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“Doc I think the shock absorbers in my knee are expired….”
By Matthew Stiebel, MD, FRCSC –
Why is it that so many knees swell up like balloons and hurt like the devil after a twisting injury? The answer is that often times knee trauma can lead to tears of the meniscus.
The knee joint primarily consists of the femur and the tibia bones. Between these bones lie two ‘C shaped’ rubbery shock absorbers known as the menisci. These menisci help stabilize the knee joint in deep flexion and with rotation. They are made of tough cartilage that resists stress in multiple planes. Unfortunately, unless you are the man (or woman) of steel, these menisci are not infallible. Repetitive stress or violent trauma can lead to tears of the menisci.
The problem with meniscal tears is that they do not often heal by themselves; they are so ‘rubbery’ and so ‘tough’ that they do not have a significant blood supply. (Possibly like the head/ego of a certain former head of the CIA…) If a meniscus does not bleed, it cannot activate healing factors. This means that most meniscal tears must be treated by an orthopaedic surgeon.
Treatment is dictated by the age of the person with the tear and the pattern of injury. Children and young adults sustain meniscal tears from severe trauma, such as football injuries or motor vehicle accidents. This type of trauma can lead to tear patterns that sometimes allow the meniscus to be sewn back together. In young patients doctors can sometimes repair meniscal tears with arthroscopic suturing techniques. Sometimes, however, these tears cannot be fixed– and parts of the meniscus have to be removed. In patients over the age of about 35, meniscal repair is significantly less successful and is rarely performed. Most of these tears are not from traumatic injury, but rather from repetitive stress and a gradual “wearing out” in the same way that our skin wrinkles, or our hair goes grey. When this happens our knee “shock absorbers” simply start to break down. The torn pieces are then removed via arthroscopic surgery.
What happens to the knee when we remove the broken shock absorbers? The answer is that over time the knee may (or may not) develop degenerative arthritis, or loss of cartilage. It is, however, unclear how long this will take, and which patients are most susceptible. A lot depends on the patient’s age at the time of surgery and the amount of cartilage damage already present. What is clear, however, is that once the offending pieces of torn meniscus are removed, the pain usually goes away.
Many patients often ask me, “What can you do to prevent meniscal tears?” The answer is simple: stop exercising, stop walking, continue to lie on the couch, watch tv and maybe even buy one of those rascal scooter things…. The truth is, there is really no effective way to prevent meniscal injuries. If you exercise, or even if you don’t, at some point the meniscus may just let you down. If it can happen to supermen like Blake Griffin and to Jeremy Lin, it can happen to mortals like you and me. It’s a good thing your friendly neighborhood orthopaedic surgeon just so happens to be at your service.
Matthew Stiebel, M.D. FRCSC
Board Certified, Fellowship Trained Orthopaedic Surgeon
Matthew Stiebel, MD FRCSC, is the newest partner at Palm Beach Sportsmedicine. After undergraduate and medical school degrees at Yale University, he completed an orthopaedic surgery residency at McGill University and a subspecialty fellowship in sports medicine at Boston University. His specialties include complex shoulder and knee injuries. Dr Stiebel has published papers and book chapters on specialty surgeries of the knee and shoulder. He is an associate master instructor for the Arthroscopy Asscociation of North America, where he instructs both arthrocopic shoulder and patellofemoral knee courses for surgeons in the US and internationally. He has lectured to the International Patellofemoral Reseach Group in London and New York City, and has worked with patellofemoral implant design companies. His other current interest involves the repair of pectoralis major muscle tears and their subsequent outcomes. While in Montreal, Dr Stiebel worked with the Montreal Canadians Hockey team and Expos Baseball team. During his fellowship time in Boston he was able to serve as team physician for the NCAA championship BU men’s hockey team, UMASS Boston Hockey, as well as work with the World Wrestling Entertainment Summer Slam Series. Locally, Dr Stiebel stays active in the community by currently serving as team physician for some of the local high school football and gymnastics programs.
Certificates/Memberships:
– Board Certification: American Board of Orthopaedic Surgery, July 2012
– American Academy of Orthopaedic Surgeons
– Fellow, Royal College of Physicians and Surgeons of Canada American Arthroscopy Association of North America
– International Society of Arthrosocopy, Knee Surgery & Orthopaedic Sports Medicine
– International Patellofemoral Reseach Group
PALM BEACH SPORT MEDICINE
561-845-6000
www.pbsportsmed.com
