Wednesday, August 11, 1999
New help for knees
Doctors find new ways to handle common injuries BY SUE MacDONALD The Cincinnati Enquirer
Pity the poor knees. They bear the body's weight, provide the oomph that powers lifting, propel people up and down steps, and absorb the shock of running, jumping, twisting and turning.
Yet they bend only forward, not backward, and they're held together by an intricate network of muscles, ligaments, tendons and cushiony, slippery surfaces that are supposed to make bone-against-bone movements smooth and painless.
Knees sideline athletes more than any other body part and cause their fair share of discomfort and disability among weekend athletes, workers of all kinds, people with arthritis and anyone who's physically active.
“In 1995, there were 4.2 million new patient visits to doctors for the knee,” says Dr. Frank Noyes, knee specialist with Cincinnati Sportsmedicine and Orthopaedic Center. “It's the No. 1 reason a primary care physician refers a patient to an orthopedist.”
A variety of new treatments and approaches are helping doctors save and repair knees in ways never before possible.
Even a seemingly simple knee injury, he points out, can have devastating consequences. “Your whole life can change — your job, your marriage, your education,” he says. A knee injury can cause muscle weakness, inactivity, weight gain, lack of motivation, worsening pain and physical/emotional stress.
“We believe very strongly that treatment of the knees involves treatment of the whole person,” he says.
Among some of the latest techniques for repairing and rejuvenating knees.
• Meniscus repair. Cushiony, rubbery tissue between the bones that form the knee can become torn, ripped or worn away from repeated stress or aging. Some doctors remove the meniscus altogether, but Dr. Noyes and his researchers have found 80 percent to 95 percent success rates by sewing the meniscus back onto the bone. If the patient's own tissue can be sutured, donor tissue can be used. “If you lose the meniscus, you're probably going to have arthritis,” he says.
• Cartilage repair. Doctors can sew damaged cartilage they way they repair the meniscus, or they can use a new procedure that injects healthy cartilage cells into damaged tissue, allowing it to replace the worn-out cartilage as the new cells take hold.
• Complicated knees. At the Cincinnati clinic, patients from all over the world who are suffering from serious knee problems or failed surgeries by other doctors can find help. Dr. Noyes' team includes specialists in gait (walking and balance), physical rehabilitation, diet, nutrition, pain management, psychology, counseling.
“In the past, we wouldn't even have attempted surgery with a lot of these patients. They just walked around with a gimpy knee,” Dr. Noyes says. But new surgical techniques and a team approach to recovery can help up to 80 percent of people get help from complicated knee problems, sometimes with extensive reconstructive surgery or, as a last resort, replacement with artificial knees.
• Lubrication injections. Two new drugs derived from rooster combs — Hyalgan and Synvisc — can be injected into the knee to replace the glide-like fluid that coats the ends of the knee bones and helps the surfaces glide smoothly without pain.
In many people, it buys time and allows them to remain active until surgery at a later date, he says. Each series of four to five
injections lasts about six months. Even new drugs like over-the-counter glucosamine are showing promise in rebuilding bone lining and easing pain, he says.
“In the past, you'd have an arthritic knee for life,” he says. “Now there are some very good strategies for arthritis, but you've got to stay active or you're going to be in trouble.”
• Women's knees. In 1994, Dr. Noyes and his researchers developed a Sportsmetrics training program, based on findings that the knees of women athletes were less stable and more likely to be injured than men's knees.
Jump training and knee strengthening exercises are now recommended for female athletes — high school to college to professional — to prevent and reduce knee injuries from twisting, turning, lunging and other motions, especially involving basketball and volleyball.
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