BIKEPGH MESSAGE BOARD ARCHIVE

Ask about viscosupplementation (synvisc, orthovisc, etc.). Sometimes that can be better than cortisone. Biking is definitely good to do, as long as your saddle is at appropriate height. It is low impact. Swimming is great, also, since it is non-impact. Sorry, I work specifically in orthopedics... Hips and knees. I see people with mild to advanced knee arthritis. Lateral compartment (outside of the knees) is less responsive to injections than medial (inside of the knee). If you have arthritis under your patella (kneecap), quad strengthening helps. Keep it to low resistance on the bike with any of the above. I don't have arthritis myself, but if/when i eventually develop it, I will keep biking.

I have a bucket-handle tear on my left medial meniscus and had it surgically operated on about 20 years ago. I can run but don't do it for exercise. (e.g., "Noooo! I want that bus!" *tears off down the street and catches it*) But I can pedal all I want, so I do. So long as I don't try any hacky-sack maneuvers, I'm OK. I guess I should count myself lucky.

There's no question that cycling is good for people with ligament problems. I'm not sure what the consensus is as regards arthritis, but it's hard for me to imagine what kind of aerobic exercise would be better/lower impact than cycling. Anecdotally, my mother has some arthritis in her knees and she has said that it bothers her less if she walks regularly (solo cycling is out of the question for her due to other health issues)

I wouldn't have thought that cortisone would do very much for arthritis, guess I have to go do some pubmedding.

stefb, how common/useful is surgery for a condition like this?

For severe arthritis that has failed injections, use of assistive devices (cane/walker) with activity-limiting pain, knee replacement works very well as long as it is done correctly. I have patients who are back on their bicycles following surgery. As far as the injections go, some of my patients get years of relief from them before they need surgery, some aren't as lucky. But it is common for subsequent injections to not work as well as the first. Of course, no one wants to have surgery, but people often tell me afterwards that they can't believe they waited so long to get it done. I don't know if that answered your question.

The first cortisone shot I recieved made it feel pretty good to normal for about 4 months, where I continued to run a little -9 miles per week average, down from 30 for the year or so before that. The second shot did nothing, so I have stopped running.

I ride maybe 80 miles per week, lift twice a week, and row on an ERG a few days a week. Elliptical runner on rare occasion, for 10 minutes, maybe 4 times in the last month. I may start swimming, avoiding breaststroke as the kick really hurts my knee. Never having had any surgery, it is something I would like to avoid and don't think it can do much for me at this point.

Will look into viscosupplementation after I learn more about it. Other than not running and frog kick, I do not feel limited at this time.

I'm 3 days post-injection for a supposed torn meniscus & worried about how it'll feel next week climbing close to 30 mi @ 7.5%+. Today wasn't that great on the few short climbs I did. Flats are no problem.

Hope your knee feels better. I hope you get an MRI to confirm a tear before anyone does surgery.. Unless it is very obvious that it is (locking or giving way the knee, etc). Some people have ligament strains instead of cartilage tears. If it was me, and I was gonna be off of the bike for a few weeks, I would want to know for sure first. I may also have a meniscus tear. I get pain every few months, but then again, I think last time it bothered me earlier this year, it was an MCL strain perhaps. 4 years ago I twisted my knee when I sat down on the second day of the MS150 and felt a pop. I thought I was going to puke from pain every time I pedaled up any kind of hill, even if the grade was like 2%. so who knows. I never had it it formally evaluated.

I injured my knee water-skiing (spectacular fall, ski didn't come off) and was on crutches with a brace for six months or so. Cycling was much easier than walking -- as long as I didn't rotate my foot and kept everything in one plane, I was pain-free. But I don't think I tried to climb any significant grade. Lately I've been having knee pain on long rides and I'm not sure what the cause is.

stefb, the kind of surgery I was wondering about was arthoscopically smoothing the bone surface without doing a full replacement. Is that not done anymore? Or is it the case that with arthritis the bone just isn't structurally sound enough for that to work?

A few things about arthroscopic surgery: we do some scopes, and if people have inflammation of their synovium (lining of the joint), it can be debrided. Same for some articular cartilage fraying. Sometime doing that can be helpful. If there is a small focal area of complete articular cartilage wear on a weight-bearing portion of the joint, a micro fracture can be done. That involves taking a pick or some sort of cauderizing device and making small holes in that area where cartilage is deficient. Usually recovery is longer, with 4-6 weeks of non weight bearing to allow time for some scar tissues to form over the bare bone. People usually recover well. And those people often have good bone quality. It is really the location and severity of arthritis that will determine what treatment is more appropriate. Most people who can be helped with a scope have good bone quality. Only when people are severely osteoporotic with complete joint wear is bone quality maybe an issue in knee replacement, but I don't believe osteoporosis would be a contraindication to knee scopes

I read you talking about cortisone and others talking about surgery.

I feel better when people talk about knee problems, I am happier to hear about stretching and physical therapy. A PT could likley recommend some productive lifting/nautilus-type exercises, that you cfould work into your regular workouts.

There used to be a non-surgeon involved in the UPMC sports medicine center, a Dr Stone. I would highly recommend talking to him. He may spend more time with you than the 40 seconds that the top orthopeadic surgeons will give you.

Biking and swimming, particularly the kicking, strike me as excellent. I'm guessing that Lyle is right about moderate walking - especially immediately followed by stretching.

Long (3-5 minute) stretches and non-impact exercises like swimming are great for joints. If there's any cartilage left between the bones, motion can help stimulate its growth. Best of luck.