Should Marathon Runners Get Surgery for a Torn Meniscus?

by Dr. Robert Marx
Marathon runners

With the NYC marathon just a few months away, many people are ramping up their training in order to run through the five boroughs with over 40,000 others. It is a great day for NYC, with people of different ages, nationalities and fitness levels running together as a group.  However, injuries are a part of sport and marathon running and are no exception. Distance running puts enormous stress on many parts of the body, including the knee.  In fact, one of the most common injuries to the knee is the meniscus.

What is a meniscus? 
There are two menisci in each knee, one medial (inside) and one lateral (outside). The menisci are made of fibrocartilage and serve as shock absorbers between the ends of the thigh bone (femur) and the shin bone (tibia). The meniscus is attached to the capsule of the knee joint, which is richly innervated. Although the meniscus does not have nerves, a torn meniscus can pull on the capsule, causing pain.

How do meniscal tears happen?
Meniscal tears in runners usually result from overuse. They can also result from a sudden injury.  Meniscal tears usually occur in degenerative menisci, and can occur in people of all ages. The average age for a meniscal tear is in the forties, but runners young and old can suffer from these tears.

Non-operative & operative treatment for mensical tears
Small meniscal tears often do not require any treatment and may not even bother the patient. In fact, it is common for people to have an abnormal appearance of their meniscus on MRI, but have no symptoms. Not every torn meniscus requires surgery. But for runners who are unable to run, and have symptoms, physical examination and MRI evidence consistent with a meniscal tear, surgery may be necessary. In many cases, surgery can be avoided with non-operative treatment such as physical therapy, anti-inflammatory medications and the use of a brace. If not, arthroscopic surgery, which requires two small incisions around the knee, can be used either to remove or repair (stitch) the torn piece.

Most meniscal tears require meniscectomy, which is an excision of the torn fragments, because the meniscus has a limited blood supply and often does not heal.  Certain tears are amenable to repair that includes stitching the torn pieces back together. Rehabilitation after a meniscectomy is quick, with patients usually walking normally within a week or two. Compared to excision, rehabilitation is longer after a repair because the tissue must heal. Physical therapy is necessary to regain sufficient strength to be able to run again.

Dr. Robert Marx, Orthopedic Surgeon

Dr. Robert Marx, Orthopedic Surgeon

Running again after surgery

Patients usually start running within two to three months, although some start earlier than that. Of course, running a marathon requires several months of training beyond that. Most patients who undergo meniscectomy can return to running without problems and do not have a significantly increased risk for arthritis, unless they have their entire meniscus removed, which is rare. Patients with preexisting arthritis of the knee often have a meniscal tear, but may or may not have significant improvement with surgery since the arthritis may be the cause of their pain, not the meniscal tear.  Patients with arthritis of the knee should approach arthroscopic surgery of the knee with caution. Consult with your physician about returning to running if you’ve had surgery.

 

Topics: Featured, Orthopedics, Rehabilitation and Fitness, Running
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The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.

Comments

Vicente says:

hi, i am not a marathon runner but i try to run 3 times a week, for the las 3 years i´ve being having a strong pain in my right knee, it is located in the lower part of the patella, it feels like a strong sting with a needle, ive have stop doing any exersise for over a month, i have done MRI´s, seing many many doctors in mexico and in the U.S, the only way to calm the pain is with strong anti-inflamatory pills, but i can´t live taking those, other than that nobody has being able to tell me what i have becouse everything looks ok with it, only one told me that maybe i have to do an artroscopic procedure to see what is wrong; the thing is that now i am having back problems and i cant rest at night becouse i think i am sleeping in a wrong positition, anyway i would like to hear your opinion.

HSS on the Move says:

Hi Vicente, thank you for your question on knee pain. Unfortunately, without being able to personally evaluate you, we are unable to provide an educated opinion.

Please contact Patient Referral Services at 877-606-1555 or visit them online at https://www.hss.edu/secure/prs-appointment-request.asp. They are knowledgeable about the capabilities of all the physicians and can help find a doctor who will be the best match for your condition. If you live in Mexico, please contact the International Center at international@hss.edu or +1 (212) 606-1186. For more information on the International Center, please go to http://www.hss.edu/international-center.asp

Rick Lorenzo says:

I”m 58 year old no arthritis marathon runner with media meniscus Tear horizontal from body to posterior horn if I have surgery what are the chances that I will be able to run a marathon . The tear happen running a half marathon cross country any help will be appreciate.

HSS on the Move says:

Hi Rick, thank you for your question. Dr. Robert Marx, Orthopedic Surgeon, says: “Whether you’ll be able to run a marathon after surgery depends on the amount of arthritis, functional limitations, acuteness of injury, duration of symptoms and size/type of tear.” To make an appointment for an evaluation, please contact Patient Referral Service at 877-606-1555 or visit them online at https://www.hss.edu/secure/prs-appointment-request.asp.

HSS on the Move says:

Dear Martin, Thanks for reaching out. You should hear from our Physician Referral Service. If you do not, please contact us at socialmediacontact@hss.edu.

alok deep says:

helo doctor m alok n m 26 yrs old , had acl surgery last janafter i had damaged it while playing basket ball in left leg and was back to games in 8 months but just last week again i had an injury but this time in my right leg and doctor told me that have my lateral meniscus damaged …..dont know realy what to do next n m realy afraid a lot thinking of my future …..will i b back again to the field?is it possible to get back to sporting action and what about future complications?

HSS on the Move says:

Hi Alok, thank you for your question. Dr. Robert Marx, Sports Medicine Surgeon, says: “Sorry to hear you injured your other knee. You should see a doctor to have an assessment and determine what the best course of action is. Most athletes with the injuries you describe are able to return to sport.” If you are interested in receiving care at HSS, please contact our Physician Referral Service at 877-606-1555.

john says:

I had a medial meniscus tear 6 years back in my right leg , I had swelling and pain. but after 1 year everything was normal, I started playing football without problem.

Recently I got interest to win a full marathon, I am running 20 to 30 kms now. I get mild pain in the bone near medial meniscus. I am really working hard to win a marathon and need to practice. Please tell me will I get arthritis if I run or is pain is becos of bones rubbing ? should I stop running. I want to run in olympics, please help me, What should I do ??

HSS on the Move says:

Hi John, thank you for reaching out! Dr. Robert Marx, Sports Medicine Surgeon, says: “If the pain is mild, surgery is not needed. There is no evidence that your situation causes arthritis, so if you can run with only mild pain, feel free to carry on. If the pain becomes more severe during or after running, you should see a knee doctor for an evaluation.” It is best to consult with your treating physician. If you are interested in receiving care at HSS, please contact our physician referral service for assistance at 877-606-1555.

Tracy says:

I have a question. Can you tear meniscus when u slip on some ice?

HSS on the Move says:

Hi Tracy, thank you for reaching out. Dr. James Kinderknecht, Sports Medicine Physician, says: “Slipping on the ice and twisting the knee is a common mechanism to create a meniscal tear. The meniscus is typically torn with a twisting type mechanism.” For more information on meniscus tears, visit http://www.hss.edu/condition-list_torn-meniscus.asp. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

matt b. says:

I am a 47 yr old male and tore my meniscus playing b naxketball. Doc says i have a torn medial meniscus snd i need surgery. I hurt it 3 mos ago. Hurt pretty bac in the beginning, wore a brace for a month, no running or hiking. I am now able to run and hike with minimal pain and swelling….sometimes it hurys and i stop. I cant kneel or squat without pain. Doc says the medial meniscus lateral posthorn is smsll. Should i have surgery?

HSS on the Move says:

Hi Matt, thank you for reaching out. Dr. Robert Marx, Orthopedic Surgeon, says: “The surgery is only necessary if you feel the problem is limiting your quality-of-life. If it is not much of a bother, you can live with it the way it is. If you’re not satisfied with your mobility and function, you may wish to consider surgery. The decision of whether to have surgery is based on limitation in function, the physical examination, and the MRI. An MRI of a torn meniscus does not necessarily mean you need surgery.” It is best to consult with your treating physician. If you are interested in receiving care from HSS, please call our Physician Referral Service at 877-606-1555 for further assistance.

Renee Wichelns says:

Afternoon Dr. Marx,

I am 47 and had my first surgergy for a bucket handle tear in my meniscus. The Ortho Dr. Says it a “youthful” injury and he sees no athritis or degenerative issues.

My question is I’m a PT (personal trainer and fitness instrcutor). 1 day after surgergy NO pain, 4 weeks after surgergy NO pain, however as I increased my daily actiity my knee was swollen and painfull. I went back to the dr and he drained the fluid out and gave mr NSAID and told me not to run till April 1st…he said what happened is very common…I am feeling better but it seems like if I over do it I am stiff and sore after? Should I be concerned? Also surgery was done on Jan 10!

Any expert adivse would be appreciated.

Thanks
Renee

HSS on the Move says:

Hi Renee, thank you for reaching out. Dr. Robert Marx, Orthopedic Surgeon, says: “It is rather difficult to provide information without seeing and examining the patient. However, it sounds like you are overdoing it and doing too much too fast. Once this happens, you have to take a step back and progress very slowly with activity. This is understandably very difficult for a personal trainer. If you keep pushing too hard, it will get too sore. The more sore you get, the harder it is to get strong and the cycle will repeat itself. Use a lot of ice as well.” It is best to consult with your treating physician. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

Amy Hirschi says:

I am a personal trainer and a runner and have been having trouble with my knee for a while. It seems to tolerate some running, but if I sit with my leg fully extended, there is significant pain. If it is slightly bent it feels fine. I have the same problem while standing. If I try to fully lock my knee straight or if someone bumps into the front of my knee, it is very painful, but feels fine when slightly bent. I thought it was my patellar tendon, but now I”m wondering if it could be my meniscus. Thanks for any suggestions!

HSS on the Move says:

Hi Amy, thank you for reaching out. It is best to consult with your treating physician to receive a better diagnosis. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

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