Transcription:
Knee Health Through The Ages

Melanie Cole (Host):  Knee injuries are one of the most common reasons people see their doctors. There were roughly ten million patient visits to doctors’ offices because of problems with their knees. My guest today is Dr. Richard Rosa. He is a renowned knee surgeon who specializes in total knee replacement and partial knee replacement at Summit Medical Group. Welcome to the show, Dr. Rosa. Tell us a little bit about the knee. It’s such a fragile joint and yet so, so important with the base starting at our feet. Go through a little bit of knee physiology for us. Then, we are going to talk about keeping our knees healthy.

Dr. Richard Rosa (Guest):    Absolutely and you are quite right. The knee is a complicated structure--a very complex structure. It’s more than just a simple hinge as some people refer to it. It has a lot of ligaments and cartilage and the biomechanics of the knee are very, very intricate and they work in a very intricate fashion. When people have injuries or develop knee problems, it is not just a simple solution. There is a very extensive and complicated thought process that goes into evaluating knee problems and coming up with an appropriate treatment plan depending on the individual patient.  

Melanie:  What are some of the main reasons people injure their knees?

Dr. Rosa:  A lot of people come in with knee problems or knee injuries that are due to fairly simple and straight forward injuries like a sprain of the medial collateral ligament or something of that nature. That’s generally a straightforward problem. It may only require some anti-inflammatory medication, some RICE - rest, ice, compression, elevation--and physical therapy. Physical therapy is very important in the treatment and rehabilitation of knee injuries and most injuries of musculoskeletal systems. Again, in younger people, you may see only a minor sprain but as you get into more complicated injuries such as torn anterior cruciate ligament or a torn meniscus, then it becomes more involved. Those patients most frequently will require surgery to reconstruct the anterior cruciate ligament and to address the torn meniscus. The nature of the treatment and the nature of the surgery does depend largely on their age group and their activity level. For example, in a younger individual if they tear that anterior cruciate ligament, the reason that it needs to be reconstructed is because the anterior cruciate ligament is the main stabilizing ligament in the knee. When you lose that, over time the remaining secondary restraints will become lose and the knee will develop significant laxity and that will lead to other problems later in life. What we do is, we reconstruct that anterior cruciate ligament surgically. We can do it arthroscopically. You can’t repair a ligament once it’s torn. You actually have to replace it with the patient’s own tendon from another part of the body around the knee or in older patients, we actually use a cadaver graft which also works quite well. We find that the patient’s own tissue works the best in younger, active patients, especially athletes such as, say, college level soccer players, or athletes of that nature. In regard to the meniscus, the menisci are cartilaginous structures that fit in between the knee joint. There is a medial meniscus and a lateral meniscus and when that meniscus tears. it usually doesn’t heal because it’s avascular – it has no blood supply. When it tears. it can catch in the knee, it pulls on the capsule and it causes pain. When we do arthroscopic surgery for a torn meniscus. we generally remove the part that is torn trying to save as much of the meniscus as we can. In a small percentage of people, you can repair the meniscus if the tear is at the outer periphery because there is some blood supply in that area. The advantage of that is that it’s better to keep the meniscus because it helps your knee in the long run. It’s a little bit longer recovery with that. That’s the only downside. The younger the patient, the greater the need and the desire to save that meniscus for as long as possible. As you start to get a little bit older, that meniscus starts to wear down and when it tears you can’t repair it and it needs to come out. Again, when we do an orthoscopic procedure to remove a meniscus in someone who, say, is in their ‘40s or ‘50s that will relieve their pain, there is a slight downslide because when you remove that meniscus, you are removing some of the cushion and you may be removing some of the cushion in a patient that already has some arthritis in their knee--early arthritis, but some none the less. That increases the stresses. So, we do know that arthritis will likely progress a little more quickly than it would have had they not damaged that meniscus.

Melanie:  Dr. Rosa, as we look at the knees through the ages, in young girls, soccer players, and you mentioned ACL injuries, give us your best tips as people age to preventing knee injuries, whether it’s a good pair of shoes, strengthening the muscles and ligaments and tendons that surround that knee and hold it strong.

Dr. Rosa:  Absolutely. The best thing that athletes can do--athletes of all ages--is to keep in shape and to train specifically for what they are doing. By that, I mean when you have a high school or college level athlete, they are generally training specifically and they are working all of the muscles in their leg and in their body for that matter. That is the best way to try to prevent an ACL injury. You can’t always prevent it regardless. We see ACL injuries happening in very high level, elite, well-conditioned athletes. But, again, the best way is to have a comprehensive conditioning and strengthening program. Most of the high schools and virtually all of the universities and colleges have those programs in place. What happens is, as you get out of that environment and you get into, say, your ‘20s and your ‘30s, you don’t have the time to put in that you had in college. You can’t be working out two to three hours a day as you would be when you are training for a specific collegiate level sport. Then, the problem comes in where you run into the problem of the weekend warriors. People are going out on the weekends and they are playing their sport and in their ‘20s and ‘30s, they still think that they can do what they did 10 years prior to that. It’s nice to think that you can, but you have to be realistic about it. You have to make sure that you keep your body in shape to do that and if you can’t, at the very least think about competing at a slightly lower level. Although that is sometimes difficult once the competitive juices start flowing, it’s hard to hold back.

Melanie:  Dr. Rosa, if people feel knee pain as generally people do with osteoarthritis and wear and tear on this joint, this complicated joint. Are you an ice man? Do you like them to brace it? Do you want them to use heat? What do you want them to do when they feel that general knee pain?   

Dr. Rosa:  I find that ice generally works better. It helps to decrease swelling. It helps to decrease inflammation and it helps to decrease pain. Very frequently, in our patients, especially our athletes, we will instruct them to ice down the knee, especially after they have competed or after they have trained, if they are having a knee problem. In terms of other treatment modalities, it depends on the nature of the knee problem. There are a lot of knee problems that will benefit from a brace or some type of support. Not all knee problems will benefit from that. A lot of patients will benefit just from a strengthening program which basically takes the place of a knee brace. It also depends on your sport. For example, you see a lot of runners. Runners can develop knee problems. They are not generally as serious as the contact athletes. They are more repetitive stress and strain and overuse. In that case, what we will do is just modify the running activities. I am very aggressive at keeping my runners running for as long as possible. If need be, we’ll sometimes cross-train. But the runners, in general, have a freer feel and they don’t like to run with a knee brace on. It is kind of restricting to them. So, we will work around it the best that we can. But, again, a lot of times with the runners, it is an overuse syndrome. We need to maybe change their style of running somewhat, which I have done many times with great results in many of my runners, including family members. We will change their running surfaces; we’ll change their workout program and we’ll add in some cross-training until we can get them back to where they were before their knee problem began.

Melanie:  In just the last few minutes, and it’s such a great topic and there’s so much to discuss, but we don’t have a lot of time in these segments. Give us your best advice for preventing knee injuries and taking care of this joint; what you really tell listeners every single day about what you do and why they should come see you at Summit Medical Group.

Dr. Rosa:   What I try to get across to them is that if they are having a problem, certainly come in and see us so we can go over it. If it’s not anything serious, we can let them know that. If it is something that is just starting, we can give them instruction on how to prevent it from getting worse and what they can do in terms of, again, their training, whether or not they may need physical therapy. For example, we find a lot of patients come in with knee problems and they have been in a gym working on the knee trying to get it better. When they come in, they’ll tell me their knee is getting worse. Sometimes when we go into the history and we’ll find that the exercises that they are doing are actually counterproductive and they are making the pain worse. In many cases, the earlier that people will come in the better because it just may be a simple matter of modifying some of their activities and adding some more specific training to their regimen. If it is more serious than that or we suspect something, if we need to, we’ll go right to an MRI just to make sure there is nothing more serious there because if there is something that is going to get worse with training, we want to know that in advance. We want to back off and we want to intervene if we need to and if that’s the best thing for the patient. The other thing that I frequently tell my patients, the athletes included, is when they do have an injury or they have been out for a while because of a problem or because of overuse, let them know that as, you start to go back, go back gradually. In the beginning, less is better because you don’t want to overdo it and end up going back to where you were before. If you are out for 4-6 weeks because of injury and you come back too quickly, you could potentially be out another 4-6 weeks. You have to use your common sense. Sometimes, less is better in that regard because you are looking at the long-term goal. What we’ll do in that regard is, if we have patients, for example, athletes that are in a season, whether it could be before pre-season, beginning of a season, middle of the season or end of the season, we will custom design a rehab program to fit that athlete for that sport so that we can get them back as quickly as possible with realistic goals and expectations.

Melanie:  It’s really great information.  Thank you so much, Dr. Rosa. You’re listening to SMG Radio. For more information, you can go to SummitMedicalGroup.com. That’s SummitMedicalGroup.com. This is Melanie Cole. Thanks so much for listening.