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As an orthopaedic surgeon and the newest member of Los Alamos Medical Center’s medical staff, I am happy to introduce myself and my family to you, and to answer some common questions regarding your knees.
My wife, Stephanie, my son, Grant, and I are settled in and looking forward to joining the community. I’m also looking forward to formally opening my practice Aug. 1 at LAMC. In the meantime, I hope you find this information helpful in preventing or treating knee injuries.
Today’s increasingly active society is experiencing more injuries related to the knee. Whether you are a weekend warrior pushing your body to the limits only when time allows, or a triathlete trying to get in as many miles as possible in a week running or cycling, most of you who are active have experienced some form of knee pain.
The knee is a complex joint composed of bones, muscles, tendons, ligaments, cartilage and a fluid network working simultaneously to allow propagation of the body. All are susceptible to injury depending on the particular activity, while treatment is dependent on the location and type of injury.
Overuse injuries are common in endurance athletes and include the following:
Stress fracture – A mechanical failure of the bone secondary to repetitive loads transmitted to the bone from running or jumping. Recommended treatment is rest from the offending activity. A period of non-weight bearing on the extremity with crutches is sometimes prescribed.
Tendonitis - Inflammation of the terminal tissue connecting muscle to bone, i.e. quadriceps tendon (thigh muscle tendon) or patellar tendon (knee tendon). In general, tendonitis responds to a period of rest, stretching, ice treatment and anti-inflammatories such as ibuprofen.
Synovitis – An inflammation of the lining of the joint called the synovium. The synovium produces the lubricating fluid of all joints. Repetition of knee bending can cause this lining to become inflamed, swollen and thickened, often manifesting as increased fluid within the knee joint. Treatment includes rest, ice, anti-inflammatories and, on occasion, aspiration of the synovial fluid and injection of the joint with corticosteroids. Rarely, if these methods fail to provide relief, arthroscopic surgery to shave away a portion of the inflamed synovium may be considered.
Chondromalacia – The gradual deterioration of articular cartilage, a protective cushion around the end of the bone within the joint. This results in pain with activities and at times can result in chronic pain. Treatment recommendations are geared towards activity modifications; if running aggravates the condition, try alternative activities such as swimming or cycling. Once the cartilage deteriorates, it does not rejuvenate as one might expect. Chondromalacia is often the early stage of a future arthritic knee.
Acute mechanical injuries to the knee are common in sports and activities which require quick acceleration, deceleration and pivoting, i.e. skiing, soccer and football. Common injuries include the following:
Torn cartilage – A quick twist of the knee joint can injure the cushions within the knee. This can manifest as tear of articular cartilage or a torn meniscus (a shock absorber between the bones of the knee). Treatment depends on the location and severity of the tear. In general these injuries require further evaluation with imaging of the knee utilizing an MRI. Arthroscopic surgery may be indicated again, depending on the location and severity of the injury.
Torn ligaments – Ligaments are sturdy tissues that provide connections between bones at joints. They allow motion about the joint while providing stability. Depending on which ligament and the severity of the tear, treatment can range from rest and therapy to surgical reconstruction of the knee ligament.
Ruptured tendons – As previously noted, tendons are the connections between bones and muscle; they allow muscles to move the joint, i.e. jumping and running. Partial tears of tendons can sometimes be treated with rest and therapy; however, complete ruptures generally require surgical repair.
In my experience, the most common ailments to the knee are those described in the overuse category. In general, they can be kept to a minimum with a well- rounded program incorporating different activities such as hiking, biking, swimming, walking and cycling. Variety is the spice of life, and when it comes to exercise, it is also the mantra to giving your knees a lifetime of longevity.
John A. Garcia, MD, is the new orthopaedic surgeon at Los Alamos Medical Center.