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