What will it be that stops your participation in sports? Back pain? Wrist pain? Lack of interest? Assuming your abundant talents have not led to you being named as head of security in Iraq, there is a strong probability that your participation in tennis or other sports will be limited by some sort of physical ailment(s). Like it or not, in cutting sports such as tennis, the knee is frequently the culprit. Consequently, it is not a bad idea to acquire a deep sense of appreciation as well as a little knowledge of this highly complex joint.

Think of your knee as the suspension of your car. Instead of riding around on the rims of your wheels (bones), you have nice rubber tires on the rims (hyaline cartilage). This hyaline cartilage coats the ends of the bone of the tibia and femur to provide a phenomenal combination of cushioning and low friction. In your car, you also have some suspension components that improve your driving performance. In the knee, these components include an intricate array of meniscus tissue, ligaments such as the anterior cruciate ligament (ACL), and muscle/tendon units. Surely you have noticed the difference in quality of a brand new tire compared to the cracked, brittle rubber of a ten year old tire. Likewise the tire tread tends to wear down with time. The hyaline cartilage in your knee undergoes a similar process. This thinning and wear of your cartilage is arthritis. Damage to the ligaments can have the effect of damage to the steering of you car whereas problems with the muscle/tendons can affect the power to the wheels. When all the components of your car are working in harmony the ride is nice. When this is occurs in the knee it can be referred to as homeostasis. Homeostasis is what you want. Homeostasis and the ability to exercise and play sports is what you really want.

Regular maintenance for your car extends its life. Likewise you can take steps that may extend the useful life of your knee. These include weight control, proper nutrition (supplements?), appropriate warm up, and exercise on a regular basis. Since the knee is a weight bearing joint, it is intuitive to suspect that excess weight can adversely affect the knee. Research bears this out. It is also pertinent that some areas of the knee may be disproportionately affected. For instance, the forces across the kneecap portion of your joint can easily be 6 times your body weight when climbing stairs. Inadequate intake of nutrients such as calcium and vitamin C can impair the body’s ability to maintain healthy bone and cartilage. There is also a substantial amount of research that supports the ability of glucosamine supplementation to improve cartilage health (keep your tire tread intact). Whether or not glucosamine has a valid role in preventive treatment in a normal healthy knee is debatable. However, given the fact that the vast majority of “arthritis” medication has not been shown to favorable affect the actual health of your cartilage, this relatively innocuous nonprescription supplement is certainly an attractive adjunct for knees that have cartilage issues.

Warming up is a time honored recommendation. It is also supported by science. The biomechanical properties of cartilage are significantly improved by warming. This in turn can make is less susceptible to injury. Warming of the knee has also been offered as an explanation of why many patients with arthritis get relief by use of a neoprene knee sleeve. In such patients, the benefits are more likely due to the warming effect on the cartilage along with possible some soft tissue support from the even compression of neoprene rather than any fancy straps or hinges. Ice has limited usefulness for joint problems and should probably be limited to use within the first 48-72 hours after a fresh injury. The benefits of stretching has actually been questioned by numerous studies and by the lack of strong evidence supporting a beneficial effect. On the other hand, it has never been shown to have a negative effect. In addition, research shows that a pre-stretched muscle can generate more power than one that has not been stretched.

Regular exercise also appears t o be significantly more beneficial to your joints that sparse irregular exercise. Think of this as keeping proper air pressure in your tires, regular oil changes and lubrication. In addition, studies have also shown a diminished rate of ligament and muscle/tendon injuries with certain types of weight training or resistance strengthening exercises.

What to do when the knee has trouble? Obviously, it depends on what the problem is. Overuse injuries can frequently be prevented or resolved by following the recommendations above to regain homeostasis. If your efforts are unsuccessful a physician exam and xrays can be helpful. I strongly advise that one not belittle the value of a well done set of xrays and exam. Conversely, one should not overate the value of an MRI.
Unfortunately, many patients are convinced they need knee surgery based on the radiology report of the MRI. Studies have highlighted the fallacy of acting on MRI findings alone. Of note is a recent study of collegiate varsity athletes with no knee problems. MRIs of these athletes revealed one or more abnormalities in approximately 75%! Likewise, well done research studies have led to a growing consensus regarding the futility of many arthroscopic procedures of the knee when there is significant underlying arthritis especially in the presence of misalignment seen on weight bearing xrays.

A comprehensive analysis of all the data (history, physical exam, xrays, etc. are more likely to lead to the best recommendation. Effective non-surgical treatments can include training/rehab adjustments (possibly with the aid of a physical therapist), anti-inflammatory medications, viscosupplementation (an injectable synthetic lubricant for pain relief with possible nutritional benefit), judicious use of cortisone injections, bracing, and shoe inserts. Surgical options range from simple knee arthroscopy to more complex knee reconstructions or replacement. I have summarized a general review of various commonly employed treatment options in Table I. This is by no means comprehensive but offers a useful framework to work with.

Remember, a little maintenance can keep you running smoothly

POSSIBLE TREATMENTS

SURGERY-  Disadvantages= Invasive. Numerous potential complications. Some commonly performed procedures such as arthroscopy with significant underlying arthritis, found to be ineffective. Cost.  Advantages= Wide variety of applications. Potential to “fix” the problem

VISCOSUPPLEMENTATION LUBRICANT or GEL INJECTIONS- Disadvantages= Often not effective for advanced arthritis. Typically requires a series of 3 weekly injections. Cost. Advantages= Safe. Possible nutritional benefit. Potential for long lasting relief and the ability to restore homeostasis

CORTISONE SHOT- Disadvantages= invasive, Probably no nutritional benefit. Can be detrimental if overused. May be associated with higher rate of infection if done within 30 days of surgery. Advantages= Can provide long lasting relief. Potential to resolve some issues such as
bursitis/tendonitis

ORTHOTICS- Disadvantages= Effect can range from no relief to marked relief. Hassle factor. Comfort factor. Advantages= Wide variety of applications. Non-invasive.

GLUCOSAMINE- Disadvantages= Not cheap. Often not effective for advanced arthritis. Benefit of other supplements such as Chondroitin, MSM debatable. Advantages= Positive nutritional effect on cartilage, very safe, good support in the literature and ability to restore homeostasis.

PHYSICAL THERAPY- Disadvantages= Cost. Many commonly employed treatments have little or no proven benefit. Advantages= Can reinforce healthy habits and restore homeostasis.

MEDICATIONS- Disadvantages= Potential side effects. No nutritional benefit to tissue or cartilage. Cost.  Advantages= Reliable pain relief. Many formulations allow for once a day dosing.

HEAT- Disadvantages= Not advised withing the first 48-72 hours of a fresh injury. Advantages= Simple to use. Analgesic effect. Favorable effect on cartilage. Promotes blood flow through tissue.

ICE- Disadvantages= Unfavorable effect on blood flow to tissue. May impede healing with long term use. Unfavorable effect on cartilage. Advantages= Simple to use, may prevent excessive swelling after a fresh injury (first 48-72 hours).

http://www.orthosurge.com/team.asp

Dr. Lurate is Board Certified in the field of Orthopaedic Surgery. He graduated Magna Cum Laude with a Biomedical engineering degree from Mississippi State University where he was inducted into the Engineering Student Hall of Fame. He went on to earn his medical degree in 1987 from the University of Mississippi Medical Center under the U.S. Navy Health Professions Scholarship Program. After completing a general surgery internship at Louisiana State Medical Center – Charity Hospital in New Orleans, LA, he then went on to complete his orthopaedic surgical training at Louisiana State University Medical Center in Shreveport, LA. While in residency, he became the first person at LSU to successfully perform many advanced surgical procedures ranging from laminoplasty (for decompression of the cervical spine) to arthroscopic ankle fusion. Thus began a commitment to performing the most technologically advanced and minimally invasive surgery possible.

Upon completion of his tour of duty in the Navy, Dr. Lurate was recruited to practice in the Panhandle area where he has been in practice since 1997. He has been the first in the panhandle area to perform such technically advanced procedures as Minimally Invasive (MIS) total hip replacement, MIS total knee replacement, arthroscopic ankle fusion, laparoscopic spine fusions, arthroscopic shoulder reconstruction, and thorascopic spine decompressions. In many cases, Dr. Lurate remains the only one in the area performing such procedures.

Dr. Lurate is committed to studying and utilizing the most technically advanced surgical methods to provide patients with the best possible result with the quickest recovery. He has also published research on cartilage healing as well as on arthroscopy. He is a fellow in the American Academy of Orthopaedic Surgeons and a member of the Society of Military Orthopaedic Surgeons. In recognition of his dedication he recently received the Physicians Recognition Award from the AMA for the sixth consecutive year.