Triathlon after Knee Surgery

author : AMSSM

comments : 4

Is it possible to compete in triathlon after an ACL reconstruction and meniscus repair?

Member Question from joezer3003

"Hello.  I’m currently three months out from ACL reconstruction & meniscus repair surgery. My knee is feeling heck of a lot better, but I still have dull pains every now and then. No running on it for at least another month. My question is: Can I come back to run Olympic, half-iron or iron distance triathlons? How will the knee hold up? (Especially the repaired meniscus.) It seems my meniscus is holding me back the most right now."

Answer from Andrew Getzin, MD
Member AMSSM

The anterior cruciate ligament (ACL) is the main stabilizing ligament of the knee.  It functions to prevent anterior or forward translation of the tibia (shin bone) in relation to the femur (thigh bone). In other words, it keeps your shin from extending past the plane of the thigh and prevents you from hyperextending your knee. 

It is commonly injured in individuals who participate in activities that involve cutting or rapid change of directions such as basketball, soccer, or skiing.  When it is injured, it usually is completely torn.  Most people will require surgery to replace the damaged ACL if they want to regain the knee control required for cutting and possibly running activities.  Post-surgically, most individuals are cleared for full activities at around six months, but certainly there is surgeon and patient variability.

Prognosis

Unfortunately, studies clearly show that people who sustain ACL injuries, whether or not they have a surgical repair, are at increased risk for osteoarthritis later in life.  The data tells us that 50 percent of people who have ACL surgery will develop mild to moderate osteoarthritis visible on x-rays within six years.  We believe the main reason is because the joint has evolved to bear forces in a certain pattern.  Once the biomechanics are altered during surgery, forces are applied unevenly to the knee, which results in abnormal wear and tear. 

The good news is that most of our long term data is on older repairs.  Today, surgeons do a much better job in coming close to re-establishing your original biomechanics with the repair.  If the meniscus is damaged, the biomechanics of the knee were further altered during the period of the injury. 

The American Academy of Orthopedic Surgeons has a new push to aggressively suture injured menisci in an effort to preserve normal anatomy.  The post-operative course takes slightly longer with a meniscal repair instead of a debridement (where the damaged meniscus is shaved off), but the thought is that the long-term result will be better. Your case is an example of a repair that includes a meniscal repair, resulting in a longer, but hopefully more full, recovery.

Returning to triathlon

In your particular situation, I see no reason that you cannot return to competing in Olympic, HIM, or IM triathlons, but there are some basic things to consider: 
  
First of all, be patient.  Talk with your surgeon and physical therapist and see when they are comfortable with you beginning to run.  This decision will be based on the amount of time post surgery and your current functional status.  If you are experiencing pain or increased swelling, you are most likely doing too much.

Many people who are status post-ACL repair never have any knee problems, but it is difficult to predict how your knee will do.  I think it is important as you go forward with running and triathlons to listen to your body.  If you have knee pain, I encourage you to get evaluated.  I discourage my patients from running with pain.  You may wind up developing some arthritis and then you will have to make the decision if it makes sense to continue to run. 

I have patients who have had ACL repairs over 20 years ago who compete in IM triathlons and don’t have any problems.   Hopefully you will fall into that group, but only time will tell.

Andrew Getzin, MD
All American USAT 2008, 2009, 2010 Cayuga Medical Center
Clinical Director Sports Medicine and Athletic Performance
[email protected] | www.cayugamed.org/sportsmedicine

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date: April 7, 2011