Sunday, September 9, 2007

Osteoarthritis

Osteoarthritis – A disease in which the cartilage that cushions
the ends of the bones is lost, leading to joint pain and
stiffness. The most common form of arthritis, osteoarthritis
grows more common with age.

Osgood-Schlatter disease

Osgood-Schlatter disease – A disease often caused by repetitive
stress or tension on part of the growth area of the upper
tibia (the apophysis). It is characterized by inflammation of
the patellar tendon and surrounding soft tissues at the point
where the tendon attaches to the tibia. The disease may also
be associated with an injury in which the tendon is stretched
so much that it tears away from the synovium.

Orthopaedic surgeon

Orthopaedic surgeon – A doctor who has been trained in the
nonsurgical and surgical treatment of bones, joints, and soft
tissues such as ligaments, tendons, and muscles.

Meniscus

Meniscus – A pad of connective tissue that separates the
bones of the knee. The menisci (plural) are divided into two
crescent-shaped discs (the lateral and medial) positioned
between the tibia and femur on the outer and inner sides of
each knee. The two menisci in each knee act as shock
absorbers, cushioning the lower part of the leg from the
weight of the rest of the body as well as enhancing stabil

Medial collateral ligament (MCL)

Medial collateral ligament (MCL) – The ligament that runs
along the inside of the knee joint, providing stability to the
outer (medial) part of the knee.

Magnetic resonance imaging (MRI)

Magnetic resonance imaging (MRI) – A procedure that uses
a powerful magnet linked to a computer to create pictures of
areas inside the knee. Magnetic energy stimulates knee tissue
to produce signals that are detected by a scanner and analyzed
by a computer. This creates a series of cross-sectional
images of a specific part of the knee. An MRI is particularly
useful for detecting soft tissue damage or disease.

Lupus

Lupus – An autoimmune disease characterized by destructive
inflammation of the skin, internal organs, and other
body systems as well as the joints.

Ligament

Ligament – A tough band of connective tissue that connects
bones to bones.

Lateral collateral ligament (LCL)

Lateral collateral ligament (LCL) – The ligament that runs
along the outside of the knee joint. It provides stability to the
outer (lateral) part of the knee.

Internist

Internist – A doctor trained to diagnose and treat nonsurgical
diseases.

Iliotibial Band Syndrome

Iliotibial Band Syndrome – An inflammatory condition in
the knee caused by the rubbing of a band of tissue over the
outer bone (lateral condyle) of the knee. Although iliotibial
band syndrome may be caused by direct injury to the knee,
it is most often caused by the stress of long-term overuse,
which sometimes results from sports training.

Hamstring

Hamstring – Prominent tendons at the back of the knee.
Each knee has a pair of hamstrings that connect to the muscles
that flex the knee. The hamstring muscles, which bend
at the knee, run along the back of the thigh from the hip to
just below the knee.

Gout

Gout – An acute and intensely painful form of arthritis.
This condition occurs when crystals of the bodily waste
product uric acid are deposited in the joints.

Femur

Femur – The thigh bone or upper leg bone. The femur
is one of three bones (the other two are the tibia and the
patella) that join to form the knee joint.

Corticosteroids

Corticosteroids – Powerful anti-inflammatory hormones
made naturally in the body or manmade for use as medicine.
Oral corticosteroids may be used to treat systemic
inflammatory diseases, such as rheumatoid arthritis or
lupus. Corticosteroid injections may be used to reduce
inflammation in a joint with arthritis, such as the knee.

Computerized axial tomography (CAT) scan

Computerized axial tomography (CAT) scan – A painless
procedure in which x rays are passed through the knee at different
angles, detected by a scanner, and analyzed by a computer.
This produces a series of clear cross-sectional images
(slices) of the knee tissues on a computer screen. CAT scan
images show soft tissues such as ligaments or muscles
more clearly than conventional x rays. The computer can
combine individual images to give a three-dimensional
view of the knee.

Cartilage

Cartilage – A tough, elastic material that covers the ends of
the bones where they meet to form a joint. In the knee, cartilage
helps absorb shock and allows the joint to move smoothly.

Bone scan

Bone scan (radionuclide scanning) – A technique for creating
images of bones on a computer screen or on film. Prior to
the procedure, a very small amount of radioactive dye is
injected into the bloodstream. The dye collects in the bones,
particularly in abnormal areas of the bones, and is detected
by a scanner. This test detects blood flow to the bone and cell
activity within the bone, and can show abnormalities in these
processes that may aid diagnosis.

Biopsy

Biopsy – A procedure in which tissue is removed from the
body and studied under a microscope. A biopsy of joint tissue
may be used to diagnose some forms of arthritis.

Arthroscopy

Arthroscopy – A surgical technique that involves making a
small incision in the skin over the joint. A small lighted tube
(arthroscope) with a camera is inserted through this incision.
It takes images of the inside of the joint and projects them
onto a television screen. While the arthroscope is inside the
knee joint, the surgeon may insert surgical tools through
additional small incisions to remove loose pieces of bone or
cartilage or to repair torn ligaments or menisci.

Avascular necrosis

Avascular necrosis – A disease in which a temporary or permanent
loss of the blood supply to the bones causes the
bone tissue to die and the bone to collapse. This condition
is also known as osteonecrosis, aseptic necrosis, and
ischemic necrosis.

Arthritis

Arthritis – A term used to refer to some 100 diseases that
affect the joints. These diseases cause pain, inflammation,
stiffness, damage, and/or malformation. The most common
forms of arthritis are osteoarthritis and rheumatoid arthritis.

Anterior cruciate ligament (ACL)

Anterior cruciate ligament (ACL) – A ligament in the knee
that crosses from the underside of the femur to the top of
the tibia. The ligament limits rotation and the forward
movement of the tibia.

Ankylosing spondylitis

Ankylosing spondylitis – An inflammatory form of arthritis
that primarily affects the spine, leading to stiffening and possible
fusion.

Arthritis Foundation

Arthritis Foundation
P.O. Box 7669
Atlanta, GA 30357–0669
Phone: 404–872–7100 or 800–568–4045 (free of charge)
or call your local chapter (listed in the telephone directory)
www.arthritis.org
The Foundation has several free brochures about the
various forms of arthritis that affect the knee, coping with
arthritis, arthritis treatment, and exercise. A free brochure
on protecting your joints is titled Using Your Joints Wisely.
The Foundation also can provide addresses and phone
numbers for local chapters and physician and clinic
referrals.

American Physical Therapy Association

American Physical Therapy Association
1111 N. Fairfax Street
Alexandria, VA 22314
Phone: 703–684–2782 or
800–999–APTA (2782) (free of charge)
www.apta.org
The goal of the American Physical Therapy Association
is to foster advancements in physical therapy practice,
research, and education. The Association publishes a free
brochure titled Taking Care of the Knees.

American College of Rheumatology

American College of Rheumatology
1800 Century Place, Suite 250
Atlanta, GA 30345–4300
Phone: 404–633–3777
Fax: 404–633–1870
www.rheumatology.org
This national professional organization can provide
referrals to rheumatologists, and to allied health professionals
such as physical therapists. One-page fact sheets
are available on various forms of arthritis. Lists of specialists
by geographic area and fact sheets are also available
on this Web site.

American Academy of Orthopaedic Surgeons

American Academy of Orthopaedic Surgeons
P.O. Box 1998
Des Plaines, IL 60017–1998
Phone: 847–823–7186 or
800–824–BONE (2663) (free of charge)
Fax: 847–823–8125
www.aaos.org
The Academy provides education and practice management
services for orthopaedic surgeons and allied health
professionals and patients. It also serves as an advocate
for improved patient care and informs the public about
the science of orthopaedics. The orthopaedist’s scope of
practice includes disorders of the body’s bones, joints, ligaments,
muscles, and tendons. The Academy produces
a variety of educational programs and informational
brochures that are available free to the public. For a
single copy of an AAOS brochure, send a self-addressed
stamped envelope to the address above or visit the AAOS
Web site.

NIH Osteoporosis and Related Bone Diseases

NIH Osteoporosis and Related Bone Diseases
National Resource Center
2 AMS Circle
Bethesda, MD 20892–3676
Phone: 202–223–0344 or 800–624–BONE
TTY: 202–466–4315
Fax: 202–293–2356
NIAMSBoneInfo@mail.nih.gov
www.osteo.org
The NIH Osteoporosis and Related Bone
Diseases~National Resource Center provides patients,
health professionals, and the public with an important
link to resources and information on metabolic bone diseases.
The mission of NIH ORBD~NRC is to expand
awareness and enhance knowledge and understanding
of the prevention, early detection, and treatment of these
diseases as well as strategies for coping with them. The
Center provides information on osteoporosis, Paget’s disease
of bone, osteogenesis imperfecta, primary hyperparathyroidism,
and other metabolic bone diseases and
disorders.

National Institute of Arthritis and Musculoskeletal and Skin Diseases

National Institute of Arthritis and Musculoskeletal and Skin Diseases
National Institutes of Health
1 AMS Circle
Bethesda, MD 20892–3675
Phone: 301–495–4484 or
877–22–NIAMS (226–4267) (free of charge)
TTY: 301–565–2966
Fax: 301–718–6366
NIAMSInfo@mail.nih.gov
www.niams.nih.gov
NIAMS provides information about various forms of
arthritis and other rheumatic diseases; as well as other
bone, muscle, joint, and skin diseases. It distributes
patient and professional education materials and refers
people to other sources of information. Additional information
and updates can also be found on the NIAMS
Web site.

What Research Is Being Conducted on Knee Problems?

What Research Is Being Conducted on Knee Problems?
Studies of the various forms of arthritis are helping doctors
better understand these diseases and develop treatments to
stop or slow their progression and damage to joints, including
the knees.
Studies are also underway to discover and/or develop safer
and more effective pain relief, particularly for osteoarthritis
of the knee. In recent years, the nutritional supplement pair
glucosamine and chondroitin has shown some potential for
reducing the pain of osteoarthritis, though no conclusive
proof has emerged to date. Both of these nutrients are
found in small quantities in food and are components of
normal cartilage.
The recently concluded Glucosamine/Chondroitin Arthritis
Intervention Trial (GAIT), which was co-sponsored by
the National Center for Complementary and Alternative
Medicine and the National Institute of Arthritis and Musculoskeletal
and Skin Diseases, assessed the effectiveness and
safety of these supplements, when taken together or separately.
The trial found that the combination of glucosamine and
chondroitin sulfate did not provide significant relief from
osteoarthritis pain among all participants. However, a smaller
subgroup of study participants with moderate-to-severe pain
showed significant relief with the combined supplements.
The 4-year trial was conducted at 16 sites across the United
States. The results were published in the Feb. 23, 2006 edition
of the New England Journal of Medicine.
Scientists continue to experiment with procedures that may
help replace lost or damaged joint cartilage. One procedure
that has met with success involves growing a person’s own
cartilage cells in a dish and then grafting the new cartilage
onto damaged areas of the joint. While the procedure has
been successful in repairing cartilage injuries at the end of the
femur, at present it is not recommended for arthritis-related
damage, and its potential use in arthritis is still uncertain.
Other areas of research involve trying to better understand
how and why joint injuries occur and the measures that
should be taken to prevent them; investigating the role of
exercise in protecting the knee; and developing less invasive
surgeries and better joint prostheses.
In December 2003, NIAMS and other groups at the National
Institutes of Health sponsored the Consensus Development
Conference on Primary Total Knee Replacement. The conference
findings underscored the value of knee replacements
for end-stage arthritis, and identified avenues for further
research

What Types of Exercise Are Best for People With Knee Problems?

What Types of Exercise Are Best for People With Knee Problems?
Ideally, everyone should get three types of exercise regularly:
• Range-of-motion exercises to help maintain normal
joint movement and relieve stiffness.
• Strengthening exercises to help keep or increase muscle
strength. Keeping muscles strong with exercises
such as walking up stairs, leg lifts, dips, or riding a
stationary bicycle helps support and protect the knee.
• Aerobic or endurance exercises to improve function
of the heart and circulation and to help control
weight. Weight control can be important to people
who have arthritis because extra weight puts pressure
on many joints. Some studies show that aerobic exercise
can reduce inflammation in some joints.
If you already have knee problems, your doctor or physical
therapist can help with a plan of exercise that will help the
knee(s) without increasing the risk of injury or further damage.
As a rule of thumb, you should choose gentle exercises
such as swimming, aquatic exercise, or walking over jarring
exercises such as jogging or high-impact aerobics.

How Can People Prevent Knee Problems?

How Can People Prevent Knee Problems?
Some knee problems, such as those resulting from an accident,
cannot be foreseen or prevented. However, a person can
prevent many knee problems by following these suggestions:
• Before exercising or participating in sports, warm up
by walking or riding a stationary bicycle, then do
stretches. Stretching the muscles in the front of the
thigh (quadriceps) and back of the thigh (hamstrings)
reduces tension on the tendons and relieves
pressure on the knee during activity.
• Strengthen the leg muscles by doing specific exercises
(for example, by walking up stairs or hills, or by riding
a stationary bicycle). A supervised workout with
weights is another way to strengthen the leg muscles
that support the knee.
• Avoid sudden changes in the intensity of exercise.
Increase the force or duration of activity gradually.
• Wear shoes that both fit properly and are in good condition.
This will help maintain balance and leg alignment
when walking or running. Knee problems can
be caused by flat feet or overpronated feet (feet that
roll inward). People can often reduce some of these
problems by wearing special shoe inserts (orthotics).
• Maintain a healthy weight to reduce stress on the knee.
Obesity increases the risk of osteoarthritis of the knee.

What Kinds of Doctors Evaluate and Treat Knee Problems?

What Kinds of Doctors Evaluate and Treat Knee Problems?
After an examination by your primary care physician, he or
she may refer you to a rheumatologist, an orthopaedic surgeon,
or both. A rheumatologist specializes in nonsurgical
treatment of arthritis and other rheumatic diseases. An
orthopaedic surgeon, or orthopaedist, specializes in nonsurgical
and surgical treatment of bones, joints, and soft tissues
such as ligaments, tendons, and muscles.
You may also be referred to a physiatrist. Specializing in
physical medicine and rehabilitation, physiatrists seek to
restore optimal function to people with injuries to the muscles,
bones, tissues, and nervous system.
Minor injuries or arthritis may be treated by an internist (a
doctor trained to diagnose and treat nonsurgical diseases)
or your primary care physician.

Plica Syndrome

Plica Syndrome
Plica (PLI-kah) syndrome occurs when plicae (bands of synovial
tissue) are irritated by overuse or injury. Synovial plicae
are the remains of tissue pouches found in the early stages of
fetal development. As the fetus develops, these pouches normally
combine to form one large synovial cavity. If this
process is incomplete, plicae remain as four folds or bands of
synovial tissue within the knee. Injury, chronic overuse, or
inflammatory conditions are associated with this syndrome.
Symptoms
Symptoms of plica syndrome include pain and swelling, a
clicking sensation, and locking and weakness of the knee.
Diagnosis
Because the symptoms are similar to those of some other
knee problems, plica syndrome is often misdiagnosed. Diagnosis
usually depends on excluding other conditions that
cause similar symptoms.
Treatment
The goal of treatment is to reduce inflammation of the synovium
and thickening of the plicae. The doctor usually prescribes
medicine such as ibuprofen to reduce inflammation.
People are also advised to reduce activity, apply ice and an
elastic bandage to the knee, and do strengthening exercises.
A cortisone injection into the plica folds helps about half of
those treated. If treatment fails to relieve symptoms within
3 months, the doctor may recommend arthroscopic or open
surgery to remove the plicae.

Iliotibial Band Syndrome

Iliotibial Band Syndrome
Iliotibial band syndrome is an inflammatory condition
caused when a band of tissue rubs over the outer bone (lateral
condyle) of the knee. Although iliotibial band syndrome
may be caused by direct injury to the knee, it is most often
caused by the stress of long-term overuse, such as sometimes
occurs in sports training and, particularly, in running.
Symptoms
A person with this syndrome feels an ache or burning sensation
at the side of the knee during activity. Pain may be localized
at the side of the knee or radiate up the side of the thigh.
A person may also feel a snap when the knee is bent and
then straightened. Swelling is usually absent and knee
motion is normal.
Diagnosis
The diagnosis of this disorder is typically based on the symptoms,
such as pain at the outer bone, and exclusion of other
conditions with similar symptoms.
Treatment
Usually, iliotibial band syndrome disappears if the person
reduces activity and performs stretching exercises followed by
muscle-strengthening exercises. In rare cases when the syndrome
doesn’t disappear, surgery may be necessary to split
the tendon so it isn’t stretched too tightly over the bone.
Osteochondritis Dissecans
Osteochondritis dissecans results from a loss of the blood
supply to an area of bone underneath a joint surface. It
usually involves the knee. The affected bone and its covering
of cartilage gradually loosen and cause pain. This problem
usually arises spontaneously in an active adolescent or young
adult. It may be due to a slight blockage of a small artery or
to an unrecognized injury or tiny fracture that damages the
overlying cartilage. A person with this condition may eventually
develop osteoarthritis.
Lack of a blood supply can cause bone to break down
(osteonecrosis4). The involvement of several joints or the
appearance of osteochondritis dissecans in several family
members may indicate that the disorder is inherited.
Symptoms
If normal healing doesn’t occur, cartilage separates from the
diseased bone and a fragment breaks loose into the knee
joint, causing weakness, sharp pain, and locking of the joint.
Diagnosis
An x ray, MRI, or arthroscopy can determine the condition
of the cartilage and can be used to diagnose osteochondritis
dissecans.
Treatment
If cartilage fragments have not broken loose, a surgeon may
fix them in place with pins or screws that are sunk into the
cartilage to stimulate a new blood supply. If fragments are
loose, the surgeon may scrape down the cavity to reach fresh
bone, add a bone graft, and fix the fragments in position.
Fragments that cannot be mended are removed, and the cavity
is drilled or scraped to stimulate new cartilage growth.
Research is being done to assess the use of cartilage cell and
other tissue transplants to treat this disorder.

Osgood-Schlatter Disease

Osgood-Schlatter Disease
Osgood-Schlatter disease is a condition caused by repetitive
stress or tension on part of the growth area of the upper tibia
(the apophysis). It is characterized by inflammation of the
patellar tendon and surrounding soft tissues at the point
where the tendon attaches to the tibia. The disease may also
be associated with an injury in which the tendon is stretched
so much that it tears away from the tibia and takes a fragment
of bone with it. The disease most commonly affects
active young people, particularly boys between the ages of
10 and 15, who play games or sports that include frequent
running and jumping.
Symptoms
People with this disease experience pain just below the knee
joint that usually worsens with activity and is relieved by
rest. A bony bump that is particularly painful when pressed
may appear on the upper edge of the tibia (below the knee
cap). Usually, the motion of the knee is not affected. Pain
may last a few months and may recur until the child’s growth
is completed.
Diagnosis
Osgood-Schlatter disease is most often diagnosed by the
symptoms. An x ray may be normal, or show an injury, or,
more typically, show that the growth area is in fragments.
Treatment
Usually, the disease resolves without treatment. Applying ice
to the knee when pain begins helps relieve inflammation and
is sometimes used along with stretching and strengthening
exercises. The doctor may advise you to limit participation in
vigorous sports. Children who wish to continue moderate or
less stressful sports activities may need to wear knee pads for
protection and apply ice to the knee after activity. If there is
a great deal of pain, sports activities may be limited until discomfort
becomes tolerable.

Tendon Injuries

Tendon Injuries
Knee tendon injuries range from tendinitis (inflammation
of a tendon) to a ruptured (torn) tendon. If a person overuses
a tendon during certain activities such as dancing, cycling,
or running, the tendon stretches and becomes inflamed. Tendinitis
of the patellar tendon is sometimes called jumper’s
knee because in sports that require jumping, such as basketball,
the muscle contraction and force of hitting the ground
after a jump strain the tendon. After repeated stress, the tendon
may become inflamed or tear.
Symptoms
People with tendinitis often have tenderness at the point
where the patellar tendon meets the bone. In addition, they
may feel pain during running, hurried walking, or jumping.
A complete rupture of the quadriceps or patellar tendon is
not only painful, but also makes it difficult for a person to
bend, extend, or lift the leg against gravity.
Diagnosis
If there is not much swelling, the doctor will be able to feel a
defect in the tendon near the tear during a physical examination.
An x ray will show that the patella is lower than normal
in a quadriceps tendon tear and higher than normal in a
patellar tendon tear. The doctor may use an MRI to confirm
a partial or total tear.
Treatment
Initially, the treatment for tendinitis involves rest, elevating
the knee, applying ice, and taking NSAID medications such
as aspirin or ibuprofen to relieve pain and decrease inflammation
and swelling. A series of rehabilitation exercises is
also useful. If the quadriceps or patellar tendon is completely
ruptured, a surgeon will reattach the ends. After surgery, a
cast is worn for 3 to 6 weeks and crutches are used. For a partial
tear, the doctor might apply a cast without performing
surgery.
Rehabilitating a partial or complete tear of a tendon requires
an exercise program that is similar to but less vigorous than
that prescribed for ligament injuries. The goals of exercise
are to restore the ability to bend and straighten the knee and
to strengthen the leg to prevent repeat injury. A rehabilitation
program may last 6 months, although people can return to
many activities before then.

Medial and Lateral Collateral Ligament Injuries

Medial and Lateral Collateral Ligament Injuries The medial collateral ligament is more easily injured than the lateral collateral ligament. The cause of collateral ligament injuries is most often a blow to the outer side of the knee that stretches and tears the ligament on the inner side of the knee. Such blows frequently occur in contact sports like football or hockey.

Symptoms
When injury to the medial collateral ligament occurs, you may feel a pop and the knee may buckle sideways. Pain and swelling are common.

Diagnosis
A thorough examination is needed to determine the kind and extent of the injury. In diagnosing a collateral ligament injury, the doctor exerts pressure on the side of the knee to determine the degree of pain and the looseness of the joint. An MRI is helpful in diagnosing injuries to these ligaments.

Treatment
Most sprains of the collateral ligaments will heal if you follow a prescribed exercise program. In addition to exercise, the doctor may recommend ice packs to reduce pain and swelling, and a small sleeve-type brace to protect and stabilize
the knee. A sprain may take 2 to 4 weeks to heal. A severely sprained or torn collateral ligament may be accompanied by a torn anterior cruciate ligament, which usually requires surgical repair.

Cruciate Ligament Injuries

Cruciate Ligament Injuries
These are sometimes referred to as sprains.3 They don’t necessarily
cause pain, but they are disabling. The anterior cruciate
ligament is most often stretched or torn (or both) by a
sudden twisting motion (for example, when the feet are
planted one way and the knees are turned another). The
posterior cruciate ligament is most often injured by a direct
impact, such as in an automobile accident or football tackle.
Symptoms
You may hear a popping sound, and the leg may buckle
when you try to stand on it.
Diagnosis
The doctor may perform several tests to see whether the
parts of the knee stay in proper position when pressure is
applied in different directions. A thorough examination is
essential. An MRI is accurate in detecting a complete tear,
but arthroscopy may be the only reliable means of detecting
a partial one.
Treatment
For an incomplete tear, the doctor may recommend an exercise
program to strengthen surrounding muscles. The doctor
may also prescribe a brace to protect the knee during activity.
For a completely torn anterior cruciate ligament in an active
athlete and motivated person, the doctor is likely to recommend
surgery. The surgeon may reconstruct torn ligament
by using a piece (graft) of healthy tissue from you (autograft)
or from a cadaver (allograft). Although synthetic ligaments
have been tried in experiments, the results have not been as
good as with human tissue. One of the most important elements
in a successful recovery after cruciate ligament surgery
is a 4- to 6-month exercise and rehabilitation program that
may involve using special exercise equipment at a rehabilitation
or sports center. Successful surgery and rehabilitation
will allow the person to return to a normal lifestyle.

Meniscal Injuries (Injuries to the Menisci)

Meniscal Injuries (Injuries to the Menisci)
The menisci can be easily injured by the force of rotating the
knee while bearing weight. A partial or total tear may occur
when a person quickly twists or rotates the upper leg while
the foot stays still (for example, when dribbling a basketball
around an opponent or turning to hit a tennis ball). If the
tear is tiny, the meniscus stays connected to the front and
back of the knee; if the tear is large, the meniscus may be
left hanging by a thread of cartilage. The seriousness of a
tear depends on its location and extent.
Symptoms
Generally, when people injure a meniscus, they feel some
pain, particularly when the knee is straightened. If the
pain is mild, the person may continue moving. Severe
pain may occur if a fragment of the meniscus catches
between the femur and the tibia. Swelling may occur soon
after injury if there is damage to blood vessels. Swelling
may also occur several hours later if there is inflammation
of the joint lining (synovium). Sometimes, an injury that
occurred in the past but was not treated becomes painful
months or years later, particularly if the knee is injured a
second time. After any injury, the knee may click, lock, feel
weak, or give way. Although symptoms of meniscal injury
may disappear on their own, they frequently persist or return
and require treatment.
Diagnosis
In addition to listening to your description of the onset of pain
and swelling, the doctor may perform a physical examination
and take x rays of the knee. An MRI may be recommended to
confirm the diagnosis. Occasionally, the doctor may use
arthroscopy to help diagnose a meniscal tear.
Treatment
If the tear is minor and the pain and other symptoms go
away, the doctor may recommend a muscle-strengthening
program. The following exercises after injury to the meniscus
are designed to build up the quadriceps and hamstring
muscles and increase flexibility and strength:
• warming up the joint by riding a stationary bicycle,
then straightening and raising the leg (but not
straightening it too much)
• extending the leg while sitting (a weight may be
worn on the ankle for this exercise)
• raising the leg while lying on the stomach
• exercising in a pool (walking as fast as possible in
chest-deep water, performing small flutter kicks
while holding onto the side of the pool, and raising
each leg to 90 degrees in chest-deep water while
pressing the back against the side of the pool).
Before beginning any type of exercise program, consult
your doctor or physical therapist to learn which exercises are
appropriate for you and how to do them correctly, because
doing the wrong exercise or exercising improperly can cause
problems. A health care professional can also advise you on
how to warm up safely and when to avoid exercising a joint
affected by arthritis.
If your lifestyle is limited by the symptoms or the problem,
the doctor may perform arthroscopic or open surgery to
see the extent of injury and to remove or repair the tear.
Most young athletes are able to return to active sports after
meniscus repair.
Recovery after surgical repair takes several weeks. The best
results of treatment for meniscal injury are obtained in people
who do not show articular cartilage changes and who
have an intact anterior cruciate ligament.

Chondromalacia

Chondromalacia
Chondromalacia (KON-dro-mah-LAY-she-ah), also called
chondromalacia patellae, refers to softening of the articular
cartilage of the kneecap. This disorder occurs most often in
young adults and can be caused by injury, overuse, misalignment
of the patella, or muscle weakness. Instead of gliding
smoothly across the lower end of the thigh bone, the knee
cap rubs against it, thereby roughening the cartilage underneath
the knee cap. The damage may range from a slightly
abnormal surface of the cartilage to a surface that has been
worn away to the bone. Chondromalacia related to injury
occurs when a blow to the knee cap tears off either a small
piece of cartilage or a large fragment containing a piece of
bone (osteochondral fracture).
Symptoms
The most frequent symptom is a dull pain around or under
the knee cap that worsens when walking down stairs or hills.
A person may also feel pain when climbing stairs or when
the knee bears weight as it straightens. The disorder is common
in runners and is also seen in skiers, cyclists, and
soccer players.
Diagnosis
Your description of symptoms and an x ray usually help the
doctor make a diagnosis. Although arthroscopy can confirm
the diagnosis, it’s not performed unless conservative treatment
has failed.
Treatment
Many doctors recommend that people with chondromalacia
perform low-impact exercises that strengthen muscles, particularly
muscles of the the inner part of the quadriceps,
without injuring joints. Swimming, riding a stationary bicycle,
and using a cross-country ski machine are examples of
good exercises for this condition. Electrical stimulation may
also be used to strengthen the muscles.
Increasingly, doctors are using osteochondral grafting, in
which a plug of bone and healthy cartilage is harvested from
one area and transplanted to the injury site. Another relatively
new technique is known as autologous chondrocyte implantation,
or ACI. It involves harvesting healthy cartilage cells,
cultivating them in a lab and implanting them over the lesion.
If these treatments don’t improve the condition, the doctor
may perform arthroscopic surgery to smooth the surface of
the cartilage and “wash out” the cartilage fragments that
cause the joint to catch during bending and straightening.
In more severe cases, surgery may be necessary to correct the
angle of the knee cap and relieve friction between it and the
cartilage, or to reposition parts that are out of alignment.

Traetments

DMARDs are a family of medicines that may be able to
slow or stop the immune system from attacking the joints.
This in turn prevents pain and swelling. DMARDs typically
require regular blood tests to monitor side effects. In addition
to relieving signs and symptoms, DMARDs may help to
retard or even stop joint damage from progressing. However,
DMARDs cannot fix joint damage that has already occurred.
Some of the most commonly prescribed DMARDs are
methotrexate, hydroxychloroquine, sulfasalazine, and
leflunomide.
Biologic response modifiers, or biologics, are a new family of
genetically engineered drugs that block specific molecular
pathways of the immune system that are involved in the
inflammatory process. They are often prescribed in combination
with DMARDs such as methotrexate. Because biologics
work by suppressing the immune system, they could be problematic
for patients who are prone to frequent infection.
They are typically administered by injection at home, or by
an intravenous infusion at a clinic. Some commonly prescribed
biologics include etanercept, adalimumab, infliximab,
and anakinra.
People with any type of arthritis may benefit from exercises
to strengthen the muscles that support the knee and weight
loss, if needed, to relieve excess stress on the joints.
If arthritis causes serious damage to a knee or there is incapacitating
pain or loss of use of the knee from arthritis, joint
surgery may be considered. Traditionally, this has been done
with what is known as a total knee replacement. However,
newer surgical procedures are continuously being developed
that include resurfacing or replacing only the damaged cartilage
surfaces while leaving the rest of the joint intact.

Treatment

Treatment
Like the symptoms, treatment varies depending on the form
of arthritis affecting the knee. For osteoarthritis, treatment
is targeted at relieving symptoms and may include painreducing
medicines such as aspirin or acetaminophen
(Tylenol2); nonsteroidal anti-inflammatory drugs (NSAIDs)
such as ibuprofen (Motrin, Nuprin, Advil); or in some cases
injections of corticosteroid medications directly into the
knee joint. Other treatments for the pain of knee osteoarthritis
include injections of hyaluronic acid substitutes and the
nutritional supplements glucosamine and chondroitin sulphate.
For more information about the use of these two supplements,
see the section titled “What Research Is Being
Conducted on Knee Problems?”
People with diseases such as rheumatoid arthritis, ankylosing
spondylitis, or psoriatic arthritis often require disease-modifying
antirheumatic drugs (DMARDs) or biologic response
modifiers (biologics) to control the underlying disease that is
the source of their knee problems. These drugs are typically
prescribed after less potent treatments such as NSAIDs or
intra-articular injections are deemed ineffective.

Arthritis

Arthritis
There are some 100 different forms of arthritis, rheumatic
diseases, and related conditions. Virtually all of them have
the potential to affect the knees in some way; however, the
following are the most common:
• osteoarthritis. Most people with knee problems have
a form of arthritis called osteoarthritis. In this disease,
the cartilage gradually wears away and changes occur
in the adjacent bone. Osteoarthritis may be caused by
joint injury or being overweight. It is associated with
aging and most typically begins in people age 50 years
or older. A young person who develops osteoarthritis
typically has had an injury to the knee or may have
an inherited form of the disease.
• rheumatoid arthritis. Rheumatoid arthritis, which
generally affects people at a younger age than
osteoarthritis, is an autoimmune disease. This means
it occurs as a result of the immune system attacking
components of the body. In rheumatoid arthritis, the
primary site of the immune system’s attack is the synovium,
the membrane that lines the joint. This attack
causes inflammation of the joint. It can lead to
destruction of the cartilage and bone and, in some
cases, muscles, tendons, and ligaments as well.
• other rheumatic diseases. These include:
– gout – an acute and intensely painful form of
arthritis that occurs when crystals of the bodily
waste product uric acid are deposited in the joints
– lupus – an autoimmune disease characterized by
destructive inflammation of the skin, internal
organs, and other body systems as well as the joints
– ankylosing spondylitis – an inflammatory form of
arthritis that primarily affects the spine, leading to
stiffening and in some cases fusing into a stooped
position
– psoriatic arthritis – a condition in which inflamed
joints produce symptoms of arthritis for patients
who have or will develop psoriasis
– infectious arthritis – a term describing forms of
arthritis that are caused by infectious agents, such
as bacteria or viruses. Prompt medical attention is
essential to treat the infection and minimize damage
to joints, particularly if fever is present.
Symptoms
The symptoms of arthritis are different for the different
forms. For example, people with rheumatoid arthritis, gout,
or other inflammatory conditions may find the knee swollen,
red, and even hot to the touch. Any form of arthritis can
cause the knee to be painful and stiff.
Diagnosis
The doctor may confirm the diagnosis by conducting a careful
history and physical examination. Blood tests may be
helpful for diagnosing rheumatoid arthritis, but other tests
may be needed too. Analyzing fluid from the knee joint, for
example, may be helpful in diagnosing gout. X rays may be
taken to determine loss or damage to cartilage or bone.

What Are Some Common Knee Injuries and Problems?

What Are Some Common Knee Injuries and Problems?
There are many diseases and types of injuries that can affect
the knee. These are some of the most common, along with
their diagnoses and treatment.

How Are Knee Problems Diagnosed?

How Are Knee Problems Diagnosed?

Doctors diagnose knee problems based on the findings of
the medical history, physical exam, and diagnostic tests.
Medical history
During the medical history, the doctor asks how long symptoms
have been present and what problems you are having
using your knee. In addition, the doctor will ask about any
injury, condition, or health problem that might be causing
the problem.
Physical examination
The doctor bends, straightens, rotates (turns), or presses
on the knee to feel for injury, and determine how well the
knee moves and where the pain is located. The doctor
may ask you to stand, walk, or squat to help assess the
knee’s function.
Diagnostic tests
Depending on the findings of the medical history and physical
exam, the doctor may use one or more tests to determine
the nature of a knee problem. Some of the more commonly
used tests include:
• X ray (radiography) – a procedure in which an x ray
beam is passed through the knee to produce a twodimensional
picture of the bones.
• Computerized axial tomography (CAT) scan – a
painless procedure in which x rays are passed through
the knee at different angles, detected by a scanner,
and analyzed by a computer. CAT scan images show
soft tissues such as ligaments or muscles more clearly
than conventional x rays. The computer can combine
individual images to give a three-dimensional view
of the knee.
• Bone scan (radionuclide scanning) – a technique
for creating images of bones on a computer screen or
on film. Prior to the procedure, a harmless radioactive
material is injected into your bloodstream. The material
collects in the bones, particularly in abnormal
areas of the bones, and is detected by a scanner.
• Magnetic resonance imaging (MRI) – a procedure
that uses a powerful magnet linked to a computer to
create pictures of areas inside the knee. During the
procedure, your leg is placed in a cylindrical chamber
where energy from a powerful magnet (rather than
x rays) is passed through the knee. An MRI is particularly
useful for detecting soft tissue damage.
• Arthroscopy – a surgical technique in which the doctor
manipulates a small, lighted optic tube (arthroscope)
that has been inserted into the joint through a
small incision in the knee. Images of the inside of the
knee joint are projected onto a television screen.
• Joint aspiration – a procedure that uses a syringe to
remove fluid buildup in a joint, and can reduce
swelling and relieve pressure. A laboratory analysis
of the fluid can determine the presence of a fracture,
an infection, or an inflammatory response.
• Biopsy – the examination of a piece of tissue under
the microscope.

What Are the Parts of the Knee?

What Are the Parts of the Knee?
Like any joint, the knee is composed of bones and cartilage,
ligaments, tendons, and muscles.
Bones and cartilage
The knee joint is the junction of three bones: the femur
(thigh bone or upper leg bone), the tibia (shin bone or
larger bone of the lower leg), and the patella (knee cap).
The patella is 2 to 3 inches wide and 3 to 4 inches long.
It sits over the other bones at the front of the knee joint
and slides when the knee moves. It protects the knee and
gives leverage to muscles.
The ends of the three bones in the knee joint are covered
with articular cartilage, a tough, elastic material that helps
absorb shock and allows the knee joint to move smoothly.
Separating the bones of the knee are pads of connective
tissue called menisci (men-NISS-sky). The menisci are
two crescent-shaped discs (each called a meniscus
(men-NISS-kus) positioned between the tibia and femur
on the outer and inner sides of each knee. The two menisci
in each knee act as shock absorbers, cushioning the lower
part of the leg from the weight of the rest of the body as
well as enhancing stability.
Muscles
There are two groups of muscles at the knee. The four
quadriceps muscles on the front of the thigh work to
straighten the knee from a bent position. The hamstring
muscles, which run along the back of the thigh from the
hip to just below the knee, help to bend the knee.

Tendons and ligaments
The quadriceps tendon connects the quadriceps muscle to
the patella and provides the power to straighten the knee.
The following four ligaments connect the femur and tibia
and give the joint strength and stability:
• The medial collateral ligament (MCL), which runs
along the inside of the knee joint, provides stability
to the inner (medial) part of the knee.
• The lateral collateral ligament (LCL), which runs
along the outside of the knee joint, provides stability
to the outer (lateral) part of the knee.
• The anterior cruciate ligament (ACL), in the center
of the knee, limits rotation and the forward movement
of the tibia.
• The posterior cruciate ligament (PCL), also in the
center of the knee, limits backward movement of
the tibia.
The knee capsule is a protective, fiber-like structure that
wraps around the knee joint. Inside the capsule, the joint is
lined with a thin, soft tissue called synovium.

What Causes Knee Problems?

What Causes Knee Problems?
Knee problems can be the result of disease or injury.
Disease
A number of diseases can affect the knee. The most common
is arthritis. Although arthritis technically means “joint
inflammation,” the term is used loosely to describe many different
diseases that can affect the joints. We’ll describe some
of the most common forms of arthritis and their effects on
the knees a bit later in the booklet.
Injury
Knee injuries can occur as the result of a direct blow or sudden
movements that strain the knee beyond its normal range
of motion. Sometimes knees are injured slowly over time.

Problems with the hips or feet, for example, can cause you to
walk awkwardly, which throws off the alignment of the knees
and leads to damage. Knee problems can also be the result of
a lifetime of normal wear and tear. Much like the treads on a
tire, the joint simply wears out over time. We’ll discuss some
of the most common knee injuries later in this booklet, but
first we’ll take a look at the structure of the knee joint.

Joint Basics

Joint Basics
The point at which two or more bones are connected is
called a joint. In all joints, the bones are kept from grinding
against each other by lining called cartilage. Bones are
joined to bones by strong, elastic bands of tissue called ligaments.
Muscles are connected to bones by tough cords of
tissue called tendons. Muscles pull on tendons to move
joints. While muscles are not technically part of a joint,
they’re important because strong muscles help support
and protect joints.

What Do the Knees Do? How Do They Work?

What Do the Knees Do? How Do They Work?
The knee is the joint where the bones of the upper leg meet
the bones of the lower leg, allowing hinge-like movement
while providing stability and strength to support the weight
of the body. Flexibility, strength, and stability are needed for
standing and for motions like walking, running, crouching,
jumping, and turning.
Several kinds of supporting and moving parts, including
bones, cartilage, muscles, ligaments, and tendons, help the
knees do their job. (See Joint Basics, below.) Each of these
structures is subject to disease and injury. When a knee problem
affects your ability to do things, it can have a big impact
on your life. Knee problems can interfere with many things,
from participation in sports to simply getting up from a chair
and walking.

Sunday, September 2, 2007

9 Delicious Ways to Fight Arthritis- Way 9

Green tea.

This mild, slightly astringent tea contains hundreds of powerful antioxidant chemicals called polyphenols and has been cited for helping prevent problems ranging from cancer to heart disease. But studies also suggest green tea may help prevent or ease symptoms of rheumatoid arthritis. In one study of induced arthritis in mice, green tea cut the disease onset rate almost in half, and follow-up studies by the same researchers, at Case Western Reserve University, in Ohio, show promise in humans.


Boil water briskly. Tea tastes best when water is at the boiling point, which allows tea to release its flavorful compounds quickly. Water that's cooler than that tends to release flavors more slowly, weakening the tea.


Keep steeping short. Let tea steep in hot water for about three minutes -- and no longer than five. This brief steeping time allows tea to acquire a full-bodied flavor and release its nutrients, but withholds compounds that make tea taste bitter.


Get a bag bonus. Tea purists favor the fresher flavor of loose tea, but some experts suggest that tea bags release more beneficial nutrients because smaller, ground-up particles expose more of the tea leaves' surface area to hot water.

Saturday, September 1, 2007

9 Delicious Ways to Fight Arthritis- Way 8

Lentils.

These dried legumes, with their rainbow of earthy colors, are prime sources of folate, with a single cup providing about 90 percent of your daily needs. But lentils also provide one of the richest plant-based sources of protein, contain large amounts of soluble dietary fiber, and hold significant stores of vitamin B6. These and other nutrients make lentils protect the body against heart disease and cancer in addition to arthritis.


Try a few soups. Not many people know a lot of lentil recipes. The most common usage -- soup -- is probably the best place to start for those new to the food. You might be surprised at how easy and tasty lentil soups can be. Add cooked lentils to water or broth, chop in carrots, celery, onions, and a lean meat, add some simple herbs and seasonings, and you are well on your way to a great meal.


Buy in bags. Though sometimes sold in bulk from bins, it's best to buy lentils in plastic bags, preferably with most beans shielded from light. Reason: Exposure to light and air degrades nutrients (especially vitamin B6) and open bins invite contamination by insects.


Pick the best beans. Even bagged products aren't pristine: Sort through lentils before you use them by spreading them on a baking sheet and picking out those that are shriveled or off-color, along with any small stones that may have gotten mixed in. After that, there's no need to soak, but you should swish beans in a water-filled bowl, discard any floaters, and rinse under cold water in a strainer before cooking.


Minimize gas. Thoroughly drain lentils before eating or adding to other dishes: Beans are famous for causing gas due to sugars they contain that the body can't digest, but these sugars are soluble in water and leach out when lentils are cooked.

Friday, August 31, 2007

9 Delicious Ways to Fight Arthritis- Way 7

Cheese.

Hard or soft, fresh or ripened, cheese in all its variety is an excellent source of calcium for bones, and protein for muscles and other joint-supporting tissues. Depending on type, cheeses (especially hard varieties such as cheddar and Colby) are also a good source of vitamin B6 and folate. The sheer abundance of cheeses makes it easy to get more in your diet -- by, for example, slicing hard cheeses onto crackers or grating them into casseroles, or spreading soft cheeses such as cottage cheese or Brie onto fruits or vegetables.


Grease your grater. When you have arthritis, grating cheese is hard enough without the grater becoming clogged. To make the job easier, give the grater a light coating of oil, which keeps the cheese from sticking and makes it easier to rinse the grater clean.


Lengthen shelf life. Hard cheeses that are well wrapped and unsliced can last up to six weeks in the refrigerator. (Chilled soft cheeses are best used within a week.) To make cheese last even longer, throw it in the freezer, but expect thawed soft cheese to separate slightly and hard cheese to be crumbly -- ideal for melting into casseroles and sauces but not as good for nibbling.


Let it warm. Cheese tastes best when served at room temperature, so if you've been storing it in the refrigerator, take cheese out and let stand at least one hour before serving to enjoy its full flavor.


Have a daily cheese platter. Healthy eaters know that every dinner table should have a plate of fresh raw vegetables in addition to all the prepared foods. Consider adding a large hunk of cheese to the platter each night, along with a knife. Sitting there in front of you, it's hard to resist slicing a piece off a few times to round out the meal.

Thursday, August 30, 2007

9 Delicious Ways to Fight Arthritis- Way 6

Sweet potatoes.

These tropical root vegetables (which, technically, not related to white baking potatoes) are such a nutritional powerhouse, they once topped a list of vegetables ranked according to nutritional value by the Center for Science in the Public Interest. Sweet potatoes are a rich source of vitamin C, folate, vitamin B6, and dietary fiber, among other nutrients.


Buy fresh. Though you'll benefit from eating sweet potatoes in any form, fresh potatoes are better than canned products, which are packed in a heavy syrup that leaches the vegetable's most valuable nutrients, including vitamins B and C.


Keep cool, not cold. Store sweet potatoes someplace dark, dry, and cool -- preferably between 55 and 60 degrees -- but not in the refrigerator: Cold temperatures damage cells, causing the potato to harden and lose some of its nutritional value.


Maximize nutrients. Eat cooked potatoes with their skin -- an especially rich source of nutrients and fiber. Handle gently to avoid bruising, then bake or boil, and serve with a touch of fat from butter, oil, or another dish and some salt and pepper.

Wednesday, August 29, 2007

9 Delicious Ways to Fight Arthritis- Way 5

Soy products.

Once relegated to the shelves of health-food stores, soy products such as tofu and tempeh have reached the mainstream largely because they've been shown to have cardiovascular benefits. But soybeans also protect bones, thanks to compounds called isoflavones and significant amounts of both vitamin E and calcium. Long a staple of Asian diets, soy can also be found in soy milk -- a boon for people who want to avoid lactose or cholesterol in regular milk.


Make the most of milk. Use soy milk (now sold in many supermarkets next to cow's milk) for puddings, baked goods, cereal, shakes -- just about anywhere you'd use regular milk. But don't mix it with coffee or other acidic foods, which tend to make soy milk curdle.


Try them whole. Trust us: Whole soy beans, sprinkled with a little salt and pepper, are delicious. They look like large sweet peas but have an even gentler, milder flavor -- nothing at all like the better known but more intimidating products like tofu. Check the freezer aisle for edamame (pronounced "ed-ah-MAH-may") -- they come both in their pods, or shelled. They cook up fast -- about five minutes in boiling water and two minutes in the microwave -- and can be eaten hot or cold as snacks or appetizers, or tossed into salads, stir-fries, casseroles, or soups.


Give tofu a few more chances. Many people don't know what to make of tofu. It's an odd color for a vegetable-derived food (white), an odd texture (smooth and moist), and comes in an odd form (usually, a block). Get past all that. Tofu is easy to work with, extraordinarily healthy, and takes on the flavors around it. Easy ideas: Drop half-inch cubes into most any soup; stir into tomato sauces, breaking it up into small pieces; or just cut into cubes, cover with chopped scallions and soy sauce, and eat at room temperature as is.

Tuesday, August 28, 2007

9 Delicious Ways to Fight Arthritis- Way 4

Shrimp.

Taste and convenience make shrimp the most popular shellfish around. But shrimp also deserves acclaim as one of the few major dietary sources of vitamin D, with three ounces providing 30 percent of the recommended daily amount -- more than a cup of fortified milk. Shrimp also contains omega-3 fatty acids and vitamin C, along with other nutrients essential for general health, including iron and vitamin B12.


Select by senses. When buying fresh raw shrimp, look for flesh that's moist, firm, and translucent, without spots or patches of blackness. Then put your nose to work: Shrimp should smell fresh and not give off an ammonia-like smell, which is a sign of deterioration. If you're buying shrimp frozen, squeeze the package and listen: The crunch of ice crystals means the shrimp was probably partially thawed, then refrozen -- a sign you should find another (less crunchy) package.


Eat or freeze. When you get shrimp home, rinse under cold water and store in the refrigerator for up to two days. If you plan to store beyond that, stick to frozen shrimp, which will keep in the freezer for up to six months.


Cook quickly. Overcooking makes shrimp tough, so it's best to cook it fast, boiling in water until shells turn pink and flesh becomes opaque, stirring occasionally. Rinse under cold water and serve alone, as part of a seafood chowder, or chilled. Shrimp can also be broiled, grilled, or stir-fried.

Monday, August 27, 2007

9 Delicious Ways to Fight Arthritis- Way 3

Sweet peppers.

A single green pepper contains 176 percent of your daily needs for vitamin C -- and colorful red and yellow varieties have more than double that amount. That makes them richer in C than citrus fruits, but sweet peppers are also excellent sources of vitamin B6 and folate.


Lock in nutrients. Store peppers in the refrigerator: The tough, waxy outer shell of bell peppers naturally protects nutrients from degrading due to exposure to oxygen, but you'll boost the holding power of chemicals in the skin by keeping them cold.


Separate seeds. Whether cutting into crudités, tossing into salads, or stuffing whole, you'll want to remove tough and bitter-tasting seeds. They're easily cut when slicing, but when retaining an entire bell for stuffing, cut a circle around the stem at the top of the pepper, lift out the attached membranes, and scoop remaining seeds and membranes with a thick-handled spoon.


Jam them in the juicer. You might not think of peppers as juicer giants, but they can add zest to drinks made from other fruits and vegetables, such as carrots.


Cook as a side dish. Tired of the same old vegetables at dinner? Slice a pepper or two and do a fast sauté in olive oil, adding a pinch of salt, pepper, and your favorite herb. The heat releases the sweetness, making sautéed peppers a wonderful counterpart to meats and starches.

Sunday, August 26, 2007

9 Delicious Ways to Fight Arthritis- Way 2

Bananas.

Bananas are perhaps best known for packing potassium, but they're also good sources of arthritis-fighting vitamin B6, folate, and vitamin C. What's more, this easily digested, dense fruit is a prime source of soluble fiber, an important part of your diet if you're trying to lose weight because it helps you feel full without adding calories.


Control ripeness. Bananas are sweetest and easiest to digest when brightly yellowed to full ripeness. To hasten or prolong the period of perfection, put green bananas in a brown paper bag, which encourages natural gases from the bananas to speed the ripening process. Rapidly ripening fruits should be put in the refrigerator, which turns the peel brown, but preserves the fruit inside.


Preserve pieces. Bananas are wonderful additions to salads or desserts, but tend to turn brown faster than other ingredients. Try tossing bananas with a mixture of lemon juice and water -- the acid will help preserve them.


Turn into drinks. Bananas, particularly ripe ones, make great blender drinks. Combine a banana, a peach or some berries, a few ounces of milk, a few ounces of fruit juice, and an ice cube, and blend for a delicious, healthy drink that is jam-packed with arthritis-friendly nutrients.

Saturday, August 25, 2007

9 Delicious Ways to Fight Arthritis- Way 1

Super Sources
It's easy to make nutrients part of a sensible daily diet once you learn there's such a variety of them within virtually every food group. As with any nutrient, certain foods will always be richer sources than others. Below are super sources of the nutrients that battle arthritis best.

1. Salmon. Salmon is among the richest sources of healthy fats, making it an ideal source of omega-3 fatty acids, especially because it's less likely than other cold-water fish to harbor high levels of toxic mercury. In addition to its fatty oils, salmon contains calcium, vitamin D, and folate. Besides helping with arthritis, eating salmon may protect the cardiovascular system by preventing blood clots, repairing artery damage, raising levels of good cholesterol, and lowering blood pressure.


Focus on freshness. To avoid bacterial contamination, look for glossy fish that are wrapped to prevent contact with other fish. If you're buying fish whole, eyes should be clear and bright, not opaque or sunken, and flesh should not be slimy or slippery. Cuts like steaks and fillets should be dense and moist. In all cases, flesh should be firm and spring back if you press it.


Use quickly. Fresh fish spoils fast, so if you can't eat salmon within a day after purchase, double its shelf life by cooking it right away and storing it in the refrigerator. (It is delicious served cold with cucumbers and dill.)


Tame total fat. While you want the beneficial omega-3s in fish oil, the fat in fish is also loaded with calories. To keep from adding still more calories during preparation, cook salmon using low-fat methods such as baking, poaching, broiling, or steaming, and season with spices such as dill, parsley, cilantro, tarragon, or thyme.


Cook by color. Following the rule of thumb for cooking fish -- to wait until flesh is opaque white or light gray -- is a tougher call with pink-hued salmon. To ensure doneness, cook salmon until it's opaque in its thickest part, with juices clear and watery, and flesh flaking easily with the gentle turn of a fork.

Tuesday, July 31, 2007

Hip Adduction

Hip Adduction

Lie on left side with top leg on chair. Slowly raise the bottom leg up to the chair seat. Hold leg up for six seconds. Do six repeats and then switch sides.

Monday, July 30, 2007

Quadricep Set --Knee Extension

Quadricep Set --Knee Extension


Lie on your back and slowly press left knee into the mat. Then tighten the muscles on front of your thigh. Try not to hold your breath. Hold the muscles tight for six seconds. Repeat six times and then tighten right leg muscle.

Sunday, July 29, 2007

Hip Abduction

Hip Abduction


Lie on left side with bottom knee bent, Raise top leg. Keep knee straight and toes pointed forward. Do not let top hip roll backward. Hold this position for six seconds. Do six repeats and then switch sides. Progress slowly to just under 1 Kg at the ankle.(Check weights with physiotherapist.)

Saturday, July 28, 2007

Straight Leg Raise -- With Internal and External Rotation

Straight Leg Raise -- With Internal and External Rotation


Lie on back, with right knee bent and foot flat. Move left foot to 10 o'clock position. Lift left leg in air about thirty centimetres (twelve inches). Keep your left knee straight. Hold this position for six seconds. Then move left foot to 2 o'clock position. Lift the leg up 30 centimetres and hold. Repeat this exercise six times and then switch legs. Slowly add weights to ankle.(Check weights with physiotherapist.)

Friday, July 27, 2007

Straight Leg Raise --Knee Extension Raise

Straight Leg Raise --Knee Extension Raise




Lie on back, with right knee bent and right foot flat on ground. Gradually lift the left leg up about thirty centimetres (twelve inches) in the air. Keep the knee straight and the toes pointed up. Hold this elevated position for six seconds. Slowly return leg to ground and start again. Repeat six times, and then start again by lifting the right leg. Slowly add weights to ankles to increase resistance.

Thursday, July 26, 2007

Fitness for Life

Fitness for Life

Follow this expert advice to get back on the exercise wagon—and make workouts a routine part of your life.

Eighty-eight percent of Health subscribers want to make exercise part of their daily lives, according to our recent Women in Motion study. So why do half of the people who begin exercise programs drop out before the 6-month mark? One reason is lack of motivation. If exercise is on the bottom of your to-do list, follow these five easy tips to make exercise a daily habit.
Treat your workouts like a standing appointment.Things happen, and workouts are usually the first thing cut if your time is short. If you write down your workouts in your daily planner, you’re more likely to view exercise as a non-negotiable.
Customize your workouts based on your mood.If you’re tired, instead of lifting weights, try shooting some hoops. Stressed? Try yoga or Pilates. By fitting the workout with your mood, you’ll increase your workout variety. And variety is vital to staying motivated. “You also need a backup plan if the gym is too crowded,” says Dr. John Raglin, professor of kinesiology at Indiana University. “You don’t want to increase an already frustrating day if someone is on your favorite machine.” Take time to plan out several workout routines so you always have a plan B.
Make your exercise goals realistic.“It takes the average adult 15 years to gain 10 to 15 pounds,” Raglin says. “You can’t expect to lose it all in 2 months.” Guilt and weight loss are not effective long-term motivators. Change your perspective to include exercising for good health, not simply for weight loss. Set smaller goals, such as running a 5K or joining a tennis league. Once you accomplish several smaller goals, you’ll be more likely to stay motivated to train for that marathon you’ve always wanted to run.

Find an exercise buddy.Exercise can be a challenge—one you don’t want to conquer alone. Friends can hold you accountable and give you increased obligation not to skip your workouts. “Exercising with other people gives you a connection, “ says Cotton, who is also a spokesman for the American Council on Exercise.
Reward yourself.You’ll do anything for a double scoop of butter pecan ice cream, right? So if you exercise four times in a given week, treat yourself. If a massage is more up your alley, schedule an appointment. Figure out which rewards will motivate you. Once you accomplish your exercise goals, be sure to take the time to reward yourself for a job well done.

If you’ve experienced exercise burnout, it may seem hard to get back in the saddle. Sit down and analyze what caused your exercise program to fail. Were you bored? Did you quit when you didn’t reach your weight-loss goal? Do you have too many work and home commitments at odds, causing you stress? Were your workouts too hard, making you dread exercise? Once you’ve pinpointed what caused you to fail, make a new exercise plan with realistic goals. “You will gain new insight every time you fail,” Raglin says. “Fail and try again. You have plenty of chances.”

Sunday, July 22, 2007

ACL Reconstruction

When you twist your knee or fall on it, you can tear a stabilizing ligament that connects your thighbone to the shinbone. An anterior cruciate ligament (ACL) unravels like a braided rope when it's torn and does not heal on its own. Fortunately, reconstruction surgery can help many people recover their full function after an ACL tear.

ACL TEAR
Ligaments are tough, non-stretchable fibers that hold your bones together. The cruciate ligaments in your knee joints crisscross to give you stability on your feet. People often tear the ACL by changing direction rapidly, slowing down from running or landing from a jump. Young people (age 15-25) who participate in basketball and other sports that require pivoting are especially vulnerable. You might hear a popping noise when your ACL tears. Your knee gives out and soon begins to hurt and swell.

First treatment includes rest, ice compression and elevation (RICE) plus a brace to immobilize the knee, crutches and pain relievers. Get to your doctor right away to evaluate your condition.
EVALUATION
Your doctor may conduct physical tests and take X-rays to determine the extent of damage to your ACL. Most of the time, you need reconstruction surgery. Your doctor replaces the damaged ACL with strong, healthy tissue taken from another area near your knee. A strip of tendon from under your kneecap (patellar tendon) or hamstring may be used. Your doctor threads the tissue through the inside of your knee joint and secures the ends to your thighbone and shinbone.
In a few cases when the ACL is torn cleanly from the bone it can be repaired. Less active people may be treated nonsurgically with a program of muscle strengthening.
OUTCOME
Successful ACL reconstruction surgery tightens your knee and restores its stability. It also helps you avoid further injury and get back to playing sports. After ACL reconstruction, you'll need to do rehabilitation exercises to gradually return your knee to full flexibility and stability. Building strength in your thigh and calf muscles helps support the reconstructed structure. You may need to use a knee brace for awhile and will probably have to stay out of sports for about one year after the surgery.

Saturday, July 21, 2007

ACL Injury: Potential Operative Complications

The incidence of infection after arthroscopic ACL reconstruction has a reported range of 0.2 percent to 0.48 percent. There have also been several reported deaths linked to bacterial infection from allograft tissue due to improper procurement and sterilization techniques.

Allografts specifically are associated with risk of viral transmission, including HIV and Hepatitis C, despite careful screening and processing. The chance of obtaining a bone allograft from an HIV-infected donor is calculated to be less than 1 in a million.

Rare risks include bleeding from acute injury to the popliteal artery (overall incidence is 0.01 percent) and weakness or paralysis of the leg or foot. It is not uncommon to have numbness of the outer part of the upper leg next to the incision, which may be temporary or permanent.

A blood clot in the veins of the calf or thigh is a potentially life-threatening complication. A blood clot may break off in the bloodstream and travel to the lungs, causing pulmonary embolism or to the brain, causing stroke. This risk of deep vein thrombosis is reported to be approximately 0.12 percent.

Recurrent instability due to rupture or stretching of the reconstructed ligament or poor surgical technique (reported to be as low as 2.5 percent and as high as 10 percent) is possible. Knee stiffness or loss of motion has been reported at between 5 percent and 25 percent. Rupture of the patellar tendon (patellar tendon autograft) or patella fracture (patellar tendon or quadriceps tendon autografts) may occur due to weakening at the site of graft harvest.

In young children or adolescents with ACL tears, early ACL reconstruction creates a possible risk of growth plate injury, leading to bone growth problems. The ACL surgery can be delayed until the child is closer to reaching skeletal maturity. Alternatively, the surgeon may be able to modify the technique of ACL reconstruction to decrease the risk of growth plate injury.

Postoperative anterior knee pain is especially common after patellar tendon autograft ACL reconstruction. The incidence of pain behind the kneecap varies between 4 percent and 56 percent in studies, whereas the incidence of kneeling pain may be as high as 42 percent after patellar tendon autograft ACL reconstruction.

Friday, July 20, 2007

ACL Injury: Operative Procedure

Before any surgical treatment, the patient is usually sent to physical therapy. Patients who have a stiff, swollen knee lacking full range of motion at the time of ACL surgery may have significant problems regaining their motion after surgery It usually takes three or more weeks from the time of injury to achieve full range of motion. It is also recommended that some ligament injuries be braced and allowed to heal prior to ACL surgery.

The patient, the surgeon and the anesthesiologist select the anesthesia used for surgery. Patients may benefit from an anesthetic block of the nerves of the leg to decrease postoperative pain. The surgery usually begins with an examination of the patient's knee while the patient is relaxed due the effects of anesthesia. This final examination is used to verify that the ACL is torn and also to check for looseness of other knee ligaments that may need to be repaired during surgery or addressed postoperatively. If the physical exam strongly suggests the ACL is torn, the selected tendon is harvested (for an autograft) or thawed (for an allograft) and the graft is prepared to the correct size for the patient.

After the graft has been prepared, the surgeon places an arthroscope into the joint. Small (one-centimeter) incisions called portals are made in the front of the knee to insert the arthroscope and instruments and the surgeon examines the condition of the knee.

Meniscus and cartilage injuries are trimmed or repaired and the torn ACL stump is then removed. In the most common ACL reconstruction technique, bone tunnels are drilled into the tibia and the femur to place the ACL graft in almost the same position as the torn ACL. A long needle is then passed through the tunnel of the tibia, up through the femoral tunnel, and then out through the skin of the thigh. The sutures of the graft are placed through the eye of the needle and the graft is pulled into position up through the tibial tunnel and then up into the femoral tunnel. The graft is held under tension as it is fixed in place using interference screws, spiked washers, posts or staples. The devices used to hold the graft in place are generally not removed. Variations on this surgical technique include the "two-incision" and "over-the-top" types of ACL reconstructions, which may be used because of the preference of the surgeon or special circumstances (revision ACL reconstruction, open growth plates).

Before the surgery is complete, the surgeon will probe the graft to make sure it has good tension , verify that the knee has full range of motion and perform tests such as the Lachman's test to assess graft stability. The skin is closed and dressings (and perhaps a postoperative brace and cold therapy device, depending on surgeon preference) are applied. The patient will usually go home on the same day of the surgery.

Thursday, July 19, 2007

TREATMENT OPTIONS FOR OSTEOARTHRITIS OF THE KNEE

TREATMENT OPTIONS FOR OSTEOARTHRITIS OF THE KNEE





In order to better understand the treatment options for osteoarthritis of the knee, it is important to understand basic knee anatomy and the function of articular cartilage. Please review the sections on knee anatomy as well as the introduction to osteoarthritis of the knee before reading this section.

Osteoarthritis is a chronic disorder that gradually progresses over time. In the knee, the symptoms of osteoarthritis may include pain, stiffness, swelling, "locking," and "catching". These symptoms may progress to an eventual limitation of activities whether it is an inability to run or an inability to walk up and down stairs. There is no cure for osteoarthritis of the knee. The therapies currently available are used only to treat the symptoms.

The 3 main goals of treatment for osteoarthritis of the knee are:
1. To decrease pain2. To maintain or improve range of motion of the knee (ability to bend and straighten the knee)3. To maintain or improve function (ability to climb stairs, run, jump, play sports, etc.)

There are many treatment options available and often, many different types of therapy must be used together to improve symptoms. The severity of an individual's symptoms

The treatment options available to individuals with osteoarthritis of the knee can be divided into the following categories;

Education and Biomechanical Treatment Options
• Educational Resources
• Lifestyle Modifications
• Physical Therapy
• Supportive Devices (Canes, Braces, Orthotics)

Medications and Nutritional Supplements
• Nutritional Supplements and Nutritional Supplement Fact Sheet
• Oral Medications (Pills)
• Topical Medications (Ointments and Creams)
• Knee Injections


Surgical Treatment Options

• Introduction to Surgical Treatment Options for Osteoarthritis of the Knee
• Arthroscopic Knee Surgery and Abrasion Arthroplasty• Osteotomy
• Total Knee Replacement Surgery
• Partial Knee Replacement Surgery
• Articular Cartilage Transplantation and Cellular Implant Surgery

OSGOOD - SCHLATTER'S KNEE PAIN

This section covers Osgood-Schlatter's Knee Pain that occurs as a result of overuse ("too much activity, too soon"). In order to better understand Osgood-Schlatter's Knee Pain it is important to understand the anatomy and function of the knee and the patellar tendon.
The patellar tendon is a thick rope-like structure that connects the bottom of the kneecap (patella) to the top of the large shin bone (tibia). The powerful muscles on the front of the thigh, the quadriceps muscles, straighten the knee by pulling at the patellar tendon via the patella. OSKP is caused by inflammation (irritation) where the patellar tendon attaches to the tibia.



Osgood-Schlatter's Knee Pain (OSKP), also known as Osgood-Schlatter's disease, is common in rapidly growing, active young teenagers and pre-teenagers. Pain from OSKP is usually felt 2-3 finger widths below the bottom of the patella. There may be swelling in the area and it can be sensitive to touch. The pain can be mild or in some cases the pain can be so bad that it prevents athletes from playing their sport.

OSKP is usually occurs as a result of overdoing an activity and placing too much stress on growing bones. Activities that include a lot of running, jumping or stopping and starting can make OSKP worse. OSKP can be prevented by easing into these types of activities and by using good training techniques. Off-season strength training of the legs, particularly the quadriceps muscles, can also help.

Examination techniques that detect tenderness and swelling at the attachment site of the patellar tendon to the tibia are helpful in determining if someone has OSKP. X-rays are occasionally done to make sure that the patellar tendon does not have any calcium in it. Other tests such as diagnostic ultrasound or Magnetic Resonance Imaging (MRI) are rarely required to rule out more extensive damage to the patellar tendon.

The treatment of OSKP may include relative rest, icing, medications to reduce inflammation and pain, stretching and strengthening exercises. Rarely is complete rest or the use of a knee brace or cast necessary. Sometimes OSKP will even go away on it's own. Doctors and physiotherapists trained in treating this type of overuse injury can outline a treatment plan specific to each individual.

QUADRICEPS TENDINITIS

In order to better understand quadriceps tendinitis it is important to understand the anatomy and function of the knee and the quadriceps tendon.


The kneecap (patella) is a small bone in the front of the knee. It glides up and down a groove in the thigh bone (femur) as the knee bends and straightens. Tendons connect muscles to bone. The strong quadriceps muscles on the front of the thigh attach to the top of the patella via the quadriceps tendon. This tendon covers the patella and continues down to form the "rope-like" patellar tendon. The patellar tendon in turn, attaches to the shin bone (tibia). The quadriceps muscles, straighten the knee by pulling at the patella via the quadriceps tendon. Quadriceps tendinitis is the term used to describe inflammation of the quadriceps tendon.


Quadriceps tendinitis usually occurs as a result of overdoing an activity and placing too much stress on the quadriceps tendon before it is strong enough to handle the stress. This overuse results in 'micro tears' in the quadriceps tendon which leads to inflammation and pain. Over time damage to the quadriceps tendon can occur. In extreme cases, the quadriceps tendon may become damaged to the point of complete rupture.






Quadriceps tendinitis is common in people involved in activities that include a lot of running, jumping, stopping and starting. Pain from quadriceps tendinitis is felt in the area just above the patella. There may be swelling in and around the quadriceps tendon and it may be sensitive to touch. The pain can be mild or in some cases the pain can be so bad that it prevents athletes from playing their sport.







Examination techniques that detect tenderness and swelling in or around the quadriceps tendon are helpful in determining if someone has quadriceps tendinitis. X-rays are occasionally done to make sure that the quadriceps tendon does not have any calcium in it. Other tests such as diagnostic ultrasound or Magnetic Resonance Imaging (MRI) are sometimes used to rule out more extensive damage to the quadriceps tendon.



Treatment of quadriceps tendinitis may include relative rest, icing, medications to reduce inflammation and pain, stretching and strengthening exercises. Quadriceps tendinitis may be prevented by easing into jumping or running sports and by using good training techniques. Off-season strength training of the legs, particularly the quadriceps muscles, can also help. Doctors and physiotherapists trained in treating this type of overuse injury can outline a treatment plan specific to each individual.

PREPATELLAR BURSITIS

PREPATELLAR BURSITIS

This section covers bursitis of the prepatellar bursa that occurs after an injury or trauma (traumatic prepatellar bursitis). In order to better understand traumatic prepatellar bursitis it is important to understand the anatomy and function of the knee and the patella. Please review the section on knee anatomy before reviewing this section.
The kneecap (patella) is a small bone in the front of the knee. It glides up and down a groove in the thighbone (femur) as the knee bends and straightens. The patellar tendon is a thick, ropelike structure that connects the bottom of the patella to the top of the large shinbone (tibia). The powerful muscles on the front of the thigh, the quadriceps muscles, straighten the knee by pulling at the patellar tendon via the patella.

A bursa (pl. bursae) is a small fluid filled sac that decreases the friction between two tissues. Bursae also protect bony structures. There are many different bursae around the knee but the one that is most commonly injured is the bursa in front of the patella, the prepatellar bursa.

The prepatellar bursa is usually very thin. When irritated or injured the prepatellar bursa can fill with fluid or blood and become large and painful. If repeatedly irritated or injured, the walls of the bursa may thicken and have irregular areas of scar tissue that are often mistaken as "bone chips". Calcium may also collect inside the bursa.

After a direct blow to the front of the knee the prepatellar bursa can become swollen. This can occur immediately or over a couple of hours. The degree of swelling can vary. The front of the knee is usually very painful to touch and it can also be painful to move. In addition, the area around the prepatellar bursa may be warm. If there is significant swelling or pain X-rays are usually performed to rule out a broken or chipped patella.

Depending on the severity of the injury, the treatment of traumatic prepatellar bursitis may include resting the knee, applying ice packs to the area, light compression of the knee with a tensor bandage and elevation of the injured leg. Medications to help reduce the swelling and pain may also be required. If there is a large amount of swelling and the knee is uncomfortable the bursa may need to be drained by a doctor.

After the swelling comes down and the bursa is less painful, padding the area may be required for some types of work, sports and recreational activities like gardening. In rare cases surgery is required to remove a prepatellar bursa that remains swollen or is repeatedly irritated or injured.

Complications of traumatic prepatellar bursitis include repeated irritation or injury, persistent pain and/or swelling or infection in the bursa. These complications require different types of treatment. Doctors and physiotherapists trained in treating these types of injuries can outline an individualized treatment for traumatic prepatellar bursitis.

ILIOTIBIAL BAND SYNDROME

ILIOTIBIAL BAND SYNDROME
Iliotibial band syndrome (ITBS) is a common cause of pain in the outer (lateral) side of the knee. ITBS is also a common overuse injury in runners. In order to better understand ITBS it is important to understand the anatomy and function of the knee. Please review the section on knee anatomy before reviewing this section.

The knee joint is made up of four bones, which are connected by muscles, ligaments, and tendons. The femur is the large bone in the thigh. The tibia is the large shinbone. The fibula is the smaller shinbone, located next to the tibia. The patella, otherwise known as the kneecap, is the small bone in the front of the knee. It slides up and down in a groove in the femur (the femoral groove) as the knee bends and straightens.

The iliotibial band is a belt-like band of tissue that runs from a muscle on the outer side of the hip, the tensor fascia lata, down the outer side of the thigh and attaches to the outer side of the patella and the tibia. Other muscles of the hip also attach to the iliotibial band and together with the tensor fascia lata control outward hip movement (abduction). The iliotibial band also provides stability to the lateral side of the knee.

A bursa (pl. bursae) is a small fluid filled sac that decreases the friction between two tissues. Bursae also protect bony structures. There are many different bursae around the knee. There is a bursa that protects the iliotibial band from the underlying femur. Normally, a bursa has very little fluid in it but if it becomes irritated it can fill with fluid and become painful.

The end of the femur has two large projections called epicondyles. When the knee is fully straight (extended) the iliotibial band lies in front of the lateral epicondyle of the femur. As the knee bends (flexes), the iliotibial band slips over the lateral epicondyle and ends up behind it. Friction occurs where the iliotibial band passes over the lateral femoral condyle. This friction can result in inflammation of the bursa that separates the iliotibial band from the underlying bone, or the iliotibial band itself.

ITBS is usually the result of overuse or over training. ITBS is found predominantly in runners and is often associated with changes in training such as a sudden increase in distance or intensity. Running on uneven surfaces such as the shoulder of the road may also cause ITBS, most commonly in the "downhill" leg. Other predisposing factors include prominent lateral femoral condyles or tight iliotibial bands.

As mentioned above, the pain from ITBS is felt on the lateral aspect of the knee. The pain may also radiate up the lateral aspect of the thigh or around to the front of the knee. The pain is usually made worse by repetitive flexion and extension movements of the knee. Initially, the pain may only be felt during a run. If training continues, pain may be felt even at rest.
On examination of the knee the iliotibial band is usually tight. There is often tenderness of the iliotibial band where it passes over the lateral femoral condyle. When pressure is applied to the lateral femoral condyle and the knee is repetitively flexed and extended the pain that is felt during training can often be reproduced. X-rays are usually normal.

Treatment of ITBS may include relative rest, icing, medications to reduce inflammation and pain, stretching, and strengthening exercises. Doctors and physiotherapists trained in treating this type of overuse injury can outline a treatment plan specific to each individual.

Meniscal Injuries



Meniscal injuries are often associated with a ligament tear of the knee. An injury to one of the main supporting ligaments of the knee can result in an unstable knee increasing the chance of tearing a meniscus. When a meniscus is injured the knee often becomes painful and/or swollen. The pain is usually made worse by specific movements such as bending or twisting the knee. Certain maneuvers may produce a "click", "pop" or sharp pain which is often localized to the medial or lateral joint line (the space between the thigh bone and the shin bone). Swelling can be caused from irritation of the knee joint by the torn meniscus.



X-rays cannot detect meniscal injuries but are useful to rule out wear and tear arthritis (osteoarthritis), loose pieces of bone or a broken bone which may mimic a "torn cartilage". Occasionally a special test called Magnetic Resonance Imaging (MRI) is required. Arthroscopic surgery is helpful in both the diagnosis and treatment of these injuries.



Initially the treatment of meniscus injuries may include activity modification, ice, medication (to reduce pain and/or swelling) and physiotherapy. If a torn meniscus does not heal, and pain, swelling or intermittent catching persists, arthroscopic surgery may be necessary. Arthroscopic surgery is usually required if the knee remains locked.

MENISCUS (CARTILAGE) INJURIES



MENISCUS (CARTILAGE) INJURIES



The meniscus is a "C" shaped "shock absorber" which lies between the thigh bone (femur) and the shin bone (tibia). There is a meniscus on the inner (medial) side of the knee and one on the outer (lateral) side of the knee. Injuries to either the medial meniscus or the lateral meniscus are common and are often referred to as a "torn cartilage". Injuries to the menisci often result in pain and swelling in the knee. If the torn piece of meniscus is large, it may cause the knee to catch, lock, or give way (For more anatomy, click here).



Catching occurs when the torn fragment briefly lodges between the bones then works its way out. If the fragment does not work its way out the knee will remain "locked", meaning the knee cannot fully bend or straighten. Locking can be brief (lasting seconds or minutes) or persistent (lasting weeks). Giving way occurs when the torn piece of meniscus slips out of place which causes pain and reflex relaxation of the thigh muscles. When the muscles relax the knee "gives way" or "gives out."



The most common cause of sudden (acute) meniscal tears in younger people is a combined loading and twisting injury to the knee. However, the medial or lateral meniscus can undergo a degenerative tear without any significant injury to the knee. The medial meniscus is more frequently injured than the lateral meniscus.




Wednesday, July 18, 2007

What is knee bursitis?

The knee joint is surrounded by three major bursae. At the tip of the knee, over the kneecap bone, is the prepatellar bursa. This bursa can become inflamed (prepatellar bursitis) from direct trauma to the front of the knee. This commonly occurs with prolonged kneeling position. It has been referred to as "housemaid's knee," "roofer's knee," and "carpetlayer's knee," based on the patient's associated occupational histories. It can lead to varying degrees of swelling, warmth, tenderness, and redness in the overlying area of the knee. As compared with knee joint inflammation (arthritis), it is usually only mildly painful. It is usually associated with significant pain when kneeling and can cause stiffness and pain with walking. Also, in contrast to problems within the knee joint, the range of motion of the knee is frequently preserved.

Prepatellar bursitis can occur when the bursa fills with blood from injury. It can also be seen in rheumatoid arthritis and from deposits of crystals, as seen in patients with gouty arthritis and pseudogout. The prepatellar bursa can also become infected with bacteria (septic bursitis). When this happens, fever may be present. This type of infection usually occurs from breaks in the overlying skin or puncture wounds. The bacteria involved in septic bursitis of the knee are usually those that normally cover the skin, called staphylococcus. Rarely, a chronically inflamed bursa can become infected by bacteria traveling through the blood.

Tuesday, July 17, 2007

Choice of Graft

Choice of Graft
No ideal graft for ACL reconstruction exists. All graft choices have advantages and disadvantages.
Patella tendon grafts are still considered the historical "gold standard" for knee stability by surgeons, however they suffer a slightly higher complication rate.
Hamstring grafts had initial problems with fixation slippage. Modern fixation methods of hamstrings avoid graft slippage, producing outcomes that are the same in terms of knee stability with easier rehabilitation, less anterior knee pain and less joint stiffness.
The main factors in knee stability are correct graft placement by the surgeon and treatment of other menisco-ligament injuries in the knee, rather than choice of graft