Feel very Depressed need help with diagnosis please?

[anthonym]

Please help. Today I received the following from my clinician after having mri scans and x ray on right knee

' ...Right ACL and PCL are intact.
No meniscal tear identified

Focal full-thickness chondral fissuring with subtle irregularity of the sub chondral bone plate and subchondral marrow oedema like signal with questionable early cystic change involving the central weight bearing aspect of the right medial femoral condyle.

Chondral fibrillation also seen involving the central weight bearing aspect of the right medial tibial plateau.

There is lateral patellar tilt with focal full-thickness chondral defect involving the medial patellar articular facet measuring 6 into 4mm in size and further partial thickness chondral fissuring involving the lateral patellar articular facet.

The rest of the Chondral surfaces appear intact

Trace of fluid seen within knee joint

Exterior mechanism is intact

Conclusion:
Focal severe chrondosis involving the central weight bearing aspect of the right medial femoral condyle.

Moderate to severe chondrosis involving the patellar articulate cartridge as described."


He basically told me my running days are over and no high impact manoeuvres. He was surprised at this injury as I'm only relatively young at 42. This has sunk me deep into depression already and feel lost.

After he told me this he explained the injury but my head was spinning and I didn't take it in. I need to start physiotherapist to nudge the kneecap slightly and take the load away from the damaged area. I think he said the shock absorber was gone from the right knee and the bone had split, nothing they can do.

He also said telling me not to run is the same as a doctor telling me not to drink alcohol and basically said it's up to me.

I suppose my question is - I need to be light running for 3-4 times a week for 30 minutes at a time, it is detrimental to my mental health, what do you think I should do, can I carry on running or will I end up like an overweight old man with a walking stick in 5 yrs time?

I really appreciate taking time to read this. Thank you in advance,
Anthony

[vickster]

What took you to the doctor? Pain running or something else?

If the former, as much as it's hard to bear, stopping running at least until you've seen the physio and had your gait thoroughly assessed would be sensible, if not just to let the joint settle, especially the bone marrow oedema which is quite a severe finding. As you have arthritic changes in the weight bearing part of your thigh and shin bones (kissing defects) which will be taking a pounding while running. Especially if the meniscus shock absorber is degenerate and the bone surface is badly damaged, this will continue to deteriorate and there aren't any great treatment options.

In the meantime, there are plenty of more knee friendly ways to keep fit, swimming, cycling, rowing, yoga, upper body work. Do you run on concrete, grass, treadmill, each surface will have a different impact on your knee
Find a physio who specialises in knees and rehabbing runners (if in the UK at least, you'll need to do this privately)

Good luck

[anthonym]

Thank you for the speedy reply to this Vickster. I really appreciate it.

What first took me to the doctor was last august (over 12 months) I was getting up off the floor at circuit training doing push ups. I planted my right knee to get up,and there was an excruciating pain in my knee. Like a tendon or muscle strain. I always had a shooting pain just to the lower right of the knee which has always bothered me since my 20s. Always put this down to meniscus tear.

Over the course of the next 2 weeks my knee came up like a football and was extremely weak. Kept snapping back etc. Couldn't bare weight at all. When that cleared it has been unsteady over the past 12 months

I've been running with a knee brace a few times over the last month and it's okay. Maybe a bit of niggling now and then but nothing serious in terms of movement or pain

I had a scan and all ligaments etc were intact. As the nhs was overwhelmed with COVID I eventually got sent private with the spire hospital who within the last 2 months have consulted me with an mri scan and an x ray and now scheduled some physiotherapy so I'm really lucky on get this level of treatment.

I guess I just don't understand the extent of the damage and suppose - well this is a really horrible and naive thing to say but I honestly felt like I'd been given some terminally ill news. Like something had been taken away and I'm really upset about it. I know there are people in much worse situations than me but I can't get over the shock. " There's nothing we can do and you need to stop running for the rest of your life" is devastating. Running is so important to my mental health. These are 25 minutes round the block 3-4 times a week, I'm not looking to do any marathons or anything!

Swimming is great but it isn't cheap - the 45 minutes it takes me to get kit together , drive to the baths, pay in, wait for a free slot, get changed - I could have ran, showered and be sitting on the couch before even touching any water yet at the baths. It's just not an option to give up running

I'm wondering if I can just keep running 25 minutes on treadmill 3-4mtimes a week and minimise as much as I can.

Consultant said it's up to you- this is like a doctor advising you not to drink. So it's not like he's said to me - "if you keep on running you will be on crutches in 1 years time". He advised good footwear and soft surfaces.

In terms of body mechanics - you are 100% right in saying wait for the physios to see what they say. He also said that. The physios are very good here and they will see you right.

I suppose I just don't know how severe this is and feel like I'm heading for old age with a walking stick already. Will,I need a knee replacement eventually. Also I've seen that people still run with knee replacements?

Thanks again,
Anthony

[anthonym]

What will happen if i keep on light jogging 4 times a week on the treadmill with this condition? (30 mins max)

I feel as though im scared to do anything at the moment. Shall I go private to see if the condition can be improved. I need to be running. Cant beleive ive been told im on the knackers yard at 42. Can i go to circuit training classes?

[vickster]

You could find your own private physio. Where in the U.K. are you?
You could use a bike outside or in the gym? Find a pool closer. Sitting on the couch is a bad thing.
Not being able to run for a few weeks is manageable, go for a long brisk walk instead.
There are plenty of things you can do without over loading your knee in weight bearing.
Or you can keep running on a treadmill or round the block, and accept that you may get pain, swelling, both of which you can hopefully manage with stretching, strength work, proper footwear and perhaps ice and/or medication

In the UK, you won't be offered a knee replacement until you have severe arthritis and are unable to function, and that probably won't be until you're at least in your 60s, so you're hardly in the knackers yard yet, you may just need to adapt your activity to maintain your knee and fitness

[anthonym]

I'm in Liverpool uk

Yeah I think 1 hour brisk walk will have to replace the running. As long as I can still do the circuit training I will be okay - I'll just swap out the high impact stuff like box jumps for step ups etc. I'll just have to get my head round the change. I'll wear a knee brace for the circuits

I'm just waiting on a start date for the physio.

Thanks again Vickster

[vickster]

There's loads of other stuff you can do in the gym, rowing is super for all over fitness and is knee friendly (just get your technique sorted), cycling, then there's the cross trainer, the skillmill unpowered treadmill thingy (that's hard work), stepper, walking briskly on the treadmill at speed
on an incline, upper body work and so on

Just need the gyms to reopen!

I've never seen the appeal of running or circuits myself

[anthonym]

Thanks Vickster - this has been a huge blow but I'm starting to get my head round it. First Physio appointment should hopefully come through soon. You've been a great help

[Tuggers1994]

I hope physio can help you 🙂

It is really tough when you can't do stuff you want to and without wanting to sound like I'm preaching what I've found really helpful is remembering that there is always someone worse off than me.

For context I'm currently waiting for derotational osteotomies of both tibias and work is my lifeline as that's about the only 'normal' thing I can do now.

My brain seems to be wired to compare my life to other people's and all the time I compare to people who can go hiking, cycling, swimming etc it just made me more and more miserable but now I'm trying to make an effort to focus on what I can do rather than what I can't do.

There are however some really good low impact workouts on YouTube so might be worth having a look and seeing if you like the look of any. I expect there will be some circuit sort of things on there although that sort of thing doesn't appeal to me so I've not looked!

[SuspectDevice]

It's really, really, REALLY tough losing the endorphins you get from a physical activity.

When I had to give up triathlon about 8 yrs ago, it took me about 5-6yrs to accept it. I still take a small dose of anti-depressants (though I think I'd have needed those anyway).

What I have learned is:

Other interests which I'd dropped due to the long hours of triathlon training have come back (fly-fishing, model building);
I developed a new interest - mountain bike riding;
If you are very, very careful & patient, you can get enough knee healing to return to your sport at a smaller level (I now do a few sprint triathlons instead of the ironman type races);
I never run more than 5kms now (used to do 21kms) and do a lot of my runs as 1-4mins run/1min walk;
If I had my time back over, I'd have completely dropped anything to do with triathlon for at least 12mths and just concentrated on healing. Being impatient and trying to cycle & run again ASAP delayed any recovery by years;
Drs always err on the side of massive caution. They do not understand the ability of knees to heal - but it is a very tricky process with lots of trial & error;
Swimming & getting back into the gym (mostly upper body work until my knees were good enough to introduce leg work) was a savior;
I started to view the whole episode as a challenge - most people are too mentally weak to get through it and sit on the couch & become fat. I was determined to find a way to avoid this. I succeeded give or take 2-3kgs, which I'm still trying to lose;
Once I got back into a few triathlons, I realised they really weren't that important. I do them more now for fitness than competition.

Keep your chin up. There is hope.

[Dave33]

Heh, I read your MRI, and it sounded identical to mine, almost to the word back when I was in my early 40s. I was a big runner then too. Marathons, triathlons, etc.

Yeah, full thickness and medial is not good. You've got a lot of options surgically, but probably the best one is none of them for now.

See if you can find an outlet like Vickster suggested; personally, I couldn't use the rower or ski or any type of exercise machine that had any sort of knee bend, but depending on the subtleties of where the damage is, you might be able to handle it.

All the best.

[bootyx]

Hi, follow and read this link:

https://www.rnoh.nhs.uk/services/joint- ... oject-sscp

If you call the Spire hospital they will give you the MRI and x rays on CD disc for free, take these and seek a second opinion.

It's always worth getting a second opinion as like you was written off, I now have a window of hope.

Good luck.