First thing he said, when he looked at my knees -- just looked, didn't take x-rays or touch -- was that I had obvious muscle atrophy of the quad muscle around the injured knee. After manipulating my knee and looking at MRI images, he said he was almost certain that I had a torn medial meniscus. I opted for surgery but by another orthopedist who was in Johannesburg, South Africa, who only did knees, and who worked on athletes (I wanted to maximize my chances to run again).
But, before going to South Africa, I took to heart the first orthopedist's observation about muscle atrophy. I reasoned that strengthening my quad muscles would improve my chances of successful surgery. So, I focused on leg lifts on my Bowflex but instead of lifting with both legs together, I did one leg at a time so that I forced my injured left leg to work as hard as the uninjured right leg. I began very cautiously because I didn't want to cause further damage to my knee.
I had the surgery and the physical therapist was in my room almost the moment I woke up. First thing she wanted me to do was stand up so she could see whether I could use the knee at all (I actually walked out of the hospital without crutches). Then, she gave me careful instructions and demonstrations of a regimen of physical therapy exercises she wanted me to do -- basically designed to strengthen the quad muscles around my knee (sounded familiar). She also gave me a time table of when I could start walking for exercise, jogging and then running. I followed those instructions religiously and within just a few weeks was back to running.
Here are my take aways from that experience and my advice to anyone facing the same surgery. (DISCLAIMER: I am not a doctor or a physical therapist. You should consult qualified medical personnel before following my advice. I will not accept responsibility for any damage, injury, loss of anything, etc. as a result of anyone following this advice.):
1. Even if you are a guy, don't deny or ignore persistent pain or a potential injury. I was fortunate and didn't permanently injure myself but your mileage may differ. See a doctor.
2. As much as possible, focus on strengthening the leg muscles before surgery. A book I'm reading now, The Powerfood Nutrition Plan by Susan Kleiner, confirms that advice. She calls it prehap. In fact, it would probably be wise to do specific strength exercises when you're perfectly healthy.
3. After surgery, get and follow directions from a good physical therapist as soon after surgery as possible. That sounds like a no-brainer and sounds like something that would happen automatically. However, a friend had meniscus surgery on both knees here in Richmond and didn't see a PT until about 10 days after surgery. She was in agony.
Surgery worked for me. I regularly run between 25 and 38 miles per week and rarely have pain greater than the occasional dull ache. I also now have a built in shoe-dometer -- when the ache in my knee becomes constant, I know I need new running shoes.
Run well and injury-free, y'all,