[ksu.deadeye]

Hey All:

I signed up to climb Denali in late May and have been on the 24 month big mountain plan for a little over 2 months.

I’ve also had a dull ache on the front side of my right knee for over 9 months or so. It comes and goes. It hasn’t prevented me from training, but it has been a constant nuisance. My doctor told me it was a VMO issue and I that I needed to strengthen the muscles connected to my knee (this is a pretty typical response I’ve heard from a few people). I was never completely comfortable with this explanation for a bunch of reasons I won’t bore you guys with.

After a few months I finally pestered my doctor about it enough that he ordered an MRI. I got the results back today.

I have a “moderate” 9mm x 4mm tear in the center of my patella through about 50-60% of the thickness of the tendon.

I scheduled an appt with an orthopedic surgeon for next week, but I have no idea what to do in the interim.

Do I stop training completely? I’m very hesitant to continue with max strength training and steep hill climbs but running and stationary bikes with resistance (Rogue Echo bikes) don’t cause me any issues at all.

Any advice would help.
Thanks very much.

-Erik

Topic

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on February 6, 2020 at 5:27 pm #37659

Erik,
That is a fairly significant MRI finding, I would be interested in your Orthopedics recommendations. For sure, pain free training is still indicated for the health of the tendon tissue. I would find a ‘baseline’ level of activity that doesn’t cause an increase in symptoms, then explore greater loading activities. Quick, dynamic, eccentric high load activities are the most significant stress to the tendon. If you’re not having significant pain, a reintroduction to strength with lower weights to start, would help the area of tendon that can still be responsive to strain. The same goes for hill climbs, start slow with some modification in grade and load. I usually recommend that you should fail a progressive rehabilitative approach before considering surgery if your symptoms haven’t ‘shut you down’.
Pete

[ksu.deadeye]

ksu.deadeye on February 7, 2020 at 2:19 pm #37728

Pete:

Thanks for the feedback. I made appointments to see two orthopedic surgeons. I just got back from seeing the first.

The tear is strange. It’s intrasubstance and in the middle of the tendon. He actually preferred to call it degenerate tissue.

He basically gave me three options:

surgery (6-8 weeks recovery)
injections including
PRP (plasma)
amniotic fluid
bone marrow stem cells
Wharton’s jelly (and others similar to it)
physical therapy with dry needling

Surgery would prevent me from training and shut down the trip. I think my body is strong enough, but my cardio endurance isn’t there yet. I’m tabling it until I get a second opinion.
I’m definitely checking out physical therapy.
The injections are the confusing part. They vary wildly in price and results for each have been mixed at best. I need to do more research.

Thanks very much for your feedback. I’m gonna ease back on my training until I figure out what to do next.

-Erik

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on February 7, 2020 at 7:45 pm #37743

Erik,
You have part of your tendon that’s not going to be healthy, but….you have a large part of the tendon that you can train to take the loads necessary for an uphill athlete. I feel this is a training/rehab issue. You see this a lot in alpine racing athletes that hang on their patellar tendon a lot with high loads. Sticking things into the tendon and filling it up with all sorts of things is kind of missing the point. Progressive load is whats going to create change in the tendon (mechanotransduction). The devil is in the details of how you gradually tease in more strength to the tendon. With time, its amazing the changes you can create.
Pete