Running After Knee Mosaicplasty, OATS, and Meniscectomy

Since my last entry here, I have made some good progress in my comeback from two knee surgeries. I've continued to run 4 days per week with a long run (that reached 8.1 miles on Aug 7) and a workout of "tread striders" where I was able to finish with 5 x 30-second repeats at 6:59/mile pace. Nice milestones for sure, but I just returned to running today after missing 8 days in a row with Covid. I feel like trying to overcome the knee injury and knee surgeries is already an extraordinary challenge. It seems unfair that I also have to deal with things like illness, running injuries, work, a poor night's sleep, etc. But it's true. I'm subject to all the same issues any other runner has to deal with...maybe even more since I haven't run much in a few years, I have a surgically repaired right knee, I'm 57 years old, and I have a more-than-full-time job and family responsibilities. It's kind of like the movie Inception , but instead of a dream within a ...

I am now over a year out from my 2nd right knee surgery and 19 months out from cartilage surgery. After experiencing a setback about 7 weeks ago, I took a few extra days off from running and reduced or eliminated exercises other than walking, running, and strength training. I slowed my pace during runs and stopped doing the "tread hills" incline workout I had been working on for several months. This has worked well. I've bounced back nicely over the last 6 weeks. For the past couple of weeks I've been running 4 days per week (vs. the every-other-day schedule I had been following). My pattern looks like this: Mon: strength training (w/ BFR) Tue: easy run (4 to 4.5 miles) Wed: off Thur: tread striders (4 to 4.5 miles w/ 12 x 30-second striders getting progressively faster. 1:30 jog intervals) Fri: strength training Sat: short easy run (2 to 3 miles) Sun: long run (6.5 to 7 miles) The distances approximate what I'm doing now. Of course I'll gradually add distance...

One week ago, I woke up with increased pain on the medial side of my right knee. It was painful to walk. I took the next 2 days off from running and dropped the strength training and physical therapy exercises. I have been able to start running again, but I've had to slow my pace down significantly to keep the pain to a minimum. I've abandoned the idea (for now) of continuing hill work and/or starting some faster striders on the treadmill. I'll run every other day for a while and I'll try to keep it slow. I will reintroduce strength training as soon as tomorrow and then gradually add back in other exercises. I may ditch the indoor cycling for a while. So...how did this happen? I really don't know. There was no obvious misstep that started the increase in pain. The day before I woke up with this pain I had a relatively easy day of exercise. No running. No strength training. I did some easy cycling, but maybe pushed it a shade harder than recent efforts. I did some ph...

It's been over 17 months since my first surgery (rt. knee mosaicplasty and OATS) and nearly 11 months after the second surgery (partial synovectomy/patellar release/fat pad resection). I'm still improving (albeit very slowly). I'm still following an every-other-day pattern of running with a 6-day cycle that includes a treadmill "hill" workout, a long run, and an additional easy run. My longest run so far has been 5 miles (which took me 48 minutes to run). On my fastest days I'm able to sustain around 9:15/mile for a while...but most of the time I'm running between 9:30/mile and 10:30/mile. I can do 5 3-minute repeats of 8% incline on the treadmill at about 10:15 pace with 2-minute rest intervals of easy running. My stride has improved a little bit, but I still have much work to restore my stride. The incline work on the treadmill has helped, but within the next several weeks I'll start doing shorter and faster intervals rebuild my stride. Well...at lea...

Earlier this week I was able to run for 40 minutes, covering a little over 4 miles. Definitely a nice milestone for me. Overall, my progress has been very slow, but steady. I'm still running every other day. Making sure I am recovering well has helped me to progress. In fact, I've almost completely stopped cycling, which I had been doing every day while recovering from my two surgeries. As the running load has gone up I needed to find a way to reduce the overall load on my knee. A few times I started to get some burning pain in the knee, but that has been absent since I dropped the cycling a few weeks back. I've restarted BFR training to strengthen my right leg, but I'm only doing that once every 4 days. The lack of exercise on non-running days is making it harder to keep my weight within reason, but eventually increased running (and possibly a return to some cycling) will make that easier down the line. I've been doing a treadmill incline "hill" workout e...

Over the past month, I've worked my way up from 20-minute runs every other day, to a 30-minute run (earlier today). I briefly plateaued at 20 minutes, then worked my way (1 minute at a time) to 25 minutes. I plateaued briefly at 25 minutes, then progressed (again, 1 minute at a time) to 30 minutes. As my runs increased in duration, my pace slowed a bit (to an average of 10:30/mile or so), but today I ran just a shade slower than 10 min/mile pace, so perhaps I am adapting to the increased load. After not running since August 2020 and going through knee surgeries in Dec 2020 and June 2021, it feels absolutely amazing to be out there running for a half hour again! I'm still feeling pain, but that has not really increased since I started running 15 seconds at a time last November. I'm concerned about the pain, but I'm going to stick to my plan, which seems to be working. So, what's next? In my last blog post I wrote, "As soon as I feel adapted to running for 20 min...

 ...well...at least for now. During my last 2 every-other-day walking/running workouts, I was able to run for 20 minutes continuously. This achieves an intermediate goal. Hopefully this is a stepping stone to further achievement. My pace has been pretty good for this stage. (Maybe too good?) I was able to average exactly 10 minutes/mile pace and cover 2 miles today. I have been having some right knee pain during these runs (although my knee felt better today than during the last run). Also there has been some pain and swelling after the runs...this started with the last interval workout I did (4 x 4:45/19 minutes of running total) before starting continuous running.  Things had gone reasonably smoothly as I worked my way from 1 minute of running to 18 minutes of running over several months. I was recovering well and always ready for the next walk/run. With the increase in pain and swelling, it is clear I need to "plateau" here for a while. I need to make sure I can recover fr...

I'm 6 months out from synovectomy/patella release/fat pad re-sectioning and 12.5 months out from mosaicplasty and OATS surgery. I'm still a long way from a full return to running...but it has been a month of good progress. My plan to gradually convert my 20-minute walks to 20-minute runs has continued without interruption. I walk/run every other day and I've been extending my 4 running intervals by 15 seconds (each) every other workout. As of last post I was up to 4 x 45s jogs (3 minutes of running) and I'm now up to 4 x 2:30 jogs (10 minutes of running). I'm experiencing some medial knee pain...but it is not worsening as I run longer (and a bit faster) and seems to have lessened a bit during the last 2 workouts. I had a slight increase in burning pain a few weeks back, but I cut back on cycling and that has reduced symptoms. I've added a short walking interval to warm up and another to cool down after each 20-minute walk/run workout. My workouts are lasting ove...

I'm 5 months out from surgery #2 and 11.5 months out from the original right knee mosaicplasty surgery. I'm still a long way from "normal", but I've started doing some "running" again. Several weeks ago, I was reintroduced to "running" on an Alter G treadmill at the place where I do my PT. I ran for 2 minutes twice (with a 3-min walk in between) at 60% of my bodyweight. Felt very strange...like I had never run before in my life. At my most recent PT visit, I did the same workout at 70% bodyweight. It went much better. I went from 14 minutes/mile pace to 12 minutes/mile. As previously mentioned, my plan was to work my way up to 20+ minutes of walking every other day and then to start adding some short running intervals to the walks. That plan has worked so far. I've done 5 walks now that included a little bit of running. I started with 4 15-second running intervals for a total of 1 minute of running and in my last walk/run I was able to do 4...

Things have continued to trend better. That is not to say it has all been easy...I have days with some pain and varying levels of stiffness. However, I have continued to walk every other day. This has gone on for 8 weeks now. I started with 5 min walks (at a pace between 25 and 30 minutes per mile) and am now walking 17 minutes (at around 18-19 minutes per mile pace). I had intended to start walking more frequently, but since this every-other-day pattern is working so well for me, I just decided to ride it as long as I continue to make progress. I never extend my walking session time (from the previous session) by more than a minute. I also repeat every session time at least once before increasing another minute. I don't push the pace at all...I just relax, try to walk without a limp, and let the pace come to me. Slow, steady, and gradual...seems to be getting it done for me. My plan, as I briefly described in my last post, is to work my way up to 20 minutes of walking (comfortably...

It's been a while since I posted here, so I'm do for an update. I'm a little over 3 months out from the second surgery (synovectomy/patellar release/chondroplasty/fat pad resection) and almost 10 months out from my first knee surgery (mosaicplasty/meniscectomy). I'm still in full rehab mode and have a lot more work to do. I'm still not real close to running, but I have made some progress. My right knee assisted ROM is 100% and my kneecap is moving much better than pre-surgery. My walking is far from perfect, but I've been walking outside every other day for 10 minutes. I still have sporadic swelling, considerable stiffness, and occasional pain in the knee, but I've been able to start some strength work. Hopefully activities like climbing stairs, driving, and returning to work are in the near future for me.  Today I started doing blood-flow-restricted (BFR) training at home. I purchased wireless Bluetooth BFR cuffs that I can calibrate and inflate with a phon...

Well, here I am again. Taking the same meds, doing the same PT, and dealing with swelling, icing, and wound care just as I did for the earlier surgery less than 7 months ago. This was a bit too soon for me, but delaying this would have delayed getting past all this...and I'm not getting any younger. I am recovering much quicker from this surgery, which is not a surprise. This was an arthroscopic procedure, not the open surgery I had last time. Today is post-surgery day 13 and its the first day with no crutch usage. I removed one of the two circular bandages covering the surgical "portals". It stuck a bit and caused some bleeding around the stitches (so I put off pulling off the 2nd bandage...maybe tonight or tomorrow). I'm taking meloxicam for the first 30 days post surgery and have not required medication for breakthrough pain (other than acetaminophen a few times). No nausea. No itching. My PT seems to be going well. I'm going in to NYC this time and other than ...

I'm one day post surgery now. It seemed to go well. Since this was an arthroscopic procedure I had a lot less bleeding and swelling this time and was able to restart PT exercises this morning. The orthopedic surgeon (OS) seemed to be pretty positive on how it went. He said he removed a substantial amount of inflamed tissue. He also said the osteochondral grafts (from the last surgery) look great. Kneecap mobility should be improved (and seems to be…although I didn’t push on it too hard today since I have a couple of holes right under my kneecap). The OS also did the patellar release, resected the scarred fat pad, and did some smoothing of patellar and trochlear cartilage. I used 2 crutches to get around yesterday after the surgery, but I've already weened myself to a single crutch. Looks like I'll be back to crutch-free walking this week. I also should be able to return to weightlifting later this week as well. Hopefully I'll be able to resume my recovery path back to r...

After visiting my orthopedic surgeon (OS), I have agreed to his recommendation to have another procedure. There are several goals of the procedure…including removing inflamed synovial tissue, cleaning up adhesions, and releasing my kneecap (which lacks mobility even though I have been working on that for months during physical therapy). He is confident that this will point me in the right direction. As I expressed in my previous post, I’m wary about having another surgery to fix the first surgery. I was very overreactive to the first surgery…won’t I be for the second one? Well, I think this approach has its risks, but I’ve not made much progress for 6 months, so it is time for a change. The procedure will be an arthroscopic surgery that should take only 20 minutes or so. I’m scheduled to do this on June 28. I am so not looking forward to being on crutches, medications, and a cryotherapy machine, but I’m going to have to grind it out. I am going to go into NYC once a week and work with ...

There is not too much progress to report here. The synovitis and associated stiffness and swelling of my right knee are still there full force. I’ve improved my strength on a few individual exercises (most notably “mini-extensions” of the right knee), but I’ve had a few setbacks where I had to drop or change an exercise that was causing too much swelling. I’ve had periods where I have felt really down about my lack of progress (especially on the 6-month anniversary of my surgery). At 6 months the goal was to return to full activity...but I can't even walk that well yet. I can't do stairs. I can't drive. I’ve wondered (or rather worried) where this is going and how it will end. I did make one change to my routine that has lifted my spirits a little bit…I’ve started doing some weightlifting and core exercises every other day. It feels good to be in strengthening/building mode instead of lying-on-the-couch-gaining-weight mode. The one thing I have not tried since I started phy...

As I near the end of Month 5 of recovery and rehab from right knee mosaicplasty, the situation that I find myself in is that certain exercises and overall exercise volume worsen my synovitis. Over the past month, I’ve been in the mode of identifying and removing exercises from my routine that flare up my synovitis. I’m also, with the support of my PT, finding replacement exercises (for those removed from my routine) that cause less knee reaction (e.g., replacing partial squats with isometric squat "holds.")  I’m trying to get to the point where my knee stiffness and swelling start to gradually improve, or at least to the point where I’m not getting worse, while doing just enough exercise to increase knee/leg strength and stability so that my knee becomes less reactive to being “loaded” in the future. This is a slow process with days that my knee feels slightly better often followed by days where my knee seems to worsen slightly (for no obvious reason…frustrating!). Overall, t...

From weeks 9-12 I continued to have issues with knee swelling but managed to make some progress on range of motion and quad strength. I began to do partial squats and modified split squats and other more intense exercises. Exactly 12 weeks out from the surgery, I had a follow up MRI. Originally the plan was not to have an MRI until a year after the surgery, but the continued swelling and lack of kneecap mobility were clearly concerning to my orthopedist. I was worried I was experiencing a graft failure of some sort. I began to fear revision surgery. One knee surgery is already more than enough for me to deal with. The MRI showed that the grafts were doing well. A relief for sure, but there was some not great news in the MRI as well. From the MRI report: “Note is made of severe scarring within Hoffa's fat pad as well as marked thickening of the synovium, with a joint effusion. There is fairly intense edema within Hoffa's fat pad as well related to synovitis.” My orthopedist resp...

I'm nearly 8 weeks out from surgery now and my progress and recovery really seems to have slowed down. The thrice daily exercise sessions and constant battle against swelling are becoming quite "the grind" at this time. I was prescribed meloxicam for the first 30 days after surgery and that appeared to be doing a great job of keeping my pain down. After withdrawing from meloxicam I started getting migraine-like headaches every other day or so for about 10 days. However, I continued to make progress on my exercises, cycling, and range of motion (ROM) taking the occasional dose of acetaminophen or ibuprofen as necessary. The period from 4 to 6 weeks after surgery I appeared to make some nice progress. I worked my way up to cycling (easily) about 45 minutes per day. I was doing a little bit of walking (just around the house) before each of my 3 daily exercise sessions and worked up to about 10 minutes per walk. Unfortunately, 45 minutes of cycling and 30 minutes of walking p...

The right knee injury that ultimately led to the decision for surgery likely started in 2017 (or earlier). While driving home from my weekly hilly long runs, I experienced sharp pain in my right knee. It made driving home from these workouts (20-35 miles, with as much as 2000 ft. of ascending) very painful, but had no impact on my training. In 2017 and the first half of 2018 I continued to train and race, completing two 100K races, a marathon, and shorter tune-up races. The knee continued to flare up while driving home after long and hilly workouts, but still did not impact training and racing. In the summer of 2018 I began to feel pain in my right knee during downhill running and fast running. After starting a VO2max interval training phase I noticed that my right knee started to malfunction...I just couldn't run fast and it seemed like my right knee wasn't completely responding to commands from my brain. I typically run these intervals at around 6 min/mile pace, but my form s...

Today is (post-surgery) Day 25 and I have made lots of progress despite a few setbacks. A few days before the surgery I rented and picked up a Game Ready ice machine to help get the swelling down the first few weeks after surgery. Pain has not been much of an issue. I take a daily dose of meloxicam, but have not had to take a single dose of rescue medication (oxycodone). There was some dull achy pain particularly during the first week after surgery, but the ice machine was enough to handle that. I left the hospital with a knee brace, which I was supposed to wear for walking and sleeping during the first two weeks. Being a “side sleeper”, I found it very difficult to sleep with the brace on. I adapted a bit, but was glad to jettison the brace after Week 2. Now I am sleeping on my side again, but still sometimes experience a bit of pain that keeps me awake. I put a small pillow between my knees while sleeping on my side to prevent any knee-on-knee violence. I left the hospital with 2 cru...

On Monday, December 7 I underwent surgery to repair three problems with my right knee. The primary lesion (the one that began to impact my running in late 2018) was a full-thickness, 1-cm, chondral defect on the lateral femoral trochlea. (Full description from MRI report: There is impending delamination of cartilage with full-thickness cartilage fissuring as well as linear basilar hyperintensity at the lateral trochlea where there is adjacent intraosseous ganglion cyst formation as well as a severe surrounding stress reaction in the bone.) The injury was repaired with a single osteochondral allograft (donor bone/cartilage). A second issue was a 1.5 x 2.0 cm Stage 3 cartilage defect on the medial condyle (not clear this was causing significant symptoms...see below). This was repaired using 3 osteochondral autografts (my own bone/cartilage from a non-weightbearing donor site (the lateral femoral notch)). The third injury treated was a small horizontal degenerative tear of the media...

I'm a long-time runner with a recent focus on ultramarathons, who is about to undergo OATS/mosaicplasty surgery and meniscectomy to repair an injured right knee. I'm hoping my recovery and rehab goes well enough for my eventual return to running...perhaps even to ultramarathoning if that turns out to be possible. My Purpose for Blogging This Experience... I'm blogging to share my experiences with others who may be making a decision about cartilage surgery or are also recovering/rehabbing from knee cartilage surgery. There are many studies and reviews of short, medium, and long-term outcomes from the various knee cartilage surgeries (including microfracture, OATs, mosaicplasty, ACI, allografts, etc.), but few details are available for endurance athletes trying to return to their sport at something at least close to pre-surgery level.  After my right knee injury worsened (in late 2018/early 2019) to the point where it was greatly impacting my training, my orthopedist suggeste...