Runners and their knees – a knee surgeon’s perspective

By Mr Ian McDermott, Consultant Orthopaedic Surgeon

You’re a runner. I’m an Orthopaedic Surgeon, specialising in knees. You all hope that you’ll never end up having to see me. I think that, frankly, you’re all a bit mad! Still, I guess you could argue that it’s better to die old with bad knees than to do no exercise, have pristine knees, but die young of a heart attack!

Regular cardiovascular exercise reduces your risk of heart disease, stroke, diabetes and hypertension. Also, when you exercise you pump your body full of adrenaline and endorphins. This makes you feel happier, it’s addictive and the endorphins also act as a natural painkiller, raising your pain threshold so that you feel less pain. Therefore, exercise is not just important – it’s vital!

Research has shown that if you have normal knees then long distance running does not increase the risk of knee arthritis. However, some people have a genetic predisposition to knee arthritis, some people have got inherent biomechanical / alignment / structural knee abnormalities, and some people suffer specific knee injuries, such as cartilage damage or ligament tears. It there is anything at all significantly wrong with a knee joint then heavy repetitive impact through the joint (i.e. running!) is only ever going to exacerbate the problem and make the damage worse, sooner.

 There are plenty of good exercises that one can do where one can maintain one’s cardiovascular fitness without unduly stressing the knees. The best and safest non-impact ‘knee-friendly’ exercises are cycling (with the seat as high as possible), swimming (particularly with front crawl legs rather than breast stroke) and the cross-trainer (which is the safest and best of all). However, from personal experience, I can tell you that there are few things more scary and intimidating for a knee surgeon than having a runner come into clinic, have them slap their copy of the latest edition of Runners World down on the table in front of you, and then have to try and advise them against continuing to run!

 As for the kinds of knee problems that I see in runners, these are many and varied, and include:-

• patellar tendonitis,
• iliotibial band friction syndrome,
• medial plica syndrome,
• fat pad inflammation,
• articular cartilage damage,
• meniscal cartilage tears,
• ligament tears and
• arthritis

Clearly, there’s no way to go through all of these different pathologies. However, if you do want to read more then there is a large amount of information on our website:- www.kneearthroscopy.co.uk and www.sportsortho.co.uk

In summary, however, the most important message to give is that if your knee hurts significantly, then get it investigated properly… ‘No pain, no gain’ is absolutely right for cardiovascular fitness and muscle strength; however, for joints it’s the absolute opposite – if you feel pain in a joint then it’s your body’s way of telling you that there’s a problem and that you need to back off and protect the joint.

If despite the usual initial ‘first aid’ period of RICE (rest, icing, compression and elevation) your knee pain fails to settle, then for most serious athletes with any significant problem their next port of call is likely to be a physiotherapist. We work very closely with our physio colleagues, and rely on them heavily. However, not all knee problems can be cured with physiotherapy alone; and for those problems that are either more major or for issues that fail to settle despite time plus physiotherapy then patients often find themselves heading our way.

When I see any patient with a knee problem, for me the first step is always to achieve a clear specific diagnosis. For this, I tend to have a very low threshold for arranging for my patients to have appropriate imaging tests. These include X-rays, ultrasound scans and/or MRI scans. Other more specialised tests that are sometimes required are bone scans, CT-PET scans or MR-arthrograms (MRI scans with dye injected into the joint). Only once a confirmed diagnosis is achieved can we then actually even start to think about actual treatment.

When it comes to treating knee problems, we have a wide variety of tools in our armamentarium. Treatment options may range from simply doing nothing, to referring back for physiotherapy, to interventional treatments such as injections, keyhole surgery (knee arthroscopy) or more major knee operations. What is at times somewhat upsetting is when some people assume that as a knee surgeon ‘all I do is just operate’! Not so – only about 25% of the patients that I see in clinic actually end up needing knee surgery. Therefore, even though I am a specialist knee surgeon, I actually prefer the term ‘knee specialist’, as absolutely not all people with a knee problem actually need knee surgery – but every person with a significant knee issue deserves a clear and accurate diagnosis, and an open, clear, comprehensive and balanced discussion about all the potential available options. Just like ‘a runner’s not just a runner’, and all runners are different – so the same applies to knee surgeons, and perhaps surprisingly there are significant differences between different specialists. Therefore, if you do end up needing to see a knee specialist, do your homework and your research, and ensure that you get to see the best person possible – and always question everything. At the end of the day, they’re your knees and if you’re going to run, you’re going to need them!

Mr Ian McDermott is a Consultant Orthopaedic Surgeon specialising in Knees. Ian is a full time private knee specialist within the London Sports Orthopaedics practice, based at 31 Old Broad Street, in the middle of The City. Ian is an Honorary Professor Associate in the Brunel University School of Sport & Education. Ian was the youngest ever surgeon to be elected onto the Council of the Royal College of Surgeons, he has been awarded the President’s Medal of the British Association for Surgery of the Knee for his research into meniscal repair, and he was awarded a Master of Surgery higher degree by Imperial College for his research into meniscal transplantation.

For further information see www.sportsortho.co.uk or e-mail london@sportsortho.co.uk