The Doctor Tells Me Not To Run Anymore!

author : AMSSM

comments : 4

The doctor says not to run again. Ever. Needless to say, I’m not taking this very well. Can I recover from this? Where should I go from here?

Member Question

After two months of pain, I’ve had a CT scan and received my results today:  retro patellar chondral fissuring.  The report said something about a chondral flap.  The doctor says not to run again.  Ever.  Needless to say, I’m not taking this very well.  Can I recover from this?  Where should I go from here?

Answer from Sam Schimelpfenig, MD FAAP
Member AMSSM 

Joints, including the knee joint, are lined by articular cartilage (also called chondral cartilage) which functions to provide a smooth surface for the movement of two bones against each other.  This type of cartilage is specially designed to be long lasting and to resist the constant mechanical forces it is subjected to.  Unfortunately, if it is damaged, or worn down over time (the process referred to as osteoarthritis), its ability to heal itself is extremely limited due to its lack of blood supply and other intrinsic factors.

The damage to your knee described in your CT report is consistent with a process referred to as Patellofemoral Chondromalacia, which can occur acutely as part of a knee injury, or develop slowly over a period of months to years.  Anterior knee pain is a common symptom ranging from subtle discomfort to excruciating pain.  Other symptoms can include feelings of ‘locking’ or ‘catching’ of the knee during movement, instability (like the knee is going to collapse), and swelling of the joint.  Typically, these symptoms are more noticeable during certain activities. 

As the name implies, Patellofemoral Chondromalacia most often involves the underside of the patella and/or the end of the femur.  Injuries to the cartilage are graded on a scale of I-IV by the extent of the damage – Grade I injuries are superficial, Grade IV injuries extend all the way though the articular cartilage into the underlying bone.  The articular cartilage can look ‘fissured’, sometimes it can be partially torn from the underlying bone and appear as a ‘flap’ – that flap can eventually detach and become a loose body floating around in the knee joint.  Damage to the articular cartilage is usually best seen on CT or MRI scans.

To partly address your questions, first consider the mechanical forces experienced by the knee when running.  Every time the foot strikes the ground, the knee feels a force that is eight times greater than one’s body weight.  That means that the knee of a person who weighs 150 pounds would feel a force of 1200 pounds with each foot strike.  Now this does not mean that everyone who runs will eventually develop problems with their knees.  However, if one has a problem such Patellofemoral Chondromalacia, activities such as running will, in all likelihood, make the problem worse.

Treatment options for this type of injury vary from non-surgical to surgical, depending on multiple factors such as the severity of the injury, lifestyle of the patient, and the presence of any other co-morbid conditions.  However, it should be emphasized that there is no ‘cure’ for this type of injury, all treatment options are designed to reduce symptoms and improve quality of life.  If you have not done so already, I would highly recommend seeking the opinion of an orthopedic surgeon who specializes in knee injuries to discuss possible surgical options.  The natural history of these injuries is difficult to predict but, in general, they tend to produce chronic knee-related symptoms. 

Based on what you have described above, I would agree that continuing to run will likely worsen your condition, and that a low impact type of activity such as cycling may be a better option for maintaining fitness, etc.  I am sorry that I cannot give you better news, but there are some treatment options that are worth exploring.  I wish you all the best!

Sam Schimelpfenig, MD FAAP
CAQ Sports Medicine
Avera McGreevy Clinic, Sioux Falls, SD

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date: March 19, 2013