Description:
Kevin R. Stone, M.D., discusses the top questions patients ask about
the knee joint: Part 1 of a 2 part series. 9:37 minutes/13.2MB |
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I am Dr. Kevin Stone, orthopaedic surgeon at The Stone Clinic in San Francisco. Today,
we are talking about the top ten questions that we are asked about the
knee.
The most common question that we are asked about the knee is, “I
hear clicking and popping in my knee. Is this something that I should
be concerned about?”
We often tell patients that clicking and popping is very common and sometimes
natural within the knee and, unless it is causing pain, swelling, or giving
way, most of the time we will ignore the clicking or popping. Clicking
and popping can be caused by the tracking of the kneecap in the patellar
groove, by catching on soft tissue or scar tissue within the knee, by rough
tissue underneath the kneecap that causes some grinding, popping, or clicking
within the joint, or, lastly, by a torn cartilage that might get caught
between the femur and the tibia. Most of the time, clicking and popping
is natural with scar tissue that may have built up or the tracking of the
kneecap. When it causes swelling, pain, or giving way, then those
are times when we worry about injury within the knee and damage to the
knee. It is most important, at that time, to examine the knee to
help make a clear diagnosis. Very often, we will obtain an x-ray
and/or an MRI, a magnetic resonance image, to study the cartilage and the
soft tissue within the knee. If the important tissues of the knee
are torn, such as the meniscus cartilage, then we will plan to repair that
tissue. If there is pain, swelling, or giving way of the knee, then
we will do a careful exam, history, x-rays, and, often, an MRI to study
the cartilage of the knee and determine if the tissues need to be repaired.
The next most common question that we are asked is, “Doc,
I hit my knee or twisted my knee and I had pain or swelling. Is
this important to have examined?”
If there is trauma to the knee, followed by swelling, this most commonly
means that there is bleeding within the knee. That bleeding comes
from torn tissue and the most common tissues injured are the meniscus cartilages,
articular cartilage, and ligaments. Trauma followed by knee swelling
is important to investigate with a history, physical examination, x-rays,
and, sometimes, an MRI. The reason is, when tissues in the knee are
torn, if they are left unrepaired, arthritis can develop, most commonly
when the meniscus cartilage, the shock absorber of the knee, is torn. If
left unrepaired, an arthritic area on the opposing articular cartilage
develops over time. Or, if the ACL, the key guide wire ligament in
the middle of the knee, is torn and the knee becomes unstable, arthritis
and disability can occur. So, when our patients tell us that they
were hit on a football field or twisted their knee and the knee swelled,
then we always examine this carefully to investigate the cause of that
swelling.
The third most common question is, “What is arthritis?”
Arthritis in the knee joint is broken up into three major types. The
first, least common, is inflammatory arthritis, which is the arthritis
of rheumatoid arthritis or gouty arthritis, where there is a disease process
of the lining of the joint, which causes swelling in the joint and then
eventual destruction of the articular cartilage. Of the 70 million
Americans who have arthritis, only about 2 million have inflammatory arthritis.
The second type of arthritis is osteoarthritis and that is where the articular
cartilage of the joint, the weight-bearing surface that covers the ends
of the bone becomes worn down and the bone is exposed. The cause
of osteoarthritis may be genetic, such as if your mom or dad had their
knees replaced or had back stiffness or other typical findings of arthritis. It
may also be secondary to an underlying disease process and there may be
viral causes, such as Lyme arthritis, where a tick bite leads to a viral
cause that leads to destruction of the joint surfaces over time. This
crosses over with inflammatory arthritis but there may be primary viral
or other types of causes of osteoarthritis that are currently a major source
of investigation these days.
The most common type of arthritis that we see in our orthopaedic practice
is traumatic arthritis, where someone has injured their knee, often playing
sports as a kid or in their early 20s and then has a surgeon remove their
cartilage. Then we see them in the office 20 or 30 years later with
knee joint arthritis and they remember that they had had an injury years
ago and that joint then went on to become an arthritic knee because they
lost the shock absorber or cartilage inside the knee was bruised and damaged. We
often relate that to a car tire. When a car is out of line, such
as when a knee is bowed, then the joint wears abnormally and that joint
surface wears down. Or, if a person has a torn meniscus that acts
as a little loose body within the joint, wearing away the opposing articular
cartilage. This we call traumatic arthritis. Fortunately, these
types of arthritis are definitely treatable, sometimes they are preventable
and there are many new ways of either re-growing those damaged articular
areas or replacing them. There are also nutrition, gait training,
and physical therapy techniques for dealing with each of these problems. There
is more information about each of these techniques on our website at www.stoneclinic.com.
The next most common question we are asked is, “Are there
any supplements I can take to prevent or treat arthritis?”
Fortunately, we believe that there are dietary supplements that can be
taken that do affect the course of arthritis. Glucosamine and Chondroitin
sulfate have gained a lot of attention over the last 20 years because veterinarians
gave these supplements to horses and dogs and noted that they did not limp
as often as they did before they were treated. People started taking
these with more and more frequency in the 1990s, leading many surgeons
and physicians to start giving their patients glucosamine and Chondroitin
as supplements before giving them anti-inflammatory medication. These
supplements work by increasing joint lubricity, or the lubrication in the
joint, by inhibiting the enzymes that break down cartilage, by stimulating
new cartilage formation, and by absorbing water and increasing the hydration
of the joints and tissues. So, many of our patients tell us that,
when they take glucosamine, they feel less stiff in the morning or less
stiff after activities. This is probably the most common benefit
that we hear and many patients, therefore, avoid taking non-steroidal medications
because they are able to use glucosamine alone. Other supplements
that are important are clearly vitamin D and calcium. It is almost
impossible for men and women to get enough vitamin D and calcium in their
diet to provide good joint health and, therefore, we encourage people to
take calcium supplements and to obtain enough sunlight in order for the
body to create vitamin D, so that you can use the calcium that you take
in your diet. Vitamin C is also helpful as an anti-oxidant and as
a builder of collagen for helping joint health and also overall physical
health. We believe that these supplements are helpful, that it is
difficult to obtain enough, even in a relatively healthy diet, and that
it does make sense for people to supplement their diet with extra sources
of each of these supplements.
Another common question is, “Are there any non-surgical
means of treating my knee joint injury?”
In fact, most knee joint injuries that we see can be treated without surgery. Most
can be treated with a careful exercise or rehabilitation program, with
gait training, with strengthening of the muscles around the joint, and
with soft tissue physical therapy, where a qualified physical therapist
applies manual pressure to various injured tissues to help them heal appropriately,
decrease swelling, or increase the way that they glide through the joint. Most
injuries can be treated by these methodologies and a careful strengthening
program to return people better, stronger, fitter, and faster, than they
were before they were injured, which is our goal.
We will continue this lecture on the most common questions asked about
the knee joint in our next podcast.
The Stone Clinic in San Francisco concentrates on returning injured people
to their active lives, fitter, faster, and stronger than they were before.
The Stone Clinic includes Dr. Kevin Stone, physician and surgeon, a staff
of physical therapists, and an x-ray and MRI facility. Our specialties
include the treatment of joint injuries and arthritis with leading edge
surgical and rehabilitation techniques. Elite athletes and everyday people
alike come to The Stone Clinic from around the world for the best in orthopaedic
care. The Stone Clinic is located at 3727 Buchanan St., San Francisco,
CA 94123. For more information, please call us at (415) 563-3110. |
