ABOUT
KEVIN STONE M.D., Founder of The Stone Clinic Dr.
Stone is an orthopaedic surgeon in San Francisco California who specializes in
sports medicine with a special interest in knee injuries and knee surgery. Dr.
Stone is a physician for the Lawrence Pech Dance Company, Alonzo King's Lines
Ballet, Smuin Ballet, and Marin Ballet. He has served as a physician for the U.S.
Ski Team, U.S. Pro Ski Tour, The Old Blues Rugby Club, the United States Olympic
Training Center. He
was educated at Harvard College and earned his M.D. at the University of North
Carolina at Chapel Hill. He trained in Internal Medicine at Harvard's Beth Israel
Hospital, General Surgery at the Stanford University Medical Center, and Orthopaedic
Surgery at the Harvard University Combined Orthopaedic Residency Program in Boston.
Dr. Stone's training also includes a Knee Surgery and Sports Medicine Fellowship
and a visiting Research Fellowship at the Hospital for Special Surgery in New
York. He
received the Albert Trillat Young Investigator's Award from the International
Society of the Knee, the Cabaud Award from the American Orthopaedic Society for
Sports Medicine, the Resident's Essay Award from the Arthroscopy Association of
North America, and has more than 40 U.S. patents for his work since 1989. He has
been the principle investigator on two N.I.H. grants. Dr. Stone is regularly sought
out as an expert for publications ranging from The Wall Street Journal and Newsweek
to Men's Journal and Elle Magazine. He has also contributed to a variety of segments
for television shows such as ESPN's "Treating Athletes in the New Millennium,"
The Discovery Channel, and FOX News' special segments on alternative treatments
for knees, as well as others. He is the author of numerous scientific articles
and is often asked to share his research and teach new surgical procedures internationally
at leading forums and symposia. He has lectured around the world as an expert
in cartilage and meniscal growth, replacement, and repair. Dr.
Stone is the co-founder of ReGen Biologics, Inc., a medical device company that
produced the first collagen scaffold for meniscus regeneration; founder and CEO
of CrossCart, Inc., a medical device company that removes the antigens from pig
tissues to make pig ligaments, bone, and cartilage available for human use; and
founder and CEO of Joint Juice, Inc., a glucosamine-enriched beverage company.
THE
STONECLINIC ORTHOPAEDIC
SURGERY, SPORTS MEDICINE AND REHABILITATION
with Special Interest in
Advanced Research and Techniques for Knee Surgery 3727
BUCHANAN STREET, SAN FRANCISCO, CA 94123 (415)
563-3110 fax: (415) 563-3301 E-mail:
avoidingkneereplacement@stoneclinic.com copyright
The Stone Clinic 2002 About
Knee Injuries and Avoiding Knee Replacementby
Kevin R. Stone, M.D.; The Stone Clinic and The Stone Foundation, with Special
Interest in Advanced Research and Techniques for Knee Surgery For
a person who engages in athletic activities, or for active seniors, sports injuries
or injuries to the knee that interfere with daily function can be crippling. The
very words either sends vivid memories of a previous injury, or anxiety about
"what-if?". People who are fortunate enough not to have a lot of experience
with knee injuries are not familiar with a lot of the more common ones. This article
seeks to help answer some of the questions of; once an injury has been sustained,
what can be done for it, short-term and long-term?. In
our orthopaedic practice, some of the more common injuries that we see are in
the knee. With the knee being extremely weak in terms of its bony arrangement,
most of its stability is gained through ligaments (which connect bone to bone)
and tendons (connect muscle to bone). Its two primary motions are flexion and
extension, but there is a little movement into rotation and to a lesser degree
some lateral (sideways) motions. It is also because of this design that the knee
is so vulnerable to injury. Once the knee has been subjected to stresses greater
than what it was designed to, injury can occur. This also explains why activities
that require a lot of quick turning and twisting have such a higher incidence
of knee injury. One
of the more common knee injuries is a sprain of one or more of the stabilizing
ligaments. A sprain is stretching a ligament further than it can tolerate
and subsequently causing varying degrees of tear. This usually happens as a result
of a planted foot and either a twist, a hyperextension, and/or an outside force
directed at the knee with the foot planted. Pain is usually immediate and
there will be some feelings of apprehension or an inability to bear weight
on that leg. One
of the more commonly injured ligaments is the Anterior Cruciate Ligament ( or
ACL). This is considered the key "guide wire" in the knee joint and
is crucial for guiding the tibia bone in a normal path along the end of the femur
bone. Often the person remembers hearing a 'pop' as the injury occurs and
there are instant feelings of instability or giving-way. The
other three major ligaments of the knee joint that are more commonly injured are:
the medial collateral ligament (MCL) which prevents the knee from moving medially,
the lateral collateral ligament (LCL) which prevents lateral movement, and the
posterior cruciate ligament (PCL) which criss-crosses with the ACL and prevents
backwards movement of the tibia on the femur. As mentioned above, sprains to
any of these ligaments illicits symptoms which are similar with respect to feelings
of instability, apprehension or inability to bear weight, and immediate pain. Initial
care and treatment of sprains to the knee joint consists of ice for
20 minutes every 1-2 hours, elevation above the level of the heart to reduce swelling,
crutch-use so as to not exacerbate the injury, and immediate follow-up with an
orthopaedic surgeon for an accurate diagnosis. Because of the relatively poor
blood supply to the ligaments of the knee, they are unable to repair themselves
like muscles or tendons. They do, however, lay down collagen-based scar tissue
which needs to be used regularly in order for it to form strong tissue. Early,
protected weight bearing is emphasized as well as prescribed range of motion and
strengthening exercises. Another
area in the knee joint where injuries are commonly sustained is to the cartilage
of the knee. There are two major kinds of cartilage in the knee: articular
and meniscus. Articular cartilage covers the end of the tibia (shin) and the femur
(thigh) and acts as a shock absorber and bone protector. The menisci are two disc
shaped wedges which float between the tibia and femur and act as stabilizers as
well as shock absorbers. Injury
to the meniscus is more common than to the soft articular surfaces and typically
results as a result of a twist or torque to the knee. Pain and feelings of
catching or "locking" are common and are the result of the torn
menisci flipping in and out of the joint space--much like trying to close a door
with a marble in the door jam. Pain, swelling and apprehension with walking will
typically resolve within a week or two, but sensations of locking, buckling or
giving out will be much more apparent as activity level increases. Because of
the poor vascularity to the menisci, they are unable to repair themselves and
typically need surgical intervention to repair or take out the torn piece.
Depending on the work that is done, return to activity takes anywhere from a few
weeks to a few months. So,
what can be done to prevent such injuries from occurring? Research clearly
shows that getting on a good strength and flexibility program can reduce the risk
of injury. The stronger and more agile you are makes you more responsive to avoid
vulnerable situations. A good weight-training and stretching program that
focuses on the major muscle groups three days per week is usually sufficient.
Other examples would be step-aerobics, a stretch cord resistance program, and
yoga classes. The
better conditioned you are aerobically also aids in preventing injuries sustained
as a result of fatigue. Cardiovascular training in the form of cycling, running,
swimming, or stair machines improves endurance. This translates into the ability
to play that extra set of tennis or take those last few runs skiing. Another
tip to aid in prevention of injuries is to train and perform activities with a
partner or group. There is no better way to get feedback on faulty mechanics or
poor technique than if someone is able to critique you. Maybe your golf swing
needs more back rotation and follow through. Or perhaps you rotate your hips and
knees too much when you are cycling. A good training partner would jump at the
chance to volunteer tips knowing that they will receive the same. The
most difficult of all injury prevention techniques is self-discipline--knowing
when enough is enough. A significant number of injuries are sustained near
the end of an activity when fatigue begins to set in and balance becomes compromised.
Next time, consider listening to that voice in your head that says: "I am
feeling a little fatigued. Do I really need to play that last game of hoops?" Information
about specific physical therapies, surgeries, transplantation, and hundreds of
articles, links, and additional resources available for patients and physicians
about knee injuries and care can be found at our web site at StoneClinic.com,
or you may contact us at the address, phone, or email above to arrange
individual medical consultation or care with San Francisco knee surgeon Kevin
Stone MD. | 
