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Twisted, Injured Knees Easily Treatable -- Especially in Young Patients

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WebMD Health News

Feb. 11, 2000 (Atlanta) -- For sudden knee injuries -- with signature symptoms like locking, popping sounds, pain, and swelling -- a minimally invasive procedure called arthroscopy is generally the best treatment, according to a paper published in the January issue of Current Opinion in Orthopedics.

"Someone twists the knee or lands on it 'funny,' causing bones to become misaligned or injuring the meniscus (the knee's bumper)," lead author Tal David, MD, an orthopaedic surgeon and sports medicine specialist at Los Angeles' Kerlan-Jobe Orthopedic Clinic, tells WebMD. "There's clearly an inciting incident that's caused the problem. This is the patient who says, 'I felt a pop, and since then my knee feels like there's something grinding in there, like something catches in there when I flex and extend it.'"

Such injuries cause painful swelling and can begin wearing away the cartilage -- the cushioning tissue that surrounds the bony knee joint, says David. Traditional procedures to treat these injuries have involved bone realignment (osteotomy) or knee replacement (total knee arthroplasty), but these are invasive procedures that mean several days' hospital stay and rehabilitation.

Arthroscopy -- a minimally invasive procedure -- has become a popular option because of its low cost and short recovery period. Typically, patients go home the same day they have arthroscopic surgery and get around on crutches for up to one week.

The procedure involves inserting a flexible tube into the joint, allowing the surgeon to view the damage and remove or repair broken pieces of bone, a procedure called debridement. Sometimes, surgeons drill small holes -- called abrasion arthroplasty -- to stimulate bone marrow cells to regenerate cartilage in small, damaged areas.

"Arthroscopy definitely has its advantages, but until now it's been unclear to physicians exactly which patients benefited most from this procedure," says David. "In this paper, we looked at the literature to clarify the positive predictors of a good outcome."

"Young people who injure the knee ... do very well with arthroscopy," says David. "The gray area will be the person over 50 who has a little bit of arthritis who injures the knee. Their outcome is not as predictable. Alignment is not as important with them."

"What's most important," says David, "is how long have they had their symptoms, whether the arthritis has become chronic, whether too much of the cartilage has worn away. Science has not given us a way to regenerate cartilage, at least at this point." For those patients -- as well as people who have had previous surgery of the knee -- knee replacement surgery is typically the only solution.

When asked for an objective assessment of the study, John D. Kelley IV, MD, assistant professor of orthopaedic surgery at Philadelphia's Temple University, tells WebMD, "It's a nice, comprehensive review." In 10 years of practice, says Kelley, "I've seen many patients do remarkably well with arthroscopic surgery. ... I think you have to be very, very careful about choosing your patients and not be overly aggressive."

However, the paper didn't mention a new technology -- the bipolar electrothermal energy "shrinkage wand" -- that can help stabilize arthritis lesions, says Kelley. "Cartilage doesn't deteriorate as rapidly. It's been shown with a microscope that it can make the very rough surface very smooth," he says. "The idea is, with lifestyle modifications [and] weight loss, maybe we can give patients a few more years [without having knee replacement surgery]."

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