Many Baby Boomers Pop Their Knees

In the end, it was not President Clinton’s regular running nor his love of golf that wrecked his right knee--but a condition he shares with his fellow baby boomers that neither he nor they can do anything about: middle age.

“A 20- or 30-year-old probably would not have sustained this injury,” said Dr. Stephen Haas, a sports orthopedist, of the 50-year-old Clinton’s ruptured quadriceps tendon, torn during a middle-of-the night stumble on a stair step. “This kind of thing is much more common in people his age.”

It is a fact of life that normal wear and tear over time--an inevitable consequence of getting older--leaves older people more vulnerable to such injuries than their younger counterparts, experts said Friday.

“Your tissues, skin and bones just aren’t as tough as they once were,” said Dr. David Hungerford, professor of orthopedic surgery at the Johns Hopkins University School of Medicine and a past president of The Knee Society.

On the bright side, however, it is likely that the president’s regular sports activities and attendant physical condition prevented the injury from being worse, experts said. The damage suffered when the president ruptured his right quadriceps tendon is not expected to be permanent, and the surgery and recuperation, while prolonged and inconvenient, are regarded as straightforward and uncomplicated.

Experts predicted that Clinton would be running and playing golf again within six months, although full recovery could take as long as a year.

“For most orthopedic injuries, the first six weeks is for primary healing, the second six weeks is for primary rehabilitation and the next three months is basically letting things mature . . . and getting flexibility back,” Hungerford said. “After that, you can get back to a pretty vigorous life.”

Clinton tore the tendon--which connects the muscles of the upper thigh to the kneecap and allows the leg to straighten--early Friday morning while at the Florida estate of professional golfer Greg Norman. He apparently caught his heel and tripped on a step.

“He’s coming down the stairs, loses his balance and catches himself--this is a fairly large individual who is falling--he catches himself with his leg and as soon as it makes contact, his muscle contracts reflexively,” Hungerford explained. “It’s a reflex to counteract the fall. And the force of the contraction causes a rupture in the system.”

Doctors said Clinton suffered a tear of more than 50% in the tendon.

Tendons “are like huge rubber bands,” said Haas, who cares for the members of the Washington Bullets basketball team and who operated on Vice President Al Gore after he ruptured his Achilles tendon playing basketball. “When they tear, they tend to retract. The structure needs to be put back together.”

To repair such an injury, surgeons drill several holes in the kneecap and use sutures to reattach the torn ends of the tendon to the kneecap.

Clinton underwent about two hours of surgery Friday afternoon at Bethesda Naval Hospital outside Washington. Spinal anesthesia left him conscious throughout the operation.

There were about 7,000 hospital admissions for this injury in 1994, according to the American Academy of Orthopedic Surgeons. Knee injuries involving ligaments and cartilage are much more common.

Saying that the president, while “not a conditioned athlete,” is “not a couch potato either,” Hungerford suggested that the severity of Clinton’s injury was limited by his athletic activities.

“It’s like anything else. If you’re in a sedentary job and you go rake leaves on the weekend, you’ll get blisters,” Hungerford said. “If you’re a farmer and go rake leaves, you won’t even notice it. We’re all conditioned by physical activities.”

Clinton’s knee will be immobilized in a brace, and he likely will have to walk on crutches for several weeks. He also will have to undergo several months of physical therapy to regain flexibility and strength in the leg.

“The structure has to heal, and it can’t heal with the stresses of bending the knee, walking and running, etc.,” Haas said. Thus, “you’ll be able to find him for the next several months without too much trouble,” Haas added.

Yet Clinton told his doctors Friday that he still plans to attend next week’s summit with Russian President Boris N. Yeltsin in Helsinki, Finland.

“It’ll be tight,” said Dr. Merrill Ritter, president of the American Assn. of Hip and Knee Surgeons. “He’ll have pain and there will be an inability to get around easily.”

But the single biggest peril Clinton faces because of the injury in coming months is gaining weight, experts said.

“He’s at some risk of bulking up during this period because his exercise will be considerably restricted, particularly those things he likes to do the most,” Haas said.

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“A Very Loud Pop”

A torn quadriceps tendon in a painful injury. The tendon attaches four muscles from the top of the leg to the joint at the knee cap. According to an aide, the president “heard a very loud pop” when he fell.

A TORN TENDON

The tendon works like a huge rubber band, straightening the leg as a person walks. When the president fell, he reportedly tore the connection to the kneecap.

THE REPAIR PROCEDURE

1) Tendon is stretched back into its original position.

2) Holes are drilled into the kneecap to make attachment points.

3) The tendon is hooked to the knee cap with surgical thread or wire.

Sources: White House, Times wires and staff, The CIBA Collection of Medical Illustrations