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Conquering Common Knee Injuries

Injuries to the meniscus - that wedge-like rubbery cushion that helps stabilize your knee joint and keep the femur and tibia from grinding against each other - are some of the most common knee problems doctors see. Meniscal tears often happen during sports activity, but they can also occur with less strenuous activity as you age and the cartilage weakens.

To get the details on such injuries, we talked to John D. Kelly IV, M.D., vice chairman of orthopedic surgery and sports medicine at Temple University Hospital.

Q: What is the most common knee injury for men?

A: The most common knee injury I see in men is most likely a tear of their meniscus (cartilage). The meniscus is a small disc-shaped structure that gives our knees cushioning and stability.

Q: How do such injuries usually happen?

A: Most meniscal tears happen from bending and twisting activities, often combined with a squatting motion. Some meniscus tears occur in conjunction with an ACL [anterior cruciate ligament] tear.

Q: How do you know if you have such a knee injury?

A: Most patients with a tear of the meniscus feel knee soreness, usually experience swelling and may feel that their knee catches or suddenly locks.

Q: What should you do if you suspect such an injury?

A: If you suspect you have a meniscal injury, you must rest, ice your knee and apply compression. Sometimes meniscal tissue gets trapped in your joint and gives you the sensation that the knee is "locked." In this case, crutches are necessary. Otherwise, you should avoid impact activities and see your doctor within a few days.

Q: What type of doctor should you see?

A: I believe that meniscal injuries are best diagnosed by either a sports physician or an orthopedic surgeon.

Q: How are such injuries treated?

A: Most meniscal injuries are treated by arthroscopic surgery, during which the surgeon makes small punctures in your knee through which the repair is performed. Most tears require a resection - the removal of small amounts of unstable tissue. Other tears can be repaired by suturing the torn edges together. Typically you'd have the surgery performed as an outpatient. It is associated with less discomfort than traditional open surgery, in which a large incision is made.

Q: What are the latest developments in treatment?

A: Some tears are amenable to repair, in which the surgeon usually places sutures across the tear. An incision is required so that the sutures can be retrieved and tied. However, newer repair systems, including absorbable "darts," "screws" and "pre-tied" sutures, enable the surgeon to reapproximate the injured tissue without the need for an accessory incision.

Q: How long should recovery take?

A: Simple resection requires only two days or so of crutches. Full recovery, including sports, takes approximately four to six weeks. Repaired menisci, however, generally require four to six months of convalescence.

Q: What are the potential long-term problems associated with such a knee injury?

A: Menisci are Mother Nature's way of providing shock dissipation, and removal of such tissue does leave the joint more vulnerable to arthritis. Repaired tissue certainly works better than removed tissue, but does not fully protect the joint from wear and tear.

Dr. John D. Kelly, IV, M.D., is vice chairman of orthopedic surgery and sports medicine at Temple University Hospital. He is a member of the American Academy of Orthopaedic Surgeons, American Medical Association, Pennsylvania Medical Society and Philadelphia County Medical Society.