-free. Patellar tendon straps can also be helpful.

Marvin Bloom, MD.

Burlingame, CA