Fun with knee pain diagnosis over the web

[Louis]

Well, the results from my most recent left knee MRI are in:

"Intrameniscal degeneration involving the posterior horn of the medial meniscus. Mild cartilaginous irregularity involving the lateral patellar facet."

The symptom, from my perspective, is mild to moderate pain below and on the right (inner) side of the patella. Earlier this year I had a few rides with pretty severe pain, but knock on wood, that hasn't happened recently.

Anybody out there care to comment? (Haven't discussed with the Doc yet, so I'm not sure what my options will be.)

Louis

[coylifut]

raise your saddle slightly or move your cleat back.

[Louis]

Slightly = say, 3mm increments?

[M.Sommers]

It's a typical summary of a 30, 40 or 50-something knee (depending on use/abuse).

Intra = inner

Posterior horn of medial (inner knee) meniscus (ring) =

http://www.orthopedie.com/en/meniscus/posterior_horn_medial_meniscus.htm

Lateral (outer, outside) patellar facet = your kneecap isn't tracking perfectly, causing stress on the area where it rides in the outer groove of the joint = (scroll down on this page):

http://209.85.215.104/search?q=cache:CAJTEkoYJN0J:www.emedicine.com/sports/byname/patellar-injury-and-dislocation.htm+patellar+facet&hl=en&ct=clnk&cd=2&gl=us

I'd kill to have your MRI. I think your MRI is great news, no tears seen, no arthritis mentioned etc. Your knee is a little mad, but not very angry. The medial meniscus is prolly what hurts you the most.

Me? I'd see a podiatrist, get your feet examined. Too many folks don't do this, they blame the link, but don't look at the whole chain.

I'd stretch that hamstring like I was a born-again yoga freak. I'd stretch that quad and hip flexor and calf like you were on a Richard Simmons show in the mid-80's.

I'd do quad sets with small (3, 5, 10lb) weights on the ankle.

I'd go to the gym and do focused, single-legged exercises for that leg.

I'd get my bike on a trainer and do single-legged, 30 second spins.

I'd see a real massage therapist and have her focus on the entire leg and knee joint.

I'd take Hyaluronic Acid Pills, Glucosamine Condroitin, Omegas (Fish Oils) and MSM.

I'd get a compact crankset and spin.

Or just come over my house and spend a few weeks with me. :beer:

On a scale of 1-10, 1 being a new knee and 10 being a knee-replacement, your knee is a 3. And if you focus, you can get it to a 2 or 1.5, atmo of course.

[M.Sommers]

Here was my 34 year old knee MRI, a couple of years ago:

Luke Skywalker's knee:

Findings: The patient is status post inner anterior cruciate ligament reconstruction and outer LeMaire reconstruction, 1987. Note is made of anterior tibial translation and buckling of of the PCL suspicious for ACL graft dysfunction. On Axial images, the proximal ACL graft fibers adjacent to the lateral femoral condyle are markedly attenuated.

Also noted is blunting of the free edge of the medial and lateral menisci in keeping with partial menisectomies. No definite meniscal re-tears are identified. There is focal area of cartilage loss in the anterior weight bearing aspect of the lateral femoral condyle. Patellofemoral joint osteoarthritis is also identified. There is extensive chondral loss noted in the femoral trochlea.

Postoperative changes of the patella and patellar tendon are most likely related to ACL graft harvesting site.

A thick medial patellar plica is identified. The patellofemoral retinacula are within normal limits.

We thank you for your kind referral.

:beer:

[coylifut]

Slightly = say, 3mm increments?

yeah, 2 to 3 mms. then go hangout at M.Sommers for a week, but laugh at the co-pay.
:D

[Louis]

Thanks for the feedback guys, that's good stuff.

Also in the works, is to get a "real" fit (as opposed to 10 minutes at the LBS). I wish I lived in Boulder - I'd be over at the Boulder Center for Sports Medicine in a flash.

Louis

[brokenladder]

a few thoughts for what they're worth...

i actually had a fitting at the boulder sports medicine joint. cashed in some frequent flyer miles and made a long weekend of it. it was a useful experience, though, mostly to confirm my set-up. the person doing the fitting suggested modest alterations to my position (cm here or there at most). but now i do feel completely dialed in and have been reproducing this same set of measurements to great benefit for over a year now.

i suspect that most riders don't give enough attention to fore-aft position--more directly the relationship to the knee over pedal stuff... that said the answer for me has been to generally run shorter stems and make sure that the tip of the saddle is sufficiently behind the center of the bb according to my fit requirements (i do have a custom ti road frame but nothing that unusual in terms of specs). in biomechanic terms, i believe that the idea here is to NOT *load* the knee as much as possible....

also, i have had good luck with the specialized inserts in my shoes which is in keeping with another poster that suggested looking at the whole alignment issue.

finally, i think that again as another has said already, stretching and strengthening the quads and hamstrings is critical (just as spinning lower gears and warming up properly). a local friend/cyclist was recently told by his orthopedist that his knees were *efficient* for/from cycling but not necessarily strong enough to ensure proper tracking. again it's probably worth considering augmenting your riding with some focused exercises to benefit your knees.

i hope that this is in someway helpful. btw--i'm 38, have had two knees surgeries to date, play tennis/squash, and ski...