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perf orthopedics Many of us weekend warriors are now taking to the softball fields, golf courses, and tennis courts.   I have found that many of my patients, as well as my own teammates, complain more about their knees than anything else this time of year.  It’s quite simple, either you have an old injury that is catching up with you over time, or time is simply catching up with you and you have injured something new because you’re not as resilient as you used to be.
If you are an “ex-jock” – who is trying to continue to be a jock – and you have a bad knee or bad knees, you’re not alone.  As a matter a fact, one of my most common types of patient is an ex-athlete in their 30’s, 40’s, 50’s, or 60’s who has “a bad knee from an injury that occurred during football, basketball, volleyball, soccer, or some other sport – back in the day.”  Let me give you a little historical perspective, and hopefully a little hope.

In the “old days,” the orthopedic community didn’t have a thorough grasp on the optimal treatments for many of the common knee ligament and cartilage injuries that we see so commonly today.  For instance, many ligament tears were simply labeled as “sprains” and allowed to “heal.”  Unfortunately, many of these “sprains” never really “healed,” and this left patients with an unstable knee that they could not trust.  Then came the era during which we discovered that many “knee sprains” were actually tears of the ACL or PCL (the major ligaments in the middle of the knee that provide stability).  We subsequently learned that these ligaments are incapable of repairing themselves, so we tried a number of things that really didn’t work: casting, sewing the ligament together, or replacing the ligament with a piece of synthetic material.

To make matters worse, prior to the advent of arthroscopic surgery and MRI, we really couldn’t look inside knees.  Treatment for many of the major cartilage injuries came down to “guess work.” Back then, many cartilage injuries were simply never diagnosed and went on to degenerative arthritis.  To make matters even worse, we went through a whole era during which we treated the meniscus (the shock-absorbing bumper cartilage inside the knee) like a tonsil – we simply took it out if we suspected it was torn.  As a result, we now have large numbers of middle-aged folks walking around with knee arthritis and a bowed leg because their entire “shock absorber” was removed.   

This is the bottom line – many of my patients have one, or a combination of, the following:
  • An unstable knee or a knee that “cannot be trusted” because of an old ligament injury that never healed
  • A knee that was good for a while, but isn’t good any longer because an old articular cartilage injury has progressed to arthritis
  • A leg that is a bit “bow-legged” or “knock-kneed” because the meniscus was taken out, and now a part of the knee is “breaking down” and causing deformity
  • A knee that swells, catches, and/or locks because it has developed a torn meniscus bumper cartilage or some other new problem
If this is you, don’t despair.  Most certainly, don’t continue to live with a bum knee – you simply don’t have to.  Times have changed, and we now have many procedures in our armamentarium that we use to combat knee problems.  These include:
  • Knee arthroscopy to clean out the arthritis, and even promote the growth of new cartilage in select candidates who have a cartilage injury but have not yet develop arthritis
  • Minimally invasive ligament reconstruction that can “give you a knee that can be trusted” (even after all these years…)
  • Osteotomy (“the Steve Yzerman Procedure”) that can realign the leg to take the stress off of the bad part of the knee and “buy you time” so the you can remain active
  • “Mini” Knee Replacement that only replaces the part of the knee that is bad
  • Minimally invasive total knee replacement
We also do some really cutting edge procedures like meniscal transplant (a cadaver meniscus is surgically transplanted into the knee) and cartilage transplant (cartilage cells are harvested from the knee, grown in culture in a lab, and then reimplanted back into the knee to fill a defect in the articular cartilage).

Unfortunately, once arthritis has set in, it is often too late for these “fancy” procedures like meniscus and cartilage transplants.  It really is too bad that these procedures were not around 20 or 30 years ago…However, there are other new things like “arthritis shots” (referred to technically as viscosupplementation and more commonly as “chicken shots”) that we now commonly use.  This short series of injections helps many of my patients stay active on knees that have mild to moderate arthritis, especially if they aren’t quite ready for a major procedure like knee replacement.  In addition, other things like more advanced braces, cartilage vitamins, and newer therapeutic modalities are also available for patients who opt for conservative treatment.

Simply stated, many of you can continue to enjoy the game you love – you just need to get that bum knee taken care of.  For more information on knee injuries go to my website at www.orthodoc.aaos.org/joeguettlermd or visit www.performanceorthopedics.com.  guettler

Dr. Joseph Guettler is an orthopedic surgeon who specializes in sports medicine, as well as surgery of the knee, shoulder, and elbow.His practice, Performance Orthopedics, is located in Bingham Farms.  Dr. Guettler is active in teaching and research as a member of the Orthopedic Staff at Beaumont Hospital in Royal Oak and as an Associate Clinical Professor at Oakland University.

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