I'm 74 and have bone on bone in my right knee. There's always a little pain and sometimes nerve pinches when I twist the knee. I do well with daily walks of 4-8 miles. My favorite exercise is snowshoeing. It has big range of motion and strength components and no shock.
8
I'm 66, a runner, cyclist, skater who had a torn meniscus a few years ago. The MRI revealed the small tear. The doctor said, "I could operate or you could go six months without stressing it and see if it fixes itself." Whenever a doctor says that it's your call to have surgery or not, you know that surgery is not a good choice because they always err on the side of doing more rather than less. I waited out the six months and my knee repaired itself. I do all those same activities. Occasionally the knee hurts, and I ease off or wear the helpful knee brace.
6
Arthroscopic knee surgery worked fine for me when I tore my meniscus. Before the surgery, I couldn't walk properly or painlessly; after a few days' recovery, I could. That was 15 years ago.
By the way, "if you are overweight, lose weight" sounds easy enough to people without a weight problem. If you have a weight problem, you know it's nonsense, akin to Nancy Reagan's "just say no" as a cure for heroin addiction. The rate of relapse, in fact, is higher with weight loss than it is for heroin addiction, getting close to 100%. Losing the weight can be done, briefly; keeping it off is beyond current medical knowledge and goes well beyond personal willpower. There's been considerable coverage of this in The Times.
By the way, "if you are overweight, lose weight" sounds easy enough to people without a weight problem. If you have a weight problem, you know it's nonsense, akin to Nancy Reagan's "just say no" as a cure for heroin addiction. The rate of relapse, in fact, is higher with weight loss than it is for heroin addiction, getting close to 100%. Losing the weight can be done, briefly; keeping it off is beyond current medical knowledge and goes well beyond personal willpower. There's been considerable coverage of this in The Times.
21
My left knee was bone on bone from age 19 until I replaced it at 59 years old, and my right knee has a torn ACL as well as cartilage damage. I have had several scopes to repair torn cartilage, and it made a big difference for me. In one case, my doctor tried to tell me it wouldnt help, but I insisted and it stopped my knee from "going out". Each time, I was having problems with my knee going out that stopped after surgery. I also had very good luck with an injection called Synvisc at 45 when my knee went out of place and I couldn't walk. They were supposed to last 6 months and lasted for a few years. I was able to stave off my knee replacement for a while as a result. Although I was bone on bone most of my life, I still skied, rollerbladed, biked and remained very active avoiding high impact activities until my 50's. My advice for bad knees is avoid all twisting and jumping (tennis, basketball, jogging, soccer), and bike as well as working out at the gym with the leg press and hamstring machines. If that doesn't work and your knee is still going out, repair the meniscus and/or try the Synvisc shots. I got an extra 10 years out of my knee. If you are old enough to replace it, don't bother with the other stuff. I waited too long and ruined my hip as a result, but that's another story.
5
Amen. I had no meniscus in my left knee for 39 years. I worked hard at keeping muscles strong but it finally reached bone on bone. After many alternatives to avoid surgery, I had my knee replaced last year and I am very happy to walk, go up stairs and have no pain.
2
disappointed the article didn't touch on prolotherpy, prp and stem cell therapy. many of us that have been through all the failures have discovered this to be the only effective treatments. of course not covered by insurance, and you weren't even aware of it. further failure of the US medical system.
2
There is no effective and accepted evidence that these procedures work - work is still ongoing and every year they have promised "conclusive proof" that they are valuable but the promise is still unproven.
If they could replace expensive knee replacements then you can bet that insurance companies and National Health Plans (Canada, UK, Australia) would have embraced them - they have not and they have spent considerable dollars assessing them via meta-analysis.
If they work for you - then good - but don't mistake a placebo effect of about 30% for actual structural improvements.
If they could replace expensive knee replacements then you can bet that insurance companies and National Health Plans (Canada, UK, Australia) would have embraced them - they have not and they have spent considerable dollars assessing them via meta-analysis.
If they work for you - then good - but don't mistake a placebo effect of about 30% for actual structural improvements.
4
I found prolotherapy & PRP a waste of time and LOTS of money for my "jumper's knee." Hope it did the trick for you.
4
My husband did prp and after thousands of dollars and no effect he finally gave up on in. No insurance plan I know covers it and they probably shouldn't. I wish he'd never heard of it but he too was seeking any options to prevent further surgery. I was a squash player - had tears in both knees, arthroscopic in one side only and both knees are now pain free. Why? Gave up squash at the age of 58.
3
I almost cancelled my Knee Arthroscopic Meniscectomy scheduled for July 12 following reading this article. Thank goodness I was 29 on the wait line when i called on July 5 and decided to go ahead partially based on Ms. Brody's comment that she had experienced several years of knee use after her surgery, contrary to the BMJ recommendation.
My surgery was miraculous, pain free sleep without pain meds the first night after surgery in 1 1/2 years. Very slight swelling and now 2 days later, near normal walking on July 15.
My injury resulted from excessive rushing long distances through Frankfurt Airport. I am 73, 6' and 255 lbs and due to medical issues including foot surgery, had to give up most sports except walking and stationary bike much earlier. Until surgery I could only use the stationary bike with minimal pain. I look forward to resuming pain free walking and biking, perhaps even a return to racketball if I can lose more weight.
I think the skill of the surgeon may have a big impact on the results of this surgery.
My surgery was miraculous, pain free sleep without pain meds the first night after surgery in 1 1/2 years. Very slight swelling and now 2 days later, near normal walking on July 15.
My injury resulted from excessive rushing long distances through Frankfurt Airport. I am 73, 6' and 255 lbs and due to medical issues including foot surgery, had to give up most sports except walking and stationary bike much earlier. Until surgery I could only use the stationary bike with minimal pain. I look forward to resuming pain free walking and biking, perhaps even a return to racketball if I can lose more weight.
I think the skill of the surgeon may have a big impact on the results of this surgery.
4
Hyaluronic acid injections (one course of 3 shots a year) have been keeping me active for the last 5 years. They really helped me to go back to exercising, but no more tennis... After a thermal cure session of three weeks, I realized that working out the knees in water was very helpful and I took to swimming two hours a week with a club. This was two years ago, At the beginning I was overweight and out of breath after 400 m... At present I swim one mile in one hour three times a week, lost 20 pounds without a diet, can walk, bike and climb. No intention to have knee surgery unless the injections stop working!
6
You didn't mention what the problem w/your knees was. HA might work for some things but not others
2
This could be my story. Ran, skied, played volleyball, softball, and basketball for years. Ignored my knee pain for many years then finally went to see an Ortho. He suggested arthroscopic surgery, which resulted in some minor pain relief. But when he suggested Orthovisc injections - which I agreed to - they actually made my knee more painful. Finally had to have my right knee replace this past December. Have made a fairly quick recovery, but it's taking a lot of cycling to build up my quad muscle again. I just hope I can avoid having my left knee done.
1
At age 68 I had a sudden meniscus tear during a jog.For weeks I could only manage a quarter mile walk before pain stopped me.Luckily I cycle too and 9 months and 2000 miles later the pain was gone and I returned to running.Now, 3 years later all is still well.
2
I had severe knee pain...went to a chiropractor and he realigned my knees. Now, I have absolutely NO PAIN...take no medical treatment or med's.
I believe we need to exhaust all natural methods and only turn to medical treatment as a last resort.
So, I think this author was off base and it was a very bad article.
I believe we need to exhaust all natural methods and only turn to medical treatment as a last resort.
So, I think this author was off base and it was a very bad article.
2
This article hits the nail on the head: Be prudent! A retired Marine, I have run for almost 50 years now. After running a team distance race 5 years ago I had knee pain and underwent arthroscopic meniscus repair. 6 months later I returned to running and have run consistently since then, but can only run every other day now (carefully!) due to steadily increasing pain in the culprit knee. I suspect arthritis is progressing there, and now at 72 will transition to walking, hiking, cycling and swimming. Life isn't over...it's just changed. Thank goodness for physical therapists who showed me that hip strength and flexibility are critical and cannot be ignored in this lower body movement calculus.
13
I developed knee pain during the winter while doing very limited exercise, mostly walking. Once spring came and I started jogging, my knee pain gradually went away. I suspect strengthening the muscles around my knee has helped. It seems that there are a whole lot of factors that can contribute to knee pain and each case needs to be treated individually.
5
Years ago (not that many), meniscectomy was standard treatment for torn menisci, followed by PT to get the knee moving and avoid, or minimize, scarring in the joint. I've seen people come out of such treatment very well--one relative still walks for miles every day almost 20 years postoperatively.
My own experience was different--I saw an orthopedist for my own torn meniscus and he recommended only PT. Needless to say, I was skeptical. However, six weeks of treatment and I was essentially cured. The knee still acts up now and then, but 10 minutes of ice and all's well.
My own experience was different--I saw an orthopedist for my own torn meniscus and he recommended only PT. Needless to say, I was skeptical. However, six weeks of treatment and I was essentially cured. The knee still acts up now and then, but 10 minutes of ice and all's well.
4
Yes, non surgery works for many. But when the time comes to bone on bone, replacement works wonderfully.
As a 4:06 miler and twice to state in cross country I like to run. An avid cyclist, Cat. 4 and touring border to border and coast to coast. Add in surfing, skateboards, skiing. To say I was an active ADHD child is putting it mildly. Not keen on sitting I took to construction and thrived. But... working ones body as a career and play takes it's toll. First scope done on the left at late twenty's. The right followed shortly after. Both after PT and time did nothing. One needs to work. By late forties and many injuries, the body was caput. First the Pt., then the cortisone, Gel, drugs and braces then a cane. Took almost 8yrs and three different insurances before they ran out of ideas and suggestions. In the mean time sleep was painful. Walking was a chore. Driving, much less sitting as a passenger was not inviting. Work was not possible. Exercise became hours of laps in the pool to save my sanity. Of course shoulder injuries curtailed that for weeks at a time. Finally the left knee was replaced. What an life changing event. One year later the right too. 8 months on I'm pain free of the deep bone on bone ache. The flexibility is not there, thus not surfing anymore. Kneeling is ... odd thus gardening and some sex positions are tougher. Golfing again. Walking the course. Spin class and swimming. Thus, for some, TKR is a game changer.
As a 4:06 miler and twice to state in cross country I like to run. An avid cyclist, Cat. 4 and touring border to border and coast to coast. Add in surfing, skateboards, skiing. To say I was an active ADHD child is putting it mildly. Not keen on sitting I took to construction and thrived. But... working ones body as a career and play takes it's toll. First scope done on the left at late twenty's. The right followed shortly after. Both after PT and time did nothing. One needs to work. By late forties and many injuries, the body was caput. First the Pt., then the cortisone, Gel, drugs and braces then a cane. Took almost 8yrs and three different insurances before they ran out of ideas and suggestions. In the mean time sleep was painful. Walking was a chore. Driving, much less sitting as a passenger was not inviting. Work was not possible. Exercise became hours of laps in the pool to save my sanity. Of course shoulder injuries curtailed that for weeks at a time. Finally the left knee was replaced. What an life changing event. One year later the right too. 8 months on I'm pain free of the deep bone on bone ache. The flexibility is not there, thus not surfing anymore. Kneeling is ... odd thus gardening and some sex positions are tougher. Golfing again. Walking the course. Spin class and swimming. Thus, for some, TKR is a game changer.
4
It would be wonderful if there was a required lesson on the difference between allegoric and statistical evidence for anyone writing in on topics involving medicine/science.
As it is the whole "I never had this problem", or "This ancient folk remedy always worked for me" letters get a tad old in the face of an article backed by a study that says something totally different.
As it is the whole "I never had this problem", or "This ancient folk remedy always worked for me" letters get a tad old in the face of an article backed by a study that says something totally different.
1
I had a meniscal tear on the left knee in 1997 which made it impossible to do anything - it was not a wear and tear injury but an 'event' (rather like Federer's lifting one of his children out of the bath-tub though I would otherwise not compare myself to him). A specialist surgeon (sports) did a scope. I did rehab on my own, fairly assiduously, for two months but, though playing tennis and biking, was still only 80 % of muscular strength in that leg. Six weeks of intensive sports rehab did the trick. In any case, 20 years later that knee is great and I've never had any real problems with it. No comparison before and after surgery.
3
Much of the issue has to do with the ethics of your doctor. I've had 4 arthroscopic procedures and was told over ten years ago I needed a new knee. Then with exercise and occasional hyaluronic treatments, my knees are hanging in there. Turns out, the people who recommended replacing were busy building up their brand as the " go to " practice for replacements. It did not matter what the question was, the answer was replace.
5
Most commenters give anecdotal evidence of relief or ways of tolerating knee issues. But, at 77, an indulger of turmeric, fish, flax, borage, coconut oils, glucosamine, etc, etc, plus 10,000 daily steps, workouts at 24-Hour Fitness 3-days weekly, I can attest and guarantee the following: none of us are getting out of here alive. LOL
8
Considering that the knee is located between the hips and feet, it is very wise to manage both prior to any attempts at surgery. Foot orthotics have been shown in repeated studies to resolve chronic stress on the knees. Strengthening the gluteals (butt muscles) can also do wonders. Local measures also work (ie, quad sets), but proper foot and backside strengthening produces consistently great results with little to no side effects.....and at a fraction of the cost of surgery.
8
I can honestly state that arthroscopic meniscal surgery helped. Left knee,much less pain and no aching at night. Active Male age 55 chubby.
4
I was surprised to see that the author received the injection of the hyaluronic acid (brand name SYNVISC or other similar). It is not meant for bone-on-bone arthritis; one still needs to have cartilage in the knee for it to work properly. Insurance usually doesn't even cover it if there is no cartilage left.
4
As I sit here with arthritic fingers that can barely type I'm thinking this: Patients (and doctors) should understand that much of health care is not an exact science; and that there is no cure for aging. However, symptom control can be a worthwhile process.
6
I had an arthroscopic repair of my right medial meniscus in 1991 after hobbling around in pain for 5 years. In my case it took about 3 months, which included 1 month of PT and 2 additional months of exercise, for my knee to heal. I continue to experience about 90% decrease in pain after nearly 26 years. I only wish that I had had the surgery sooner.
4
Knee replacement took the pain away - although the recovery is long and a bit painful. Prior to that I tried mostly everything because I view surgery as a last resort.
A scope for a meniscus tear. It tore again.
Celebrex. Worked like a charm but only for about ten months.
Cortisone shots. Worked very well but you can't take more than a few due to the destructive side effects; i.e., severe tissue damage.
In retrospect I should've done surgery as a first resort. Or not played basketball 2-3 times a week for 45 years
A scope for a meniscus tear. It tore again.
Celebrex. Worked like a charm but only for about ten months.
Cortisone shots. Worked very well but you can't take more than a few due to the destructive side effects; i.e., severe tissue damage.
In retrospect I should've done surgery as a first resort. Or not played basketball 2-3 times a week for 45 years
2
When I was teaching ballroom dancing (at age 62) I developed torn miniscus in both knees. I continued to teach full time for 8 years, during which time the pain went away. I refused surgery and physical therapy. Now at age 83, I work at Home Depot (in the garden) and walk 8-10 miles a day. Pain has returned but I am taking 1000 mg of Vita C daily and sometimes naproxen. Pain is minimal and sporadic.
4
This article seems to suggest that arthroscopic surgery, steroid and gel injections are a waste of time and money, if you read between the lines, she is saying that these measures help reduce knee pain and can buy time, maybe even years, before a total knee replacement becomes necessary.
4
Everyone's situation is different but orthopedic surgeons are often enthusiastic about surgery. Even great ones. If someone is out of shape with no muscle tone supporting the knees, overweight and a smoker and or drinker the prognosis will likely be poor.
2
Stop advising us to take acetominophen for anything joint-related. Just stop. It's useless for anything but fever, and it's highly liver toxic in low overdoses.
5
@Kelly R I disagree, sort of. Yes, it’s extremely dangerous to recommend it without a big warning about the overdose issue, but it can relieve pain, and ibuprofen in big doses for a long time can cause stomach ulcers (#1 cause in US, according to a GI doc I saw). I guess I wish people would stop recommending both acetaminophen *and* ibuprofen as easy, risk-fee, go-to options. They’re not.
2
On March 13th, NBC News reported a new procedure using artificial cartilage made from the material contact lenses are made from. While this is currently for arthritic big toes, the doc from Duke Medical Center mentions that it is being tried on knees in Europe:
http://www.nbcnews.com/health/health-news/new-arthritis-treatment-could-...
I hope Jane Brody will research and report on this.
http://www.nbcnews.com/health/health-news/new-arthritis-treatment-could-...
I hope Jane Brody will research and report on this.
5
One important distinction that is not clearly stated in the article is that arthroscopic surgery for knees with both arthritis and a meniscal tear is not useful. The way it is written, some might think that arthroscopic surgery for arthritis or a meniscal tear is not useful, and this would be wrong. In other words, if you don't have arthritis in your knees, and have a meniscal tear that has remained symptomatic despite conservative (nonoperative) treatment, you will usually benefit from arthroscopic surgery.
5
Avoid exercise that POUNDS the knees. it's not worth a life long injury and pain, or countless operations.
2
Why is there no mention of the costs of knee replacement in this article? It often costs tens of thousands of dollars - any sensible doctor isn't going to recommend that unless it's a last resort or the patient is fabulously wealthy.
2
I Run everyday in Trail running sandals. Works for me maybe for you too:-)
Let the foot be the foot and get out of the over corrective overpriced footwear.
Let the foot be the foot and get out of the over corrective overpriced footwear.
1
Also, the efficacy of hyaluronic acid injections has been questioned by the American Academy of Orthopedic Surgeons, who put out a position statement that they are no better than placebo a few years ago. However, doctors continue to give them, in the hope that it may help some of the people some of the time, and insurance continues to cover the injections.
2
A significant proportion of knee replacements fail. For many people it's not the miracle the author makes it out to be. Orthopedic surgeons are urging younger and younger patients to undergo this major surgery and these patients will then need them redone two or more times since the artificial joints only last 15-20 years. Medical scientists need to devise a way to regrow cartilage in a noninvasive manner.
2
I had arthroscopic meniscus repair and three months PT post op for severe tears in my left knee in 1999 after a fall playing volleyball. I cycle and walk everywhere and it wasn't until five years ago that I had any problem - and that was due to overstress from hiking in western Scotland for a week. It took a few weeks to sort itself out and now I'm fine again (though I now hill walk with poles). Not sure how much my success was due to my surgery or the PT but like others, while I do exercise 4-5 times a week and lead an active lifestyle I don't do those PT exercises anymore. I was unable to walk without assistance after my fall and before my surgery. I also know others that were helped by meniscus repair. <14% improvement seems to me to be a very low percentage for success. I am left wondering what the outcome measures were and how large the sample size was - will definitely be reading up on this study for more insight.
2
This 68 year old cyclist has for years counseled folks on a bike purchase after their doctors told them to stop or cut way back on running.
Except for my softball years in my twenties, I have always tried to follow one of the helpful homilies from the great Satchel Paige, "Avoid running at all times." I have never had knee problems as a result. Luck? Partially, perhaps, but no pounding surely has been a factor.
As soon as the knees begin to issue that pain, buy a bike or ride more and run less. They will thank you.
Except for my softball years in my twenties, I have always tried to follow one of the helpful homilies from the great Satchel Paige, "Avoid running at all times." I have never had knee problems as a result. Luck? Partially, perhaps, but no pounding surely has been a factor.
As soon as the knees begin to issue that pain, buy a bike or ride more and run less. They will thank you.
2
Goes to show, everyone is different and should listen to their own bodies. I had right knee scoped 26 years ago after PT did not help torn miniscus. It took a year afterwards, with no PT, to feel normal. Started running (and snowboarding) again several years later and continue now. But six months ago, diagnosed with severe arthritis in the knee. Reduced running, more cross training, some strength training (and maybe glucosomine) and knee feels good. At times of diagnosis, doctor said I will need replacement in ten years. We'll see.
1
It all depends. Years ago my left knee would give out just by catching it a certain way on a table leg or char or whatever. I would be off my feet for days until things settled down. Finally with an MRI, and a orthopedic MD I had arthroscopic surgery. This has been 25 years ago, and my left knee has not let me down since, thank you very much.
1
Good and timely article. I've been running middle distance (14km) for 15 years then football (soccer) at high school and again seriously at 35. I am now 41 and MRI for knee pain revealed a meniscus tear of the posterior horn of the medial side of the left knee. First point of call - specialist who exaggerated the condition but grudgingly suggested I check with physio. The physiotherapist has me on daily exercises to strengthen the muscles around the knee. Clams for hip and calf raises for calves etc. I've been taking glucosamine and fish oil said to be good for joints. Progress after 4 weeks encouraging. The meniscus will scar with tissue but that's OK - beats intrusive surgery that risks arthritis.
I've read the comments and suggest stretching a good idea as prevention- NOT as a cure for an already stretched ligament! Hope this helps
I've read the comments and suggest stretching a good idea as prevention- NOT as a cure for an already stretched ligament! Hope this helps
1
I had surgery performed on the meniscus of my right knee in 2013 after suffering years of pain, and for the last two years I've been able to run, at age 65, pain free in that knee. The surgery was performed by a much-younger Seattle Seahawks team doctor, who'd had the same meniscus surgery performed on his own knee. He assured me my knee would get better; he was right.
Your article is a good discussion point. Like many of those commenting, I had arthroscopic repair of my meniscus six years ago. It was the best thing I ever did for myself. I also commend my orthopedist, a sports medicine specialist, for allowing me to complete a course of physical therapy before we decided to do the procedure. I don't feel that surgery was the default. We also considered hyluronic acid injections, but decided to wait. I've been fine until recently and will see my surgeon to determine what is causing the current pain.
Most importantly, everyone's situation requires the treatment/therapy that works best for him or her. Age and health status are major considerations. Finding the right orthopedist is key. Be clear about what causes the pain and what relieves it. Make sure that s/he listens to what activities you do everyday. Remain as active as possible.
Lastly, making generalized statements that arthroscopy has limited utility and that it exists as a means to "enrich practitioners' pockets" isn't helpful. Citing one or two viewpoints provide weak support against surgical intervention. Again, find the best orthopedist possible. Get a second opinion if any doubts. Doing what is best for yourself counts the most.
Most importantly, everyone's situation requires the treatment/therapy that works best for him or her. Age and health status are major considerations. Finding the right orthopedist is key. Be clear about what causes the pain and what relieves it. Make sure that s/he listens to what activities you do everyday. Remain as active as possible.
Lastly, making generalized statements that arthroscopy has limited utility and that it exists as a means to "enrich practitioners' pockets" isn't helpful. Citing one or two viewpoints provide weak support against surgical intervention. Again, find the best orthopedist possible. Get a second opinion if any doubts. Doing what is best for yourself counts the most.
1
Yes, lose the weight! Every pound of weight adds 4 pounds of force on the knees just when walking, not to mention when jogging and bouncing around a tennis court.
Eat more fat. And Stop Eating Carbs! You won't feel starved, the pounds will disappear, and your blood markers will improve, with no exercise even needed. And you might no longer need to take some of those heart and pain meds anymore. Fewer expensive visits to the doctor, too.
Eat more fat. And Stop Eating Carbs! You won't feel starved, the pounds will disappear, and your blood markers will improve, with no exercise even needed. And you might no longer need to take some of those heart and pain meds anymore. Fewer expensive visits to the doctor, too.
4
This article should have been accompanied by the disclaimer, "Your experience may be different."
Physical therapy did not help the torn meniscus in my right knee (caused by rising from a squat with the foot/leg/knee not being in alignment). The resultant bone-on-bone contact and locking made surgery a necessity.
The article makes no mention of the difference between meniscus repair and meniscopy. My injury required the more severe meniscus repair, needing ten stitches on the medial and two on the lateral.
In spite of my age (75) I was able to find a top-ranked orthopedic surgeon who specialized in meniscus repairs and was willing to operate -- as my knees were "in better condition than most 50-year-olds" and my pre-operation leg/muscle strength was "excellent."
Recovery was neither easy nor pain-free. And finding a good physical therapist with experience in treating meniscus repairs would seem to be essential. As Is doing the work, religiously.
I can now kneel and sit on my heels without pain or having the bones "lock". However, running is not recommended. Speed walking is OK, as is my regular somewhat rigorous yoga practice (which includes a variety of lunges and knee bends).
Physical therapy did not help the torn meniscus in my right knee (caused by rising from a squat with the foot/leg/knee not being in alignment). The resultant bone-on-bone contact and locking made surgery a necessity.
The article makes no mention of the difference between meniscus repair and meniscopy. My injury required the more severe meniscus repair, needing ten stitches on the medial and two on the lateral.
In spite of my age (75) I was able to find a top-ranked orthopedic surgeon who specialized in meniscus repairs and was willing to operate -- as my knees were "in better condition than most 50-year-olds" and my pre-operation leg/muscle strength was "excellent."
Recovery was neither easy nor pain-free. And finding a good physical therapist with experience in treating meniscus repairs would seem to be essential. As Is doing the work, religiously.
I can now kneel and sit on my heels without pain or having the bones "lock". However, running is not recommended. Speed walking is OK, as is my regular somewhat rigorous yoga practice (which includes a variety of lunges and knee bends).
4
After years of road running,my one knee gave out. The knee specialist recommended I change my sport. My cardiologist ( a runner) suggested wearing the correct shoe for my body and foot.
I found the only shoe for me and replace it more often. I even pay full price.
Problem solved!
I found the only shoe for me and replace it more often. I even pay full price.
Problem solved!
2
My experience is different. I had a torn medial meniscus at 19 years old and had surgery to smooth the tear many years later. That was not problematic. In my 40s I was hot by a car as a pedestrian. Among my injuries was another meniscus tear and a torn ACL in the other knee. Had the meniscus surgery but not ACL surgery. I studied and learned from physical therapists and on my own, about the exercises to protect my knees. I cycle, hike, swim and run. I do not do sports requiring quick turns and jumping. I have no knee pain. 10 years later I got a Bakers Cyst, which is fluid behind the knee. That passed and I learned about avoiding recurrence from a sports trainer on line.
I created better balance of my hamstrings, quad and calf muscles without over dining anything. I also had Euflexa hyoloronic acid shots which helped. 13 years later I am ok.
I created better balance of my hamstrings, quad and calf muscles without over dining anything. I also had Euflexa hyoloronic acid shots which helped. 13 years later I am ok.
2
And I'm in crazy good condition lol
Left knee replaced 1992, right one 1996. Original surgeon was scheduled to revise left knee in 2010 but primary doctor said with NO, not until replaced knee is painful. Both originals are still working -- at 82 yrs old I very worried about any type of surgery plus current ortho surgeon advised revisions are more painful than replacements.
4
At age 50 I had to wait an hour or so after getting up to run, to let the pain in my knees work itself out. Now, at 63, I run 7 miles a day without a twinge of any pain, and I can hop out of bed and be on my way. The difference--I ditched the "arch-support" running shoes and wear only barefoot styles. The musculature in my legs has developed properly so the muscles no longer tug my knees out of alignment.
3
I am a 71 year old tennis player with bad knees. Regenerative therapy(prolotherapy, platelet rich plasma, 1 stem cell treatment) over the past 5 years has improved my knee function. The knee healing also shows up on ultrasound.
I chose this route after 4 different surgeons all recommended bilateral knee replacement with 4 different surgeries. I also had the (probably useless) meniscal cleanup 10 years ago.
I chose this route after 4 different surgeons all recommended bilateral knee replacement with 4 different surgeries. I also had the (probably useless) meniscal cleanup 10 years ago.
5
Thanks for this article. Being the recipient of 3 ACL repairs, which lengthened my athletic "career" by many years by maintaining the stability of my knee (and thus preserving my cartilage), I'm now suffering a degraded/torn meniscus that clicks all the time (surprise! :-0). When told by my GP that my HMO will not do anything about it since I'm over 50, I was annoyed. This sheds some good light on that policy, and I'm glad to read that the policy is reasonable and sane. Naturally, I'm not enthusiastic about a knee replacement nor continuing to ski in with pain, but sounds like there aren't many choices, given that I exercise regularly and do keep the surrounding musculature in good shape ??
4
At 65 I began to have knee issues when using the elliptical at the gym. I moved to the recumbent bike, and after a few months of hard word the problems went away. During that time I also lost 25 pounds that I did not need, and am currently at 180.
5
Your article did not mention platelet rich plasma injections or stem cell injections. What is your view of those therapies? Can they actually halt the deterioration of cartilage?
5
There is no good proof that they do anything but make those who receive them poorer and those who give them richer. Why do you think that insurance doesn't cover them? It's a great cash-only business!
1
I'm pretty sure I would not have replaced my old knees if i'd read all these reader comments including my own. JGAIA
5
Thank you to all the readers and your advice! I have a degenerative hip and think joint replacement sounds barbaric. Please let us know of alternative treatments to cartilage replacement. The surgeons may not like it but hopefully we will see new and easier treatments soon.
1
Hip joint replacement is very different from knee joint, with minimal pain and the highest success rate of major orthopedic surgeries. I recommend you have it done by an experienced surgeon, follow the phyical therapy recommendations every other day for the rest of your active life, no more pain and you'll feel 20 years younger. Had mine done in 2004 & still going strong.
3
About 15 years ago I was set to have my knee scoped after I developed water on the knee after playing basketball. Lucky for me, the surgeon who was ready to do the procedure retired so I went to his successor. He moved my knee around, looked at the X-ray, pronounced it 'pretty stable,' and said come back immediately if the same problem recurred. I also did some PT. Long story short, I am still playing basketball once a week at 60, walking 10,000 steps/day, and my knees are fine. Sadly, friends who had their knees scoped are now hobbling again as their surgeries, sometimes as many as six, didn't take. My lesson is PT first (so far I have had it for knees, shoulder and sciatic pain), followed by recommended follow-on exercises at home once PT has run its usual six visit course, and then see how things go. So far, so good and I feel lucky when I read these other stories.
10
What intrigued me the most was that meniscal repair is nothing but a temporary fix for a long term issue. Being that I am only 15 and have had many issues involving my knees/pattela this article drew me in with its highlight on sport activity with knee problems. I chose this article hoping to learn a bit about knee injuries and I most definitely have. I am a very fit and active person being that I am a cross country runner. And the fact that my knees have caused an issue for me within my sport is very fustrating. Reading the bullet points on how to avoid knee issues really broadened my spectrum on keeping my knees healthy.
7
Best advice that I've received is:
1. Loose weight
2. Give up running
3. Depend on cortisone
1. Loose weight
2. Give up running
3. Depend on cortisone
9
Want healthy knees? Strengthen, work, and stretch everything around them. Use them by running. We are designed to move, not sit. Also, go cold turkey on refined sugar. After I did, my knees improved significantly.
4
I have found that Medical Massage Therapy (by a licensed and skilled practitioner) along with the PT, has been very effective in relieving my 54 year old knees.
2
I'm surprised that no one recommended the use of medical marijuana instead of the problematic anti inflammatories. Godsend for me.
9
What intrigued me the most was that i'am an athlete that always has to be careful and watch out for injuries most importantly knee injuries. I say most importantly because unlike most bones and joints in your body the knee is by far the most important. The ol' reliable joint will be there for your whole life, so it's important to take good care of them and your body. Articles like this one shows that not all surgerys work, so you just can't rely on that in the end. It's what you do now that'll either haunt you or help you forever.
2
I'm always distressed by articles claiming that meniscus surgery is a useless waste.
In my late 40's I took a nasty fall; enough to rip heavy jeans and deeply bloody my knee. The pain continued to worsen despite many treatment modalities. Surgery was recommended. I was afraid and delayed for years until I could barely walk. After meniscus surgery the relief was near immediate, and I did physical therapy religiously for several months. My recovery was complete, and I've always regretted postponing surgery.
Whether the cure was due to physical therapy or arthroscopic surgery appears to be answered. After the prescribed course of physical therapy I never did those exercises again. If physical therapy had been the cure I would have relapsed by now. Instead, after 17 years, I am 68 with strong knees and no trace of arthritis.
Clearly not everybody has such a positive outcome, but it doesn't mean that meniscus surgery should no longer be an option.
Jane Brody frequently extrapolates her personal experience and applies it to all of us. My experience after a lifetime of physical work; is that while using one's body keeps us healthy, overuse of one's body can cause injury, and that age makes this more likely.
In my late 40's I took a nasty fall; enough to rip heavy jeans and deeply bloody my knee. The pain continued to worsen despite many treatment modalities. Surgery was recommended. I was afraid and delayed for years until I could barely walk. After meniscus surgery the relief was near immediate, and I did physical therapy religiously for several months. My recovery was complete, and I've always regretted postponing surgery.
Whether the cure was due to physical therapy or arthroscopic surgery appears to be answered. After the prescribed course of physical therapy I never did those exercises again. If physical therapy had been the cure I would have relapsed by now. Instead, after 17 years, I am 68 with strong knees and no trace of arthritis.
Clearly not everybody has such a positive outcome, but it doesn't mean that meniscus surgery should no longer be an option.
Jane Brody frequently extrapolates her personal experience and applies it to all of us. My experience after a lifetime of physical work; is that while using one's body keeps us healthy, overuse of one's body can cause injury, and that age makes this more likely.
7
Cycling and running are particularly bad for degenerative knee disease. Avoid like the plague as those will only accelerate the degeneration.
Light to moderate exercises using machines, such as leg extensions and hamstring curls, are the best for strengthening leg muscles to provide stability to the knee joint.
Light to moderate exercises using machines, such as leg extensions and hamstring curls, are the best for strengthening leg muscles to provide stability to the knee joint.
5
same info a year ago:
https://www.nytimes.com/2016/08/04/upshot/the-right-to-know-that-an-oper...
I had somewhat ruptured disks, back surgery decades ago, doubt they'd do that now but some would despite evidence back surgery is not helpful (wasn't for me.)
https://www.nytimes.com/2016/08/04/upshot/the-right-to-know-that-an-oper...
I had somewhat ruptured disks, back surgery decades ago, doubt they'd do that now but some would despite evidence back surgery is not helpful (wasn't for me.)
2
Evidence back surgery isn't helpful???? Source, please.
Back surgery helps thousands of people a year.
Back surgery helps thousands of people a year.
There are two kinds of articles I know will have so much controversy and disagreement in the comments that I leave more confused than when I started. One is peace in the Middle East, the other is dieting. I will add knees to that list.
13
Thinking is difficult, right?
I had a minor arthro procedure for a meniscus tear(on 3/2) that got infected and I have not worked since. Also, it was a second opinion and really feel that I did not get good medical care the doctor who did the procedure was in California when I was in the hospital for ( 8 days*) and so that kicked the can down the road and did 3 arthro wash outs and it seems that has damaged my permanently my knee.
* total of 11 days in the hospital plus 2 ER visits and I the same procedure years ago on the other knee and it was a non event.
* total of 11 days in the hospital plus 2 ER visits and I the same procedure years ago on the other knee and it was a non event.
1
Thank you for suggesting occupational therapy at the end of your article. Activity modification is perhaps the best pre- and post-knee replacement intervention. https://ortho.duke.edu/sites/ortho.duke.edu/files/u18/Occupational Therapy Following Total Knee Replacement.pdf
Success rate for full knee replacements are abysmally low, about 40%, compared to hips at 90%. No mention of that. Muscle strengthening is key.
6
Tell me about it.
5
I had Synvisc injections in each knee once without seeing a huge benefit and when I'm tired and bend over they creak like door hinges and are painful. When I went to Hawaii last year I heard about the stem cell injections which are combined with extensive PT. I'm holding out for that but plan to start PT ASAP. It's reaching the crippling stage but I refuse to submit to total knee replacement where success is only 66% (per Jane's article). Wish there were more on this new, non invasive method in the NYT.
3
My wife had a meniscal tear carrying our 2nd child. She began PT after delivering, but had no significant improvement. A successful arthroscopic repair was performed about 9 months after the injury. After PT she was well again.
About 20 years later that compartment (half) of that knee began to "collapse". After 5 years of injections of hyaline and cortisone, braces, and physical therapy these no longer provided any relief and she looked for a surgical solution to avoid becoming immobile.
A full knee replacement would mean losing much of the range of motion and the prospect of a repeat procedure every 15 to 20 years as the pressure of the implant damaged the leg bone, but there's only enough leg for 2 re-do's.
The surgeon who performed the arthroscopy 25 years earlier did a partial knee replacement (refacing only the failed compartment) using a custom implant made from imaging of her knees. She was diligent doing physical therapy and regained a full range of motion, from just past straight to heel touching the buttocks, as well as the rotation of the straight leg. She walks without pain and enjoys dancing again.
This history supports the article's thesis and refutes it. What's missing from the NYT article is that cartilage has distinct layers, a tough surface, a stretchy core and an attaching layer. An incomplete understanding of the anatomy has led to the failed treatments discussed. What's needed isn't replacements, it's new treatments.
About 20 years later that compartment (half) of that knee began to "collapse". After 5 years of injections of hyaline and cortisone, braces, and physical therapy these no longer provided any relief and she looked for a surgical solution to avoid becoming immobile.
A full knee replacement would mean losing much of the range of motion and the prospect of a repeat procedure every 15 to 20 years as the pressure of the implant damaged the leg bone, but there's only enough leg for 2 re-do's.
The surgeon who performed the arthroscopy 25 years earlier did a partial knee replacement (refacing only the failed compartment) using a custom implant made from imaging of her knees. She was diligent doing physical therapy and regained a full range of motion, from just past straight to heel touching the buttocks, as well as the rotation of the straight leg. She walks without pain and enjoys dancing again.
This history supports the article's thesis and refutes it. What's missing from the NYT article is that cartilage has distinct layers, a tough surface, a stretchy core and an attaching layer. An incomplete understanding of the anatomy has led to the failed treatments discussed. What's needed isn't replacements, it's new treatments.
4
"With walking now painful and my quality of life diminished, I finally had both knees replaced, which has enabled me to walk, cycle, swim and climb for the last 13 years."
My neighbor is very active, in his early 50's, and is undergoing the same procedures that you had gone through. I told him, if you continue your beast-mode endeavors, go straight to the knee replacement. It's one of the few things that has a 15 year guarantee.
I did my undergraduate in bio engineering and studied the knee replacement technologies, and this is one aspect of medicine that we will all need as we live past our 90's.
NYT might want to check out the HOAG Orthopedic Institute in Irvine, CA. It's the next generation hospital, and they market bundled knee replacement packages nationally. Insurance doesn't pay for hip or knee replacement until you are past 65, at which point Medicare will also contribute to the total cost. However, for the weekend warriors, for the gunner, type-A personality among us, the cash payment is probably equal to all the other procedures combined (arthroscopy, hyaluronic acid or steroid injections, physical therapy). Some companies are even sending their executives coast-to-coast for it.
On another note about arthroscopic surgery - it can be done with robotics now. I heard of one orthopedic surgeon who went out on his own, bought 8 of these machines, and and maximizes his productivity and returns on investment.
American medicine = technology = procedures = $$$$.
My neighbor is very active, in his early 50's, and is undergoing the same procedures that you had gone through. I told him, if you continue your beast-mode endeavors, go straight to the knee replacement. It's one of the few things that has a 15 year guarantee.
I did my undergraduate in bio engineering and studied the knee replacement technologies, and this is one aspect of medicine that we will all need as we live past our 90's.
NYT might want to check out the HOAG Orthopedic Institute in Irvine, CA. It's the next generation hospital, and they market bundled knee replacement packages nationally. Insurance doesn't pay for hip or knee replacement until you are past 65, at which point Medicare will also contribute to the total cost. However, for the weekend warriors, for the gunner, type-A personality among us, the cash payment is probably equal to all the other procedures combined (arthroscopy, hyaluronic acid or steroid injections, physical therapy). Some companies are even sending their executives coast-to-coast for it.
On another note about arthroscopic surgery - it can be done with robotics now. I heard of one orthopedic surgeon who went out on his own, bought 8 of these machines, and and maximizes his productivity and returns on investment.
American medicine = technology = procedures = $$$$.
1
I damaged my knee while building our new home, shredding the meniscus from a lot of kneeling. Arthro surgery cleaned it up and I was pain free in three days and it has been a year with zero problems.
7
See how it is in ten years.
2
I had arthro on a torn meniscus in 2005. I only have an occasional twinge of discomfort when running now.
my knee was scoped 25 years ago with great success, thank you
ActiPatch is newly cleared by the US FDA for OA of the knee. Surprising the author didn't mention it.
5
developing a yoga practice is crucial! i cant imagine how bad my knees would be without 4-5 days a week of yoga
6
A meniscal repair is nothing but a band-aid for serious knee pain and arthritis. I underwent HA injections for many years and they brought only some relief. Bilateral replacements (five years apart) and PT restored good function to both knees and now I don't even know they are not "original equipment." The only gripe I have is that I can no longer kneel.
7
Haven't had time to read the other comments but has anyone noticed this brand new non-surgical knee procedure which recently received fda approval and looks incredibly promising & could the author please comment on it:
see this article from NBC news:
http://www.nbcnews.com/health/health-news/cool-new-knee-procedure-eases-...
see this article from NBC news:
http://www.nbcnews.com/health/health-news/cool-new-knee-procedure-eases-...
2
I'm enrolled in a double-blind clinical trial for stem cell injection into the knee joint. Before the study, every 4th step was a bone on bone grind, now nearly a year later I'm running 5Ks. Given my miraculous improvement, I'm on the search for stem cells for the non-study knee. It's the future of medicine - regrow your own cartilage with objective proof by looking at cartilage thickness on MRI.
8
I've had arthroscopic repair done to meniscus tears to both knees. One was very successful and the other never got better due to a synovitis condition in that knee. Today I have bone on bone arthritis on that knee. Many doctors today refuse to even do meniscus repair saying it doesn't pay them enough (under Medicare) so only want to do knee replacements. My pain has been manageable with only running and jogging a restriction. I recently consulted with a surgeon about knee replacement and was surprised that he didn't push for replacement saying as long as I was not in unmanageable pain it wasn' necessaryt
4
A primary issue of trying to stay fit as I get older--exercising enough to do some good and not so much I cause injury. And there is no obvious operators' manual telling me how to do that, as my hernia surgery demonstrated. So, I dial it back a little and keep on truckin'.
7
Maybe after getting the first surgery you should have cut back on the cycling, swimming, and exercise and your knee would last longer.
4
At yes, but your life would likely not, and what was left it it would be hideously boring and sedentary.
1
Be careful with study results. Only a double blind prospective study can tell you that there is a direct cause and effect between a treatment and an outcome. In the case of the Symvast study cited, unless mock injections were done on the knees of all these patients (and it is very unlikely that they were) we do not know if Symvast was the cause of the delay until knee replacement--or if those who hoped to delay knee replacement or had less severe disease opted for the Symvast injections.
1
It would always be helpful to see some of the other Reader Comments before sending in ones own- this to compare experiences. No replacement or doing so in my case. JGAIA
1
The lack of central repository for information about knees puts those of us with keen problems at a serious disadvantage. After a bad slip and fall on ageing NYC MetroNorth stairs 8 years ago, my right knee got stuck in a bent position. I had meniscus surgery without trying PT first, and after a course of post op PT, no improvement. The same surgeon recommended ACL surgery. After reading up on ACLs, I decided I didn't need it and sought a second opinion. A second meniscus surgery was done at HSS, and afterwards I had a full year of PT, most of which I paid for out of pocket.
When right knee finally started to improve, let knee started bothering me. I had meniscus surgery on it also.
Was my improvement due to the surgery or the PT?
SYNVISC WARNING - although I had a very long recovery period, when my knee was stuck in a bent position it did not hurt.
The greatest and longest period of pain I have experienced is after my second SYNVISC injection in left knee. I was in mind altering pain for 5 days after the second injection. Besides the emergency room and the doctor's office, I didn't go anything for 10 full days due to the pain. There is plenty of anecdotal information that some people have severe adverse reactions to this treatment, but the drug manufacturer doesn't want you to know it. 62 days after SYNVISC injection I am still in significantly more pain/swelling than before injection.
When right knee finally started to improve, let knee started bothering me. I had meniscus surgery on it also.
Was my improvement due to the surgery or the PT?
SYNVISC WARNING - although I had a very long recovery period, when my knee was stuck in a bent position it did not hurt.
The greatest and longest period of pain I have experienced is after my second SYNVISC injection in left knee. I was in mind altering pain for 5 days after the second injection. Besides the emergency room and the doctor's office, I didn't go anything for 10 full days due to the pain. There is plenty of anecdotal information that some people have severe adverse reactions to this treatment, but the drug manufacturer doesn't want you to know it. 62 days after SYNVISC injection I am still in significantly more pain/swelling than before injection.
2
Thanks for this useful and informative article. I blew my ACL in college and now I'm 52. I'm an avid runner and skier, the exact target market for your article.
3
I've struggled with damaged knees for many years from physically demanding work & a tendency towards overweight. I've had arthroscopic surgery & injections in both knees with short term modest improvement. I've also visited several orthopedic specialists & found their approach to my problems troubling at best. Only the one who did my first surgery followed up with physical therapy. My last specialist didn't accept my insurance for therapy & failed to inform me until after the surgery. He also liked X-rays every three months. I ended that relationship. None of them were honest about the pain, complications & length of recuperation. Replacement surgery is a money maker & aggressively promoted so do your homework before making this choice.
3
Had a torn miniscus develop 3 years ago followed by arthroscopic surgery 6 months later, perhaps due to a brief experience adding some sprints to my jog. Have always maintained normal weight and frequent low impact exercise, varying between jogging, swimming, yoga, etc. Maybe I'm fortunate, but the surgery was a tremendous success. Minor arthritis in the knee that was operated on and occasional pain in the other, but presumably normal for a 58 year old male. Happy that I had the procedure since the pain was only getting worse over the 6 month period.
3
I’m having a hard time thinking of a NY Times article that had such a wide array of well thought-out and informed comments.
And it’s hard to think of an article that generated so much controversy, with so many issues left unresolved. These are not just “my opinion” issues (e.g., “Highway 88 is much more scenic than Highway 99”); these are cases where people are either receiving medical treatment or prescribing it for themselves and the treatments may be at best ineffective or at worst actually harmful (e.g., take Ibuprofen”). Part of Ms. Brody’s goal was to resolve some of these issues, yet in an unexpected way more questions are now up in the air. But this may actually be beneficial.
Here’s my suggestion – since there’s such high interest in this, maybe the Times could run a follow-up article or even a series to lay out all of these issues, big and small (e.g., Cassandra says Turmeric is helpful), and systematically present the arguments for both sides. I noticed there was a lot of passionate advocacy for physical therapy—I’d especially like to see the argument for therapy versus invasive operations.
And it’s hard to think of an article that generated so much controversy, with so many issues left unresolved. These are not just “my opinion” issues (e.g., “Highway 88 is much more scenic than Highway 99”); these are cases where people are either receiving medical treatment or prescribing it for themselves and the treatments may be at best ineffective or at worst actually harmful (e.g., take Ibuprofen”). Part of Ms. Brody’s goal was to resolve some of these issues, yet in an unexpected way more questions are now up in the air. But this may actually be beneficial.
Here’s my suggestion – since there’s such high interest in this, maybe the Times could run a follow-up article or even a series to lay out all of these issues, big and small (e.g., Cassandra says Turmeric is helpful), and systematically present the arguments for both sides. I noticed there was a lot of passionate advocacy for physical therapy—I’d especially like to see the argument for therapy versus invasive operations.
16
PT's are lower in the medical hierarchy, hence many orthopedists don't view them as equal partners in rehabilitation. It's more of a chef/busboy relationship. Moreover, orthopedists are not trained in the details of rehabilitation. Ask your orthopod how many hours he spent studying musculoskeletal pain. Their focus is on surgical techniques and internal medicine, meaning pain relievers.
1
Mike from NYC, exactly! This is my FOURTH comment on this topic, but I find I keep having things to add. I had a bad experience where a doctor wrote a prescription, the therapist did what the doc said, nothing was working, and I was only saved when what I learned was my "regular" therapist returned from maternity leave, got the doc on the phone, and fixed things. What can make the system work is when the doc authorizes treatment but writes a very general prescription and then an energetic and creative therapist makes it work. As you read these hundreds of comments, one of the big themes is we may be doing too much with heroic treatments and not nearly enough with physical therapy.
2
I had arthroscopic surgery on one of my knees in 2002 for pain caused by a torn meniscus. It was not getting better by itself. So far so good 15 years later.
6
I had the same experience with arthroscopic surgery on my hip. After the procedure I developed a slight limp when physical therapy did not help I complained to the surgeon, He asked whether there was less pain than before. I said yes, he smiled and said ok then...his suggestion was to try another physical therapist. Two years later, after my limp and the pain had gotten much worse i had a hip replacement using a different doctor.That was 8 years ago and I have resumed biking, hiking,horseback riding without pain or limitations. I felt"duped" by the first doctor but have recommended the excellent surgeon who replaced my hip to multiple friends.
2
It's all about ego. The rage in my community for the over 60s is pickle ball, a short-court form of tennis. Running and pounding on a hard surface, no matter how short, is still running and pounding the body and joints on a hard surface. In fact, some players have fallen backwards, hitting their heads on the hard surface.
Walk, swim, hike, do the NYT Seven Minute Workout. Lots of low-impact, healthy choices.
Walk, swim, hike, do the NYT Seven Minute Workout. Lots of low-impact, healthy choices.
11
I have a bucket handle meniscus tear in my left (non dominant leg) knee. It used to lock up on me, resulting in pain so severe it cannot be put into words. When I was not yet 30, a surgeon told me -- after doing a remarkably brief exam and no imagery -- that I should have the cartilage removed. I ran this by another surgeon who had no financial stake in the matter, and he told me I should hold onto my cartilage (I was too young for the surgery) and instead work to strengthen the muscles that would keep my knee stable. I followed his advice. Almost 30 years on I still have my cartilage, and very strong legs. My knee has not locked up in probably 20 years. It hurts sometimes, but I can live with that.
Too many (exceedingly well paid) orthopedic surgeons are selling product rather than healing patients. My obese mother-in-law has had three knee replacements in her long life, because the things wear out. She was never advised, before that first replacement that doomed her to further swap-outs, to lose weight or do physical work to strengthen the muscles around her knee. She's the type of person who worships doctors and likes drama anyway, so she was susceptible to the sales job. She should never have been sold a new knee at age 50.
My advice is to do the work to keep your parts, and only let go when there is no alternative.
Too many (exceedingly well paid) orthopedic surgeons are selling product rather than healing patients. My obese mother-in-law has had three knee replacements in her long life, because the things wear out. She was never advised, before that first replacement that doomed her to further swap-outs, to lose weight or do physical work to strengthen the muscles around her knee. She's the type of person who worships doctors and likes drama anyway, so she was susceptible to the sales job. She should never have been sold a new knee at age 50.
My advice is to do the work to keep your parts, and only let go when there is no alternative.
17
Isn't there an app for that?
Twenty years ago, when my knee pain got serious, my orthopedist told me that medical research to, well, replace knee replacements, was the most well funded field of elective surgery. The reason was that my generation, the boomers, were the first ever in which a large percentage played hard sports well into middle age. Hence, the ever growing knee problems.
I put off knee replacements for as long as I could, hoping for a research breakthrough that never came.
At a class before my first replacement, I left in horror when the instructor showed life-sized models of what would be cut out of me. I put it off for another year, but finally had both replaced. I can walk without pain, cycle, spend long hours in the gym.
But, uh, I sometimes wistfully look at a runner plugging along in the open air, as if catching sight of a woman who dumped me.
Why is there no app for that?
Twenty years ago, when my knee pain got serious, my orthopedist told me that medical research to, well, replace knee replacements, was the most well funded field of elective surgery. The reason was that my generation, the boomers, were the first ever in which a large percentage played hard sports well into middle age. Hence, the ever growing knee problems.
I put off knee replacements for as long as I could, hoping for a research breakthrough that never came.
At a class before my first replacement, I left in horror when the instructor showed life-sized models of what would be cut out of me. I put it off for another year, but finally had both replaced. I can walk without pain, cycle, spend long hours in the gym.
But, uh, I sometimes wistfully look at a runner plugging along in the open air, as if catching sight of a woman who dumped me.
Why is there no app for that?
2
We changed clinics for our medical care after my orthopedist left the practice.
My new orthopedist he informed me that Synvisc is now not considered a good treatment. I was surprised because it had worked for me.
After I took up cycling in my 60s I frequently had knee pain that was so bad that after riding I couldn't walk down stairs. A shot of the Synvisc cleared it up almost immediately. It was a miracle. For the first 3-4 years I had one each year.
Now, perhaps because I have strengthened the muscles in my legs I haven't needed one (for about 2 years).
But without them I would have had to have given up cycling, which is an essential activity for me because I will need open heart surgery in a few years to correct a valve problem. I need a strong heart to survive this surgery. We do many other activities (hike about 500 miles a year, play ping pong, dance, do yard work, etc.), but for 6-7 months of the year we try to cycle about 3 out of every 4 days.
The new orthopedist I consulted suggested steroid shots if my knees started acting up, instead of Synvisc. I have issues with steroid shots for the reasons mentioned in this article.
If I need another Synvisc shot I am going to go to another orthopedist. This article is greatly appreciated, as is the reference to the study showing its effectiveness. One really has to be on top of things these days because not all physicians are. It is one major benefit of the internet (and of my NYT subscription).
My new orthopedist he informed me that Synvisc is now not considered a good treatment. I was surprised because it had worked for me.
After I took up cycling in my 60s I frequently had knee pain that was so bad that after riding I couldn't walk down stairs. A shot of the Synvisc cleared it up almost immediately. It was a miracle. For the first 3-4 years I had one each year.
Now, perhaps because I have strengthened the muscles in my legs I haven't needed one (for about 2 years).
But without them I would have had to have given up cycling, which is an essential activity for me because I will need open heart surgery in a few years to correct a valve problem. I need a strong heart to survive this surgery. We do many other activities (hike about 500 miles a year, play ping pong, dance, do yard work, etc.), but for 6-7 months of the year we try to cycle about 3 out of every 4 days.
The new orthopedist I consulted suggested steroid shots if my knees started acting up, instead of Synvisc. I have issues with steroid shots for the reasons mentioned in this article.
If I need another Synvisc shot I am going to go to another orthopedist. This article is greatly appreciated, as is the reference to the study showing its effectiveness. One really has to be on top of things these days because not all physicians are. It is one major benefit of the internet (and of my NYT subscription).
6
i tried synvisc with great results you need three shots three weeks in a row every six months my surgeon a young woman who trained at harvard has seen success with synvisc in even bone on bone knee arthritis even though the package insert says it is only for milder forms of knee osteoarthritis a friend was told by her ortho it wouldnt help different doctors different answers the real problem is ortho surgeons make a lot of money doing replacments and the knees replacements are as good as hip
1
Good Article which reflects a study put out by AMA many years ago about the
dangers of arthroscopic surgery and steroid injections, and I avoided both but
still ended up with b/l Knee Replacements at 55. My 3 sisters have no knee
problems while I am totally disabled. The difference is that my sisters had desk
jobs and maintained normal weight. I worked 16 hr. Hospital shifts walking on cement floors, was a long time runner daily, always used stairs at work for
extra exercise, and eventually gained weight and still struggle with this.
My knees were bone on bone by age 50 and I regret all this wear and tear
and abuse I caused for my body. Life after Knee Replacements for me has been awful. No amount of PT, exercise, or nutrition/supplements has helped
and the pain is crippling. If I could do life over I would rest more and avoid
all high impact activities and above all maintain a normal weight.
dangers of arthroscopic surgery and steroid injections, and I avoided both but
still ended up with b/l Knee Replacements at 55. My 3 sisters have no knee
problems while I am totally disabled. The difference is that my sisters had desk
jobs and maintained normal weight. I worked 16 hr. Hospital shifts walking on cement floors, was a long time runner daily, always used stairs at work for
extra exercise, and eventually gained weight and still struggle with this.
My knees were bone on bone by age 50 and I regret all this wear and tear
and abuse I caused for my body. Life after Knee Replacements for me has been awful. No amount of PT, exercise, or nutrition/supplements has helped
and the pain is crippling. If I could do life over I would rest more and avoid
all high impact activities and above all maintain a normal weight.
5
I've had bad knees for most of my adult life. It didn't matter if my weight was normal or above normal. In time I was diagnosed with osteoarthritis and told my knees were bone-on-bone (there was no cartilage left to cushion them and I had developed many bone spurs). I had to wait until I was "old enough" to have knee replacement surgery and received the hyaluronic acid injections regularly, but had little relief from them. Eventually, I walked like a penguin, my leg bones were out of alignment, and I was in near-constant pain. To their credit, my doctors never suggested arthroscopic surgery. The best thing I ever did was have both knees totally replaced when I reached my 60s. I can walk and do everything I want without pain. I am not and never have been an athlete, so nothing I do puts exceptional stress on my knees.
Total knee replacement surgery is a growth industry. We baby boomers refuse to adjust our life styles to accommodate age and we are mostly overweight, and our joints can't withstand that. I have a growing number of friends and acquaintances who have had knee replacement surgery, some with less success than I experienced. Some also had arthroscopic surgery, but not all. We are riding the wave of the future!
Total knee replacement surgery is a growth industry. We baby boomers refuse to adjust our life styles to accommodate age and we are mostly overweight, and our joints can't withstand that. I have a growing number of friends and acquaintances who have had knee replacement surgery, some with less success than I experienced. Some also had arthroscopic surgery, but not all. We are riding the wave of the future!
1
I went through arthroscopic surgery 8 years ago on left knee. The doctor cleaned up the small tears which were rubbing inside. I was in such pain that I found myself walking around London streets swallowing ibuprofen whilst feeling like an old city pigeon looking for a place to die. The surgeon informed me that the knee was riddled with arthritis but that the tears were cleaned up. Since then I have gone back to singles tennis twice weekly wearing a tight band which seems to keep the knee more secure. The best advice I received came form a therapist who told me to do leg exercises which strengthen the three muscles which encircle the knee. This makes sense and has helped. My compromised knee functions well, and without pain, when I keep up the exercises to keep the muscles strong.
9
I agree with many of the points here and am happy that word is finally getting to the public that surgery is rarely necessary. One of the biggest problems I see with the American approach to treating orthopedic pathology is the lack of understanding regarding how the body works as a whole, not to mention using imaging exclusively to diagnose. In well over half of my patients with knee complaints, the spine is involved directly or indirectly. Nerve compression in the low back can shut off the electricity to the muscles supporting the knee and derangement of the low back joints can alter the mechanics at the knee joint - even in the absence of low back symptoms. Applying this understanding in the clinic is paramount. For this reason, I cringe at the possible recommendation to see a "knee specialist." This over-specialization when it comes to clinical care (not surgical care) is a shame; I became the clinician I am today once I became well versed at diagnosing and treating the spine, as it is ultimately the fuse box that controls the entire musculoskeletal system.
8
Dr (?) Manning, what should we then get in addition to imaging to diagnose my problems.
I'm a runner (55) whose decline in performance has become quite marked. knee pain. Run four to five days a week. 30 minutes average per session. Normal weight. Haven't been able to descend bus stairs normally in years.
Right knee feels abnormal in shape and can't bend properly. Thigh muscles have grown incredibly weak. But pain inhibits motivation to do any strengthening work. Most alarming is numbness in feet or thigh at high exertion around 30: to 50: into workout.
Aside from all that though, everything's great!
Can't help thinking nerves or something like that in my spine are being compressed (if it's not just outright heart disease).
What are my options to getting a good accurate diagnosis?
I'm a runner (55) whose decline in performance has become quite marked. knee pain. Run four to five days a week. 30 minutes average per session. Normal weight. Haven't been able to descend bus stairs normally in years.
Right knee feels abnormal in shape and can't bend properly. Thigh muscles have grown incredibly weak. But pain inhibits motivation to do any strengthening work. Most alarming is numbness in feet or thigh at high exertion around 30: to 50: into workout.
Aside from all that though, everything's great!
Can't help thinking nerves or something like that in my spine are being compressed (if it's not just outright heart disease).
What are my options to getting a good accurate diagnosis?
I think I have identified your problem.
"After 10 years of jogging, decades of singles tennis and three ski injuries, my 50-plus-year-old left knee emitted clear signals that it was in trouble. "
You're welcome.
"After 10 years of jogging, decades of singles tennis and three ski injuries, my 50-plus-year-old left knee emitted clear signals that it was in trouble. "
You're welcome.
10
What I'd wished I'd known about my knees is that osteoarthritis is partly hereditary. My father had horrible knees. I went blithely on for decades doing high impact aerobics because it was "good for me". It was good for my cardiovascular system but it wasn't good for my knees. If I had known about the genetic connection to osteoarthritis I probably would have hiked more or done Nia or gone swimming. I now have 2 replaced knees. Ugh. It would be great if the fitness folks could make us more aware about the hazards of some of the activities they advocate. That way we could make better informed choices.
7
I had arthroscopic knee surgery (for a meniscal year), recommended and performed by a senior physician at New England Baptist Hospital. It was a horrible waste of money and time spent recuperating from the surgery. My meniscus was fine so he ended up doing a different procedure (lateral release). It took twelve weeks of rehab to get me back to where I was pre-surgery. No improvement whatsoever. Further surgery was recommended (involving a plate and rod), but as my pain worsened I instead consulted a physiatrist who recommended PT. Here I am again. Trying to be hopeful.
1
I wrecked (ACL tear, meniscus tear) at 21. And then I hurt it more, over and over, as a farm worker. When I was about 50, one day I couldn't walk any more, and I had clean-up arthroscopic surgery. That stabilized my knee, and 17 years later I'm still walking around, never strong the way I would have been without the injury, but with only minor pain and mild arthritis. It was definitely the right thing for my knee, and I don't even think about knee replacement any more.
3
Most studies indicate that Tylenol is useless for pain relief. And, about NSAIDs, you really should check with your physician. On a routine endoscopy i had last year, a peptic ulcer was discovered (not pylori related). I didn't even know I had it. But it was determined it was after trying to help my knee pain that taking them probably caused the ulcer. Just saying, be careful with OTC meds, especially after 60.
3
Sounds like this person's medical issues are more to do with an unhealthy degree of exercise than bad surgery. It's funny that the response after treatment is to run out and do those destructive behaviors all over again. Why not just relax on the patio and read the newspaper instead of running around like some Olympic champion?
9
I am having my right knee replaced tomorrow, the left will have to wait until next year. Both are shot after 61 years of chronic dislocations interspersed by eight open surgeries to repair the damage when chronic became constant. I am fortunate, my doctors tell me, because my knees are the only weight bearing joints in my body that dislocate. My brother-in-law had the hyaluronic acid injections in both knees - so far it has worked for him. He is retired now after spending 40 years hauling logs, an occupation notorious for knee and shoulder problems.
I've had knee pain since my teenage years. At age 57 I had both knee's meniscus 'cleaned up' and experienced significant relief of pain. I wasn't expecting a return of athletic function and didn't get any (my doctor suggested I would get some but I knew better).
However I abused my knees again due to some unexpected activity and returned for another cleanup of 1 knee. Same relief of pain and swelling which has persisted for 5 years.
I work out regularly but began avoiding knee stress for some time now. I stopped jogging 15 years ago. The Stairmaster 8 years ago, even the parabolic machines 5 years ago. It's hard to get some cardio without using the legs but rowing works for now without undue stress. Intense weights at times but little or no leg work.
You just have to give broken knees a break, forever.
However I abused my knees again due to some unexpected activity and returned for another cleanup of 1 knee. Same relief of pain and swelling which has persisted for 5 years.
I work out regularly but began avoiding knee stress for some time now. I stopped jogging 15 years ago. The Stairmaster 8 years ago, even the parabolic machines 5 years ago. It's hard to get some cardio without using the legs but rowing works for now without undue stress. Intense weights at times but little or no leg work.
You just have to give broken knees a break, forever.
6
As a licensed physical therapist with 18 yrs experience, I can assure you that for many people with advanced knee OA arthroscopic surgery to address a meniscal tear is a losing proposition! Get some good quality PT, do your home exercises and buy yourself some time before knee replacement. Sinvisc injections and the like work well for some people but not for others. Being fit, active and not overweight will also buy you some time before knee replacement. Activities should minimize impact and stress on the knees while emphasizing motion and strength.
8
Well let me raise my voice to object. Some six years ago I had arthroscopic surgery on my knee to remove a meniscal tear. I had been in agony and barely able to walk. The surgery had a great outcome for me.
Same for my wife, and the shots have allowed her to remain mobile, active and put off knee replacement surgery, at least for the time being.
The problem with articles and studies like these is that it enables insurers to deny coverage and put these procedures and treatments out of reach for many who are justified.
Same for my wife, and the shots have allowed her to remain mobile, active and put off knee replacement surgery, at least for the time being.
The problem with articles and studies like these is that it enables insurers to deny coverage and put these procedures and treatments out of reach for many who are justified.
6
Exactly. If my insurer had denied my meniscus surgery I shudder to think of the pain I'd still be in and all of the activities I wouldn't have been able to do. I think the real solution is to be able to determine which injuries warrant repair. I'm guessing that those caused by a known "event" differ from those that are caused by overall degeneration., usually age related.
The only thing that I hear when reading most of these comments is the distant sound of physicians all over the world snickering in response to those commenters who are proposing quakery, placebos and scams. There are a lot of competant researchers working on solutions to degenerative knee pain, but so far not much of a practical nature has emerged. Except of course, the TKR.
2
If mainstream physicians are laughing about alternatives to TKR that probably suggests we alternative seekers are on the right path. While physicians and big drug companies do many good things, treatment of chronic conditions is generally not among them. I fear that some of these competent researchers will come up with a new biologic that will eliminate your knee pain, but put you at risk of something far worse. You can call it quakery or a placebo effect, but I know I still have highly functioning knee joints at 82 with no pain and a good range of motion that is for the most part attributable to the biological properties of a group of natural substances. I know that my experience isn't translatable to all people with meniscus tears and other knee problems, but it has been profoundly effective for OA.
4
I had arthroscopy 3 weeks ago to trim a torn meniscus - it had been painful for three months and was getting worse. The op has worked like magic for me; no more pain and immediately back on my feet.
4
After 40 years of running and walking I have some arthritis in both knees. The pain comes and goes and is rarely severe. I find that a combination of rest, heat AND remaining active keeps me away from the doctor's office and the medicine chest. I take an Aleve or ibuprofen maybe five times a year if I have major soreness after a run. I bike more, but I still like running (or now, jogging), so I don't plan to give it up. I never squat anymore, but I can run up stairs without difficulty or pain. The benefits I've gotten from being a runner far outweigh the knee issues I've experienced. My knees won't last forever, but neither will the rest of me.
My wife has bad knees and found that a cortisone shot provided major relief. But it's been over a year since she had that shot. She should probably get another one, but I guess she's waiting until the discomfort becomes more than a nuisance.
My wife has bad knees and found that a cortisone shot provided major relief. But it's been over a year since she had that shot. She should probably get another one, but I guess she's waiting until the discomfort becomes more than a nuisance.
3
You note that the injection helps 2/3 patients. That's not useless at all.
Also you note that your friend had improvment without surgery. That does not necessarily mean that your own knees would have improved without any treatment. Maybe, maybe not.
Also you note that your friend had improvment without surgery. That does not necessarily mean that your own knees would have improved without any treatment. Maybe, maybe not.
5
Like some people have already mentioned, the author - and many others - need to reduce their obsession with exercise, especially running. It's good to be active, and exercise should be a part of a healthy lifestyle, but not to a point where you destroy your body. If you really enjoy the overexertion, you need to eat like an athlete - read dozens of eggs a day - to counter the damage.
2
" take an over-the-counter pain reliever like acetaminophen (Tylenol and others)" My reading of medical literature seems to indicate that acetaminophen lacks effectiveness in pain due to arthrosis, but NSAIDs do help, though they increase the risk of GI bleeding.
2
Jane Brody, why is this article predicated on YOU & what happened to YOUR knees? You say you "succumbed to wishful thinking" when it sounds like you needed either additional medical opinions OR you needed to understand knees better.
How about if *I* re-write your column, in which case it would say roughly: I was very active for decades but ultimately tore the meniscus in both knees, as proven by MRI. This was managed conservatively by my orthopedist until I couldn't stand the pain any more: stepping off a curb literally hurt so much it made me want to cry. I stopped being active b/c I was in so much pain.
Finally I had arthroscopy on both knees, which got me out of pain for the most part, though I could not go back to the activities that had damaged my knees.
Eventually one knee became painful again, due to a physical therapist who did NOT follow the doctor's clear directions; that physical therapist did a movement on my knee that re-tore the meniscus (as proven by another MRI).
Had 3rd arthroscopy, which was successful - but was left with little medial meniscus in one knee. Eventually tried hyaluronic acid injections, which have kept me from needing total knee replacement for 14 years so far. I consider those injections a MASSIVE success.
I know many people who've had knee replacement, and it's no walk in the park. I won't have it until utterly necessary, which I hope is never. I use an elliptical trainer & walking to keep myself fit.
The BMJ study baffles me!
How about if *I* re-write your column, in which case it would say roughly: I was very active for decades but ultimately tore the meniscus in both knees, as proven by MRI. This was managed conservatively by my orthopedist until I couldn't stand the pain any more: stepping off a curb literally hurt so much it made me want to cry. I stopped being active b/c I was in so much pain.
Finally I had arthroscopy on both knees, which got me out of pain for the most part, though I could not go back to the activities that had damaged my knees.
Eventually one knee became painful again, due to a physical therapist who did NOT follow the doctor's clear directions; that physical therapist did a movement on my knee that re-tore the meniscus (as proven by another MRI).
Had 3rd arthroscopy, which was successful - but was left with little medial meniscus in one knee. Eventually tried hyaluronic acid injections, which have kept me from needing total knee replacement for 14 years so far. I consider those injections a MASSIVE success.
I know many people who've had knee replacement, and it's no walk in the park. I won't have it until utterly necessary, which I hope is never. I use an elliptical trainer & walking to keep myself fit.
The BMJ study baffles me!
7
Surgical interventions, apart from total joint replacement for hips and knees, have long been shown to be ineffectual or even deleterious for most neck, lower spine, hip, knee and shoulder problems, particularly if they are of a degenerative nature -- wear and tear, scarring, arthritis, which some 80+% are. Steroid and gel injections provide some temporary relief in some people, but many studies conclude this is mostly placebo effect. Speaking of which, ibuprofen and other anti-inflammatories and pain relievers (up to and including opiates) are also ineffective, apart from psychological effects. The former, anti-inflammatories, raise the risk of heart attack and stroke and directly cause renal failure; the latter, apart from adverse cognitive and gastro-intestinal effects, invite addiction. Stretching, exercise and weight loss are the only effective longer term remedies. And, of course, changing your activity regime to reduce further wear and tear and aggravation of existing injury.
1
I was supposed to have athroscopic surgery on a complaining knee; the day before the physician and I quarrelled and I cancelled the surgery. This was six or seven years ago; my "bad" knee has been just fine since then, without surgical intervention. Go figure.
1
I am one of the lucky whose shredded meniscus responded well to surgical removal of torn tissue and two or three follow-up courses of Hyalgen injection (five shots each time). 10 years later, I'm still pain-free and active, though I had to give up joint-damaging fun like skiing and racketball.
3
I recently encountered sever knee pain as i stride up stairs and no where else. I am taking a daily dose of tumeric in the hopes of resolving any issues.....I continue to walk my dog, run occasionally and do all the tasks I've
done in the past....even limited my crouching at which time the pain is rather awful......I'll continue this prior to any notion of surgery, thank you!
done in the past....even limited my crouching at which time the pain is rather awful......I'll continue this prior to any notion of surgery, thank you!
1
And what a coincidence! Just been at the clinic to check on my knees. It looks like they have taken a beating after my long runs both indoors and outdoors. I hear that awful sound where the bones meet in my left knee as climb the steps at home. I have just been given advice on some exercises I have to practice plus been advised to reduce my running passes. I have gone over to cycling and it works. I feel les pain doing so.
Hopefully, with the help of some advice in the commentaries featured here, I will get back to doing what I love most during my free time - training with running as part of it.
Hopefully, with the help of some advice in the commentaries featured here, I will get back to doing what I love most during my free time - training with running as part of it.
In my early 60's I had arthroscopic procedures done on both my right and left medial menisces. On was damaged in a bicycle accident and the other tear was attributed to "wear and tear".
Prior to having the arthroscopic procedures the knees (each meniscus was torn at different times) had become stiff, swollen, and full of fluids - which had to be drained several times.
Being an active person, these injuries prevented me from bicycling, hiking down into canyons for fishing etc.
After having the arthroscopic procedures both knees healed nicely and I did my own strengthening and rehab in the gym. I also lost around 7 pounds.
Now I am 70 years old and I bicycle around 30 miles a week and jog between 5-7 miles a week plus do kayak fishing twice a week. Although I cannot say that other treatment modalities might have worked better or not, I - for one- am totally pleased with the results of both my arthroscopic procedures and have no regrets.
Prior to having the arthroscopic procedures the knees (each meniscus was torn at different times) had become stiff, swollen, and full of fluids - which had to be drained several times.
Being an active person, these injuries prevented me from bicycling, hiking down into canyons for fishing etc.
After having the arthroscopic procedures both knees healed nicely and I did my own strengthening and rehab in the gym. I also lost around 7 pounds.
Now I am 70 years old and I bicycle around 30 miles a week and jog between 5-7 miles a week plus do kayak fishing twice a week. Although I cannot say that other treatment modalities might have worked better or not, I - for one- am totally pleased with the results of both my arthroscopic procedures and have no regrets.
4
Your comments regarding "physical therapy" could be more explicit and explain that strength training, particularly of the quadriceps and hamstrings are the most critical components, along with weight loss, in alleviating knee pain and avoiding surgery. And the "therapy" is not a once and done which, unfortunately is how most people view it. The strengthening program must become a routine of daily life. Don't stop just because you now feel better or it won't last.
9
My torn meniscus was repaired nearly four years ago. After a long recovery and physical therapy, it functions adequately. I can't know if I would have recovered without surgery, though I do wish I'd waited longer before deciding to have it done. What I learned from my physical therapist was the importance of maintaining strong quadriceps, which I have done. My arthritis hasn't disappeared from knee and other joints, but I never have, nor am I likely to, use injected substances. I've learned to distinguish warning pain from annoying pain, and that will have to do.
3
I tore my my left meniscus from running and eventually it became too painful and arthroscopic surgery was recommended. But at the last minute I had to cancel as I moved out of state at the scheduled time. In the new location I took up swimming and specific weight lifting for knees and legs and have continued that for twenty years. I no longer run, but treadmill, must wear a knee brace to play tennis, and take glucosamine and Omega 3 daily. I always wondered if I should have been scoped, but learning about these studies at the age of 75, I feel that I might have made a lucky choice to cancel the operation.
3
Madison, WI is the home of the HHPF which is the first and still principal training institution for prolotherapy in the world. You should consult the department of Family Medicine at UW if you are still symptomatic. I understand BCBS is now covering prolotherapy in WI.
Sometimes the meniscus is crimped or folded in its torn state and it has to be repaired. Mine was successfully repaired and my knee has been fine ever since even though my primary care doctor said that the arthroscopic surgery is the beginning of the end for the joint. Sounds like adjustments in approach need to be incorporated, but a surgeon, rather than an insurance company, still needs decide when surgery is definitely needed.
3
Still recovering from the arth. surgery in May. Seems like most evidence points to a new knee in less than 4 years in many cases, despite standard procedures and gel injections. I wish I had just gone for the new knee in the first place, if it is inevitable. (Don't know for sure, but I wouldn't be surprised if insurances wouldn't cover the new knee before trying all the procedures first).
The problem with research & anecdotal stories like this one is that we are not robots who can be treated like the next one. I've had meniscal tears in both knees and when my knees started locking it was time for surgery. No amount of physical therapy or training cures that. The surgeries were a success. My knees no longer locked. So you see sometimes arthroscopic surgery is called for.
2
If you have an acute meniscus tear there is a definite role for surgery- not for chronic degeneration- an important distinction not made by Dr. Siemieniuk- they are not at all the same thing. Only surgery works.
4
Having sold stem cells for the past three years, I have seen them help with pain and inflammation in about 85% of patient's that get them. There is currently a multi-center, 200 patient, knee osteoarthritis study underway that will compare stem cells, HA, and a placebo. An earlier, smaller stem cell study showed significant improvement in all categories, including pain and inflammation. There may even be some regenerative benefits. Being all natural, there have been no reported side effects in over 40,000 injections with this company's product. It also seems to work in hips, shoulder's, ankles, and spine too. Unfortunately, it is not currently covered by insurance. Hopefully that will change once the efficacy and safety of stem cells are definitivly proven through studies.
1
I must be part of that 15%. After having knee pain for close to 30 years due to a Coast Guard injury I elected to have ACL surgery. Compared to the pain I had before, even just 12 hours after the surgery my knee felt better. Four years later and it still feels like the knee of a 20-year-old. One thing I thankful for is putting it off for as long as I did. How the CG wanted to operate on it in the 1980s compared to how London's UCL did it is night/day difference.
I had the arthroscope procedure about 12 years ago after many falls. What has kept me from a knee replacement is a great podiatrist who custom made orthotics for me. They changed my gate and i've been pain free ever since.
I also recommend physical therapy - it's the best!
I also recommend physical therapy - it's the best!
4
At 25, I tore up my knee playing intramural basketball. I did not have recommended surgery. At 50, I had meniscus repair. I was relatively pain free for 18 years. At 68, down to bone on bone, I had my knee replacement. I think by delaying it, the materials and procedures were very much improved and the surgery and recovery were routine. So my opinion runs counter to the author's thesis. I recommend delaying the knee replacement until it becomes necessary to maintain an active lifestyle and relieve the pain.
3
What is the cost of knee replacement and what percentage of Americans have
adequate insurance to cover the cost? Could these questions provide at
least a partial understanding of why Trump was elected?
adequate insurance to cover the cost? Could these questions provide at
least a partial understanding of why Trump was elected?
3
In 2006, when I was 59, I had meniscus surgery on my right knee. The knee locked several times while surfing and it was very painful when I tried to stand on it. After the surgery, I was diligent about the PT. I have stopped running, but bike, climb, surf and swim. Every morning I do yoga. Today my range of motion in my knee is much better than before the surgery and my knee does not hurt.
3
I had my hip replaced in 2006, and it transformed my life. I should have been cycling in the years leading up to the surgery, but I pursued a lifelong dream -- building my own house. My recovery was great, and after 6 weeks of walking the streets of Colorado Springs I returned to Taos and began climbing mountains. Predictably for a 65 year old I came up with knee injury. The orthopedist took one look at the MRI and scheduled a miniscus repair procedure. I declined and returned to a less ambitious exercise, hiking and show-shoeing regime. 8 years later after returning from a 70 minute hike in the mountains behind my house I feel a little twinge in the knee and immense satisfaction after reading this article.
3
I've shared my experience before in response to one of your pieces about arthroscopic meniscus surgery, and I'm compelled to say it again here.
I've now had that surgery to repair a torn meniscus in each of my knees, where physical therapy and strength training were ineffective in reducing my pain.
It's been 3-6 years now, and my pain in each knee is 95% gone compared to before the surgeries.
I continue to do strength training with my hips and legs, but it was the meniscal surgery that made the dramatic difference in letting me continue to play active sports. I don't think people should discount it as an option.
I've now had that surgery to repair a torn meniscus in each of my knees, where physical therapy and strength training were ineffective in reducing my pain.
It's been 3-6 years now, and my pain in each knee is 95% gone compared to before the surgeries.
I continue to do strength training with my hips and legs, but it was the meniscal surgery that made the dramatic difference in letting me continue to play active sports. I don't think people should discount it as an option.
4
Other non-pharmacologic treatments that have essentially no side effects that can be beneficial for knee pain are acupuncture and a TENS unit.
And another drug which although it requires a prescription has no side effects, unlike the NSAIDS, is the lidocaine patch.
Finally, studies have shown that for overweight people, weight reduction offers as much pain relief as does knee replacement. However, as doctors make little money by encouraging weight loss and a lot by doing surgery, guess which they encourage patients to do. But why put what's in the best interest of patients ahead of the pocketbook of doctors.
And another drug which although it requires a prescription has no side effects, unlike the NSAIDS, is the lidocaine patch.
Finally, studies have shown that for overweight people, weight reduction offers as much pain relief as does knee replacement. However, as doctors make little money by encouraging weight loss and a lot by doing surgery, guess which they encourage patients to do. But why put what's in the best interest of patients ahead of the pocketbook of doctors.
1
I have done over 50 years of clinical research in the field on the effects of alternative treatments to surgery for sports injuries - on my own body! Physical therapy, rest, moderate amounts of NSAIDs and ice keep me going as strong as ever. I still play competitive tennis tournaments along with other sports and workout at the gym.
Here's what most people don't realize:
- the body had amazing healing power. In the time it takes to recuperate from surgery and physical therapy, often the body would heal itself, especially if a rigorous program of physical therapy is undertaken.
- professional athletes opt for surgery NOT because it's the best prognosis for long term, complete recovery, but because it's the quickest. They have short careers and need to get back playing ASAP. They're worried about this season, not the next five years.
Every once in a while, I still waste my money on MRI's and Dr. consultations, but still ignore their advice for surgery. If they got paid for getting patients to avoid surgery, you'd see a dramatic shift in their recommended method of treatment.
If possible, avoid surgery.
Here's what most people don't realize:
- the body had amazing healing power. In the time it takes to recuperate from surgery and physical therapy, often the body would heal itself, especially if a rigorous program of physical therapy is undertaken.
- professional athletes opt for surgery NOT because it's the best prognosis for long term, complete recovery, but because it's the quickest. They have short careers and need to get back playing ASAP. They're worried about this season, not the next five years.
Every once in a while, I still waste my money on MRI's and Dr. consultations, but still ignore their advice for surgery. If they got paid for getting patients to avoid surgery, you'd see a dramatic shift in their recommended method of treatment.
If possible, avoid surgery.
6
Interesting that none of the top comments are from people that had successful arthroscopic surgery for a meniscus tear. I did, about 8 years ago. I waited a year before getting the surgery, curtailing various physical activities. Doctors also had me on so much anti-inflammatories that I began having stomach issues. The surgery was uncomfortable, but I had good follow up physical therapy. That knee has been completely pain free and functional for the past eight years. I was even able to resume running. I can't believe I was such an outlier. I would absolutely consider the surgery again. To all those that say you just have to age gracefully into the rocker, I say, phewy! My mother had a hip replacement at 85 and was, in Dicken's words, "recalled to life". She id 91 and walks daily.
4
There is also stem cell therapy, which is not mentioned in the article.
My wife had her stem cells drawn and then injected into the knee. She has been happy with the results.
This is just one anecdote, but the procedure is another therapy which may have benefits.
My wife had her stem cells drawn and then injected into the knee. She has been happy with the results.
This is just one anecdote, but the procedure is another therapy which may have benefits.
5
The scientific evidence to date does not support your anecdotal evidence.
OK, Jane: I had the arthroscopic meniscus surgery 8 years ago. I suffered first for a full year with knee pain, enduring upset stomachs from the high doses of ibuprofen the doctors wanted me to take. My surgery and follow up therapy went well and I have had no pain and a fully functioning right knee for the past eight years, and it's going strong. Even if new problems start tomorrow, the surgery was totally worth it. I can't believe my story is such a clinical outlier, especially given the similar stories I have heard from others
3
I had Orthoscopic surgery done on my right knee for torn meniscus 4 year ago. When my left knee began to show the same signs, my wife, who is an avid alternate medicine researcher, told me about the Ming Chew method of treating joint pain. I have been following that to great benefit for the past 3 years and I can claim that it has prevented me from going to surgery on my left knee. It has also prevented my right knee from relapsing. I would advise that to all of you who are even thinking about a surgery after a torn meniscus diagnosis.
I have undergone regenerative PRP treatments over the last 5 years with very good results - lasting a year or more. I have had these treatments from 2 doctors who specialize in non- surgical procedures. I highly recommend this as first treatment to try. However, it is not covered by most insurance.
1
The fact is that our bodies get old, wear out and eventually stop working. I was an avid long distance runner, triathlete and rower in my 20s through early 30s but I saw/felt the writing on the wall and switched to cycling, swimming and sailing which, while not eliminating the possibility for injury, largely took the strain off of those already overused articulations.
Now in my mid 50s I respect and even envy those of my age who continue to run but I am very aware of my body's limitations and have chosen to go the distance.
We can indeed keep repairing with new and often successful medical means the wear and tear we put our bodies through, be it via work or play, but the end is always near.
I'll be happy to be able to continue swimming and doing some yoga into my twilight years... body willing.
Now in my mid 50s I respect and even envy those of my age who continue to run but I am very aware of my body's limitations and have chosen to go the distance.
We can indeed keep repairing with new and often successful medical means the wear and tear we put our bodies through, be it via work or play, but the end is always near.
I'll be happy to be able to continue swimming and doing some yoga into my twilight years... body willing.
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i'm not sure what the author's point was.
while it may be true that long-term benefits of arthroscopic procedures for degenerative meniscus deterioration are scant, when physical therapy an dlifestyle are good, it may also be true that short-term return-to-function is improved with surgery. a major benefit of sport-medicine procedures in healthy people is to enable quuicker return to function, which would include physical activities, both sturctured and unstructured, that maintain muscle strength and coordination. these short-term benefits may not be captured in longer-term followup studies, which, of course, are ialso mportant.
so - whether an individual chooses to hobble around for months or years living with impaired function, or chooses to suffer through a few days of pain for quicker return to function, should remian in individual choiuce, informed by consideration of individual medical risks, functional capabilities, and all competing factors such as work and family constrints. for some, it might be wiser to avoid surgery. for others, it might be well worth the risk, pain, and expense, for the likely short-term benefit of improved function.
i hope that we can continue to have the luxury of choices in health care.
while it may be true that long-term benefits of arthroscopic procedures for degenerative meniscus deterioration are scant, when physical therapy an dlifestyle are good, it may also be true that short-term return-to-function is improved with surgery. a major benefit of sport-medicine procedures in healthy people is to enable quuicker return to function, which would include physical activities, both sturctured and unstructured, that maintain muscle strength and coordination. these short-term benefits may not be captured in longer-term followup studies, which, of course, are ialso mportant.
so - whether an individual chooses to hobble around for months or years living with impaired function, or chooses to suffer through a few days of pain for quicker return to function, should remian in individual choiuce, informed by consideration of individual medical risks, functional capabilities, and all competing factors such as work and family constrints. for some, it might be wiser to avoid surgery. for others, it might be well worth the risk, pain, and expense, for the likely short-term benefit of improved function.
i hope that we can continue to have the luxury of choices in health care.
1
I was prescribed a month of PT when I first saw an orthopedist for knee pain. Although the pain abated initially, it returned shortly thereafter. An MRI revealed a medial meniscus tear and surgery was done. Recovery has taken 5 months, including PT 3x a week for most of it, but now I live pain free and can walk without the sharp pain previously experienced. A meniscus repair on the other knee, done 15 years ago, was worth it, as well.
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The alternative method not mentioned, surprisingly, is stem cell and PRP therapy to regenerate lost cartilage that causes osteoarthritis and is cleaned out during méniscal surgery. After a méniscal surgery in 2010, i gradually developed osteoarthritis and suffered a second tear in the same knee. I am almost 6 months on from my series of PRP and stem cell treatments and am back to my normal active routine.
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I am 75 years old, my heart is strong and my knees are great. I have maintained my weight through a good diet and my only exercise all these years has been walking several miles 3 or 4 times a week. No running no strenuous sports. When I see people pushing their bodies to the extent as mentioned by the author, I am amazed that they are surprised by the result! I follow the old Greek philosopher who once said "moderation in all things"!
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l loved reading all the comments to this article, so much information for someone, at 54, who is also dealing with different joint pain problems. I've learned a lot.
A few years ago, the New Yorker magazine published an article about radon gas mines in Montana that many people go to as an antidote to different types of musculoskeletal ailments. I have gone there for the past two years and have found amazing improvements in my knees, back and rotator cuff.
I know that many people will remark that radon has been proven to be cancer-causing etc, and it is in high amounts. But in the low levels found in the mines for a brief amount of time, radon is extremely beneficial.
In Germany, and other European countries, radon spas are part of the regular treatment for these kinds of issues. Below is a link of the above-mentioned article:
http://www.newyorker.com/magazine/2001/07/16/the-radon-cure
A few years ago, the New Yorker magazine published an article about radon gas mines in Montana that many people go to as an antidote to different types of musculoskeletal ailments. I have gone there for the past two years and have found amazing improvements in my knees, back and rotator cuff.
I know that many people will remark that radon has been proven to be cancer-causing etc, and it is in high amounts. But in the low levels found in the mines for a brief amount of time, radon is extremely beneficial.
In Germany, and other European countries, radon spas are part of the regular treatment for these kinds of issues. Below is a link of the above-mentioned article:
http://www.newyorker.com/magazine/2001/07/16/the-radon-cure
Some other countries also include such flagrant nonsense as homeopathy among the accepted therapies, so that means nothing. After smoking, radon exposure is the leading cause of lung cancer deaths in the US., and about 6% of homes expose residents to levels of radon that exceed the safety threshold.
I had stem cell treatment for my excruciating painful knee arthritis five years ago, having been told a total knee replacement was the only solution. I am today able to hike up and down mountains and the most pain I experience is a slight ache on occasion. Not everyone is a suitable candidate and there are some practitioners doing it who have marginal expertise in it. And it is not covered by insurance. But the cost is not exorbitant (~$5000) and it certainly worked for me.
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Chronic knee pain bright me to my chiropractor. After adjustment, he told me I sadly had arthritis. When I asked him any other suggestions, he directed me to a web site about inflammation and diet. Two weeks after eliminating wheat, knee pain subsided. Now, five years later,after having adding wheat back, knee pain returned. And so again after eliminating wheat, dairy, sugar- all inflammatory foods for some- pain is gone. How easy was that, but does take discipline and commitment. But worth it. No drugs, no surgery.
At 40, I had an orthopedic surgeon tell me I needed bilateral knee replacements immediately. Now at 60 I still have the original equipment. Yoga and weight loss are responsible for my knee longevity.
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Seems like I have benefited strongly from many of the joint procedures that are now being discouraged. Twice I have had steroid injections into my spine--instantly curative for 5 years both times. I had arthroscopic knee surgery, 90% reduction in pain, very effective. I fear that this epidemic of stories like this one will eventually lead to insurance companies not covering these hugely valuable procedures.
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Arthroscopic surgery worked for me. A lifelong student of ballet, my left knee began to hurt in my late 30s. I stopped doing jumps and turns in class and that helped. But the soreness did not go away. Six months later, trying a low jump, something snapped and within hours, my knee was the size of a grapefruit. Arthroscopic surgery removed the back 1/3 of the inner meniscus. After physical therapy, the pain was gone. I returned to dance for ten years, pain-free. My knee is still okay as long as I do not carry heavy items. I don't think there is one answer that fits all.
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In my 20s back in the 1980s I tore my meniscus and anterior cruciate ligament in my right knee. I was frustrated for a few years because I couldn't participate in sports like I used to. Then I started to pray over my knee every single day quoting I Peter 2:24. After a few weeks of doing this my knee was back to normal and has been ever since.
I underwent full knee replacement in one knee about the time Jane Brody had hers replaced and have recovered well. The other knee, however, has since suffered from a similar diagnosis, perhaps from the stress of the first knee healing. This time, though, I've been pursuing sessions of acupuncture, and, after seven, am now wondering whether they can really be the cause of significant relief. I shall continue with the sessions periodically while I keep my eye on the reduced discomfort.
I have seen lots of studies which later on are set aside for omission of certain controls such as whether the patient truly did follow through with aftercare AS PRESCRIBED or they failed to even do any of the recommended PT. Then there are the patients who are overweight to begin with thus negating the prescribed aftercare if they do it at all. Questions to ask are: how was accuracy in reporting confirmed especially re follow up and after care - was it self-reporting? Were participant all between their recommended weight spectrum? And who funded the studies - makers of NSAIDS et al? I am much more circumspect of studies now. Period.
I myself have an underlying congenital arthritis and did end up undergoing a miniscus repair years ago on one knee. The knee began to lock entirely results of which any bending became impossible. I had the surgery and UNLIKE many popular HMOs and insurance required 'blockers', I fought for the MD's recommended PT aftercare regimen and adheree to it exactly. I have not had a problem since and am in my 60s and my arthritis has definitely progressed but that knee is not my problem any more.
The objective of many of these types of studies may well be to justify denying these services to Americans due to a healthcare system where private insurers dictate to MDs in the service of wealthcare vs. healthcare.
I myself have an underlying congenital arthritis and did end up undergoing a miniscus repair years ago on one knee. The knee began to lock entirely results of which any bending became impossible. I had the surgery and UNLIKE many popular HMOs and insurance required 'blockers', I fought for the MD's recommended PT aftercare regimen and adheree to it exactly. I have not had a problem since and am in my 60s and my arthritis has definitely progressed but that knee is not my problem any more.
The objective of many of these types of studies may well be to justify denying these services to Americans due to a healthcare system where private insurers dictate to MDs in the service of wealthcare vs. healthcare.
so are you saying to have the knee replacement? I'm not clear on that. also, I have had both the arthroscopic surgeries and cortisone injections ever after an arthrotomy in 1976 to repair, actually rebuild, the knee. replacement was not common yet having only been started a year or two before. plus, in the specs for the surgery I was considered too young. I guess I consider myself lucky that the procedures I had have worked.
"Arthroscopic surgery can sometimes be useful, he said, citing as examples people with traumatic injuries and young athletes with sports injuries. " As someone who had a meniscal tear at 17, I have to say the arthroscopic surgery made a huge difference in my life. I couldn't run or do much of anything until I had surgery. Since then, I have lived an active life that I don't think would have been possible without surgery. I am cautious about some activities, but I can still snowboard 30+ days a year so I am one very happy patient.
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I'm a retired nurse and even 10 yrs ago it was known that arthroscopic knee work did not help.
Something cheap relative to medical procedures that I learned from an orthopod is that FitFlop shoes that have wobbleboard midsole, disperses the weight to the knee more evenly. Thus enabling more activity and keeping muscles from atrophying from pain. Pain can be quite subjective but I tried the shoes and have been amazed. Not all of their shoes have that midsole so read description/label carefully. Worth a try. You'll know right away.
Something cheap relative to medical procedures that I learned from an orthopod is that FitFlop shoes that have wobbleboard midsole, disperses the weight to the knee more evenly. Thus enabling more activity and keeping muscles from atrophying from pain. Pain can be quite subjective but I tried the shoes and have been amazed. Not all of their shoes have that midsole so read description/label carefully. Worth a try. You'll know right away.
Thank you for this excellent article. I would have to say though that as someone who had both torn meniscus repaired in my early 30s to 40 that both operations caused an immediate relief from serious pain and that was after I had gone through months of physical therapy otherwise. But I do agree that the steroid shots do not do much good.
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Can't say I agree, certainly not in my case: arthroscopic surgeries on both knees for torn meniscus, one 5 yrs ago, the other 1 yr ago - unable basically to walk or jog for any distance. Huge improvement in both. Able to walk and jog almost entirely pain free - not perfect, but very happy with the results so far.
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In 2014, I was diagnosed with a torn meniscus. I had severe knee pain that only reduced somewhat over time and with PT so I scheduled surgery with my orthopedic surgeon. The surgery was to be performed in a stand alone surgery center. On the day Joan Rivers had her failed endoscopy resulting in her coma and eventual death, I was in PT but already had surgery scheduled. After being refused the option of local anesthesia (instead of general), I canceled the surgery--deciding I'd never have anesthesia in an ambulatory surgery center. It was the best decision I've ever made. In the months following, I did enough research to realize that the surgery wouldn't have helped and that continued therapy along with exercise as tolerated would be more beneficial. Now, 3 years later, I have only minor knee pain and I walk at least a couple of miles each day. (outdoors as recommended by another article in today's Science Times).
You for got to mention maybe the most important advice to prevent meniscus injury in older physically active people. Dehydration is one of the biggest risks to meniscus knee injury. Staying hydrated during physical activity is the best advice to take.
Brody tried all of the most invasive techniques, but she says nothing about acupuncture, massage, herbal remedies, chiropractic or yoga. The world has been dealing with pain relief for thousands of years in various ways. These modalities are still around because they work for millions of people. I have used acupuncture for over 25 years for pain relief for my knee. I also now find that taking turmeric (in curry, as a tea, or in a capsule) helps with the inflammation. And like many people, I stopped playing tennis! But, most importantly, I can still play pickleball!
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Indeed, quackery, bolstered by the placebo effect, confirmation bias, and hope, has staying power.
60 years ago, I injured a semi-lunar cartilage in both knees as a result of my only few minutes on horseback. An orthopedic surgeon at New York University , my medical school, taught me how to do quadriceps strengthening exercises.He said that the stability of the knee depended on these muscles; if their strength was maintained I might never need surgery. I trained race walking to age 62 and competed until well past 40. I have never been able to run or do deep knee bends.
The other critical factor is body weight. Most importantly, % body fat. Ideal body weight, the real goal, can be calculated from various formulas, there is one in The Merck Manual (for professionals). Life insurance company tables have listed average weights for various ages, not ideal weight. Where a person carries 20-60 pounds of excess weight for years, it is not surprising that knees and spinal elements will pay a price with early degeneration, arthritis and functional limitation and pain.
The other critical factor is body weight. Most importantly, % body fat. Ideal body weight, the real goal, can be calculated from various formulas, there is one in The Merck Manual (for professionals). Life insurance company tables have listed average weights for various ages, not ideal weight. Where a person carries 20-60 pounds of excess weight for years, it is not surprising that knees and spinal elements will pay a price with early degeneration, arthritis and functional limitation and pain.
My story. In my 50s, I first experienced knee pain due to a lifetime of athletics, including basketball and softball (catcher), tennis, and some running. My first intervention was acupuncture, which worked well. Five years later, consistent pain returned. I tried cortisone shots. First time, I had relief for about a year. Second time, not so good. I had Synvisc shots with pretty much no results. Then I had both knees scoped and a procedure called articulate perforation on the right knee. The left knee clean up helped but the procedure I had in the right knee actually made it worse.
I have consulted a new ortho who says I can do knee replacement whenever 'I can't do my daily activities to my satisfaction'. Thus, it's up to me. At 63 I have chronic pain in both knees but I manage it by staying in weight range, moderate exercise and daily Mobic. My ortho also gave me a gel (RX) Pennsaid, to use as a topical before/after exercise.
I appreciate the comments about yoga, Pilates, and turmeric. I am worried about the NSAIDS and am going to go off them and try the turmeric. I am not totally opposed to knee replacement but want to try everything else first.
I have consulted a new ortho who says I can do knee replacement whenever 'I can't do my daily activities to my satisfaction'. Thus, it's up to me. At 63 I have chronic pain in both knees but I manage it by staying in weight range, moderate exercise and daily Mobic. My ortho also gave me a gel (RX) Pennsaid, to use as a topical before/after exercise.
I appreciate the comments about yoga, Pilates, and turmeric. I am worried about the NSAIDS and am going to go off them and try the turmeric. I am not totally opposed to knee replacement but want to try everything else first.
As a previous commenter said, I don't know about the research documented here, but I had surgery for a meniscal tear in one knee 13 years ago, and the other knee 8 years ago. I'm 60 and have had no knee issues since. Perhaps knowing your limitations helps. I'm active: hiking, occasional tennis and even running. But I keep my runs to 3 miles or shorter. And I throw in some yoga and plenty of stretching for the hips and lower body to strengthen muscles that support the knees.
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I was all set to have a complete knee replacement when, during a Tampa Bay hockey game, I saw an advertisement for a PARTIAL knee replacement, on thin inside only. I did extensive research and found out the Oxford partial knee replacement is still effective after 15 years in 98% of cases. So that's the procedure I chose. You only need to replace the inner part of the knee; and with a partial replacement, you retain many knee functions you'd lose with a full replacement.
I want to put off knee replacement as long as possible. In the meantime, my doctor has given me Synvisc injections (twice over the last 3 years) and using KT tape around my knee has made it possible to remain pain-free and active.
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In 2012 I had meniscus surgery on both knees a few months apart. Both were likely damaged due to running. I do not think foregoing the surgery was an option for me. The pain was severe and constant. My knees were constantly very swollen and I was walking with a cane a lot of the time due to the pain. NSAIDs did not help at all and PT was out of the question since I could barely move. After surgery and PT my knees returned to something like normal -- but it took months. There is still low-level pain that sometimes becomes acute and I avoid running and squatting, but otherwise I do all normal activities. I focus on swimming rather than high impact activities to try to preserve the cartilage. Since the surgeries I have not had any episode even close to as bad as before and no swelling. In short, the surgery may help you as it did me, but it is not a miracle cure and may require hard work from you in sticking to the PT. But it should not be ruled out as an option for those who may benefit.
I consider myself to be incrdibly fortunate to be a among the peole who have been able to avoid all of the medical solutions to knee pain, including knee replacement. I was incapacitated with a pain in my right knee that developed from playing racquetball for many years. It developed gradually during my late 60's and became a full-blown acute problem at about age 70. I was told I had bone on bone osteoarthritis and that there was no way to eliminate the pain short of surgery. I will avoid surgery at all costs, so I lived with the pain while I searched for natural substances that might help. Long story short, glucosamine/chondroitin didn't help at all, but I found 5 newer joint supplements that eliminated my pain and allowed me to continue to use my own knee joint. The supplements are fish oil, krill oil, rosehips, collagen II, and pine bark extract (omniflex). I have been using these supplements for going on 10 years (I'm now 82), and I still play competitive racquetball, run 5K's and am generally very active, with no knee pain. I call that lucky.
Lumping together meniscus tears and arthritic knee joints is questionable. I tried months of non-surgical treatments to ease the pain of my meniscus tear that showed up as a flap of tissue folded over like a "u" on the MRI. Arthroscopic repair that removed just the minimal amount of meniscus resolved my pain that has not recurred after 5 years. Understand that removal of too much meniscus can be problematic. I would rely on careful evaluation of specific individual circumstances rather than statistical conclusions that may not be totally relevant to a specific case.
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I'm one of those for whom arthroscopic surgery was a blessing. Almost four years ago, at age 57, I damaged my knee (doing yoga, of all things) and it took 8 months of uncomfortable knee pain (which showed no sign of improving) before an MRI diagnosed a torn meniscus.
Arthroscopic surgery and a period of recovery left me with a knee as good as new - I run a couple of miles every few days and use a rowing machine on other days (I seem to have fallen out of love with yoga).
So very glad of the surgery and appreciative of the system that allowed it to go ahead... If the same thing happened again it seems I may have an uphill battle to achieve the same outcome. Sad!
Arthroscopic surgery and a period of recovery left me with a knee as good as new - I run a couple of miles every few days and use a rowing machine on other days (I seem to have fallen out of love with yoga).
So very glad of the surgery and appreciative of the system that allowed it to go ahead... If the same thing happened again it seems I may have an uphill battle to achieve the same outcome. Sad!
1
As an arthroscopic surgeon, I agree with many things Ms. Brody has to say here. Weight loss goes a long way to decreasing knee pain. Physical therapy to strengthen/stretch your muscles can alleviate many knee issues (getting patients to do it is like pulling teeth, however).
However, simply disparaging arthroscopic surgery as a sham for anybody who's not in their 20s is off-base and oversimplifying the literature. She dances around the controversy of the quoted research studies deftly, but the main point is: arthroscopic surgery when your main issue is arthritis does not help. But, if your main issue is a meniscus tear, it can certainly help. Reference: her first surgery which allowed her to return to many sports which she loves. The problem is too often an issue of proper diagnosis, not a fundamental problem with the procedure. Furthermore, what no surgeon likes to admit is that not every surgeon performs a given procedure similarly. There is a big difference in recovery and outcomes for a procedure performed in the hands of someone who's done thousands within 15 minutes, versus one performed under the watch of a professor teaching a resident and taking an hour.
As a patient, how do you navigate this? Ask questions, make sure you trust your doctor and his/her experience, follow recommendations for non-surgical measures even though they might require additional effort on your part.
However, simply disparaging arthroscopic surgery as a sham for anybody who's not in their 20s is off-base and oversimplifying the literature. She dances around the controversy of the quoted research studies deftly, but the main point is: arthroscopic surgery when your main issue is arthritis does not help. But, if your main issue is a meniscus tear, it can certainly help. Reference: her first surgery which allowed her to return to many sports which she loves. The problem is too often an issue of proper diagnosis, not a fundamental problem with the procedure. Furthermore, what no surgeon likes to admit is that not every surgeon performs a given procedure similarly. There is a big difference in recovery and outcomes for a procedure performed in the hands of someone who's done thousands within 15 minutes, versus one performed under the watch of a professor teaching a resident and taking an hour.
As a patient, how do you navigate this? Ask questions, make sure you trust your doctor and his/her experience, follow recommendations for non-surgical measures even though they might require additional effort on your part.
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Agreed. My ortho doc sent me to someone who does tons of these repairs and often on athletes. I attribute the success of the procedure to both being a good candidate with an injury caused acute tear and the skill and experience of the surgeon. I didn't just go to the local hospital and have whomever do the job. I'm careful with who works on my car; isn't my body at least as important?
I had my left knee replaced 2 years ago. I was bow-legged and overweight. Losing weight and aggressive daily exercise helped considerably. When I go to the gym I make sure I do one set of pushing a weighted sled and it has made all of the difference. My quality of life is excellent with swimming and walking the dog daily. The one draw back from the knee replacement is the outward indentation on the left leg of all my Levis from my previous knee positioning - always a point of discussion in mixed company :).
I had surgery after I tore my meniscus and it was life changing in a positive way. My tear wasn't due to age issues and I had no arthritis. Still I was about 50 or so. PT didn't help at all and I was in constant pain. Arthroscopic surgery did the trick. It's been about 10 years now since it was done and my knee feels perfect.
While I hope that uncesssary surgeries aren't performed, I truly hope that this isn't seen as a blanket condemnation of this procedure. I shudder to think of how much I wouldn't have done these past 10 years had I not had this done.
While I hope that uncesssary surgeries aren't performed, I truly hope that this isn't seen as a blanket condemnation of this procedure. I shudder to think of how much I wouldn't have done these past 10 years had I not had this done.
This article doesn't match my experience with arthroscopic surgery for a badly torn meniscus at age 73. Besides the meniscus problem I had only mild degenerative arthritis, which may be why I was a surgical candidate. First, though, I tried conservative treatment (RICE, steroid injections, PT, hyuraluronic acid injections, OTC pain meds) for six months but they didn't work, and the pain increased to the point that I could barely walk around. The internet is full of information on healing meniscus problems without surgery, with plenty of suggestions like these, including herbal supplements (turmeric, glucosamine, etc.); but in my case surgery was indicated because nothing else helped, while the condition went from bad to worse. After arthroscopic surgery, recovery has not been as fast as a younger person's, but after a couple of months the pain was gone and since then I've been able to resume a routine that doesn't overly stress the knee. Now four months out, strengthening with PT is allowing me to slowly resume more knee-stressful activities. In short, my experience suggests that someone with a badly torn and frayed (and flapped) meniscus who doesn't have more than mildly degenerative arthritis and is otherwise healthy is a good candidate for this surgery.
I'm not a health care professional. I just know what works for me--and has done for well over a decade.
When I first began to experience significant knee pain, I started drinking extremely strong ginger tea I made myself from fresh ginger. I increased my dosage of vitamin C which was already more than is commonly taken by the average person who may use supplements. That cured me fast.
That routine worked for me last year when I experienced severe pain in my left knee and the connecting tendons, after wearing one of those dinosaur boots on my right foot because of a fracture and ankle sprain. The injured foot healed quickly but the left leg was a mess for months. The maximum one-time dose of aspirin, taken with vitamin C to reduce its toxicity, once daily, dramatically reduced inflammation, and the vitamin C and ginger promoted healing.
When I first began to experience significant knee pain, I started drinking extremely strong ginger tea I made myself from fresh ginger. I increased my dosage of vitamin C which was already more than is commonly taken by the average person who may use supplements. That cured me fast.
That routine worked for me last year when I experienced severe pain in my left knee and the connecting tendons, after wearing one of those dinosaur boots on my right foot because of a fracture and ankle sprain. The injured foot healed quickly but the left leg was a mess for months. The maximum one-time dose of aspirin, taken with vitamin C to reduce its toxicity, once daily, dramatically reduced inflammation, and the vitamin C and ginger promoted healing.
Anecdotes are worthless in science. Sometimes worse than worthless. The placebo effect, confirmation bias, cognitive dissonance, and of course the absence of a control all conspire to neutralize this sort of personal testimonial.
Well, sure. But there's plenty of controlled scientific research on the anti-inflammatory/healing properties of ginger, of vitamin C, and aspirin.
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Two decades ago, at age 45, I suffered severe pain from a torn meniscus and bone-on-bone contact in my arthritic knee. The surgeon transplanted bone and cartilage from a part of my knee where he said I didn't need it, to the affected area. This procedure has brought me two decades of relief without undergoing a full knee replacement. Thus, in some cases, there may be an effective surgical remedy lying between arthroscopic surgery and a full knee replacement.
Jane- This all rings true to me having ski-id both my knees out years ago and having had them having had them replaced on the advice of my Internist. I do wonder if the old ones would be easier to live with- especially in airports. JGAIA
Perhaps Ms Brody's most helpful column, and i appreciate that she's speaking from personal experience. I had the surgery before arthroscopy to trim my meniscus, which was catching in the joint when i played tennis, and i continued to run cross country and play tennis afterwards. Now at the age of 107 (just kidding), i am having knee problems again, in that the muscles around the knees are stressed, hurt, after running, and xrays/mri show no cartilage. I have been advised, both by physicians and myself--mostly myself--just keep going, don't do the replacement.
In stem cell biology, one of the things we studied in mesenchymal cells was regrowing cartilage thru stem cell therapy. the experiments were being done in rabbits at the time. (In the U.S.,not only the healthiest mice, but also the highest jumping rabbits) So where has this gone? How successful was this, and are there any human trials, or new theories/research of how this might work. From other stem cell trials getting the cells to the affected area and the sheer number of cells that have to generated has been a big problem.
Thank you for this article, and Happy Trails in your walking and swimming.
In stem cell biology, one of the things we studied in mesenchymal cells was regrowing cartilage thru stem cell therapy. the experiments were being done in rabbits at the time. (In the U.S.,not only the healthiest mice, but also the highest jumping rabbits) So where has this gone? How successful was this, and are there any human trials, or new theories/research of how this might work. From other stem cell trials getting the cells to the affected area and the sheer number of cells that have to generated has been a big problem.
Thank you for this article, and Happy Trails in your walking and swimming.
1
I'm a 77 year old (hate adding the word old). I'm here in Spain having just completed El Camino Primitivo...26 days of going up and down the steep mountains of northern Spain. I also should add I'm a middle distance runner who in recent years moved down to the Sprints (50, 100, and 200 meters). I did win the Silver Medal at World Masters Games in the 800 meter. For close to 8years I've had bone on bone arthritis in my left knee. However, after a prolonged warm up at the track, I'm ready for my workout Pain Free. There is no secret here. I stay intensely active including two days of lifting. I do take large quantities of my Glucosamine/Chondroitin. It works for me. During a very steep 3 and a half hour decent on the Camino, I stopped and popped 4 capsules. About 30 minutes later, the pain was gone. Magic, psychosomatic, placebo effect I have no idea. My Orthopod says keep doing what you're doing because it is working.
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Two-thirds is, well, just 67%. A good outcome should be hoped for, but not expected.
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ARGHH! After pointing out the fallacy of anecdotal medicine she and many readers repeat the errors.
Having a procedure and then getting better does NOT prove that the procedure was the cure!
We now know that for meniscus tears, surgery is unnecessary, a waste of time & money and increases the risk of complications.
The same may turn out to be true the ACL surgery her son had, and a host of other procedures.
We need good data analysis not anecdotes.
Having a procedure and then getting better does NOT prove that the procedure was the cure!
We now know that for meniscus tears, surgery is unnecessary, a waste of time & money and increases the risk of complications.
The same may turn out to be true the ACL surgery her son had, and a host of other procedures.
We need good data analysis not anecdotes.
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The ACL repair success isn't anecdotal. There are many studies on ACL repair using the patellar tendon, hamstring tendon, and cadaver. If you do not repair a torn ACL, there is serious instability in the knee it belongs to. It is among the well known procedures in orthopedic surgery, and does not naturally heal.
Surgery for a meniscus tear fixed my knee. I think this article presents an erroneous message.
Great tips at the end but you chose knee replacements... the most invasive of the treatments listed
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Acupuncture works for the pain.
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As do placebos.
Thank you for this extraordinarily useful article on a common problem.
4
Ms. Brody writes, "Many of the procedures people undergo to counter chronic knee pain in the hopes of avoiding a knee replacement have limited or no evidence to support them."
Stem Cell Therapy is mentioned by a few commenters. The excellent website "Science Based Medicine" has a few informative articles on the subject. One is titled "Be Wary of Stem cell Pseudoscience" by Steven Novella, MD another is "Stem Cells and Chiropractic" by Harriet Hall, MD.
Stem Cell Therapy is mentioned by a few commenters. The excellent website "Science Based Medicine" has a few informative articles on the subject. One is titled "Be Wary of Stem cell Pseudoscience" by Steven Novella, MD another is "Stem Cells and Chiropractic" by Harriet Hall, MD.
6
I have not seen anyone mention prolotherapy. This is a 70+ year old therapeutic technique of strengthening supporting tendons and ligaments (whose job is to protect joints from excessive wobble, and keep them functioning smoothly). These support structures have minimal blood supply, and thus minimal ability to repair themselves. Prolotherapy involves very precisely administered injections of dextrose solution into tendons, ligaments, and joints themselves so as to stimulate the release of cytokines and other healing elements to restore the tensegrity of the system. It has been demonstrated by MRI's in knees to promote cartilage repair. If a series of 3-6 injections is not curative (total cost varies by location but could range from $100-$450 per treatment), or if a faster response is desired, then platelet rich plasma or stem cell prolotherapy often will be. Insurers and patients and a growing number of practitioners are beginning to realize that it makes more sense to support the joints you were born with, than to amputate and insert new (but temporary) metallic, potentially toxic and very expensive ones, with all the attendant hazards of surgery.
But please, Jane, DON'T use NSAIDs, which prevent the body from repairing its cartilage effectively. Prolotherapists will not treat patients who are taking NSAIDs as they are antithetical to the joint healing process.
But please, Jane, DON'T use NSAIDs, which prevent the body from repairing its cartilage effectively. Prolotherapists will not treat patients who are taking NSAIDs as they are antithetical to the joint healing process.
8
I have been bedridden now off and on due to a knee replacement. Too many medical errors and my first doctor turned out to be a very poor surgeon. Never again
6
While in the US Army I injured my left leg falling off an armored personnel carrier. My 220+ pounds of body weight landed squarely on my left leg from about 6 feet high.
As a result occasionally my left knee would swell up and I would suffer from a LOT of pain. The fall also affected my left foot and lower back and I was resigned to suffering from pain the rest of my life until a previous employer provided me with some Airrosti treatments:
https://www.airrosti.com/
The doctors at Airrosti are trained chiropractors but instead of adjusting bones they manipulate the ligaments and soft tissue. The theory behind Airrosti is that your skeleton's alignment is important and that by properly adjusting the soft tissue and ligaments your body can get back into its natural alignment.
From my personal experience Airrosti works. The treatments are painful as the doctors will push in the direction of the injury but within a couple of days your body will snap back into its proper alignment, much like a stretched rubber band stretched wants to return to its natural unstretched state.
Once painful my left knee now feels relatively normal. It rarely swells up like it used to and my left foot and lower back do not hurt as much as they did before the Airrosti treatments.
Before considering surgery you really should give Airrosti a try. If your knee problems are due to injuries Airrosti can definitely help. As a plus Airrosti is also less painful and has fewer side effects than surgery.
As a result occasionally my left knee would swell up and I would suffer from a LOT of pain. The fall also affected my left foot and lower back and I was resigned to suffering from pain the rest of my life until a previous employer provided me with some Airrosti treatments:
https://www.airrosti.com/
The doctors at Airrosti are trained chiropractors but instead of adjusting bones they manipulate the ligaments and soft tissue. The theory behind Airrosti is that your skeleton's alignment is important and that by properly adjusting the soft tissue and ligaments your body can get back into its natural alignment.
From my personal experience Airrosti works. The treatments are painful as the doctors will push in the direction of the injury but within a couple of days your body will snap back into its proper alignment, much like a stretched rubber band stretched wants to return to its natural unstretched state.
Once painful my left knee now feels relatively normal. It rarely swells up like it used to and my left foot and lower back do not hurt as much as they did before the Airrosti treatments.
Before considering surgery you really should give Airrosti a try. If your knee problems are due to injuries Airrosti can definitely help. As a plus Airrosti is also less painful and has fewer side effects than surgery.
8
There's no quality clinical data supporting this therapy. See https://sciencebasedmedicine.org/can-airrosti-really-resolve-most-chroni... for a discussion.
Thanks, This sounds very similar to Active Release Technique, which worked for a friend's meniscus tear. (I only mention this because there are no Airrosti practicioners listed in New York!)
The first item on the bullet list should be:
Don't play tennis.
Don't play tennis.
19
Thank you New York Times commenters! There is nothing like a bunch of unrelated anecdotes to overcome the evidence found in several carefully planned, controlled studies.
15
Everybody who has a knee will also have an opinion, and frequently, an anecdote or two to go with. Please see a doctor and read sources of qualified medical advice; please do not place your faith or hope in any of the novices kibbitzing here.
3
How is all that "exercise" not the same as smoking--self-inflicted damage to your lungs or joints? Like smokers, don't you just deserve it?
9
Really?
1
People who run and play tennis have better joints on average. It's more about weight and bad habits. Biking, for example, sets my knees off if the muscles aren't balanced out (phys therapy taught me this), so I do cross training, since I commute by bike. Works well.
And, you know, old age happens, bodies are different, YMMV, etc. We can't always find a culprit for a health condition and it's pretty useless to point fingers.
And, you know, old age happens, bodies are different, YMMV, etc. We can't always find a culprit for a health condition and it's pretty useless to point fingers.
After reading the article and comments, I have to wonder why health plans will continue to pay for these unnecessary ops. Especially Medicare. I get it that if MDs tell you to get it, you get mad if they won't pay, but send them the study! This makes me furious! Why don't best practices prevail?
5
@caharper: Because "one size" does not fit all, that's why! What's best for one person may not be right for another. For me, those meniscus surgeries were the difference between being able to walk versus not being able to walk, literally.
PS: Don't get furious; it's not good for your blood pressure.
PS: Don't get furious; it's not good for your blood pressure.
1
GLA:D is a "prehabilitation" program designed and tested successfully in Denmark on people with arthritic hips or knees. It is a physiotherapy program to mobilize and stabilize the joints to improve function and wean people off pain medication. It is becoming quite popular in Canada. Readers suffering from joint arthritis might want to check it out even if they will eventually need surgery.
5
While squatting may be contra-indicated once damage is present, it is one of the best things you can do for your knees and hips as a younger person or person without any issues. Unfortunately in our culture we rarely sit on the floor or squat regularly through the course of the day and incidences of degradation and replacement of those joints is much higher than in cultures that do. Squatting and sitting on the floor naturally brings these joints through their full range of motion, increasing circulation, helping to bring to maintain plasticity and flexibility in the muscles and connective tissue's and also creates an environment for the lower back that keeps it from becoming stiff, tight and weak.
13
Several years after arthroscopic surgery sounds like success to me. "New" knees can't take the same pounding which the original ones do, and deferring joint replacement often means quality improvement.
3
This is incorrect. The new (not in quotation marks) knees can be used at full capacity. As a therapist who treats knee replacement patients nearly daily, I have countless first-hand knowledge of post-op procedures of a variety of orthopedic surgeons and not once have I had a surgeon order a restriction on activity after the first few weeks. And even then it has because of some atypical complication or comirbidity. Please share your source so I may add to my knowledge.
Over twenty years ago I went to see a top orthopedic surgeon about a clicking knee. I thought that I might need arthroscopic surgery. After giving me an MRI (of course he had his own MRI) he told me that "it is much too bad for that. You need a total knee replacement. I will schedule it for next month." I told him that I preferred to wait and see. Today I am still walking on the original knee.
One thing that helped me decide not to take his advice? He had yachting magazines in his waiting room
One thing that helped me decide not to take his advice? He had yachting magazines in his waiting room
63
Excellent move! My spouse broke a shoulder badly, in three places, went to the ER where doctors said that an operation will be necessary, then visited a top surgeon who said, dryly, "If I were a younger man I'd operate on you. As it is, keep your arm in a sling and start doing these exercises I'm going to show you."
Exercises: Walking the fingers up a wall several times a day until the arm almost hurt.
Pain: sometimes when it's very wet out. Otherwise, full motion, the ability to garden and haul stuff out of the basement.
Exercises: Walking the fingers up a wall several times a day until the arm almost hurt.
Pain: sometimes when it's very wet out. Otherwise, full motion, the ability to garden and haul stuff out of the basement.
7
Glad you have been doing tolerably well without surgery.
However, many medical, dental and offices with waiting rooms get enormous discounts on magazines that are sold across a broad interest range as a package, and don't imply any sort of interest or interest to the practitioners behind the desks. So I hope you are more scientific in your analysis of all things beyond thinking having a yachting magazine implies the doctor is unethical in recommending surgery to support an expensive hobby, when there are alternative and better explanations.
However, many medical, dental and offices with waiting rooms get enormous discounts on magazines that are sold across a broad interest range as a package, and don't imply any sort of interest or interest to the practitioners behind the desks. So I hope you are more scientific in your analysis of all things beyond thinking having a yachting magazine implies the doctor is unethical in recommending surgery to support an expensive hobby, when there are alternative and better explanations.
All about the almighty Dollar. Isn't this most always the case? And people doing this who swore: "first of all, do no harm".
I tore the meniscus in my right knee playing flag football 10 years ago. Maybe it was my left? I think it was my right.. couldn't really tell you which one they both feel great and continue to support me through child raising, skiing, distance running. The moral of the story is don't play flag football.. and don't believe everything you read.
4
This is painful to read. Why not cut out the jogging, tennis, and skiing? Sit down, read a book. Maybe walk your dog in the park. You'll feel better.
13
No, if you don't exercise, you'll get worse. Research agrees with that. Walking a dog might be enough for some people, but we're not all built like a twig.
Why didn't Ms. Brody do this research before undergoing worthless treatment, rather than after? She is supposed to be a health journalist! I am flummoxed.
9
As a not-by-my-own-choice former avid skier living in an extraordinarily active community conducting a hardly scientific survey, I can state without reservation that: every body is different. I went through Synvisc injections and had both knees "scoped", (arthroscopic meniscusectomies). I'm not sure the injections did anything, by the time the trauma of having a needle jammed into the innermost workings of my knees wore off I couldn't tell if the pain was better or worse. I do believe the surgeries extended my ski career and improved my quality of life.
Overall the definitive conclusion of this community of everyone from weekend warriors to actual Olympians is that different regimens work for different people. Without question, physical activity and staying in shape is the key. But some folks' joints are just going to last longer than others, get over it. Fortunately, this is Colorado and we're allowed joints for our joints. IT DOES WORK! At least somewhat to actually alleviate pain and somewhat to let you focus on the activity, physical sensations and glorious environs.
Overall the definitive conclusion of this community of everyone from weekend warriors to actual Olympians is that different regimens work for different people. Without question, physical activity and staying in shape is the key. But some folks' joints are just going to last longer than others, get over it. Fortunately, this is Colorado and we're allowed joints for our joints. IT DOES WORK! At least somewhat to actually alleviate pain and somewhat to let you focus on the activity, physical sensations and glorious environs.
10
The best thing for your joints is to keep them moving and putting them through their full range of motion. I realize that's hard to do when they hurt, but surgery only treats the symptoms and not the source. Knee replacement is irreversible. I had a LCL tear and meniscus tear and was treated with super concentrated platelets (from my own blood) by the Regenexx clinic in my state. I will turn to them for stem cell therapy should I need it in the future, but I have dedicated my life to avoiding having my joints amputated (which is what a knee replacement is).
7
arthroscopic procedures, $3 billion per year is a pocket change, US spent more than $3 trillion per year on healthcare in 2015, let's assume at least one third is unnecessary procedures plus diagnostic monstrous waste, it is one trillion dollars. you think the physical therapy is the answer? think again, how about do nothing and wait for few weeks with common sense approach and I am certain this will bring the same outcome. when you take a video of the face, over 70s yrs old taken with HDTV camera, almost everybody will show the wrinkles, grey hairs and freckles. are these the sign of disease need to be treated? same with the knees, spines and shoulders with MRI. no wonder more than half of the personal bankruptcy is due to inability to pay for the medical bill
5
Seems like the advice whether to squat or not with knee arthritis/pain changes from one article to another......
6
Spot on with the suggestions to lose weight and get a good physical therapist who will give you personal attention, with exercises you can do any time anywhere with no equipment needed. I'm 45 pounds lighter (from 180 to 135) . It's essential to keep moving. Inertia will kill you, painfully.
17
Good shoes. If your shoes are loose or worn, replace them. Buy some good shoe inserts (I use ones I purchased online, not the unnecessarily expensive prescription ones). I use them consistently when my knees are hurting. When they are not, I use them for long walks or hikes.
8
If you have joint issues in your family history, probably don't play tennis or other activities that put sharp stresses on knees. You are just asking for trouble.
8
Your story sound much like mine! If found the hyaluronic acid injections to be useful for about a year, but ultimately I had to get a knee replacement, that was the ultimate solution. Physical therapy/exercise definitely helps to stave off the inevitable, but that is just putting off a knee replacement sometime in the future.
A very good article, two thumbs up.
A very good article, two thumbs up.
7
Having been where you are , the writer came from, I disagree to some extent. All meniscus tears are not the same. Some do heal on their own and some won't; depends on location of tear. Where there is good blood flow in the meniscus, the outer 1/3 of it, a good chance of healing on its own. However, a bucket type in the inner ring requires surgery and suture. Same as a flap tear. If not the loose piece catches in the knee and is extremely painful---- I know!
However, an arthroscopic meniscus repair on my right knee left me in more pain because now all the cushioning is gone on the medial tibial plateau. Tibia and femur articular cartilage long gone , I suffered for a year and in 2015, got a TKR which has not gone well.
Now I am faced with the same decision on the left knee, suffer in pain with torn meniscus occassionaly in the same place of left knee which will probably require another TKR.
My advice is to stay away from NSAID, they'll eat a hole in your stomach.
The injection remedies don't work either. OA is OA and it's progression cannot be stopped. You can arrest the progression by sofa riding the rest of your life, but I have too much to do athletically.
However, an arthroscopic meniscus repair on my right knee left me in more pain because now all the cushioning is gone on the medial tibial plateau. Tibia and femur articular cartilage long gone , I suffered for a year and in 2015, got a TKR which has not gone well.
Now I am faced with the same decision on the left knee, suffer in pain with torn meniscus occassionaly in the same place of left knee which will probably require another TKR.
My advice is to stay away from NSAID, they'll eat a hole in your stomach.
The injection remedies don't work either. OA is OA and it's progression cannot be stopped. You can arrest the progression by sofa riding the rest of your life, but I have too much to do athletically.
7
There are lots of good ideas here. What I found worked the best for me was to get two old slightly stretchy not-too-long and not-too-short socks and tie then around my legs just below the knees tightly. With the knot facing forwards, I spread each sock’s width as much as I can at the back of the leg to stop constriction. Now I can run everyday without any problems.
3
Stop playing tennis over the age of 50 or be prepared to suffer the consequences.
10
The PLOS paper cited in this article was underwritten by a company that markets a hyaluronic acid injection. The online journal it was published in is a pay-to-publish internet business. The AAOS has issued a clinical practice guideline which recommends against the use of hyaluronic acid injections due to their lack of efficacy. It is not clear why the NYTimes writer chose to reference a dubious study rather than the accepted professional society recommendations. HA injections are of unproven efficacy, vastly overutilized, and highly subject to fraud, waste and abuse. I believe their continued use is based on their profitability for drug companies and non-surgeons.
15
I had three hyaluromic acid (Synvisc) treatments on my right knee, and I'm satisfied with the results. My knee probem was progressive arthritis. The first HA treatment (at age 67) was effective for about 16-18 months; the second gave me relief for 11-12 months; the third treatment wore off in about 6 months, and I opted for replacement surgery at that point.
The HA injections were not at all painful and were, in my opinion, well worth the expense to Medicare (about $1500 to $1700 at the time). My orthopedic surgeon informed me at the time that HA was only a temporary solution, so I knew I would eventually be going under the knife if I lived long enough.
I have had both knees replaced, and I recommend it to anyone whose quality of life has been severely impacted by painful knees, as mine was. I have been walking on artificial knees for years (17 on the left, 8 on the right). I'm about to enter my 80th year, and I still lead a very active life — chainsawing to clear brush and trees on my 13 acres, working out at the gym several times a week, flying and helping my mechanic with grunt work on our four-seat Cessna travel machine, doing remodeling work on our home and outbuildings.
Yes, I'm lucky to have good longevity genes, but TKR has given me the opportunity to enjoy these last years by leading an active life instead of being crippled, sedentary and in pain.
The HA injections were not at all painful and were, in my opinion, well worth the expense to Medicare (about $1500 to $1700 at the time). My orthopedic surgeon informed me at the time that HA was only a temporary solution, so I knew I would eventually be going under the knife if I lived long enough.
I have had both knees replaced, and I recommend it to anyone whose quality of life has been severely impacted by painful knees, as mine was. I have been walking on artificial knees for years (17 on the left, 8 on the right). I'm about to enter my 80th year, and I still lead a very active life — chainsawing to clear brush and trees on my 13 acres, working out at the gym several times a week, flying and helping my mechanic with grunt work on our four-seat Cessna travel machine, doing remodeling work on our home and outbuildings.
Yes, I'm lucky to have good longevity genes, but TKR has given me the opportunity to enjoy these last years by leading an active life instead of being crippled, sedentary and in pain.
1
Thank you for pointing this out.
The public has no way of evaluating such "research".
Jane is an accomplished medical columnist who has been dubbed the "High Priestess of Medicine" by TIMES mag, who should have known better; but I think she may have missed it on this one.
The public has no way of evaluating such "research".
Jane is an accomplished medical columnist who has been dubbed the "High Priestess of Medicine" by TIMES mag, who should have known better; but I think she may have missed it on this one.
I'm debating on whether to go ahead next week with arthroscopic surgery of my right rotator cuff (bicep tenodesis sub scap repair). I had my left shoulder done, and still have pain two years following surgery. I can't imagine enduring another 9 months of post-op agony for the same result.
Is there anyone out there who has had similar surgery, and can relate their results?
Is there anyone out there who has had similar surgery, and can relate their results?
4
Patient: "Doctor, Doctor, my knee hurts after I play 2 sets of tennis and then jog for 5 miles. What should I do?!"
Old Country Doctor with some horse sense: "Don't play 2 sets of tennis or jog for 5 miles."
Old Country Doctor with some horse sense: "Don't play 2 sets of tennis or jog for 5 miles."
13
I'm amused that Jane Brody thinks tennis is an essential activity whereas sitting 'too long' is not. A lot of people over 50 have to work desk jobs, Ms Brody. Do try to get out of your bubble.
Also, I've also read those studies (most recently the Tampere University ones) that tell us to avoid arthroscopy for meniscus tears. But what about pain relief? Meniscus tears often cause the knee to hurt - a lot - and arthroscopy often relieves that pain. Maybe I'm in a minority - but both times I finally decided on an arthroscopy for a meniscus tear (both times past 50) I saw immediate relief. Isn't that a good enough reason to do it?
(Arthroscopy for arthritis is another matter - my European doctor has always told me it doesn't work, and I should do what I can to avoid or stave off arthritis because there's no magic bullet).
Also, I've also read those studies (most recently the Tampere University ones) that tell us to avoid arthroscopy for meniscus tears. But what about pain relief? Meniscus tears often cause the knee to hurt - a lot - and arthroscopy often relieves that pain. Maybe I'm in a minority - but both times I finally decided on an arthroscopy for a meniscus tear (both times past 50) I saw immediate relief. Isn't that a good enough reason to do it?
(Arthroscopy for arthritis is another matter - my European doctor has always told me it doesn't work, and I should do what I can to avoid or stave off arthritis because there's no magic bullet).
10
The hard truth is our muscular skeleton system was not designed to last as long as we are living and we have not waited for evolution to make adjustments to thep original design.
9
I found that prolotherapy worked well for me, and it has allowed me to repair injured joints and remain active. Starting 15 years ago, I luckily avoided the recommended mainstream destructive treatments like cortisone injections and radical surgeries that are not restorative. When the only tool in the toolbox is surgery: "just take pain medications until you finally need a joint replacement" is the religiously recited advice. Amazing that prolotherapy isn't mentioned in this poorly researched article.
3
I think people should first train their muscles so physical activities won't hurt their joints. Or actually listen to your bodies and don't ignore the pain and continue the painful activity. It's good to be active until you break everything in your body and you can't move on your own. I would hire a personal trainer or coach before doing any sports because if you injure yourself, it's all on you. You could have listened to your body or have professionals help you but you are the only one that can feel your body. When people outsource their own health, it's going to be expensive to get it fixed.
5
Well, if you know the activities that are adversly affecting your knees and don't change to other forms of excercise (swimming?) then I'm not sure what you expect. I've seen runners continue running after a hip replacement when told not to. There is probably a psychological problem that is being masked by exercise that is harmful to you but you continue. Please get some therapy.
10
Until my primary care doctor finally called for an MRI to determine that it had been a necrotic hip causing my leg pain, arthroplasty was one of the unnecessary procedures I was put though. The procedure on the knee was a total waste of time, I could have managed just fine with the tear in my meniscus. Oh yes, I should mention that another misguided attempt to fix my leg pain was having it pulled on by a physical therapist. Start with the hip, folks!! Check that first!
5
For what it is worth: I've had ragged meniscuses (meniscii?) in both knees, had arthroscopic surgery and have no pain in either now.
8
This article should have been titled "What I Wish I'd Known About My Health Care System". Jane Brody is educating all of us about how much waste and useless medical procedures there are when you begin to have knee deterioration. Thank you Jane Brody.
6
Have you researched CooliefTM, or radio frequency chelation? I'd be interested in your research and thoughts.
1
Most knee pain can be successfully treated by strengthening the quadraceps muscles. I find that when on long hikes in the mountains my knees actually hurt less (or not at all) than when I am at work.
7
a few years ago, approaching 50, I stopped being able to wear my (beloved) heels, and was experiencing pain in both knees, especially on stairs. Not one to rush off the the doctor....I did not rush off to the doctor. I did stop wearing heels, which helped a bit, but not completely. A few months later I was in a yoga class and mentioned the knee issue to the instructor. I was standing up at the time; she ran her thumb. HARD, down the outside of one of my thighs. I screeched in pain. "Oh", she said. "You have tight IT bands".
I had never heard of an "IT band", but she told me to massage it by rolling around on a pool noodle, which i did. Knee pain disappeared. When it acts up, I pull the pool noodle out. Cost of pool noodle: less than 5$ at Target.
I had never heard of an "IT band", but she told me to massage it by rolling around on a pool noodle, which i did. Knee pain disappeared. When it acts up, I pull the pool noodle out. Cost of pool noodle: less than 5$ at Target.
15
Thanks LC, wonderful suggestion. I've noticed that when I go to yoga at least twice a week my pain is greatly diminished. When I skip yoga for a few weeks, the pain returns. I find yoga boring, to be honest, but it seems to work!
The shots available in America for the knee injections you describe were garbage for me. An alternative, fermathron, available in Europe, worked for years. What worked best of all was a pre-op anesthetic in the prep room, my bad knee turning to spaghetti, the op canceled for other reasons and tentatively rescheduled. Only to find that the anesthetic acted in mysterious fashion and once it wore off, left my bone-on-bone, crutch-assisted walk painless, effortless. The knee has handled miles of cobblestones in Europe, ladder work in Vermont, daily up-and-down the stairs at home.
Six years later, my GP still grins and says, "You discovered something orthopedic surgeons do not want to know."
Final note: keep your knees until they make you crawl and cry. If ever a joint deserved its own hall of fame, it's the knee.
Long live my knees! I love them! I never want to let either of them go.
Six years later, my GP still grins and says, "You discovered something orthopedic surgeons do not want to know."
Final note: keep your knees until they make you crawl and cry. If ever a joint deserved its own hall of fame, it's the knee.
Long live my knees! I love them! I never want to let either of them go.
10
Another note: The best physical therapists are available for FREE.
Google and youtube. It's all there.
Google and youtube. It's all there.
5
Jane, now you know what mainstream medicine and insurers won't tell you: arthroscopic surgery doesn't work, and if you don't already realize it, knee replacements are not for a lifetime (and carry their own additional hazards)! You have unfortunately been duped by a system that is tilted heavily towards pharmaceuticals and surgical procedures that are unproven, costly, and often unsafe.
You also are not aware (most doctors are not) that NSAIDs such as aspirin, ibuprofen, naproxen and almost all of the others inhibit proteoglycan synthesis, thereby disabling effective cartilage repair. The widespread use of these agents is probably largely responsible for the epidemic of osteoarthritis and the ubiquity of joint replacement surgery.
Not only have we crippled our bodies' own ability to repair ourselves with these drugs, but by covering up the pain we have encouraged overuse of joints that are trying to repair themselves (think racehorses and butazolidine). It is almost a perfect storm.
You should consider doing another column about what DOES work (disease modifying osteoarthritic agents and supplements, dextrose prolotherapy and other forms of regenerative medicine) now that you have started the education of your massive following about what does NOT.
You also are not aware (most doctors are not) that NSAIDs such as aspirin, ibuprofen, naproxen and almost all of the others inhibit proteoglycan synthesis, thereby disabling effective cartilage repair. The widespread use of these agents is probably largely responsible for the epidemic of osteoarthritis and the ubiquity of joint replacement surgery.
Not only have we crippled our bodies' own ability to repair ourselves with these drugs, but by covering up the pain we have encouraged overuse of joints that are trying to repair themselves (think racehorses and butazolidine). It is almost a perfect storm.
You should consider doing another column about what DOES work (disease modifying osteoarthritic agents and supplements, dextrose prolotherapy and other forms of regenerative medicine) now that you have started the education of your massive following about what does NOT.
4
Re Running: I used to run 5 miles a day on weekdays and 7-8 miles on one day of the weekends. Unfortunately I had trick knee surgery in the early sixties when I was 13. The then standard treatment was to re-route a tendon and nail it to the bone with a one inch steel pin. This barbaric surgery (not my words, words of 1990's oethpod) finally caught up with me and I had to stop running. However, as I always ran with a little pain I learned that the surface you run on and the angle of the surface are very important in minimizing damage.
The worst surface you can run on is concrete. Asphalt is better, but grass or just plain dirt is good. The best place is to run is in the desert before sunrise. (You have the added benefit of watching the owls hunt from their nests in the cacti.)
Another thing: surfaces have to be flat. All roads are built to peak in the middle so that rain runs off into the gutter. Some people think you can cancel out the threat by running halfway in one direction and then turning around and running back, but you still have unequal stresses on your joint. You also have the problem of being run over. Another problem place is indoor running tracks which are built on a curve.
Unfortunately, time waits for no man or woman. You will ultimately have to recognize that the abuse your body could put up with in your 20's can't be tolerated in your sixties or seventies. Jane Brody seems to be having a hard time coming to grips with this fact of life.
The worst surface you can run on is concrete. Asphalt is better, but grass or just plain dirt is good. The best place is to run is in the desert before sunrise. (You have the added benefit of watching the owls hunt from their nests in the cacti.)
Another thing: surfaces have to be flat. All roads are built to peak in the middle so that rain runs off into the gutter. Some people think you can cancel out the threat by running halfway in one direction and then turning around and running back, but you still have unequal stresses on your joint. You also have the problem of being run over. Another problem place is indoor running tracks which are built on a curve.
Unfortunately, time waits for no man or woman. You will ultimately have to recognize that the abuse your body could put up with in your 20's can't be tolerated in your sixties or seventies. Jane Brody seems to be having a hard time coming to grips with this fact of life.
13
Water exercise is wonderful for the knees. Everything gets strengthened.
2
What about using hiking poles? I find them very helpful to reduce load on knees even when walking in flat trials and especially helpful when climbing inclines.
7
I played hockey all my life and now at 50 I've only been doing yoga , walking and weight lifting. Have friends that insist on running activities and they are getting hip replacements.
At some point you have to listen to your body. Surgeons cut open your body and that itself leaves scar tissue.
Be conservative and yet continue to enjoy exercise. You cant do the things you did in your twenties.
At some point you have to listen to your body. Surgeons cut open your body and that itself leaves scar tissue.
Be conservative and yet continue to enjoy exercise. You cant do the things you did in your twenties.
5
Meniscal tears and pain in both knees beginning at 59. Avoided all painful activities as long as I could get around. No orthopedic interventions. 75 in September, still playing basketball and tennis.
2
Any exercise that pounds the knees-skiing,running, maybe cycling- is flat out dangerous after a certain age. You are just asking for it.
Weight management means almost everything.
Be cautious and conservative. permanent pain and/or operations aren't worth the kicks.
Weight management means almost everything.
Be cautious and conservative. permanent pain and/or operations aren't worth the kicks.
4
I'm 54. Tore left ACL and Meniscus at 20. ACL Replacement surgery at 28. I have biked daily and had no problems. My ankles wore out, stopped biking: knee pain came back. Bone on bone knee at this point. Started biking again after two ankle fusions; no knee pain. Get the picture. Biking heals the knees.
1
What about Platelet Rich Plasma injections?
Jane Brody, the PLOS ONE hyaluronic acid research you quote has problems due to bias risk and should not be used as evidence to recommend this. The research was paid for by the Seikagaku Corporation of Tokyo which makes hyaluronic acid and one of the researchers is an inventor and patent holder for a hyaluronic acid product.
The OARSI guidelines suggest that more evidence is needed before a recommendation can be made for this injectable treatment:
https://www.oarsi.org/sites/default/files/docs/2014/non_surgical_treatme...
The OARSI guidelines suggest that more evidence is needed before a recommendation can be made for this injectable treatment:
https://www.oarsi.org/sites/default/files/docs/2014/non_surgical_treatme...
6
My dad, a real sportsman in the 1920's and 30's, had two knee and two hip replacements in the mid-1980's, then broke his femur in 2001, and got a pacemaker in 2003. Nothing could keep him from his daily walking ritual. He kept at it until he was 93. So, my take is, do the replacements first and worry about the rest later, just do not stop enjoying life.
4
read the book "Saving My Knees: How I Proved My Doctors Wrong and Beat Chronic Knee Pain" ... it worked for me.
3
Another waste of money are Stem Cells.
Don't run.
Put your knees through a full range of motion everyday.
Do slow, deep knee bends three times a week through a pain free range of motion
Don't run.
Put your knees through a full range of motion everyday.
Do slow, deep knee bends three times a week through a pain free range of motion
3
Wow, I hope people take Ms Brody's column with a pound of salt. I had meniscus surgery on both knees and it has given me pain-free, nearly 100% functional knees, when before the surgery both knees hurt like the devil and I could barely bend one.
It is indicative of the flaws in her reasoning and the study she quotes that her surgeon did not do an MRI before her surgery to see what was actually going on in her knee.
Plus, she abused her knees, by her own admission, for years. What did she expect?
I have seen Ms. Brody give surprisingly bad advice before. Like the Times employing someone who went through bankruptcy as a financial columnist, I have to wonder what's going on here.
Perhaps the Times should have kept the Public Editor, their last fig leaf over their irresponsible journalism, and let Ms. Brody go instead.
It is indicative of the flaws in her reasoning and the study she quotes that her surgeon did not do an MRI before her surgery to see what was actually going on in her knee.
Plus, she abused her knees, by her own admission, for years. What did she expect?
I have seen Ms. Brody give surprisingly bad advice before. Like the Times employing someone who went through bankruptcy as a financial columnist, I have to wonder what's going on here.
Perhaps the Times should have kept the Public Editor, their last fig leaf over their irresponsible journalism, and let Ms. Brody go instead.
7
I come from a family of talented MDs, so I noted the referral for knee pain to my local D.O. with a raised eyebrow. After the first prolotherapy treatment, my knees felt 30 years younger. No surgery, back to kicking like a 20-year-old. http://prolotherapycollege.org/what-is-prolotherapy/
Rule #1 of good journalism...there's always 2 sides to a story. Where was evidence contradicting the main point that arthroscopic surgery is a bad idea for "arthritis and meniscal tears?" You won't have to look hard to find patients who bought years of pain free knee activity from getting scoped. Count me as one (meniscus tear). And on the subject of tylenol and anti-inflammatories, you'd better warn costumers about their risk of taking them long-term. Therapy is great - after you see a good orthopedist.
Meloxicam has been wonderful. I don't know what the long term effects might be, and I don't want to know because the bliss of having pain free knees is too good.
2
I have had arthroscopic surgery on both knees, one 7 years ago and one 10 years before that. Today both knees are wonderful and I have no problems. Why? Because I wasn't so stupid as to just resume the activities that damaged my knees in the first place. Had the author taken better care of his body AFTER his arthroscopic surgeries he might not have needed total joint replacement.
One thing to be aware of is the evidence that steroid injections done too close to knee or hip replacement surgery can increase infection risk.
http://newsroom.aaos.org/media-resources/Press-releases/steroid-injectio...
http://newsroom.aaos.org/media-resources/Press-releases/steroid-injectio...
1
I don't want to get boring on the subject of cannabis, but science has revealed that the cartilage in our knees is rich in cannabinoid receptors. It is claimed by many athletically inclined cannabis users that their cannabis use has relieved inflammation in their knees and protected their meniscus from inflammatory damage. These claims ought to be studied by science. An ounce of prevention is worth a pound of cure.
Unbelievable that there is no mention of taking glucosamine, chondroitin, and MSM, which rebuild cartilage! This is the best solution. Turmeric and bromelain also help, acting as anti-inflammatories. (Bromelain must be taken on an empty stomach to act this way; taken with food it acts as a digestive enzyme.)
Knee replacement is not the wonderful thing this author implies. I know of people who had that surgery and couldn't walk afterward.
I would never let the medical system touch my knees!!
Knee replacement is not the wonderful thing this author implies. I know of people who had that surgery and couldn't walk afterward.
I would never let the medical system touch my knees!!
3
If my knees ache- I take a long walk in a forest where the ground is soft- and wearing old fashioned knee pads you can buy at Walmart for $5- and my knees then feel great.
1
I was about to do an entire treatise on Stem cell injections which this article totally missed. I see Terese and Jody have both mentioned that. We have Dr. Adelson here who has been performing stem cell treatments for 20 years. To go that far back, there must be something to it. I think there is way too much knee replacement going on.
2
1993 torn ACL, I was 23. The sport doctor I saw in NY pushed my knee upward and sideways and my knee moved up, loose. He looked at me and said, "megh there is nothing to do really, are you a ski athlete? No, so your knee is what is it now, only strengthening it through PT will improve it. You will never be able to ski without a knee brace, trampoline may be in 3 years, and forever now you will have to be mindful of your knee and do PT every single day of your life at home." 24 years later every time I wait for the subway here I am discreetly standing on one leg flexing my knee, I have never ever skied without a nasty looking brace on, but I ski, play tennis, run, always mindful and always shortening purposely my activities. I am always thankful for the advise of this sport doctor.
1
For too many surgeons "First do no harm." has somehow turned into, "No worries! The first cut is the deepest."
Rafael Nadal had stem cell "injections" done on his knees. He's still playing tennis and winning. He said playing on grass is more difficult for him because the ball bounces lower which requires him to bend more from his knees. I'm surprised stem cell therapy is not used more in the US.
2
Losing significant weight while exercising less due to pain and bone-on-bone areas grinding is quite a difficult combination! I eat very little, always healthful foods, zero junk food. The pain and weakness of hunger permeate my days, even when I very lightly snack.
6
Managed care is the best way to avoid unnecessary procedures, in my own experience and reading, especially an HMO run by a provider.
The provider is paid a fixed, risk adjusted amount per enrollee, and has an incentive to emphasize primary care and chronic care management over specialists and procedures.
As a very active person, I have had my share of ankle sprains, partial shoulder dislocations, serious herniated discs, hip, knee and Achilles pain and more, but have fortunately avoided surgical intervention. Every condition has improved or disappeared over time. A doctor told me that ligaments that stiffen with age can help to stabilize loose joints like ankles and shoulders.
Strengthening muscles or activating them with pre-exercise drills can help with problems, especially in knees and hips. Remaining active and watching your posture while walking or sitting is cheap and effective therapy.
The provider is paid a fixed, risk adjusted amount per enrollee, and has an incentive to emphasize primary care and chronic care management over specialists and procedures.
As a very active person, I have had my share of ankle sprains, partial shoulder dislocations, serious herniated discs, hip, knee and Achilles pain and more, but have fortunately avoided surgical intervention. Every condition has improved or disappeared over time. A doctor told me that ligaments that stiffen with age can help to stabilize loose joints like ankles and shoulders.
Strengthening muscles or activating them with pre-exercise drills can help with problems, especially in knees and hips. Remaining active and watching your posture while walking or sitting is cheap and effective therapy.
22
Not for everyone. Sometimes cartilage simply wears away, no matter what you do to keep active.
If you run or walk for exercise, replacing your running/walking shoes every three months or around 300 miles of wear is essential. Most people wait far too long and are paying a higher physical price.
Also, the beginning of this article seems to imply bad knees from running or playing tennis are inevitable. They're not.
Also, the beginning of this article seems to imply bad knees from running or playing tennis are inevitable. They're not.
2
What worked for you will not work for everybody. Managed care indeed!
My knee pain was correlated with loss of cartilage on one side of my knee with narrowing of the joint space.
I used a proper knee brace for about 18 months and the pain resolved all by itself. Because I live in Canada, there was no push to have unnecessary surgery.
A few years later I had exactly the same symptoms on the other knee. Same treatment, same good result.
I used a proper knee brace for about 18 months and the pain resolved all by itself. Because I live in Canada, there was no push to have unnecessary surgery.
A few years later I had exactly the same symptoms on the other knee. Same treatment, same good result.
116
Could you describe or name the knee brace? I have bilateral Baker's cysts with far more pain than expected & concern about a torn meniscus or two, and I'm wondering how a brace might help.
1
What kind of knee brace was it?
Thank you. American's have the view that in Canada you can't get all these surgeries on a whim so its proof your health care is bad. There is an adage that says: don't mistake doing something for progress. More evidence that US health care is just a profit making sham!
3
The best pain reliever I’ve found is turmeric (cucurmin), which is used as a seasoning in India. It’s simply a ground-up root (“natural”), which helps not only my knees but also arthritis pain elsewhere, with NO side effects. (I prefer Eden Pond turmeric, from Amazon, but there are many other brands as well.) As for physical therapy, I do a daily stint on my exercise bike, which immediately makes my knees feel better, and also stretches on my exercise mat. Finally, at age 85, I have never learned how to drive. I do all my errands on foot and live in a third-floor walkup, so it may be that all of that also helps.
271
Tumeric has the side effect of thinning the blood. People who are taking blood thinners such as Plavix should use it with caution.
2
Just like hemlock is natural. Or poison ivy.
4
Curcumin works wonders. Should be mentioned here - there are high quality studies showing works better for knee osteoarthritus than the common pain killers with no side effects.
I have not seen regenerative medicine mentioned. This comes in the form of PRP and STEM cells. We have had thousands of successes at our clinic. Ranging from folks suffering from bone on bone arthritis to acute injuries. Menical tears in particular respond well. Agreed the first line of defense is taking the weight off. We feel best way is by eating low glycemic index. The benefit is the decreased physical strain as well as overall diminished inflammation in the body.
65
This treatment is not covered by insurance, at least not by my BC/BS policy, which is fee for service and not HMO. It sounds great, but at $1600 out of pocket for both knees (the quote from my orthopedist), I can't afford it. I tried the hyuralonic injections Jane Brody mentioned. Like her, I am one of the group for whom this treatment is not effective. I am not overweight and I get a lot of exercise (yoga, weight training, biking, walking) despite my knees. However, it would be really nice to be able to do these things pain-free. Glucosamine did nothing; prescription NSAID gel for my knees did nothing. I am going to try working with a physical therapist who knows about knee issues; perhaps that will be the best bet.
I had PRP treatment recently, $700.00 out of pocket, most insurance dose not cover this treatment for a tear in an ankle tendon. Did not work had to have surgery, so beware of this treatment.
I just finished my PRP treatment for arthritis and other problems of my knee. It is working beautifully. The problem is you are not offered this treatment unless you do not have insurance (I do, but the deductible is $7200). I paid out of pocket. $800 per treatment (two is recommended). Why does it not get covered by insurance? I wonder if it is because it is not profitable to sustain our 7 star health care facilities.
Nothing about stem cell treatment? It appears to be quite successful with many people now.
41
Really? Could you please refer us to the randomized double blinded studies showing this.
There are no studies yet proving this unlike acupuncture for which there are many studies doing so.
If it were successful and could replace a very expensive knee surgery then national (UK, Canada, Australia) and individual insurance plans would embrace it - they don't.
I tore my left medial meniscus during 2 separate ski accidents in Feb.2016 .
I received advice both pro and con regarding having it scoped . I knew that it would ache and swell when downhill skiing . So I backed off to light , flat XC and easy cycling . Still ended each session with discomfort . An MRI revealed
that I did in fact have a complex tear of this meniscus , but , that otherwise my knee cartilage was in fine shape ( I stopped running in my 20s , now 69 ) . The recommendation was to scope it followed by 6 weeks of PT . I am now back to full downhill skiing , cycling and hiking . I have added carefully spotted weight lifting with no issues . I saw the high res pictures of my knee cartilage surfaces both before the procedure , irregular flaps and tares , and after very cleaned up . I believe I made the right choice to scope it .
I received advice both pro and con regarding having it scoped . I knew that it would ache and swell when downhill skiing . So I backed off to light , flat XC and easy cycling . Still ended each session with discomfort . An MRI revealed
that I did in fact have a complex tear of this meniscus , but , that otherwise my knee cartilage was in fine shape ( I stopped running in my 20s , now 69 ) . The recommendation was to scope it followed by 6 weeks of PT . I am now back to full downhill skiing , cycling and hiking . I have added carefully spotted weight lifting with no issues . I saw the high res pictures of my knee cartilage surfaces both before the procedure , irregular flaps and tares , and after very cleaned up . I believe I made the right choice to scope it .
24
I had meniscus tear in one knee 13 years ago had surgery it totally took care of the problem. Three years later same problem in right knee. Same surgery same result. I am now 66 no pain and lots of exercise. I bike ride, ski, hike, golf work out in the gym regularly. Don't know what to say about the studies. Worked for me.
42
I had the same experience. Severe knee pain in both knees relieved through simple arthroscopic surgery (several years apart).
1
Worked for me too. Had a meniscus tear repaired surgically 9 years ago. No problems since then.
1
How do you know it worked? The point is, most people get better with time.
In the late 1990s, when I was in my mid 50s, my orthopedic surgeon recommended trimming meniscal tears in both knees, and when that didn't relieve my pain, offered shots of cortisone, and then hyaluronic acid. A few years later, after I tore both ACLs, I ended up with knee replacements. The TKRs have mostly (but not entirely) worked. At about the same time, a few friends (who had torn or severed ACLs) took very different paths and successfully rehabilitated their knees--without surgeries--through physical therapy and modified yoga. We'll do almost anything when the surgeon promises to relieve our pain; but I'm sorry no one told me there were other good options.
81
Arthroscopic surgery on my left knee just removed cartilage and made it 'bone on bone' and NG!!! Tried the hyluronic shots. 3 months later I had a knee replacement which relieved most of the pain. I don't play tennis anymore and cut back on golf. Was shocked after knee replacement that I could not bend the knee as well --- makes sitting in yoga class a problem and cannot do a tight 'tree pose' anymore. I'm lopsided.
Rest and physical therapy and TIME was what I SHOULD HAVE DONE.
I watch enviously as a friend of mine who was basically injured similarly, is now back playing lots of golf. She left it alone. Patience and time. P.S. she is Christian Scientist.........
Rest and physical therapy and TIME was what I SHOULD HAVE DONE.
I watch enviously as a friend of mine who was basically injured similarly, is now back playing lots of golf. She left it alone. Patience and time. P.S. she is Christian Scientist.........
Perhaps the problem is that people engage in behaviour that is unnecessarily harmful. I note the author proudly recites in one spot her jogging, tennis and skiing, and in another tennis and cycling. Those activities are unnatural stresses. Too many fanatics out there are obsessed with exercise to the exclusion of good sense. A few steps, every day, is what we are designed for. Anything more leads to pain and injury.
117
I would rather replace my knees than my heart. I will keep exercising thank you very much....
3
Agreed that the author most is most likely overdoing it, causing too much stress on her knees, etc.
But to say we're designed for a "few steps a day" is silly: A) we weren't designed, we evolved; B) We certainly did not evolve into a sedentary animal that is meant to take only a few steps a day. There is a happy medium...
But to say we're designed for a "few steps a day" is silly: A) we weren't designed, we evolved; B) We certainly did not evolve into a sedentary animal that is meant to take only a few steps a day. There is a happy medium...
5
It's called "living". People do these things because it's what they enjoy doing. It's their passion, it makes them glad they are alive. If they are unable to do their favorite activities, thier quality of life plummets.
3
Long term use of Tylenol and other pain relievers noted in this article can lead to liver failure.
68
At recommended dosage and minimal or no alcohol use, acetaminaphen sure beats opioids, which some docs hand out long-term.
1
Oh well eat right, exercise, die anyway. Happy 4th!
Only if you overdo it, and don't pay attention.
I, myself, am a physical therapist, and, sadly, we often do not see the patient until they have been scoped. Physicians should send patients to rehab prior to any surgery. And, as your article pointed out, a high percentage would be well without arthroscopy.
111
EXCELLANT EXCELLANT article! THank you Jane Body I have followed for many years. Thank you for your run down of all you have been through over the years( sounds similar). Have been signed up for months for the surgery and keep putting off. I am all the things you have been i.e.:avid tennis player , skier swimmer etc. have modified over years because of pain..PILATES is a must help and extra weight loss(as statedin your article) is key.
I do more yoga also but really believe PILATES is key( I have done mat for over 10 years and am also cert. in)
It can strengthen all the key muscles around knees and for older (50+) stability, core all..!!
Thanks for your enormously insightful article!
I do more yoga also but really believe PILATES is key( I have done mat for over 10 years and am also cert. in)
It can strengthen all the key muscles around knees and for older (50+) stability, core all..!!
Thanks for your enormously insightful article!
30
Dear gnlnse,
May I share with you that I had major foreboding second thoughts and that "knowing feeling in my belly"-not to go through with it. I stretched my knee past my back so my toes were touching my shoulder blade as I was on the phone with the Nurse before the knee scope, I asked her, will I still have my flexibility? Will I be able to do this?-she said, oh, absolutely!
Complete. Total. LIE!!!
I cannot tell you the suffering, the massive pain, loss of flexibility, and fighting over a year plus just to ride a bike again. I am telling you this because no-one told me. My Pilates machine actually was the only thing that strengthened my knee and returned some, and never all, of the flexibility I used to have. I will go out on limb and say, don't have the surgery!
I learned that the hard way. You will NEVER be the same once they go into that knee. If I were you, I'd stick with walking and Pilates and Yoga. I wish you the BEST possible recovery.
May I share with you that I had major foreboding second thoughts and that "knowing feeling in my belly"-not to go through with it. I stretched my knee past my back so my toes were touching my shoulder blade as I was on the phone with the Nurse before the knee scope, I asked her, will I still have my flexibility? Will I be able to do this?-she said, oh, absolutely!
Complete. Total. LIE!!!
I cannot tell you the suffering, the massive pain, loss of flexibility, and fighting over a year plus just to ride a bike again. I am telling you this because no-one told me. My Pilates machine actually was the only thing that strengthened my knee and returned some, and never all, of the flexibility I used to have. I will go out on limb and say, don't have the surgery!
I learned that the hard way. You will NEVER be the same once they go into that knee. If I were you, I'd stick with walking and Pilates and Yoga. I wish you the BEST possible recovery.
1
Odd that you hold surgery to the standard that it needs to be proven vs. placebo, but don't do the same for PT. There is almost no proof PT works for osteoarthritis. You have an evidenced based medicine article then off handedly throw in PT is very beneficial at the end.
43
Our PT management of OA is evidenced based!!!
exactly what I was thinking as I read the article.
PT is generally not a treatment with a high risk of complications (infection, bleeding, surgical mishap) and is low cost. It does require more time and effort by the patient than the post-scope 'recovery' regimen. PT strengthens adjoining muscles and ligaments, helps identify and correct pt behaviors such as poor posture that contribute to damage or developed to compensate for pain, etc. It is a very good first line treatment. It is harder to have statistical information on efficacy over time as the element of pt participation is key but cannot be measured accurately outside of research period.
I had a painful baker cyst which was a large ball of fluid behind my knee as a result of a torn meniscus. I am very thankful for the surgery. I have had a complete recovery, no more fluid, and play tennis and hike mountains with no issues!
24
As a 53-year-old runner (I've been at it for 10-12 years), I'd suggest that many of these knee injuries could be prevented by not running on pavement. I've done much of my running on grass, a skill that takes a short time to learn, but which pays off with much-reduced wear and tear on the joints.
Those who run for years on pavement are just asking for it. Even with good shoes, the human body was not designed for this.
Those who run for years on pavement are just asking for it. Even with good shoes, the human body was not designed for this.
73
When I was in the US Army infantry, every morning we ran in formation on pavement. That always killed my knees, after I injured my left knee I was told to run on the side of the road and not on the pavement. That helped me a lot as far as knee pain.
I probably should have taken more time off to let my injured knee heal but when you are in the infantry you are under a lot of peer pressure. You don't want to lose the respect of you peers by holding back when doing physical training.
What can I say, we all do stupid stuff when are younger. Luckily I only spent two years in the Army so it did not injure my left knee permanently. These days I meet a lot of veterans my age who spent 20+ years running on pavement while in the Army who now have two bad knees.
I probably should have taken more time off to let my injured knee heal but when you are in the infantry you are under a lot of peer pressure. You don't want to lose the respect of you peers by holding back when doing physical training.
What can I say, we all do stupid stuff when are younger. Luckily I only spent two years in the Army so it did not injure my left knee permanently. These days I meet a lot of veterans my age who spent 20+ years running on pavement while in the Army who now have two bad knees.
I have a similar opinion about playing tennis. I play 19 out of 20 times on soft courts rather than hard courts.
Most running injuries (including but not limited to the knees) can be prevented by learning about the stresses involved, conditioning properly, and then utilizing efficient mechanics to minimize stress that leads to trouble. The issues (read pain or injuries) that an individual may experience are specific in type and magnitude. A physical therapist with experience in this area should be consulted, ideally before the problem occurs. You can't start too early when it comes to prevention. If you're a reader, here's the book: Anatomy for Runners by Jay Dicharry. He's a researcher, runner, and physical therapist (MPT). The principles can be applied to any sport/activity. Just switching to a grass surface is not going to be the fix for most of us. The good news is that this approach is readily available to any one that can read.
I developed arthritis in my left knee at age 62, 12 years after breaking my knee cap in an auto accident. I gave up running but started doing lots of road biking (2,000+ miles per year). Nine years later my knee felt so strong after all that biking that I took up running again. At age 79, I run about 15 miles per week and still bike over 2,000 miles per year. Biking really strengthens the knee muscles which helps support and prevent knee problems. I recommend it.
59
I had to stop jogging due to osteoarthritis in both knees. I switched to walking, swimming and an elliptical. Every time I ran, my knees ached for days. Since switching my routine, the pain has diminished.
Also extremely helpful has been yoga, including strengthening and stretching positions. When I resumed yoga practice, I could not kneel for longer than a few seconds due to pain. Now, after a few weeks of regular practice (30 minutes, 3-4 times weekly)I can maintain postures for the full 30-60 second intervals.
By changing my exercise program, I hope to avoid knee replacement. Yoga also aid my back. (I had a herniated disc last fall; hence the break in yoga practice.)
One specialist suggested gel injections; another, a noted NYC knee expert, advocated exercise w/cortisone shots. I decided to forgo both the gel injections and cortisone, but adopted the exercise plan. I also take 2 baby aspirin a day; I was scared off Motrin and other NSAIDs by recent reports that they can cause heart attacks.
I've also lost 12 pounds, over the course of 10 months. Although I hadn't been overweight, I'd gained weight over the years and wanted to see if weight loss helped; it did. I used a free app- MyFitnessPal, although there are many available -to count calories. I did not change my basic diet, which was healthy -veggies, fish, little red meat, sugar or packaged foods- but cut out the snacking -e.g. those "healthy" seeds and nuts. Kept the dark chocolate; there are limits!
Also extremely helpful has been yoga, including strengthening and stretching positions. When I resumed yoga practice, I could not kneel for longer than a few seconds due to pain. Now, after a few weeks of regular practice (30 minutes, 3-4 times weekly)I can maintain postures for the full 30-60 second intervals.
By changing my exercise program, I hope to avoid knee replacement. Yoga also aid my back. (I had a herniated disc last fall; hence the break in yoga practice.)
One specialist suggested gel injections; another, a noted NYC knee expert, advocated exercise w/cortisone shots. I decided to forgo both the gel injections and cortisone, but adopted the exercise plan. I also take 2 baby aspirin a day; I was scared off Motrin and other NSAIDs by recent reports that they can cause heart attacks.
I've also lost 12 pounds, over the course of 10 months. Although I hadn't been overweight, I'd gained weight over the years and wanted to see if weight loss helped; it did. I used a free app- MyFitnessPal, although there are many available -to count calories. I did not change my basic diet, which was healthy -veggies, fish, little red meat, sugar or packaged foods- but cut out the snacking -e.g. those "healthy" seeds and nuts. Kept the dark chocolate; there are limits!
40
"Every time I ran I ached for days"?
And you thought that that was GOOD for you?
Wow, the power of the Exercise-Medical Industrial Complex!
How gullible we are!
And you thought that that was GOOD for you?
Wow, the power of the Exercise-Medical Industrial Complex!
How gullible we are!
The article demonstrates once again that the medical community will almost always default to a more financially lucrative procedure-oriented approach to curing patients. I would replace recommendations to "lose weight" and "take over-the-counter pain reliever like acetaminophen.." with, "Go on a whole food plant-based lifestyle by avoiding all animal based protein (i.e. meat, dairy, eggs, etc.) and easily digestible carbohydrates (i.e., sugar and processed grains) and take at least three teaspoons of turmeric 3 times daily (there is generally no overdose or other adverse effects)." This approach would reduce weight and inflammation and possibly avoid other chronic illnesses such as arthritis at the same time. Remember, most doctors have little training or financial incentive to use evidence-based nutrition as a means of treatment. Becoming more knowledgeable about these approaches than your doctor (which is usually easy to do) could save you lots of pain and money. Read "How Not to Die" by Michael Greger if you want to get serious about avoiding chronic disease in the first place instead of leaving your damage from the Standard American Diet ("SAD") in the hands of others. The SAD is an almost certain guarantee to a lifetime of inflammation, pain and other chronic diseases.
34
James so well put. I agree with everything you said. This is the basis of heath, maintaining the body so it stays in balance, it's natural state. Avoid so much pain and chronic disease by eliminating processed foods and get out in nature if you can every day. Walk hike bike swim yoga things like this. The pounding og running the repetitive motion of golf and tennis can be difficult as we age.
Read Perlmutter's "Grain Brain" and skip this misinformed commenter's advice to avoid meat. Eliminate most grains instead and you'll reduce inflammation.
Right on the money! Will read that book on your recommendation.
The assumption in this article is that people should play tennis, run an de pursue high impact activities into their later years. Those lucky souls who don't have a genetic predisposition to arthritis. I stopped running in my forties, had arthroscopic surgery in one knee followed by pt and hydrolonic knee injections. Since I retired from a high impact career involving standing on concrete floors and running around all day with time to weight train my knee problems are resolved. But I don't play tennis, run, or play basketball. It would be nice but.
28
Earlier a friend in agony, before and after recent surgery on his knee, was explaining to me the meaning of the meniscus. He had a partial replacement on his other leg a decade ago. At 70, he does not wish or plan to have another knee replacement.
We share the same physician and planning to forward this article to her attention. There is no need to mention the name of her patient, she reads the NYTimes, and this may be helpful. Many thanks.
We share the same physician and planning to forward this article to her attention. There is no need to mention the name of her patient, she reads the NYTimes, and this may be helpful. Many thanks.
6
I am 71 years of age and am able to walk for miles, even over fairly rough terrain. When I was in my 30s, I experienced some pain in my knee and consulted a doctor about arthroscopic surgery. He told me that he had experienced very similar pain years before due to a torn or shredded meniscus. He opted for the surgery at the time, but now he wished he had not. He told me that, quite frankly, his knee had never been the same since. As a result, I did not have the surgery, and am thankful to this doctor who was honest with me. I sometimes have slight twinges of pain in my knee, that soon passes if I treat it reasonably.
37
I had arthroscopic surgery 15 years ago at 53. I also had a shredded meniscus. Altho I had been a distance runner, the pain caused me to stop running..I had intensive physical therapy a year previous to the procedure but it stopped working regardless of my continuing to do the exercises.
The surgery was a total success. 14 years later, altho I no longer run, I have no pain whatsoever in that knee and walk or bicycle everywhere.
The surgery was a total success. 14 years later, altho I no longer run, I have no pain whatsoever in that knee and walk or bicycle everywhere.
13
In my 20s I had mild but noticeable knee pain, especially after sitting for long periods. Then I took a job that involved walking all day, and stairs. After a short period, all knee pain was gone, permanently. I share this story only to suggest that sometimes the problem may be lack of muscle development around the knee.
86
Within the article, as comprehensive as it was, stem cell procedures were not mentioned. They are very effective as permanent solutions for joint problems, especially arthritic bone deterioration. Any chance of including this alternative in a further analysis?
20
Thank YOU for mentioning stem cell treatments!-because I have a complete breakdown of my knee and will ask my Dr. about them.
It sounds helpful, especially for some of us really struggling just to walk.
It sounds helpful, especially for some of us really struggling just to walk.
I feel this article is way to simplistic to be putting it out as gospel. I've had two meniscus tears on one knee, medial and lateral, with no issues. Although I have skied some of the toughest terrain in the U.S. for over 40 years, I did not suffer either of these injuries skiing, but skiing is what drove me to the doc. PT without surgery did not work either time although I gave it a go. Both of these tears were painful but relatively minor and the doc left the majority of the cartilage intact. It's been three years since the second one and no issues with none expected barring further injury. It seems to me their are degrees of meniscus damage and the amount of cartilage that has to be removed would be a key factor in the meniscus surgery equals eventual knee replacement fallacy. This article is just not worthy of its subject.
17
Two MMTs and orthroscopies of my right knee by 2002 left me 40% of my right medial meniscus at age 36, with two scuffed kneecaps and recurrent minor tears in both knees. My orthopaedic surgeon advised me to delay a TKR as long as possible saying that I would need one in 5-10 years but due to my youth it would need replacing after another 7-10 years, would probably bring forward failure of my left knee, and by my late 60s I would be running out of bone to attach TKRs to - separate to the progressive and accelerating superbug risk for each surgery as time moves on.
It's not the first TKR, it's the consequent surgery later in life. Our bodies may not be designed to last 100 years of high-intensity sport, high sugar/fat diets, etc etc - replace one part, and something else fails.
16 years later, I revisit the decision every few years; I now walk with a stick - slowly, I am committed to deep water running and hydrotherapy 3-4 days/week, physiotherapy 2-3 days/week involving deep tissue massage/acupuncture/dry needling/SCENAR, and a number of painkillers. Absolutely no impact work. Weight is a constant challenge.
There has been no silver bullet, but I am one for whom orthroscopies were genuinely helpful. The commitment to avoiding TKR has allowed me to find a reasonable mix of therapies that has slowed the decline.
It's not the first TKR, it's the consequent surgery later in life. Our bodies may not be designed to last 100 years of high-intensity sport, high sugar/fat diets, etc etc - replace one part, and something else fails.
16 years later, I revisit the decision every few years; I now walk with a stick - slowly, I am committed to deep water running and hydrotherapy 3-4 days/week, physiotherapy 2-3 days/week involving deep tissue massage/acupuncture/dry needling/SCENAR, and a number of painkillers. Absolutely no impact work. Weight is a constant challenge.
There has been no silver bullet, but I am one for whom orthroscopies were genuinely helpful. The commitment to avoiding TKR has allowed me to find a reasonable mix of therapies that has slowed the decline.
I had three arthroscopic surgeries on my knees in my later 20's and early 30's (I didn't like my knees locking up ). I managed to play tennis and volleyball until my mid-50's. Even now my knees feel fine - I attribute their condition to resting at least one day between similar activities, filling in with biking and swimming.
Frustrated by tennis elbow and foot problems, I gave up tennis and concentrated on badminton - that's much easier on the knees, btw.
Frustrated by tennis elbow and foot problems, I gave up tennis and concentrated on badminton - that's much easier on the knees, btw.
3
Badminton? Sudden stops and starts? Good luck with that sport.
2
There is a better and more simple solution to pain in the knees. It is surely worth it to try since it is one from nature and really WORKS. Comfrey! My husband had pain in both knees and got some comfrey powder which is sold here and mixed it with oil to form a paste which he applied daily at night to his knees and wrapped them up to sleep overnight. In just a few days of doing this his pain was greatly reduced. In ten days there was no pain at all! His sister had an even more serious problem with her knees and was ready to go under the knife until we stopped her and asked her to try to solve the problem this way before she took such drastic measures--she did and was amazed by the wonder cure! Neither of them has ever had any pain in the knees again. Both of their problems were of a meniscal nature.
13
My physician's first suggestion for the pain from a torn meniscus was to take ibuprofen for a year or two. I held out for arthroscopic surgery. Afterwards the pain was gone. I had, incidentally, read the placebo or nocebo experiment where the real pains from unnecessary cuts convinced the subjects that they had been healed.
3
In 2011 at age 61, I slipped on ice and tore my meniscus. I heard the pop, felt severe pain, and my knee immediately swelled. Over the next year, with physical therapy, my knee still swelled and ached after moderate exercise. Then I had surgery to clean up the meniscus and immediately felt less pain and the swelling all but disappeared. In the five years since, my knee has continued to improve and allows intense exercise without pain. To say this procedure benefits no one is false. I benefited greatly from the surgery, and think this procedure should still be available at the discretion of the patient and the surgeon. I do not anticipate needing a knee replacement for many, many years.
12
I did physical therapy for a shoulder injury for a while, with a terrific sports physical therapist, and we used to talk about various exercise options and studies all the time. He advised no running, EVER, on concrete, because of the wear and tear on knees and maybe other joints from that. Dirt and treadmills were fine. And turmeric for inflammation. He's recommended it for tendinitis and had people report back that it cleared up their arthritis, too. There are also diets that are anti-inflammatory (think more veggies, less animal products). Highly trained yoga instructors will often tell you that knee pain is a symptom of weak or tight quads or hamstrings.
8
While credit is deserved for educating regarding the paucity of evidence for many common knee surgeries, Ms. Brody would do better than to cite a poor quality selective retrospective review type article regarding the efficacy of hyaluronic acid injections written by individuals employed by the purveyors of hyaluronic acid! The American Academy of Orthopaedic Surgeons (whose members administer various kinds of joint injections and who would undoubtedly like to do more of them) has issued a strong recommendation not to perform these injections due to lack of demonstrable efficacy. No single individual can conclude that such injections delayed his or her need for a knee replacement; that is why we do controlled studies on large groups of patients. It is likely that the benefit that Ms. Brody cites is placebo effect and/or confounded by other therapies such as physical therapy that patients often undergo in tandem with injections; it is best to base recommendations to the public on sound science rather than industry-funded papers or personal anecdote. Save your money!
6
Yes. And apart from placebo effect there is something called "regression to the mean" -- people go in for help when symptoms flare-- but those symptoms are often destined to subside on their own, back to the average... and any "treatment" offered during the flare gets falsely credited with efficacy. It's another reason why groups of similar patients have to be randomized and followed prospectively so you can sort out the effect.
@Brad: Sorry to burst your prejudice, but THIS single individual can conclude that Hyaluronic acid injections have delayed the need for a knee replacement - I've been getting those injections for 14 years with excellent results. If you think that's placebo effect, I have a bridge to sell you.
2
The take away is that what works for one patient may or may not work for another.
20
As borne out by the diversity of these comments !
When one knee was bone on bone, the gel injections did nothing for me but steroid injections got me walking and exercising some until the bone began eroding and we decided to take care of replacing it.
11 months later, I developed severe pain in the original equipment knee. After time, bracing, x-rays, a steroid injection, more time with bracing and icing, the pain and inability to walk was too much. I ended up having a scope to trim a torn meniscus and drain a rather large Baker's cyst. That evening the knee hurt less than it had in 3 months. The scope couldn't fix the arthritis in my knee, but it made it possible for me to function with a minimum of pan until the joint deteriorates further.
Maybe it's because I have psoriatic arthritis, and have had it for decades, so my knowledge and expectations differ from many patients. Maybe it was because my surgeon specializes in replacements and does scopes on the side (only 1/10 as many as replacements annually). Maybe it was because my surgeon was up front about what the scope could and couldn't do for me - and it was based on his own experience with having had torn meniscii. Probably it was a combination of all those, but my experience was far more positive than any you mention in the column.
11 months later, I developed severe pain in the original equipment knee. After time, bracing, x-rays, a steroid injection, more time with bracing and icing, the pain and inability to walk was too much. I ended up having a scope to trim a torn meniscus and drain a rather large Baker's cyst. That evening the knee hurt less than it had in 3 months. The scope couldn't fix the arthritis in my knee, but it made it possible for me to function with a minimum of pan until the joint deteriorates further.
Maybe it's because I have psoriatic arthritis, and have had it for decades, so my knowledge and expectations differ from many patients. Maybe it was because my surgeon specializes in replacements and does scopes on the side (only 1/10 as many as replacements annually). Maybe it was because my surgeon was up front about what the scope could and couldn't do for me - and it was based on his own experience with having had torn meniscii. Probably it was a combination of all those, but my experience was far more positive than any you mention in the column.
7
Constantly having to read about seeing an expert of whatever physical problem we have is insulting to the body. These doctors are nothing but security blankets, always bragging about there knowledge, years of experience, and many patients they have helped. Follow your own instincts and respect reality of your own body.
7
I had a torn meniscus and arthroscopic surgery to remove the tear 12 years ago, and it made a huge difference. I can job, play tennis, etc., and I could do none of those things before the surgery. At least some times, it works!
7
Dr. Mark Shulman advises below that long term use of NSAIDs can actually exacerbate knee problems. I'm not a doctor, although I probably could be an amateur one with all the advice I've collected over the years concerning my bad knee plus hips, etc. And one item of advice was stop taking NSAIDs. And the reason was not knee problems, it was heart problems.
I took NSAIDs for at least ten years, first Celebrex, then Nabumetone--they worked great! But then my doctor said new studies had shown NSAIDs increased the risk of heart attacks. I already had a bad family history of heart problems, and so getting off these was an easy decision. Our author advises an over-the-counter NSAID like ibuprofen; based on this people might start popping these long term, and I must say I'm a little disappointed this bad advice made it into print. Acetaminophen might not work as well, since it's just a pain reliever and not an anti-inflammatory like NSAIDS. But even with these, if you're popping these long term seek the advice of your doctor--a real one, not an amateur like me.
I took NSAIDs for at least ten years, first Celebrex, then Nabumetone--they worked great! But then my doctor said new studies had shown NSAIDs increased the risk of heart attacks. I already had a bad family history of heart problems, and so getting off these was an easy decision. Our author advises an over-the-counter NSAID like ibuprofen; based on this people might start popping these long term, and I must say I'm a little disappointed this bad advice made it into print. Acetaminophen might not work as well, since it's just a pain reliever and not an anti-inflammatory like NSAIDS. But even with these, if you're popping these long term seek the advice of your doctor--a real one, not an amateur like me.
11
So here's a real doctor. As Shulman advised, long term NSAIDs, like steroids themselves, can be harmful in a variety of ways. But even short term use of almost any NSAID affects glycosaminoglycan synthesis, and thereby adversely affects your body's ability to repair its own cartilage. The nearly universal use of NSAIDs since the late 70s is largely responsible for the epidemic of joint replacements caused by worsening of osteoarthritis. We have won the daily battle with pain and lost the joint wars.
1
water aerobics
15
the frustrating truth is that most folks, regardless of the problem, focus on the symptom and rarely the source.
Joints suffer, weaken and become succeptable to injury because the muscles supporting and connecting to the joint aren't flexible enough to accommodate whatever moment is being asked of them.
Most garden-variety knee problems originate from overly tight hamstrings.
Spend money you don't have you'll go into debt.
Work muscles that aren't flexible you'll injure your joints.
Lots of websites and services designed to help folks with their debt. Best way is to not get into debt in the first place.
Want a surefire way to stop smoking? Don't put a cigarette in your mouth. Problem solved.
Take the time to Intelligently stretch all muscle groups will dramatically decrease your rate of injury.
yes it takes time.
yes, a habit like smoking is hard to overcome.
but the remedy is there, in plain sight.
if everyone took even the smallest amount of preventative care around their health there wouldn't be a health care crisis.
Joints suffer, weaken and become succeptable to injury because the muscles supporting and connecting to the joint aren't flexible enough to accommodate whatever moment is being asked of them.
Most garden-variety knee problems originate from overly tight hamstrings.
Spend money you don't have you'll go into debt.
Work muscles that aren't flexible you'll injure your joints.
Lots of websites and services designed to help folks with their debt. Best way is to not get into debt in the first place.
Want a surefire way to stop smoking? Don't put a cigarette in your mouth. Problem solved.
Take the time to Intelligently stretch all muscle groups will dramatically decrease your rate of injury.
yes it takes time.
yes, a habit like smoking is hard to overcome.
but the remedy is there, in plain sight.
if everyone took even the smallest amount of preventative care around their health there wouldn't be a health care crisis.
75
Sorry, but I have knee problems (no ACL, ragged miniscus, osteoarthritis) and I do NOT have tight hamstrings. In fact a PT who helped somewhat with this said I was practically the only client she had had who did not need to stretch hamstrings. I am very flexible and can put my palms flat on the floor when I do a forward fold but will need a knee replacement soon anyway. I wonder if some tighter tendons might have kept things lined up better.
Not to worry - the years will get you in the end.
1
A few years ago, I had knee pain on the outside of both knees. I've been a yoga practitioner for decades, used to be a regular runner and tennis player. I'm over 50, so I thought, well, this is it. Bring out the knives.
Instead, I switched from my daytime flip-flops and flats to Birkenstocks. Goodbye, pain, hello, questionable (but oh, so comfortable) fashion choice. Knock wood and German engineering, I've been pain-free since. (Oh, and weight training helps - I've added that more regularly to my regimen, along with good ol' long walks.)
Instead, I switched from my daytime flip-flops and flats to Birkenstocks. Goodbye, pain, hello, questionable (but oh, so comfortable) fashion choice. Knock wood and German engineering, I've been pain-free since. (Oh, and weight training helps - I've added that more regularly to my regimen, along with good ol' long walks.)
107
I wear good running shoes, even in the office, and make sure they are replaced every three months. The low expense of wearing good shoes all the time pays back in spades. Broke my leg once mowing with "bald eagle" yard shoes. Saved a lot of money with worn out shoes after $10k in hospital bills didn't I?
2
I believe you G. A. Costa. Funny thing though, for me switching TO flip-flops and going barefoot did the trick. I used to wear the expensive type of clogs surgeons wear, and not just at work. My pain was on the inside one knee. Pain started about a year after starting to wear clogs and lasted the entire six years I wore them. I switched to flops and bare feet 20 years ago and have been pain free since.
All I know is it works for me. My left knee was buckling under me without warning. After the simple outpatient surgery, my knee was fine and has been for years. I don't avoid squatting or any activities for that matter. No one asked me to complete a survey, either!
10
Hard to say, really. I had the same problem, took a staff with me everywhere for years in case my knee gave way. Couldn't kneel down without a lot of pain. Then I started doing exercises based on what I had learnt at Feldenkrais classes years earlier - gentle, circular movements of the kneecap. First one way, then the other. It wasn't too long before something rolled under the sofa and i had no choice but to get down on my knees to retrieve the object. Surprise: no pain. I also realised my knee hadn't given way recently. That was about 10 years ago. Haven't had any problem since. I still do the kneecap exercises when I remember. Just gentle micro-movements.
5
Arthroscopic surgery provided no benefit whatsoever to me and it was only after the surgery that the surgeon "confessed" that it rarely helps patients who already have arthritis in the knee. I think that orthopods just have it in their DNA to cut, cut, cut!
15
You let them off too easily. This is all about making MONEY. Got it ?
The surgeon should have told you that BEFORE he/she operated. That should have been an integral part of the risks and benefits of the surgery that should have been discussed with you before you went under the knife. The failure to disclose the low likelihood that the surgery would help you before you submitted to it, with all the attendant risks, is malpractice.
Before committing to surgery, ask the surgeon if their plane is a single or twin engine model. That may tell you who really needs the surgery...
1
Who knows what is right? I had an extensive meniscectomy 25 yrs ago and ran another 20 yrs until a foot tendon did me in (and I switched to biking). After 40 yrs of running and 5 yrs of biking, my knees give me no trouble whatsoever.
The variable that no one wants to discuss is the skill of the surgeon. Mine was the surgeon for the FSU football and basketball teams. I think that mattered.
The variable that no one wants to discuss is the skill of the surgeon. Mine was the surgeon for the FSU football and basketball teams. I think that mattered.
23
Oh my FAVORITE studies are regarding arthroscopic surgery vs “sham” surgery.
At least seven good clinical studies have shown that patients receiving arthroscopic surgery to reach in via trochanters (BIG needles) to break up and vacuum out old torn cartilage, then flush out with saline VERSUS just making an incision then suturing the cut closed resulted in the SAME results!
https://www.painscience.com/biblio/fascinating-landmark-study-of-placebo...
Yet orthopedic surgeons STILL do the surgery! Most MDs aren’t true “scientists.” Medical school professors teach what THEY were taught and it goes on and on.
I just finished reading three different peer review journals on three different specialties where docs continued to do procedures that actually caused more harm than good.
One was placing stents in coronary arteries of patients who did NOT have chest pain. Stents were placed as it was found that one or more arteries had some occlusion...but not enough to deprive the heart of oxygen--which causes angina or chest pain. Study after study showed that there was no decrease in eventual cardiac death. (The ONLY time stents worked was if a patient presented with unrelenting angina.)
When cardiologists were asked “You’ve seen the research--so why do you continue placing stents in patients without symptoms?” They would just shrug and say “That’s what I’ve always done.”
Evidence based medical care is a century away!
At least seven good clinical studies have shown that patients receiving arthroscopic surgery to reach in via trochanters (BIG needles) to break up and vacuum out old torn cartilage, then flush out with saline VERSUS just making an incision then suturing the cut closed resulted in the SAME results!
https://www.painscience.com/biblio/fascinating-landmark-study-of-placebo...
Yet orthopedic surgeons STILL do the surgery! Most MDs aren’t true “scientists.” Medical school professors teach what THEY were taught and it goes on and on.
I just finished reading three different peer review journals on three different specialties where docs continued to do procedures that actually caused more harm than good.
One was placing stents in coronary arteries of patients who did NOT have chest pain. Stents were placed as it was found that one or more arteries had some occlusion...but not enough to deprive the heart of oxygen--which causes angina or chest pain. Study after study showed that there was no decrease in eventual cardiac death. (The ONLY time stents worked was if a patient presented with unrelenting angina.)
When cardiologists were asked “You’ve seen the research--so why do you continue placing stents in patients without symptoms?” They would just shrug and say “That’s what I’ve always done.”
Evidence based medical care is a century away!
99
Wasteful medical procedures? One entity's waste is another entity's revenue stream.
1
Speaking of peer review -- let's look at hyaluronic acid injections -- a heavily marketed product with no reliable evidence favoring it. There's a reason that professional societies do not recommend it. It's a moneymaker without value. Jane, you need to get someone to help you "vet" the studies you quote .. for instance the one from PLOS claiming that hyaluronate allows postponing of joint replacement. That study (2015) is another commercially-corrupted observational study which by definition cannot allow a conclusion, and whose specific design actually creates the false conclusion it wants to arrive at. A more proper interpretation is that the patients with more intense and incapacitating osteoarthritic symptoms went quickly to surgery, forestalling the years of useless hyaluronate dosing inflicted on those with lesser symptoms. Just because the latter patients had fewer surgeries doesn't at all mean that hyaluronate helped. It was just a marker for a class of patients. The only way to believably address this kind of issue is with a prospective randomized study .. and the answer is already known. As far as the programs of steroid injection and oral nonsteroidals or analgesics, the JAMA study mentioned failed to address the pertinent question which is how much greater was the physical dynamism, general fitness, and life task maintenance of treated patients - and whether the cartilage reduction seen was a marker of prolongation of successful use of already-failing joints.
1
“That’s what I’ve always done.” Wrong answer. "I am greedy and don't want my income to drop" is more akin to the truth.
Why, why WHY aren't doctors telling us exactly what Jane has just told us? I've had a few totally disinterested and/or incompetent doctors leaving me absolutely clueless. One began by saying, "Well, you only get so many miles." After telling another my degree of pain and lost activities, he ran through some of the thing's Jane mentioned. When I asked if any would relieve my condition, he shrugged. When I asked a third doctor if continuing jogging and basketball might cripple me in later years, he outright refused to comment. Jane, thanks for the hard truths!
10
Yup. My knees were injured when an unlicensed driver ran a stop sign and hit me on my bike when I was 20. I have had stage 4 arthritis ("the knees of an 80-year-old") since my early 30s. I finally had surgery to repair the meniscal tear in one knee from the car accident about a year after 9/11 -- I was standing so much that day that my knee swelled up the size of a melon and did not return to its normal size until a month later. My knee was much worse after the surgery and I was left with lingering weakness and instability even after physical therapy. I had a second emergency surgery a year later after another piece of something got stuck in my knee joint and I could not bend it. I saw a different physical therapist, who did not use weights but used an entirely Pilates based therapy regime. It worked wonders. Since then, I have seen other doctors and they have had no advice for me when my knees flare up except that eventually I will be old enough for total knee replacements. But, at 45, I am way too young, they say. On the other hand, on the several occasions when I have consulted physical therapists to help with my knee pain, they have always helped me tremendously. Basically, until you are ready to replace your knees, it seems that the best thing is to avoid doctors altogether and just keep up your knee exercises, occasionally seeing PTs for tweaking and new ideas. A good PT who keeps up with the research is an invaluable resource. Losing 20 lbs also helped.
4
I began to have serious knee pain in my left near the year I turned 50. When the pain became so severe I could not walk without limping I went to see an orthopedist who diagnose a torn meniscus and recommended arthroscopic surgery. Before the surgery he told me "too bad your meniscus is torn, you have the cartilage of a 25 year old". The surgery went well and after 6 weeks I was pain free and stayed that way for 3 years. At age 53 the pain came back and the MRI indicated more tearing in the meniscus. This time the surgery did not help and an x-ray showed that "the cartilage of a 25 year old" was completely gone and bone was resting (and rubbing) on bone. I had no choice but a total knee replacement if I was going to continue the activities I love (bike, climb, ski). The rehab from the replacement was very unpleasant but today I'm happy to say that I'm still hiking, climbing, biking, and skiing. But I do wonder: Would I still have all that cartilage instead of a knee full of metal and plastic if PT had been recommended instead of that initial arthroscopy? This article makes me think so...
38
Maybe if he'd quit playing tennis after the first scope he'd kept those knees longer.
7
@Hilda
I gather from your comment that you don’t participate in sports. For many of us playing tennis or golf or running IS life. It’s what we truly live for!
I guess if we all just NEVER played any impact sports such as jogging, tennis, etc then we would never have knee problems! For you that may seem the right thing to do.
But being physical EXTENDS our lives and makes our lives quite enjoyable. These knees are HIS knees. He is simply pointing out what research study after study show is that a specific type of surgery--arthroscopic surgery to remove torn cartilage in patients over a certain age- is useless.
I gather from your comment that you don’t participate in sports. For many of us playing tennis or golf or running IS life. It’s what we truly live for!
I guess if we all just NEVER played any impact sports such as jogging, tennis, etc then we would never have knee problems! For you that may seem the right thing to do.
But being physical EXTENDS our lives and makes our lives quite enjoyable. These knees are HIS knees. He is simply pointing out what research study after study show is that a specific type of surgery--arthroscopic surgery to remove torn cartilage in patients over a certain age- is useless.
17
I started my orthopedic residency in 1995. We had a monthly journal club where we met at a fairly expensive restaurant (paid for by pharmaceutical or joint replacement companies!) to discuss the articles in the latest orthopedic journals.
The article that generated the most buzz was a double blind study of patients with meniscal tears. Half the patients got the actual arthroscopic repair, the other half underwent the same general anesthesia and had the same surgical incisions but no actual arthroscopy. Double blind means neither the patients or the surgeons knew which patients were in which group. No difference was seen in the two groups. Some protested that the study was unethical by subjecting the placebo group to the risks of general anesthesia and infection. In retrospect the same could have justifiably been said about those getting the actual procedure.
Two decades plus, nothing has changed. Arthroscopy is the bread and butter for orthopedic surgeons. A general orthopedist might do a handful of knee replacements in a week while they do twenty scopes. The latter can be scheduled like a factory line, each scope taking less than half an hour to perform. Doesn't pay like a knee replacement but it's far less grueling on the surgeon (and the patient!). Far less likelihood of complications.
Nothing's changed in 2+ decades, don't hold your breath waiting for the ortho docs to give up their bread and butter!
The article that generated the most buzz was a double blind study of patients with meniscal tears. Half the patients got the actual arthroscopic repair, the other half underwent the same general anesthesia and had the same surgical incisions but no actual arthroscopy. Double blind means neither the patients or the surgeons knew which patients were in which group. No difference was seen in the two groups. Some protested that the study was unethical by subjecting the placebo group to the risks of general anesthesia and infection. In retrospect the same could have justifiably been said about those getting the actual procedure.
Two decades plus, nothing has changed. Arthroscopy is the bread and butter for orthopedic surgeons. A general orthopedist might do a handful of knee replacements in a week while they do twenty scopes. The latter can be scheduled like a factory line, each scope taking less than half an hour to perform. Doesn't pay like a knee replacement but it's far less grueling on the surgeon (and the patient!). Far less likelihood of complications.
Nothing's changed in 2+ decades, don't hold your breath waiting for the ortho docs to give up their bread and butter!
261
Wow! I certainly hope everyone was informed that they were going to undergo anesthesia and penetration of the skin, but may or may not have the meniscus repaired. This seems nothing like taking a pill that may or may not be a placebo!
Not "bread and butter." In the attorney world, we call this "fraud." Of course, because they are well-educated whites, the get Mercedes, instead of prison time and records...
2
Yes, even when it has been proven not to work. Reprehensible.
2
Not to get off topic, but we have been complaining that people who were not dieting and exercising properly have been increasing our health care costs by getting diabetes, hypertension and related ailments. But it looks like some of these folks who are playing Tennis, Basketball, swimming, jogging, hiking into their '80s are also the culprits in raising our healthcare costs.
So it is the few who take good care of their diet, their waistlines and their joints who are getting totally scammed by the health insurance system. Huh? Who would have thunk it???
So it is the few who take good care of their diet, their waistlines and their joints who are getting totally scammed by the health insurance system. Huh? Who would have thunk it???
15
Not quite. There's no evidence that runners (or the more active, generally) develop osteoarthritis issues at higher rates than non-active folks. In fact, it may be the opposite. According to a separate NY Times article, "Running May be Good for your Knees:" "Epidemiological studies of long-term runners show that they generally are less likely to develop osteoarthritis in the knees than people of the same age who do not run."
That said, I agree that is silly and unproductive to point fingers at the less-active, or those with higher BMIs, and try to scapegoat them for higher healthcare costs.
That said, I agree that is silly and unproductive to point fingers at the less-active, or those with higher BMIs, and try to scapegoat them for higher healthcare costs.
16
And there are those of us with a family history of arthritis on both sides...didn't ask for it, don't want it, still got it despite efforts to keep it at bay!
24
And there are some like the poster above, self righteously taking care of himself and willing to impugn others for not doing so, who may still unexpectedly, for a host of reasons, develop a costly, life threatening, or life impairing condition, in the light of which my 60,000 two day hospital stay cost for knee replacement will pale in comparison.
3
I tore a meniscus in my knee about 25 years ago. I visited a Yale-trained orthopedic surgeon at the Hospital for Special Surgery who immediately told me I'd need surgery. I was leaning toward doing it until he told me there would be five operating rooms set up and he'd move from one to another. At that point I said no, I didn't want to be part of his assembly line. Six months later I was running again without surgery. A friend of mine was told 40 years ago that removing both menisci would be no problem - 15 years later he had to have both knees replaced. Lesson: for meniscus tears avoid surgery.
9
I had patellar tendinitis for a long time. There is a guy in Germany who has a book on the subject. I followed his exercises and advice. No more patellar tendinitis. Total cost of about $20.
14
What is the title of the Germany published book you referred to? Thank you.
9
Beating Patellar Tendonitis, by Martin Koban. He has many stretches and exercises that are very effective.
Would you please share the title of the book?
1
Absolutely and totally stay away from arthroscopic surgery to repair miniscus tears. I lost all of my cartilage from that--and others with the same surgeon had the same result. I was in excellent health at the time and had never had a knee problem of any kind. Just put it in a soft brace and stop exercising for a month. Really. For many people, the idea of not exercising for a month is unthinkable. but I think that is the only solution.
18
The SAD (Standard American Diet), loaded with meat, dairy, eggs, sugar and fat is inflammatory. Inflammation contributes to arthritis. Just sayin'.
10
Just sayin', 20 years ago I had arthroscopic surgery for a meniscus tear that had been bothering me for the previous eight years. Best health care decision I ever made. I am a 53 year old gym rat and my knee gives me less trouble than any other body part.
14
partial meniscectomy, both sides different years, one of the best things ever happened to me, first one is 3 years out from surgery. Recreational athlete around 50 yrs old. Knees like new. So thankful this technology is here. Though I'm biased and agree with getting educated and having common sense about things, I do not feel this article is useful.
6
As a practicing othopaedist for 15 years I can tell you the hardest thing is to decide who and who not to do what treatment on what knee. Sometimes the osteoarthritis is no very obvious on the X-rays and mri and when u get in their knee there IS a meniscus tear (which in isolation is very amenable to surgical correction) AND arthritis. I agree some docs do scope way too many knees. Sometimes people will never go for knee replacement but are happy to go for something less invasive. The gel lubricant injections and corticosteroid injections do have some efficacy but the same thing doesn't always work for different patients.
I believe in the 90/10 rule of people. 90%of people want and do the right thing 10% don't. Medical care is a team effort between doctor and patient. There is still too much of the "this is what I always do" attitude, but some of the studies quoted in this article were not done by surgeons, which leads to an inherent bias against surgical intervention.
I believe in the 90/10 rule of people. 90%of people want and do the right thing 10% don't. Medical care is a team effort between doctor and patient. There is still too much of the "this is what I always do" attitude, but some of the studies quoted in this article were not done by surgeons, which leads to an inherent bias against surgical intervention.
8
You might well be experiencing the placebo effect. There is interesting research that the brain triggers the body to begin healing processes when it *thinks* it has received treatment even if the treatment itself objectively does nothing useful.
My frustration is when the knee doctor says that the x-rays don't support he level of pain which I describe. Last night I awoke with excruciating knee pain in both legs. Wonder if I could get a home x-ray for those moments?
6
Have them check your hips. Many times hip disease masquerades as knee pain. I have seen people who had their knees operated on (unsuccessfully) when the problem was in the hip.
58
Many studies have shown that imaging does not correlate well with pain except when there is severe arthritic changes. Much joint pain is from the soft tissues around the joint and will not show on radiographs and often not on advanced imaging.
I do not understand why so many orthos do not know or understand this information. Not like it is brand new.
I do not understand why so many orthos do not know or understand this information. Not like it is brand new.
11
Here is the article I mentioned in my earlier comment, although I don't know if the NYT screener will post it.
"Conclusions. Knee pain, stiffness, and duration of disease may affect the level of disability in the patients with knee OA. Therefore treatment of knee OA could be planned according to the clinical features and functional status instead of radiological findings."
https://www.hindawi.com/journals/arthritis/2012/984060/
"Conclusions. Knee pain, stiffness, and duration of disease may affect the level of disability in the patients with knee OA. Therefore treatment of knee OA could be planned according to the clinical features and functional status instead of radiological findings."
https://www.hindawi.com/journals/arthritis/2012/984060/
Another somewhat odd and imbalanced and oddly headlined story. The things to try, as any really savvy ortho and really savv PT will (and do) tell you, are serious strength work (VMO and more, calves too), stretching, getting flapped / catching meniscal tears smoothed as necessary, giving several months of gluco-chondro a try, nsaids absolutely, icing (no mention of that either), realigning bracing (this too can be v helpful), weight loss as possible, and finally 'chicken oil' injections (hyaluronic), repeating as efficacious. Standard and well-known approaches, and have been for years. No more, and no less.
12
Instead of glucomamine supplements, I discovered polysulfatedglycosaminoglycan...it is fantastic, reduces inflammation, slows the progression of OA, attracts fluid to the knee joint within an hour of an intramuscuscular injection! Oh, yeah, there's a catch! Though a drug in Europe for decades, here in the U.S., only our dogs and horses get it! If you can get it, it is a lifesaver!
Why not just get the knee replacement in the beginning and be done with it?
3
a) Because not all knee replacements work....when they go bad they go very, very bad
b) Knee replacements eventually wear out.
b) Knee replacements eventually wear out.
22
Risk vs Reward. If arthroscopy will buy you 20 years, take it. If you go directly for replacement, what option will you have in 20 years? Another replacement? Compare the physical and financial cost of the two procedures and the answer will become clearer. Cheers.
5
Two very good points Gary. Surgical complications can be very serious and disabling, and second knee replacements have a much higher complication rate.
11
first do no harm
5
After reading all the comments regarding treatment of degenerative O.A and/or soft tissue injury of the knee, I am still surprised by Ms. Brody's advice to take NSAIDs. I can understand using them over the short term ( i.e.: 2-4 weeks). However, what she doesn't tell you is just as it is with long-term use of steroids, the prolonged use of NSAIDs will also cause rapid deterioration of what ever remaining cartilage is still there. Of course, that may the least of your problems, considering that long term use also is the #3 cause of renal failure, significantly causes liver damage, and of course, causes gastric distress.
The other problem is that even if Rx intervention works, you will probably cause more damage if you continue to do your physical activities as you always do. No pain, no gain should really be no pain, no brain.
One method is to analyze the biomechanics of the lower extremity from the pelvis to the feet. Orthotics could be useful if there is a chronic biomechanical imbalance that is causing the knee to compensate. Pelvic imbalance could also be the cause, with knee pain and O.A being the symptom.
Exercise is fine, but make sure you have a wholistic biomechanical diagnostic work-up before pursuing more radical treatment.
The other problem is that even if Rx intervention works, you will probably cause more damage if you continue to do your physical activities as you always do. No pain, no gain should really be no pain, no brain.
One method is to analyze the biomechanics of the lower extremity from the pelvis to the feet. Orthotics could be useful if there is a chronic biomechanical imbalance that is causing the knee to compensate. Pelvic imbalance could also be the cause, with knee pain and O.A being the symptom.
Exercise is fine, but make sure you have a wholistic biomechanical diagnostic work-up before pursuing more radical treatment.
47
I know that chiropractors like to sell expensive orthotics, but I thought there was a lot of good peer-reviewed research out there, including a massive Army study, that orthotics not only don't work but often do more harm than good.
1
I am wary of advice from a practitioner who can't spell "holistic". More significantly, concerns about NSAIDs and articular cartilage in the reviewed literature are more than 10 years old. Where is the recent evidence?
1
At 30 I listened to an orthopedic surgeon who said if I kept jogging I would be coming to him for knee replacement surgery. So I stopped. Recently I had minor tears of my meniscus on the right side and went through 7 weeks of physical therapy AND ACUPUNCTURE, which was not mentioned in the article. Because the meniscus had no innervation nor vascular supply I knew that I needed to do something to improve my chances of success. I am walking 3-7 miles per day. Unlike many of my peers I will not have knee replacement surgery. In an article in What Doctors Won't Tell You they reviewed many of the knee ailments and noted that physical therapy to realign the muscles would prevent many from undergoing surgery. So take a lot of what you read in this article lightly and read and google and watch some youtube.com films on knees and knee ailments.
8
I agree with the person who recommended early intervention for flat feet. My doctor told me when I was 22 that I had flat feet and I needed to wear decent shoes, and get orthotics, but I was 22 and stupid and I ignored the advice since the temporary pain I was being treated for subsided. Now I'm 51 and I finally got good orthotics and it has made a world of difference - finally I walk in alignment and so much pain that had started has gone away.
Also, I tore my meniscus when I was 38 and I went to a specialist who said that it would only get better with arthroscopic surgery. I asked how trimming the torn meniscus would "fix" my knee and he couldn't tell me (and he was really annoyed that I kept asking after he said essentially, I'm an expert and I say this is what you need). So, I refused the surgery, the knee got back to 90% on its own - I can't rollerblade anymore but I can do every other thing that I did before. When the studies came out recently that showed little difference between arthroscopic surgery and not with meniscus injuries, I felt vindicated....
Also, I tore my meniscus when I was 38 and I went to a specialist who said that it would only get better with arthroscopic surgery. I asked how trimming the torn meniscus would "fix" my knee and he couldn't tell me (and he was really annoyed that I kept asking after he said essentially, I'm an expert and I say this is what you need). So, I refused the surgery, the knee got back to 90% on its own - I can't rollerblade anymore but I can do every other thing that I did before. When the studies came out recently that showed little difference between arthroscopic surgery and not with meniscus injuries, I felt vindicated....
5
Sixteen years ago, I had both knees replaced with 6 months between surgeries. Within 4 days I was able to walk up stairs easily. I had amazing recoveries both times with just minimum of PT. My advice to anyone with the bone on bone diagnosis: don't wait too long( though you will be advised to) after diagnosis, otherwise your muscles, and tendons will be twisted and stressed and recovery will be longer and more painful. Get it done, and start living fully again!
8
and EXERCISE however you can before the replacement. I found I could still do the cross-trainer at the gym, even though I could barely walk. PT was surprised by how good my muscles were immediately post-op and how quickly I improved, though not as impressively as you recovered.
2
I keep seeing these articles. I've had both my knees scoped for small to moderate meniscal tears. I am totally pleased with both surgeries, one about 10 years ago and the other 6. Before the surgeries my knees clicked and caught and were painful. I now play aggressive singles tennis a couple of times a week and have no knee pain whatsoever. I'm 56.
4
Why no mention of using a gym to strengthen knees?
There are machines with a bar where you can push down or pull up with your ankles, thereby making the knee area stronger.
Also, there are ankle weights you can use at home sitting on a chair
I would think this is a first-line of defense before medical intervention. It certainly is working for me.
There are machines with a bar where you can push down or pull up with your ankles, thereby making the knee area stronger.
Also, there are ankle weights you can use at home sitting on a chair
I would think this is a first-line of defense before medical intervention. It certainly is working for me.
6
Shoes make a difference. My knees became seriously unhappy for weeks from a new pair (no not heels, no not extreme, practical and well made). Gone and the knees are back to being fine. Finding the right pair of shoes is another story and the expense of failures adds up quickly.
8
@poslug: You are on to something important that isn't very much talked about. And you're right that the expense of failures (and time spent shopping) adds up quickly.
1
Save your money and buy the book "Treat Your Own Knees." Changed my life. Short version: You must strengthen your hips, quads, hamstrings, and calves. Knee pain isn't always about the knees.
213
Several books out there with that title. Who is the author?
2
Flip - There are several books by that title. Which one did you find useful? - (author, please)
This has not been my experience. After a lifetime of playing basketball - the early portion of which was in the Converse canvass high tops era when real basketball shoes with any kind of support had not yet been invented - my left knee finally gave out. At age 51 I underwent arthroscopic surgery for a torn meniscus. In actuality it turned out to be that plus a lot of missing cartilage and bone on bone. As my doctor had predicted, it took about 3 years before I felt that the surgery had been the right call. It was at that point that my knee felt pretty normal and I could do a catcher's squat again. I had no injections of either steroids or substances designed to mimic cartilage. I'm now 14 years post-surgery and sometimes I have to remind myself which knee it was. Now admittedly, I followed my doctor's advice and gave up my beloved basketball (as well as running) and I did weights to strengthen the knee. Giving up basketball was hard. I was one of those guys who played 5 on 5 full court for 2 to 3 hours one night a week and otherwise carried my basketball and shoes in the car for the random pick up game. I understand that people have a similar passion for tennis but you can't reasonably expect to subject compromised knees to that type of pounding and sudden starts and stops and not expect to pay the price. Life goes on. I still hike, ski, and I'm an avid cyclist, all of which are relatively knee friendly. So, I would have to say my arthroscopic knee surgery was a success.
5
As someone who had the meniscal tear on my right knee "fixed" (at which time the doc noted the extensive arthritis in that knee) and who has left the meniscal tear in my left knee "unfixed" except for physical therapy with no surgery (and hence am familiar with treatment of the condition both with and with out surgery), is it possible that the improvement in your knee might have had more to do with the strength conditioning work that you added to your regime more than the surgery?
" If you are overweight, lose weight."
Why not just suggest "If you have knee pain, don't have knee pain?"
Why not just suggest "If you have knee pain, don't have knee pain?"
22
Honestly, losing 20 lbs did wonders to alleviate my arthritis pain. But it took starting a physical therapy program to find ways to exercise that didn't hurt my joints. Before then, it hurt too much to exercise. And it was being able to exercise that caused me to lose the weight. It all was a wonderful, unplanned for benefit of 3 months of PT, without dieting. So it's not really a silly suggestion, but one that is easier if done in conjunction with a bigger plan, including exercise.
3
I personally like "if you are poor....just earn more and spend less, and you'll get rich".
1
i have residual right hemiparesis since 5/87, walk with a cane and a quite severe recurvata. i kept in practice my daily pt routine from rusk, plus i went to the gym 3x wk and went horseback riding 2x wk [down from 3x wk]. then i tore and shredded the right knee's meniscus in 6/2001 getting up from the garden. the knee swelled up like a honeydew melon and my md at the time prescribed water pills. found a new md.
i went to see my dr at rusk who referred me to a surgeon who made my skin crawl - when a dr takes your films out of the exam room to review instead of going over them with you, this is not only bad practice, but fear on the dr's part. i immediately collected my info and called my dr for another surgeon, who was the head of orthopaedics at nyu. we reviewed my info together and agreed on maintaining pt, riding, and an op date.
so since 4/2002's arthroscopy, and follow-up pt [i could no longer afford to ride] i have a pain-free knee. do not discount this route!
i went to see my dr at rusk who referred me to a surgeon who made my skin crawl - when a dr takes your films out of the exam room to review instead of going over them with you, this is not only bad practice, but fear on the dr's part. i immediately collected my info and called my dr for another surgeon, who was the head of orthopaedics at nyu. we reviewed my info together and agreed on maintaining pt, riding, and an op date.
so since 4/2002's arthroscopy, and follow-up pt [i could no longer afford to ride] i have a pain-free knee. do not discount this route!
2
Words of wisdom from my Dad who died just before his 95th b'day: "Getting old is not for wusses."
Or, as attributed to GB Shaw: "What a shame it is to waste youth on the young."
Or, as attributed to GB Shaw: "What a shame it is to waste youth on the young."
6
Glucosamine chondroitin tablets daily did it for me. It's been 15 years now. Probably costs me about $30 a year.
5
Another intervention with the same outcome as a placebo.
6
This a reply to the reply from moi about the purported placebo effect. This may not work for everybody but it worked for me.
My doctor made the suggestion when my knees started clicking 15 years ago. After three months of the glucosamine the clicking went away. I stopped taking the glucosamine after a while and the clicking started to come back. I started taking the glucosamine again immediately and the clicking stopped. And it has never returned. Like I said - worked for me.
My doctor made the suggestion when my knees started clicking 15 years ago. After three months of the glucosamine the clicking went away. I stopped taking the glucosamine after a while and the clicking started to come back. I started taking the glucosamine again immediately and the clicking stopped. And it has never returned. Like I said - worked for me.
1
In my twenties I tore up my knees skiing. I had no major accidents, I just got arthritis from the steady pounding repetitive stress injury of free-style skiing. I haven't skied in decades but otherwise live a normal life. And I'm a happy knee-pain-free glucosamine user.
For the past 28 years, people have told me it's the placebo effect. But when I stop taking the glucosamine, the pain returns within two weeks. Long live the placebo effect!
For the past 28 years, people have told me it's the placebo effect. But when I stop taking the glucosamine, the pain returns within two weeks. Long live the placebo effect!
1
Umm. PT therapy is a mixed bag, and depends very much on the therapist. Almost all studies of PT exercises recommended for relieving knee are underpowered (looking at 30 people or less, for example). Moreover, they are typically not stratified by age, and, well,... the researchers seem to be more focused on prime age athletes rather than those of us who are 50+ and still trying to run, play soccer, tennis, and such.
Regarding the individual PT, most apply cookie-cutter reasoning. A common disorder such as runners' knee (thought to be a mistracking patella) gets a one-size fits all set of exercises in response, without much regard to the person's physique, lifestyle, other exercise activities, and so on. Little is done to test individual muscle strength, sitting tension/flaccidity, etc. - the kind of individualized analysis that is most likely to be useful in identifying the imbalance that underlies the problem. Most PTs have their favorite single cause hypothesis of what causes the problem in all cases, rather than a nuanced approach that recognizes that the cause will differ from person to person and from age group to age group.
In sum, PTs are also quite often an expensive boondoggle whose only empirical basis tends to be, simply, that they get people to exercise more muscle groups than before, with inevitable benefits. Other than that crude beneficial response, they have as much evidence supporting their work, and are as enamored of the latest fad as your surgeon is.
Regarding the individual PT, most apply cookie-cutter reasoning. A common disorder such as runners' knee (thought to be a mistracking patella) gets a one-size fits all set of exercises in response, without much regard to the person's physique, lifestyle, other exercise activities, and so on. Little is done to test individual muscle strength, sitting tension/flaccidity, etc. - the kind of individualized analysis that is most likely to be useful in identifying the imbalance that underlies the problem. Most PTs have their favorite single cause hypothesis of what causes the problem in all cases, rather than a nuanced approach that recognizes that the cause will differ from person to person and from age group to age group.
In sum, PTs are also quite often an expensive boondoggle whose only empirical basis tends to be, simply, that they get people to exercise more muscle groups than before, with inevitable benefits. Other than that crude beneficial response, they have as much evidence supporting their work, and are as enamored of the latest fad as your surgeon is.
19
Please do not give misinformation to people on this important topic.
The 2015 Cochrane review of exercise for knee osteoarthritis (OA) concludes that "High-quality evidence indicates that land-based therapeutic exercise provides short-term benefit that is sustained for at least two to six months after cessation of formal treatment in terms of reduced knee pain". It is comparable to estimates reported for non-steroidal anti-inflammatory drugs.
http://www.cochrane.org/CD004376/MUSKEL_exercise-for-osteoarthritis-of-t...
The 2014 Osteoarthritis Research Society International (OARSI) guidelines for knee osteoarthritis (OA) are developed by the world's leading OA researchers. They state that the level of evidence for physical therapy is good across strengthening, land and water based exercises.
https://www.oarsi.org/education/oarsi-guidelines
Finding a good physical therapist who can create a tailored exercise program for you is key. You can ask them to show you the evidence for what they're prescribing.
The 2015 Cochrane review of exercise for knee osteoarthritis (OA) concludes that "High-quality evidence indicates that land-based therapeutic exercise provides short-term benefit that is sustained for at least two to six months after cessation of formal treatment in terms of reduced knee pain". It is comparable to estimates reported for non-steroidal anti-inflammatory drugs.
http://www.cochrane.org/CD004376/MUSKEL_exercise-for-osteoarthritis-of-t...
The 2014 Osteoarthritis Research Society International (OARSI) guidelines for knee osteoarthritis (OA) are developed by the world's leading OA researchers. They state that the level of evidence for physical therapy is good across strengthening, land and water based exercises.
https://www.oarsi.org/education/oarsi-guidelines
Finding a good physical therapist who can create a tailored exercise program for you is key. You can ask them to show you the evidence for what they're prescribing.
1
My PT has been very helpful with manual tgerapy to mobilize the knee. She has continually adjusted the treatment for my current fitness level and other life factors. She has been very motivating even though I am in my sixties and she is in her twenties. I think it depends on the PT.
Agree that you need to find a good PT. I have had 4 different PTs over the years. The first one applied what in retrospect was a cookie cutter approach and the exercises really did not help much. The other 3 have been amazing and helped me immensely, including the shoulder guy (who was the PT for the Australian swimming team and accompanied them to several Olympics) who taught me the exercises that fixed a year long shoulder injury (I could not raise my arm above chest height without shooting pain) in a week. So I would not be so negative on PT, but I *would* advise people not to stick with a particular therapist if they are not noticing significant improvement after a couple of weeks. Personally, I found that PT that relied on weight machines (the first PT's mode of choice) was much less useful than PT that forced me to work against my own body weight, often with a balance component.
1
A project in Finland a few years ago convinced me not to have the recommended laparoscopic surgery for my torn medial knee meniscus.
Two groups were treated - one with real surgery and the other with sham surgery. Sham or fake surgery can be extremely helpful but is not allowed in the US. In the sham surgical group - 3 appropriately holes were made in the knee and then sutured closed without any surgical treatment. The other group received the indicated surgery.
Both groups received the same physical therapy and were followed for several years. The results showed that some knees got better, some stayed the same and some got worse. The conclusion was that meniscal surgery acted as a placebo at best, and should not be recommended.
Arthroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative Meniscal Tear
Raine Sihvonen, M.D., Mika Paavola, M.D., Ph.D., Antti Malmivaara, M.D., Ph.D., Ari Itälä, M.D., Ph.D., Antti Joukainen, M.D., Ph.D., Heikki Nurmi, M.D., Juha Kalske, M.D., and Teppo L.N. Järvinen, M.D., Ph.D., for the Finnish Degenerative Meniscal Lesion Study (FIDELITY) Group
N Engl J Med 2013; 369:2515-2524December 26, 2013DOI: 10.1056/NEJMoa1305189
Two groups were treated - one with real surgery and the other with sham surgery. Sham or fake surgery can be extremely helpful but is not allowed in the US. In the sham surgical group - 3 appropriately holes were made in the knee and then sutured closed without any surgical treatment. The other group received the indicated surgery.
Both groups received the same physical therapy and were followed for several years. The results showed that some knees got better, some stayed the same and some got worse. The conclusion was that meniscal surgery acted as a placebo at best, and should not be recommended.
Arthroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative Meniscal Tear
Raine Sihvonen, M.D., Mika Paavola, M.D., Ph.D., Antti Malmivaara, M.D., Ph.D., Ari Itälä, M.D., Ph.D., Antti Joukainen, M.D., Ph.D., Heikki Nurmi, M.D., Juha Kalske, M.D., and Teppo L.N. Järvinen, M.D., Ph.D., for the Finnish Degenerative Meniscal Lesion Study (FIDELITY) Group
N Engl J Med 2013; 369:2515-2524December 26, 2013DOI: 10.1056/NEJMoa1305189
6
I don't care so much about the results as what deplorably unethical behavior on the part of the researchers! what the heck is wrong with these Finnish doctors?
I have had a sports doctor and a vet, both of whom told me that x-ray evidence of arthritis does not necessarily correlate with pain. My dog and I have run together for nine years. Both of us are in our 60's in people years. I had a cortisone shot for my knee pain. My dog takes glucosamine. My knee pain magically went away ia day after my shot and never came back. The dog has good days and bad ones. Overall we run half as much as when we were younger. Running less has kept us running. The vet said that running helps keep the pain away but too much is destructive. I don't know, I'm not a doctor. Bu that makes sense to me.
4
If you can get it (you may have to find a Canadian vet or pharmacy), you might want to try your dog on Cartrophen (NOT CarPROfen), or Pentosan. One of the very few disease modifying osteoarthritic drugs (DMOADs), this polysulfonated glycosaminoglycan actually helps cartilage to repair itself.
It works very well in small animals and also in race horses (whose legs and knees are far more valuable than mine). It is also effective in human osteoarthritis and is safe, and is therefore used in Australia and Europe, but will never be approved in the US for this indication (it IS approved for bladder conditions) because it is VERY cheap and therefore no one could afford the FDA's required studies to "prove" its effectiveness in humans for this indication here. Never mind that dogs and horses are the animal model used to test drugs for effectiveness of osteoarthritis treatments.
It works very well in small animals and also in race horses (whose legs and knees are far more valuable than mine). It is also effective in human osteoarthritis and is safe, and is therefore used in Australia and Europe, but will never be approved in the US for this indication (it IS approved for bladder conditions) because it is VERY cheap and therefore no one could afford the FDA's required studies to "prove" its effectiveness in humans for this indication here. Never mind that dogs and horses are the animal model used to test drugs for effectiveness of osteoarthritis treatments.
As noted previously, insurance coverage and required approvals can make treatment choices and timing moot. I had to wait 3 years for knee replacement surgery until it could be documented that the arthroscopic surgery, subsequent shots, and oral pain medication were all ineffective.
6
I always read your articles with great interest and have learned much from your research and comments. In response to this article, I would like to offer my own successful outcome with arthroscopic knee surgery nearly three years ago. I was almost 69 at the time and had been a runner (completed several marathons) since my early thirties. I had also been a very active gardener for nearly twenty years. I believe perhaps these activities might have contributed to the meniscus tear in my right knee. After the surgery, September, 2014, I had three months of superb physical therapy at the same facility which houses the surgeons' offices. My PT was overseen by my surgeon who is world famous for his cutting edge work in knee surgeries. Since my PT ended, I have continued with long term strength training two or three times a week. Although my surgeon did advise me that I would probably need a knee replacement within the next ten years following the meniscus surgery, I am happy to report that I rarely feel any pain or discomfort in my right knee. Strength training, regular walking and spin classes really help. If I am not active for a few days, I begin to feel the usual stiffness associated with OA. I've just returned from a trip to Boston, Cape Cod and New York City where I spent many hours each day walking and cycling. I was grateful that I had no pain, fatigue or discomfort at all with my knee. I agree with Mr. Allaway's comments!
1
thought i had a meniscus tear but it was degenerative cartilage loss and arthritis. My mom told me she had same knee issues when she was my age. three things i have been doing: 1) lifting weights. Leg lifts. build up that muscle around the joints. I had given up weight work for many years, running immediately onto tennis court or paddle court, not spending any time in weight room; 2) biking; and 3) gave up paddle (or platform) tennis.
3
While the data do seem to suggest that PT benefits many people with a torn meniscus what is left out of your argument is the fact that the success of arthroscopic surgery is to some extent dependent on the amount of arthritis that is present. I had months of PT for a torn meniscus with no relief and then had a renowned surgeon at HFSS do arthroscopic surgery,which he was only willing to do because of the minimal presence of arthritis. Four years later at 76, I'm still enjoying pain free use of that knee,
1
This article makes no mention of PRP or platelet-rich plasma injections, which is said to contain growth factors and anti-inflammatory substances in it. PRP is also being used in sports injuries these days. PRP is prepared from autologous blood and is not that expensive. Some researchers consider it to be promising, but more data needs to be acquired before a definitive conclusion is drawn.
2
Three skiing injuries? Skiing is not something the knee was meant to do.
3
I hope you keep writing. Over the years of my medical practice from 1980-2016 I used many of your articles as teaching aids to emphasize about what I was advising my patients. On this particular topic I recall using your article re your experience about double knee replacement when my patients asked me for my advice about the procedure their orthopedist had recommended. It was so useful that I started giving it to my patients when I would be referring them for their advanced knee arthritis to the orthopedist to discuss replacements.I only wish what you wrote today could have been written back then as I along a number of other general internists had long been skeptical of the value of corticosteroid injections. Two aphorisms seem apt. Don't be the first doctor to embrace a new therapy or the last to abandon about old one. And, surgery is dangerous; medicine, useless; God, merciful.
9
While it took little to no evidence to introduce the widespread use of these ineffective or harmful procedures, the existence of compelling evidence that would suggest ceasing with such practices immediately will have little to no effect on what actually happens in clinical practice. So it goes in U.S. medicine.
4
Guess I'm one of the lucky one ... or is it just that I had a terrific surgeon? (Dr. Answorth Allen of Hospital for Special Surgery)
First torn meniscus followed up with Sinvisc at age 64 and the same on my other knee two years later put me back in great shape.
Ten years later, once in a blue moon my knees will give me trouble, but that soon passes and I'm like new again.
I would do it all over again if necessary. Physical therapy is very important too but by itself would not have solved the problem. Everyone is different so explore and look at your choices carefully.
First torn meniscus followed up with Sinvisc at age 64 and the same on my other knee two years later put me back in great shape.
Ten years later, once in a blue moon my knees will give me trouble, but that soon passes and I'm like new again.
I would do it all over again if necessary. Physical therapy is very important too but by itself would not have solved the problem. Everyone is different so explore and look at your choices carefully.
2
one thing not addressed in this article is that knee replacements do wear out, so deciding when to have knee surgery may be related to projected longevity and the increased risks of surgery as one ages. effective delay may be a viable plan in some cases.
4
Hyaluronic acid is shown to be no better than a placebo in meta studies - this is the exact reason why national health plans like those in Canada and the UK do not allow this procedure.
If it actually worked and could put-off more expensive replacement surgery both of those national health plans would recommend it.
It is "wishful thinking".
The low cost solution that I follow echo those of the author about maintaining weight and regular 10K steps/day brisk walks - I have found that Capsaicin Cream works for me - your mileage may vary.
If it actually worked and could put-off more expensive replacement surgery both of those national health plans would recommend it.
It is "wishful thinking".
The low cost solution that I follow echo those of the author about maintaining weight and regular 10K steps/day brisk walks - I have found that Capsaicin Cream works for me - your mileage may vary.
9
@Steve: Those "meta studies" have not met my knees, which have benefited greatly from 14 years of Hyaluronic acid injections. For me, it HAS worked and has allowed me to postpone knee replacement surgery. Is 14 years of relief just "wishful thinking" on my part? I don't think so!
2
My knee pain is abated by a simple exercise using one of the lime green stretch elastics commonly seen in exercise facilities.
Fold the elastic and put it under your foot whie sitting. Do about 60 slow reps( after a build up period) every morning upon rising and sometimes later in the day depending on how one feels. Arms, shoulders tri and biceps get beneficial exercise. While at it use the elastic for curls after. Mimimal time and maximum benefit. Win...Win..
Fold the elastic and put it under your foot whie sitting. Do about 60 slow reps( after a build up period) every morning upon rising and sometimes later in the day depending on how one feels. Arms, shoulders tri and biceps get beneficial exercise. While at it use the elastic for curls after. Mimimal time and maximum benefit. Win...Win..
4
My knees began to show signs of age about 15 years ago (I am now 81). I danced all my life so I was quite active. I know that hardly anyone reading this comment will put any validity into my story, however, I was advised by an acquaintance to coat my knees with rosemary oil that I could purchase at the health food store among the essential oils section. I began using this oil and within a month, the pain subsided. Every so often, I would again use this oil and again gain relief. I haven't had to use it for quite some time now but keep it on hand just in case. I have mentioned this to friends and a few doctors since having such relief for my knees and receive blank stares in return for this information. Just thought I would pass this on.
17
I worry about the advice presented at the end regarding medications "If the pain is bad enough, take an over-the-counter pain reliever like acetaminophen (Tylenol and others) or an NSAID (nonsteroidal anti-inflammatory drug) like ibuprofen or naproxen." Every medication has risks, and I see patients all the time in clinic who think it is safe to take NSAIDs daily and chronically because it is over the counter, but then develop renal disease, gastric ulcers, elevated blood pressure, among others. It is particularly dangerous for older adults with chronic diseases. Please add that NSAIDs are only to be taken for a short term basis (NOT CHRONICALLY) and patients should discuss with their providers. What is written here is potentially dangerous because people will think it is ok to take NSAIDs all the time.
14
Me and my knees have had several injuries over the years, with good insurance and lousy insurance, rest and an ACE bandage vs. arthroscopic surgery. After the quick surgery, I saw a sports-oriented PT who worked me very hard, and said strengthening the area was the best possible treatment. Either you take PT seriously (and find a different PT or pay for extra sessions if needed), or a simple problem can turn into loss of mobility. It's difficult to build strength, but much more difficult to hobble! Knowing what I do now, I might have tried PT first.
I tried Synvisc hoping for some relief as suggested by the doctor and found none at all. My doctor (not an orthopedic surgeon) did not warn me that my orthopedic surgeon would tell me that total knee replacement cannot be done for three months after the injection! I had to wait through three months more of pain and another fall from my unstable knee joint. Maybe this experience could help someone else with this problem of figuring out exactly when the right time is to replace the knee joint.
2
A little caution is warranted regarding the use of over-the-counter pain relievers. Extended use of acetaminophen can (and will) cause liver damage, and extended use of NSAIDs generally runs the risk of causing stomach bleeding. Over-the-counter does not equal safe, and these drugs should most definitely not be part of your daily regimen.
14
Thanks for sharing your personal experience and helpful studies. It's important to remember that these evidence based studies should guide what type of care will work with most of us, that there are cases that arthroscopic surgery can be helpful. I am a Physical Therapist and hope that most have a better experience with PT then what the comments that Catherine made indicate. I recommend looking at the APTA's site for a therapist that is a orthopedic specialist (the initials "OCS")or has manual therapy training and make sure that you tell them ahead of time your preference that you want to would like to have a good evaluation and to be seen for follow up visits to up-date your home exercise program. A good PT will be able to explain and justify their plan of care.
1
I too had knee pain that was in my mind pretty significant. This last time was during my 73rd year. Some years prior to this incident, I had the same thing in the other knee. I did do physical therapy. The orthopedist also prescribed a knee brace. What a bad idea. I did the physical therapy, but I also wrapped my knee with ace bandages and that stabilized my knee much better than the knee brace. I am lucky that I do not have arthritis in my knees, but I now know that when the knee flares up again, it's back to the ace bandage.
1
When will the NYT write about the brain, nervous system, and muscles in regards to muscle and joint pain? After 4 knee surgeries and multiple overtraining injuries during my professional dance career, at 45 I couldn't sit on my knees due to pain. Stretching, PT, massage - nothing worked to get rid of my pain. I am now 60 with no knee pain or arthritis. This is NOT luck. What I learned isn't written about has been studied in Sweden (considered the most effective help for back pain) and retrains the sensory motor system of our brains: Somatic Education.
I learned how to reduce accumulated muscle tension that impinged on my joints and caused pain and painful, restricted movement. I learned how the brain and nervous system work together to either create length and efficiency in muscles -or habituate excess muscle tension. It's the source of the problem. My brain and muscles now coordinate more effectively, my joints have space and my movement is fluid. Before I go into my day I prepare my body to move well with Somatic Exercises. I'm aware of how I respond to the events of my life that cause muscle tension.
And now that I have more body ownership and control I can do strength training in the form of loads of walking and uphill hiking.
Somatic Education is, truly, the least invasive form of preventive medicine you can find. Movement IS medicine.
Read Thomas Hanna's book, Somatics. It's a great place to start in learning how to keep moving, despite your age.
I learned how to reduce accumulated muscle tension that impinged on my joints and caused pain and painful, restricted movement. I learned how the brain and nervous system work together to either create length and efficiency in muscles -or habituate excess muscle tension. It's the source of the problem. My brain and muscles now coordinate more effectively, my joints have space and my movement is fluid. Before I go into my day I prepare my body to move well with Somatic Exercises. I'm aware of how I respond to the events of my life that cause muscle tension.
And now that I have more body ownership and control I can do strength training in the form of loads of walking and uphill hiking.
Somatic Education is, truly, the least invasive form of preventive medicine you can find. Movement IS medicine.
Read Thomas Hanna's book, Somatics. It's a great place to start in learning how to keep moving, despite your age.
3
I had arthroscopic surgery on both knees for ripped menisces, almost 20 years ago. Relief was immediate, or at least immediate when the immedite post-operative swelling cleared up in a few days, and has lasted to the present day. Clearly, it works sometimes. Also, it's a mistake to lump in knee pain not due to a physical injury with an physical injury that's painful.
3
I broke my ACL twenty years ago. The only surgical option involved six months of little activity and a year of physical therapy. For someone as active as I, that was a bleak remedy. Because cycling was/is my sport of choice and I was strong, the orthopedist said I might get by with physical therapy alone. I chose that path.
Twenty years later the affected knee remains stable for most activities because I've continued the strengthening exercises. I've moved to a place where I do a lot of hiking over rough ground, so I got a prescription brace for lateral stability.
At 71 lots of parts hurt, but fortunately I can take naproxen with no side effects. Aging is a series of adjustments and compromises. Go with what works for you.
Twenty years later the affected knee remains stable for most activities because I've continued the strengthening exercises. I've moved to a place where I do a lot of hiking over rough ground, so I got a prescription brace for lateral stability.
At 71 lots of parts hurt, but fortunately I can take naproxen with no side effects. Aging is a series of adjustments and compromises. Go with what works for you.
3
Appareently not all results are the same. I am a runner. Several years ago I tore the miniscus in my knee (not a running injury). While the pain was moderate the knee would swell significantly if I tried to run. I had arthoscopic surgery and was able to run two weeks later. I have been running 6 days a week for the past ten years without a problem. In some cases it would seem to be effective.
9
In a similar fashion, I had really bad flu - I sacrificed a chicken - and I got better.
I would hesitate to opine on the efficacy of live fowl sacrifice. The dirty little secret of medicine - sometimes you just get better on your own over time.
The evidence on meniscus repair surgery is deep, long, and well-documented.
https://www.sciencedaily.com/releases/2016/07/160722093239.htm
I would hesitate to opine on the efficacy of live fowl sacrifice. The dirty little secret of medicine - sometimes you just get better on your own over time.
The evidence on meniscus repair surgery is deep, long, and well-documented.
https://www.sciencedaily.com/releases/2016/07/160722093239.htm
8
As a retired ER doc and epidemiologist, I would agree the data is well-documented, but it is important to describe what type of meniscal tear. A simple bucket-handle, no scope probably need. An torn, macerated, tear obstructing full range of motion then you will likely benefit from a scope to eliminate the physical barrier to full range of motion.
No doubt many if not most of scopes are unneeded, but if you have a genuine obstruction to full range of motion, it is warranted. In 25 years of ER medicine, I learned very little is black and white.
No doubt many if not most of scopes are unneeded, but if you have a genuine obstruction to full range of motion, it is warranted. In 25 years of ER medicine, I learned very little is black and white.
13
Interesting but this article assumes that the readers have health insurance and the time and money to pay for therapy, drugs, etc. It also assumes that insurance will cover it. In today's America we can't assume anything. It would have been better to write an article on how to ensure that we don't age.
There is a way to stay limber: be careful, mind what your body tells you, stop when it hurts, and because of the vagaries of our health care system, don't take any risks.
There is a way to stay limber: be careful, mind what your body tells you, stop when it hurts, and because of the vagaries of our health care system, don't take any risks.
87
You couldn't be more wrong. The five treatments the writer recommends instead of surgery are all readily affordable without insurance. Losing weight, in particular, costs nothing. And stopping when it hurts, which you tout, is also recommended by the writer.
1
She did say: If you are overweight, lose weight. Given more than a Americans are obese and a third overweight, this advice is crucial both for benefit and affordability.
Now why do we find it so hard to move is another question that has been hijacked by the willpower brigade with no long-term success stories. And yet every child knows without the adult reminding her that movement is a joy -- and the more challenging it is the greater the joy.
Now why do we find it so hard to move is another question that has been hijacked by the willpower brigade with no long-term success stories. And yet every child knows without the adult reminding her that movement is a joy -- and the more challenging it is the greater the joy.
As a regular reader of the health section in the times and as an interested party, I am personal trainer. When discussion is about orthopedic issues there is never mention of properly designed and executed strength training programs. Surgeries and physical therapy are discussed at length but never mention of long term strength training that can provide wide benefits, with over 30 years of experience there is no better defense against the stresses of an active lifestyle than the ability to squat, deadlift or carry heavy loads.
314
You are right. Being strong means you can do more. And just "doing" means you can do more.
I retired to a house with stairs. Going down is not as easy as it once was, but not doing stairs would mean that after a while I couldn't do stairs. Use it or lose it.
I retired to a house with stairs. Going down is not as easy as it once was, but not doing stairs would mean that after a while I couldn't do stairs. Use it or lose it.
21
Totally agree with Keith. I am also a regular reader, a physician, and an ultramarathon runner. Folks always ask "what about your knees?" I tell them that I run smart, take rest days, and rely on strength training.
3
With all due respect. I've seen personal trainers at the gym, most do more harm than good.
People are better off doing their own research. Get in touch with your own body and training
People are better off doing their own research. Get in touch with your own body and training
2
At some point you have to accept that your aging and/or just plain old and can no longer run, swim, climb, play tennis, etc. the way you did at 20. Sorry, but that's a fact of life, pleasant or not,
221
I cannot and will not accept stopping as a fact. Use it or lose it.
29
Still no reason not to aspire to exercise and play sports as well as you can in your 50s, 60, 70s, etc.
13
The guy had his knees replaced and has been active for 13 years since.
There is no reason why we can't extend or lives and healthy years. I don't think we have a right to tell or even suggest that people accept their "fates" regardless of their age
There is no reason why we can't extend or lives and healthy years. I don't think we have a right to tell or even suggest that people accept their "fates" regardless of their age
5
A lifetime of walking on flat feet (and body therefore out of alignment and knees, ankles, hips all rubbing in their sockets the wrong way) will also harm your knees. If your child has flat feet get them fitted with a good orthotic and help them avoid trouble later in life. For severe flat feet there is also a simple surgery called hyprocure that will create an arch and put the body in alignment. This was a lifesaver for my son.
26
I'm glad your son benefitted from surgery. I have had flat feet since birth. Early in my life my shoes were fitted with orthotics. My feet hurt whenever wore them. I took them out of my shoes and found relief from foot discomfort. Now, 70+ years old and having spent 50 years in a profession that didn't accommodate sitting, neither my feet nor my knees cause me any discomfort. I still stand for hours at a time and walk for miles. This is not to discount the success your son found but rather to suggest that one treatment is not necessarily best for all; get a second and third opinion before surgery.
4
Or, as my physical therapist has recommended, try strengthening your arches before you resort to orthotics. I developed knee pain as a result of arches that have fallen as I've aged. We're working on exercises to regain my arch in the hopes of avoiding insoles.
1
Where are we supposed to find a good physical therapist? Most therapists here tend to double and triple book. That means you spend an hour and get maybe 20 minutes of PT. When I had an arm injury I was left to do exercises with no supervision while the therapist helped someone else and chatted with her buddies. The clinic suggested 12 sessions when I really needed two. They all charge for a "diagnostic" that wastes time and money. Good PT is valuable but this industry needs more regulation.
297
I am a Physical Therapist and up to very recently, an owner of a PT practice. I deplore the fact that many practices operate in this fashion. Unfortunately there are a lot of factors that likely create this business model in your area. Where I live, we have been able to schedule 1:1 30 to 40 minute sessions and provide a nice living for ourselves and our employees. Margins however are tight and are becoming tighter. It has always been my contention that in treating ethically you make a living with the quantity of patients treated, not the quantity of each visit a patient receives. Our industry like others responds to the pressure of consumers. Ask for what you want, don't pay for what you don't receive.
4
Sadly, I've had similar experiences in Physical Therapy. Bored and disinterested "therapists" who spend more time checking their phones or chatting with co-workers. I get a better workout at the YMCA, where I'm going shortly. Also, there are good, reliable web sites where one can find exercises to do for various problems. But, always, self-motivation is critical for improvement. Don't be a slug, MOVE!!!!!!
4
I found a good PT because years ago I had a friend with a Ph.D. in the field. When I developed a cyst in my spine, he recommended a PT who had done extensive additional training in back pain. I inquired about a clinic closer to home, and he said, "Well, I don't know anyone there. It's all about the person." Ask around, a lot, with the emphasis on someone who will give you a good, low-tech home program using a mat, resistance bands, etc. Then stick with it forever. I've successfully rehabbed my back (synovial cyst) and a knee (torn ACL, MCL, meniscus), both without surgery. It took months of exercising to get relief, but neither bothers me now.
That said, my friend also mentioned that when he got out of college, he became a PT with a bachelor's degree. Now, a post-graduate degree is required. I asked why, and he said, "The schools. They put pressure on the licensing and regulatory bodies, saying more education is necessary," which obviously benefits them financially. Of course, it costs a lot more to hire a Ph.D. than a B.S., and, since there is a great deal of pressure on insurance payment, that means that the actual PTs are spread much thinner. In practice, most work is done by aides, with a few weeks of training, or PT assistants, with two years of training (associate's degree). This all factors in.
That said, my friend also mentioned that when he got out of college, he became a PT with a bachelor's degree. Now, a post-graduate degree is required. I asked why, and he said, "The schools. They put pressure on the licensing and regulatory bodies, saying more education is necessary," which obviously benefits them financially. Of course, it costs a lot more to hire a Ph.D. than a B.S., and, since there is a great deal of pressure on insurance payment, that means that the actual PTs are spread much thinner. In practice, most work is done by aides, with a few weeks of training, or PT assistants, with two years of training (associate's degree). This all factors in.
8
Interesting. I always thought I was an unlucky and neglectful knee owner. I tore my meniscus very badly playing rugby when I was 16 (an amazing amount of pain). That was many years ago, and the medical treatment advised was to put a bandage around it and rest. After a while I recovered. I have retorn the cartilage about five times through hyperextensions of the knee over the years. And each time I have recovered to about a 95% level after about two weeks, and almost fully thereafter. In the meantime I have lead a very full physical life, climbing, skiing, running, hiking etc. I protect the knee, and I don't stretch it out much because I don't want it to hyperextend again. My knee and I get along -- most of the time we take good care of each other. Now I am approaching my sixties, I hope the situation will continue. My orthopedist asked me if I wanted to get an MRI of my knee and I said no, because I didn't want to know too much. She laughed and said she felt exactly the same about her rugby-injured knee. I am not advising anyone medically, and if you want or need knee surgery that is your deal. But I do think people should consider the alternatives. Thanks for article, Ms. Brody.
34
At 73 I've taken pretty good care of my knees. After a non-sports accidental injury about 6 years ago, I had a lot of pain, so went to see a sports medicine doctor, one who does not do surgery, therefore does not recommend an immediate MRI or replacement. With conservative management, one single course of hyaluronic acid injections and physical therapy, I am just fine. I garden, cook, shop, walk 8,000 steps/day (dictated by my fitness tracker) hike, bike and play actively with my grandkids. I do not do things that make my knee hurt, and when I do, I rest for 2 days, and the pain goes away on its own.
I'm so happy my first trip to the doctor was to someone without a vested interest in getting me into surgery!
I'm so happy my first trip to the doctor was to someone without a vested interest in getting me into surgery!
I am curious about the same thing as the first commenter. How are the knees after surgery? Wish you'd done it earlier?
I've had the fluid injections. Didn't feel much and it didn't last long for the cost.
I've had the fluid injections. Didn't feel much and it didn't last long for the cost.
7
I had my left knee replaced 13 months ago and am extremely happy with it. After 8 weeks we met our three grand daughters at Disney World for a 4 day stay. We walked 6+ miles per day and I was completely pain free. One very important point to remember: the physical therapy after surgery is vital to recovery. My neighbor stopped her PT before it was completed and now complains that the new knee 'is no good'. It's not the knee that's bad but her unwillingness to endure a little pain during PT is causing her unhappiness now.
5
My replaced knee is now my stronger leg, and I'm just so thankful that I had it done. But, make sure you go to a good orthopedic surgeon who has lots of experience in knee replacement. I went to New England Baptist in Boston, and they are the best!!! Yes, there are challenges after the surgery, but I was off pain meds within three days, and drove a week later, AND it was my right knee that I had replaced. But, if you are motivated, you'll do great!!!!!
4
The Synvisc injections are a total waste of time and money.
4
Interesting article and pretty much in line with what happened to me. Both knees had problems at different periods of my life. Tried arthroscopic early on and not much relief if any. Did the synvisc and other brand injections...complete bust and painful and took time...like recall three trips over a period of time and not much result if any. Finally surgery...bingo, got rid of pain in right knee. Now left been bothering me for years, goes in and out of pretty good pain to no pain. Interesting mostly when sleeping wake up with pain. Well someday shortly time for left knee replacement. Just hate the thought of it. But for my money nothing really works from a doctor except complete replacement, or partial in some cases.
2
The problem all along was probably due to imbalance of muscles due to bad movement habits. Easily fixed by making the right movement adjustments.
13
But to make the "right movement adjustments", you need an exercise physiologist who knows what they're doing to show you what you're doing wrong and how to change it to a healthy movement pattern.
2
I have a torn miniscus and I was originally scheduled for surgery but cancelled it for purely personal reasons, meaning to reschedule some day. I have never rescheduled, I have lost weight and the pain has subsided to nearly nothing. I had read an earlier piece in this paper citing evidence that people who had miniscus repair surgery were more likely to need knee replacement earlier. I lucked out.
69
Thanks, Jane, for another well-cited report.
More 'therapeutic' exercise (that which heals more than wears) can be very useful, both for prevention and recovery. The professional athletes do much more therapy than the amateurs . Quadriceps- and calf- strengthening exercises stabilize the knee joint. So, too, does stationary bicycling, which also stimulates the ligaments, while improving circulation. The stationary bicycle should be done with no resistance, for significant duration (~ 45 minutes, or 3000 rpms).
The quality of the scar tissue which heals 'soft tissue' (including menisci) can be dramatically improved by including 'omega-3' lipids (as fish-oil/flax-seed) in the diet.
Stretching the muscles either side of a joint before sleeping can much improve the healing blood flow while resting.
Eating significant vitamin C can double (or triple) the rate of healing growth of the menisci. Some report that vitamin E helps seemingly lubricate joints.
All these techniques are optimal as preventives, but can also aid recovery.
Rest is also sometimes very helpful. Notably, healing of the articular cartilage can require about 10 hours of rest between weight bearing intervals.
More 'therapeutic' exercise (that which heals more than wears) can be very useful, both for prevention and recovery. The professional athletes do much more therapy than the amateurs . Quadriceps- and calf- strengthening exercises stabilize the knee joint. So, too, does stationary bicycling, which also stimulates the ligaments, while improving circulation. The stationary bicycle should be done with no resistance, for significant duration (~ 45 minutes, or 3000 rpms).
The quality of the scar tissue which heals 'soft tissue' (including menisci) can be dramatically improved by including 'omega-3' lipids (as fish-oil/flax-seed) in the diet.
Stretching the muscles either side of a joint before sleeping can much improve the healing blood flow while resting.
Eating significant vitamin C can double (or triple) the rate of healing growth of the menisci. Some report that vitamin E helps seemingly lubricate joints.
All these techniques are optimal as preventives, but can also aid recovery.
Rest is also sometimes very helpful. Notably, healing of the articular cartilage can require about 10 hours of rest between weight bearing intervals.
21
I had arthroscopic surgery on my right knee in 2001 at the age of 54. I haven't had a problem since. But yikes, my hips, particularly my right hip, is a real problem. Now what to do?
Too much activity leads to body breakdown issues. So does sitting at the computer. So does being overweight, not good for the joints.
Genes, moderation and luck!!
Too much activity leads to body breakdown issues. So does sitting at the computer. So does being overweight, not good for the joints.
Genes, moderation and luck!!
7
It could be coincidental, but the arthritis in my knee stopped hurting after I started eating Montmorency cherries in powdered form.
17
Whatever works! I say, go for it. But did you change your activities in any way?
2
This article, like most of Brody's work, is well-researched and personal. But it omits a major factor in avoiding both knee pain and injury, especially in people over 50, which is the simple practice of stretching. Stretching, consistently and in an organized way, helps the tendons, muscles and ligaments in the knees stay aligned with the leg and hip muscles that they connect with, greatly reducing the chances of injury or pain. Interestingly - and unfortunately - many doctors miss this important and very low-cost approach.
134
Excellent ! I stretch daily with a long lime green elastic and it works well.
Low cost...purchase the elastic...startt stretching
Low cost...purchase the elastic...startt stretching
3
"Old age doesn't come alone my dear" is what I have been told many times. Physical therapy plus modification of exercise plus mild pain relievers are probably less risky than (highly profitable and ubiquitous) surgery for most.
14
But seriously -- do people really NEED to be TOLD "just take Tylenol" for knee pain?
I suspect long before such folks even see a specialist, they have taken a LOT of Tylenol, Aleeve, Motrin and aspirin in a vain attempt to control the pain.
I suspect long before such folks even see a specialist, they have taken a LOT of Tylenol, Aleeve, Motrin and aspirin in a vain attempt to control the pain.
2
" ... Probably most helpful of all, ... physical therapy ... Be sure to do the recommended exercises at home and continue to do them indefinitely ..."
ABSOLUTELY essential.
I had arthroscopic surgery on both knees (separate operations years apart) a dozen or more years ago. I still remain active with tennis, golf and limited running. To this day I still do the same exercises I was taught in the PT sessions. The people I have met that continued to have knee pain only half heartedly applied themselves to PT, skipping exercises and sessions. PT has to become your new job.
ABSOLUTELY essential.
I had arthroscopic surgery on both knees (separate operations years apart) a dozen or more years ago. I still remain active with tennis, golf and limited running. To this day I still do the same exercises I was taught in the PT sessions. The people I have met that continued to have knee pain only half heartedly applied themselves to PT, skipping exercises and sessions. PT has to become your new job.
145
I totally agree about physical therapy! Almost 50 years ago, I broke my jaw in two places (from a fall from a bike), and several years later, I developed TMJ, with pain and difficulty chewing and eventually even opening my mouth. I went to a specialist, who recommended PT exercises for my jaw, and I remember thinking: "I paid $175 out of pocket to learn how to do some exercises?!" But I did them -- and they were effective! And I still do them to this day, because if I don't, my jaw can seize up. I have other tales, but suffice it to say, I practice PT exercises religiously.
3
The pain from the arthroscopic surgery was some of the worst I've ever experienced -- and I include childbirth. I was in pure agony for six weeks -- ordinary agony for 3 months -- then slowly able to walk with a cane, and then by the 9 month point, I was fine. For 10 years.
It worked for me, that's all I can say. And my insurance used physical therapy FIRST before agreeing to pay for the procedure -- it was worse than useless, being forced to do exercises that ground "bone on bone" to no avail.
After the surgery, they did not suggest nor pay for ANY physical therapy. I had a border collie, a dog that requires a LOT of walking and it was she who got me well again.
It worked for me, that's all I can say. And my insurance used physical therapy FIRST before agreeing to pay for the procedure -- it was worse than useless, being forced to do exercises that ground "bone on bone" to no avail.
After the surgery, they did not suggest nor pay for ANY physical therapy. I had a border collie, a dog that requires a LOT of walking and it was she who got me well again.
4
Thank you for this story.
I am glad you and your son are on the mend.
Yet, I cannot but fail to note that as soon as your knees were "back to being good" - you indulged into sports that had done the damage in the first place.
Why do folks not listen to their bodies and either quit those exhaustive and damaging sports and do something less harmful.
I am living in London and I am a retirement age.
I find it refreshing when the English of similar age confess that they gave up this or that activity because of age related health issues and took up something more suitable. And they are not ashamed.
I find in America, we are conditioned to think that medical practitioners can put things back together that Mother Nature took so long to perfect it.
And if I may, its one reason why medicine in America is so expensive and lucrative.
I am glad you and your son are on the mend.
Yet, I cannot but fail to note that as soon as your knees were "back to being good" - you indulged into sports that had done the damage in the first place.
Why do folks not listen to their bodies and either quit those exhaustive and damaging sports and do something less harmful.
I am living in London and I am a retirement age.
I find it refreshing when the English of similar age confess that they gave up this or that activity because of age related health issues and took up something more suitable. And they are not ashamed.
I find in America, we are conditioned to think that medical practitioners can put things back together that Mother Nature took so long to perfect it.
And if I may, its one reason why medicine in America is so expensive and lucrative.
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"Yet, I cannot but fail to note that as soon as your knees were "back to being good" - you indulged into sports that had done the damage in the first place."
1. What evidence do you have that those sports did the damage in the first place (other than skiing, where she says she was actually injured)? There's no scientific evidence connecting those activities to arthritis in the knees.
2. She clearly states that she changed her activities to mitigate the pain-- she only was doing low-impact activities like swimming and biking. It was when walking became painful that she explored surgery. Now, after her replacement, she says she now walks, cycles, swims, and climbs -- all fairly low-impact activities.
In other words, she did exactly what you suggested.
1. What evidence do you have that those sports did the damage in the first place (other than skiing, where she says she was actually injured)? There's no scientific evidence connecting those activities to arthritis in the knees.
2. She clearly states that she changed her activities to mitigate the pain-- she only was doing low-impact activities like swimming and biking. It was when walking became painful that she explored surgery. Now, after her replacement, she says she now walks, cycles, swims, and climbs -- all fairly low-impact activities.
In other words, she did exactly what you suggested.
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How do we know it was the tennis that blew out her knees vs something else or simply genetics.
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A lot of people -- not just Americans - - cannot accept aging and the natural decline of your body -- they want to be the same young, peppy, sporty people they were at 35.
If they are Jane Brody, they also want to be very, very thin and ergo, all their advice on eating and diet and exercise is geared to being thin -- not genuinely healthy or fit or free from pain.
I had my knee surgery at 51 and I was not remotely overweight or unfit. If losing weight is the solution...why not tell normal weight people to take off 20 pounds? I mean, that should be easy -- right?
If they are Jane Brody, they also want to be very, very thin and ergo, all their advice on eating and diet and exercise is geared to being thin -- not genuinely healthy or fit or free from pain.
I had my knee surgery at 51 and I was not remotely overweight or unfit. If losing weight is the solution...why not tell normal weight people to take off 20 pounds? I mean, that should be easy -- right?
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Since physical therapy is shown to be a successful alternative to surgery and some other treatments like steroid injections, it would be good to have a complete article about its uses.
Perhaps another time?
Perhaps another time?
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And, so, how do your knees feel and work 12 years past replacement?
Is there any indication that - of the folks who use hyaluronic acid injections - that the eventual results of a knee replacement were better or worse when delayed ?
Is there any indication that - of the folks who use hyaluronic acid injections - that the eventual results of a knee replacement were better or worse when delayed ?
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