Keyhole knee surgery (arthroscopy) and realistic return to training

I have just found out that I am due to have minor keyhole surgery on my knee on 20th July. I have a little flap of cartilage that’s niggling a bit. I have been about to have this surgery since Sept '19, but due to a bunch of things… its now landed.
I also have one race this season, 6th Sept, 100 miles TT.

What’s realistic in terms of recovery time?
What might be the impact if I get on the bike early?

Please note, I’m after your experience and opinions. I’ll be asking my doctor - but I am surely likely to get a pessimistic view.

I had the same op to remove a bucket tear on my knee cartilage. I had a bit of a nightmare getting it back right to be honest - I didn’t take the physiotherapy seriously enough.

Probably 6 months to a year before it was 100% right.

That being said - cycling was one activity it didn’t impact much at all and was recommended as part of rehab.

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Hi
I had keyhole surgery, just a tiny flap. I think September… 100miles is tight. the surgery you will be moving okay 1-2 days , Bending sore , Up and down stairs really sore… Bike 3 weeks … if you have no hills gentle winds. Take it gently if you have scare tissue it will take 9 weeks to heal properly, think of the stress of 100 miles with healthy knee. The scare tissue is weak and can be torn. Take it easy, my Doc said listen to your body, it will tell you you have over done it. … Very quickly do not ignore it, i was walking to start with and even over done that.

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I echo what @C10oky said. I’ve had 5 arthroscopic knee operations (2 right knee, 3 left knee), and unless you have access to a daily PT person, being in shape to do a 100 mile ride roughly 2 months after the surgery is going to be very difficult.

It’s surprising how much strength you will lose from the surgery / how much time you will need to dedicate to rehabilitation to eliminate the swelling. All of which will lead to detraining.

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I would do one session of “pre-hab” - get w/ a PT, have them describe what the first 10-14 days will be like post surgery, and get a home exercise program. you can start those exercises as soon as you wake up in post-op. PT sessions can start within a few days unless your doc says otherwise. don’t use the bike to force your range of motion, but as soon as you have about 105-110 degrees flexion, you can do easy spin on the bike (think of it as knee rehab, not as a bike workout). Have your PT do girth measurements of quad and calf before and after surgery, you can use those to judge how your strengthening is going afterwards. Doing the 100 miler…maybe. Depends on your conditioning prior to surgery, how hilly the course is etc, but I wouldn’t rule it out. good luck

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2 years in a row had each knee done with flaps, tears and scar tissue in each. While not true training, was on the bike trainer the next day; ran after 2 weeks and 10 milers in a month. I realize this is not doing a cycling 100, but I feel running was more problematic. Surgeon was with the Chicago Bulls and let me be very proactive. Water running was huge to break up the stiffness and each session gave me more range of motion. I went under the Doc’s words that there was nothing structural in the knee and that helped when I was trying to determine whether the pain was a good or bad thing. 15+ years later and still going strong. Do whatever you can to keep the aerobic system strong and even improving, as that will be what you need for that event anyway. How that system is developed matters little. Cycling specific training can be accrued once you feel it’s not pushing too hard, but having the aerobic already built you be huge. I have no doubt you’ll be back to strength in no time…good luck!

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I’ve had both knees done - two different types of tear. Both times it was a couple of weeks before I was back on the bike. It will feel weird for a few weeks. You need to remember they dislocate your knee to get access to the cartilage so your ligaments and tendons need time to heal.

I described it as feeling like somebody else’s knee for a few rides.

I’m just going to call if now - don’t do the race. I was in top form when I had my first knee done; no chance I was going to race a 100 miles 2 months afterwards. I was definitely back training etc; but you’ll effectively need 2 solid weeks off any intensity and then start building slowly; so you really are starting your training season again.

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Thanks for all the advice guys. I really appreciate your thoughts and experience. There’s a good amount for me to take in, and some great questions for me to ask my surgeon too;

They had not explained this to me; I will double-check, but I can understand that if my ligaments have been seriously pulled about, I am not likely to just jump right back into training.

I’ve heard this from others, and its what I was hoping… But I don’t want to be unrealistic.

I have also been told by the consultant something similar - that whilst the knee may be painful/uncomfortable, there is no risk of damage by exercise.

This is a key question I need my surgeon/consultant to answer. I’ve been led to believe there won’t be damage within the knee, but if there is, I guess that puts a different perspective on getting back on the bike.
Thanks again - I’ll report back once I know more!

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I’d surgery about 10 years ago, approx 30 at the time. I’d a 2 week surfing holiday booked 6 weeks after my surgery was scheduled, my surgeon assured me I’d fully recovered by then. I’d a pre-surgery consultation with my PT and he was horrified😅.

I went ahead with it anyway, PT took a pretty aggressive approach and I stuck to the programme very diligently. Wore a brace for the surfing and was mostly grand. I’d given up cycling/triathlons about 2 years prior because of the knee pain, eventually had gotten to the stage where I had trouble driving.

I took up cycling again a couple of weeks after getting home from the holiday. I’d a good bit of muscle wastage, but power balance on both legs was identical on both legs by time I’d gotten a PM (6years ago). I think it’s doable but very dependent on age and recovery ability, I’m not sure I’d get away with it now. Avoid low cadence/high force though.

I’d prioritise the surgery, and play everything else by ear, even if you’re 80% through the race - be ready to pull the plug.

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I’m 46 years old now. I just don’t know how my recovery compares, I don’t have much experience (thankfully!)

Training is going really well right now. My FTP is up ~40W since last year, and probably 30W higher than I’ve been before, and partly this is helped by having a target. Especially with the season we’re experiencing, racing opportunities are… a bit thin! So, in some ways I’m trying to balance the need to get the op (I can’t run, and it is, very slowly, getting worse) versus the motivation (I just hit 300W FTP, and I’m not sure I want to celebrate by having 8 weeks off the bike).

Ditching the race and settling for recovery and then base season will be mentally very tough, but if I can’t ride, for sure I can’t race. I won’t pull the plug until I’m 4 weeks into recovery, I guess. At least I can pretend I still have a 2020 goal!

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I had both knees scoped to perform partial meniscectomies in each of them (October 2017 and January 2018). Was a marathon runner…now a cyclist (we’ll at least trying to be :grinning:)

The recovery was different from each and my right knee still gives me fits every now and then. I still run occasionally and both of my knees will let me know when they have had enough. So for me it’s a judgement game. As others have said take the PT seriously and I would echo that it will be 6-12 months before it feels right. For me it wasn’t a flip the switch realization but rather one where I didn’t notice anymore discomfort, had the strength I wanted and had its full range of motion back.

The one thing my surgeon said that always stuck with me was “we don’t know exactly why, but people who tear their meniscus are placed in the high probability group for knee replacement down the line”.

At 51, I still have a lot of living to do, exercise daily and lead a very active lifestyle. I’d like to keep my original parts (as I think they’re best) so I need to be aware of my limitations and accept them. Low RPM-High Torque workouts are NOT my cup of tea :slight_smile:

Best of luck!

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You’re 46; I was in my 50’s, so somewhat comparable.

There is NO 'dislocation" of a knee! The biggest cause of pain and stiffness afterwards is the fluids they pump in to expand the joint and the body needs to work that out. That’s why movement is key. If you have any scar tissue, it will likely be taken out while in there. One thing I did on both that I might suggest is to do a spinal anethsthesia and stay awake during the procedure. It’s fascinating and I viewed the screen as the Doc showed me there was no wear, no arthritis, and ligaments were fine after many years of running. To me it was very comforting to know those things for my long term exercise and health after decades of running and cycling. I had surgery in January and did the World Championship Tri in September and other long races after that. Go into the surgery in exceptional shape, which helps a ton. As I said, unless you have other issues to ligaments or structure, the procedure is a breeze and one I’d do in a minute.

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Three surgeries on left knee. Two of them being scopes. You can ride the bike which will be part of PT, took me about a year to feel 100% from the two scopes.

With that being said, I believe everyone is individual and will heal at a different rate. Can you do a 100 mile TT? Likely yes. But it’s not going to be your best time. I wouldn’t do it, just from my experience. That small surgery is a big trauma to all the tissues around the knee.

Good luck trying to do the TT.

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Greg, I just had a meniscus repair done last month (May 2020). I think my recovery was easier than normal, as I was back on the bike starting the 3rd day after surgery. Just spinning for 10 min. Ramped up my time each day thereafter. I was up to spinning for about an hour a week after surgery. Back to doing group rides about 2 weeks post-op. I was riding completely normal on the bike within 3 weeks. Did a ramp test a month post-op and FTP was down only a couple of points from before surgery.

I’m taking my return to running more cautiously. Started running 10 min/1 mi a few times a week starting in week 3. No pain, but not going to push the running as quickly.

Best of luck to you.

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Ggeiger is correct. there is absolutely no dislocating of the knee during arthroscopy. there are 2-3 incisions approx 1cm through which the various instruments are inserted (irrigation, camera, tool(s)). It’s about as minimally invasive a procedure as you can have done. That being said, I always remind my patients that it is still invasive, and even if they only went in to take a peak and did no surgery, you would still have pain, swelling, loss of strength and range of motion. I tell them if it was 100 years ago, they just took a couple of arrows to the knee. I think the other poster was referring to a total knee replacement, which is far more advanced (but still does not involve dislocating anything, just sawing off the end of the bone. kinda fun to watch, but not much fun to have done. hip replacements can involve dislocation in order to position correctly for the procedure)

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I was spinning after a couple of weeks, as soon as the swelling from the 3 small incisions was down. I guess how quickly you could ride a century or longer depends on your level of fitness going in. For me, I had been pretty sedentary for over 3 months prior to surgery (I had a loose piece of cartilage that got wedged behind my knee so even walking was painful and my insurance co was dragging their feet to approve the surgery) so I was building aerobic fitness along with strength, so it took about 3 months to get back to where I was. Definitely follow the advice of your doc, do all the recommended PT and be patient/willing to back off if necessary.

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Thank you all, sincerely, for sharing your experience. I appreciate it hugely. I’ll probably read and reread all your posts to help get my head around the best approach.
What I take from all your comments so far is that;

  • The procedure is low-risk and little tissue damage is likely

  • However, swelling is still inevitable, and with that comes some pain/discomfort, some loss of strength and a more limited range of movement

  • Different folks have recovered at different rates, but in terms of getting back on the bike, one day(!) to 3 weeks seems to be the range

  • And then a couple of weeks to 6 months plus for full recovery and the knee to feel normal.

So, I will finish a block of training the day before-hand, and plan to take the following two weeks post-surgery very easy - get on the bike if I feel ready, but be mindful that my body may have other ideas!
If I’m on the bike and things are improving (ie I can start gentle training) after 2-4 weeks) then I might be on-track to race.
But I guess there is a chance that my recovery won’t be as swift as I hope, and I need to get my head around the risk that I might not be racing - and instead, I will have the longest base-phase ever recorded!

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Arthroscopy surgery is not minor for many people. In my case, I had preexisting arthritis, so the procedure caused a significant flare up. If you have a good non arthritic knee, except for your meniscus pathology, you will be able to return quicker. Your orthopedist, based on the pathology he sees during the procedure, is the one to ask regarding recovery time. Good Luck.

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sigh
I have just got a letter through to tell me the surgery is NOT going ahead on 20th July.
On the one hand, this is great for training and the one race I have this year. I can really focus on the last two months of training.
On the other hand, my knee isn’t getting any better (can’t run, and its pretty gritty now when I walk). I am hoping that I am rescheduled for surgery some time during the winter months.

Many thanks to you all for your help, advice and support - I appreciate it. I’ll come back to this thread when I have surgery reconfirmed, as it will all be very helpful!

You can look at what are called “unloader” braces, which use various methods of taking pressure off one side (the injured side) of the joint. They are pricey, but insurance usually covers a portion depending on you plan. The brand I like best (and use for myself) is Ossur https://www.ossur.com/en-us/bracing-and-supports/knee/unloader-one-x

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