Is it possible to play sport with osteochondral damage of the knee?

Hi

In August 2019 I injured my left knee playing a Gaelic Football game here in Ireland. I received an MRI on the week of injury. The main findings were:
Osteochondral damage
Complex tear of lateral meniscus

The following month I had an arthroscopic meniscectomy carried out to which the lateral meniscus was repaired.
Upon my one month check-up with the surgeon he noted that there was a complex tear of my articular cartilage present- approximately 2cm in diameter. He was quite concerned and stated it could hinder my chances of returning to sport swiftly.

5 months have passed since the surgery and during that time I have worked closely with my physiotherapist to regain muscle and strength in the leg since the injury. I have been successful in doing so have also regained flexability and full range of motion which was an issue initially. In the past 2 months I have also returned to running and twisting on my own but am yet to return to the playing field and match scenarios due to the physio's orders. The physio however has stated that I will be able to do so within the next 2 weeks.
My main concern is with the articular cartilage damage. Is it even possible to return to sport successfully with such a sizeable tear in the cartilage? Is it going to lead to further injuries down the line? The physio has assured me that if I maintain leg strength and if i keep working on my single leg control, balance, running, jumping and landing mechanics, It shouldn't be a concern.

I am wondering about people's thoughts on this as I am a little concerned.
Thanks

Hi ItsmeJPaulC,

If your physiotherapist is specialised in sports, then you can probably trust him. Return to sport is possible if you train up your agility, strength and endurance gradually. You may not be 100%, but maybe close depends on your condition. However, you are still more at risk now than you were before the injury. Your knee will also degenerate quicker compare to your other leg, because of your past injury. How serious do you play football? like professionally? or just causal? Because when playing sports, things happen very quickly and sometime you just dont have the time to prepare yourself for actions like sudden stop, sudden turning. These can be dangerous for the knee. Also there are external factors like someone kicking on your lower leg while you are standing on that leg. That would be dangerous too (i know nothing about Gaelic Football). So if the matches are quite competitive I would not want expose myself to those kind of risks again. You can call me chicken, I just like to be on the safe side all the time. I even tell my friends to avoid running, hiking or unnecessary stairs to minimize the risk of knee degeneration. I am kinda extreme on that, I have seen plenty of people has their mobility very limited by their knees, and I already have knee pain from work.

Talk to your physiotherapist again and decide if you want to take those risks, then you have your answer.

Hi ItsmeJPaulC,

It would be easy to be scared of putting load through your knee knowing about the tear, I can definitely see that.

I'm inclined to agree with your physiotherapist. I think if you are feeling good symptom-wise during activities, I think that is a good sign. A popular saying in the physio community is "treat the patient, not the scan". The body is pretty miraculous at adapting and coping very well to deficits in structure and the MRI alone really doesn't give the full picture. There have been lots of studies in recent times where they have put lots of people without any symptoms through MRIs and they have shown some pretty horrendous tears and degeneration ect on the picture, but the person has experienced no symptoms at all! That doesn't mean the scan is completely useless, but it shouldn't be taken in isolation.

At the end of the day, I think you should do what you enjoy. If that was my knee and it was coping well during rehab and progression of activities, i.e symptom free, no swelling, no clicking or locking of the knee ect, I would keep going. It is probably sensible to do it under the guidance of your physio to check in on things, make sure youre coping well and have a good strengthening/balance/plyometric preventative kind of program to continue on down the track. It's also important that your rehab has been/is progressive and gradually working you up to the demands of football and you dont jump the gun. Maybe when you return your knee isnt coping (mentioned above are some of the potential signs) and you have to modify activities accordingly, but its tricky to estimate how it would go just from theory. If you are super keen on returning I think its definitely worth a try given adequate preparation and confirmation with your physio.

Strength is a huge protective factor when it comes to knee health and prevention of arthritis symptoms, and avoiding all "unnecessary" activity in the long term I think would be hugely detrimental. And on running and knee health, studies have shown that not only does running not cause degeneration of the knee, but it may even be a protective factor for diseases such as arthritis. Regardless of whether you return to football or not, I think you should definitely be doing a comprehensive strength and neuromuscular based rehab program, as it is a sizeable tear.

Good luck with it! Keep us updated.