Weak Knees Could Be Your Achilles Heel
The Knee.
Most exercisers worry at least a little about this body part, their ears alert for any weird clicks, pops or crunches. And for good reason.
The knee has been dubbed the body’s most vulnerable joint, with its malfunctions sidelining big-name athletes, everyday exercisers and even sofa spuds. It’s the joint that produces pain more often than any other, according to the American Academy of Orthopaedic Surgeons.
Trouble can strike in the cartilage or surrounding ligaments, tough bands of tissue that support the joints. Nearly 400,000 knee surgeries are performed each year on an in-patient basis, according to the academy, but three to four times that number are done on an outpatient basis.
The good news? The chances of getting almost-good-as-new knees through surgery or non-surgical treatment are better than ever, thanks to improved tools and refined surgeons’ skill. Carefully designed rehabilitation programs and sound exercise habits can help knees stay pain-free.
The Cartilage Connection
In the 1970s, surgeons were quick to remove damaged knee cartilage. But now they realize they underestimated its value in proper knee functioning. The new credo for cartilage: repair if possible.
When cartilage was routinely removed, it solved the problem temporarily. But years after the original surgery, patients complained of arthritis and other problems.
Even in the best of hands, cartilage repair is not always possible nor prudent, says Dr. James M. Fox, attending physician at the Southern California Orthopedic Institute, affiliated with Valley Presbyterian Hospital, Van Nuys.
A patient’s age, along with the site of injury or abnormality, play a big role in the decision. The older a patient and the farther a cartilage tear is from the blood supply, the less likely repair is the best strategy, says Fox.
Ligament Remedies
When tears affect the knee ligaments--often the anterior cruciate ligament--surgery is often recommended. But now some doctors say non-surgical treatment might be worth a try. In one study, non-surgical treatment proved satisfactory for middle-aged exercisers, who healed enough to return to their workouts.
The Donor Option
A new procedure uses donor cartilage and ligaments from cadavers.
“More than 100 have been done worldwide,” estimates Dr. Eugene M. Wolf, an orthopedic surgeon at California Pacific Medical Center, San Francisco, who has performed five such procedures.
For now, the surgery is considered an option for those whose previous knee surgeries have proved unsuccessful over the long haul, Wolf says. Some of his patients were walking with canes and crutches before surgery and now can walk unassisted.
The new procedure is best reserved for patients in their 20s and 30s, Wolf says.
If both cartilage and ligaments are reconstructed, the surgery can take five hours and require two or three days of hospitalization. The cost ranges from $15,000-$25,000.
“It gives the person the best chance for having a normal knee in the future,” Wolf says.
As promising as the new surgery sounds, it is still considered investigational, cautions Fox, whose institute also offers the procedure.
The HIV Factor
The risk of transmission of the human immunodeficiency virus through a donor transplant is “extremely remote” but a possibility, says Scott Bottenfield, a nurse and spokesman for LifeNet Transplant Services, a Virginia organ procurement agency and tissue bank.
There have been no documented cases of HIV transmission with freeze-dried donor tissue, says Bottenfield, who published an article on the topic last month in The American Journal of Sports Medicine. There was one case of transmission from a ligament that was preserved by traditional freezing, he reports, but it is believed to have occurred before HIV testing was initiated for organ and tissue transplantation in 1985.
Patients need to discuss the topic with their doctors, Bottenfield advised. If ligaments are the problem, cadaver transplants aren’t the only option; the patient’s own ligaments from elsewhere on the leg can sometimes be used.
Shorter Stays
Knee surgery is a good candidate to be performed on an outpatient basis. One reason is the trend to arthroscopic surgery, performed through a special telescope that eliminates the need to open up the knee, thus minimizing recovery time.
Rehab
Physical therapy can help restore knee strength and function and teach patients how best to prevent further injury. The length of rehabilitation prescribed varies dramatically, says Kathy Greene, a physical therapist in Waterford, Conn., who specializes in knees.
“Rehabilitation tends to take longer, for instance, for cartilage repair (than removal),” she says. Her advice? “Discuss rehabilitation prior to surgery. A lot of people with very involved surgeries have very involved rehabilitation, and they don’t think to ask about it.”
Knowing the length of rehabilitation might influence a patient’s decision to have surgery or not.
There’s a growing trend to home-based physical therapy, which saves time and money, says Rick Ricafrente, a Beverly Hills physical therapist. After several supervised therapy sessions at a clinic, he sometimes allows patients who are doing well to continue rehab exercises at home, with telephone supervision.
Knee-Saving Steps
Common sense measures can help preserve knees. Don’t run on concrete if you can avoid it, Wolf says, and pick a better surface like a track instead. Wear shoes with good shock absorption, especially for running and other high-impact activities.
Knee Noise
So which knee sounds should you worry about and which do you ignore?
“A lot of people have clicks and pops,” Fox says. “If the knee doesn’t hurt or swell, don’t worry.” But crunching sounds need an evaluation pronto.
Fitness runs every other week in View. Doheny cannot answer mail personally but will attempt to respond in this column to questions of general interest. Please do not telephone. Write to Your Body, View, Times Mirror Square, Los Angeles, Calif. 90053.
