Re: Study Sheds Light On Dark Side Of The Knee

[Guest guest]

Hi I am starting the series of 5 injections over 5 weeks in my left knee this

Fri. God, I hope it works...it has gotten so bad these past 2 weeks.......I

had a shot of steroids in it on May31....so that didnt last long...I just

spent most of the holiday weekend with it packed in ice and taking lots of

darvocets.

I also am going for another infusion of remicade on Wednesday...I think I am

only getting the 3%solution or the placebo cos I sure dont see any real

difference in me. So this time or the next I will get the real thing for sure

......and if I have been getting only 3% I'll get the 10%....so we'll see.My

hands are always stiff and swollen ...especially if I am in out in the heat

much. I have had worse flares ...but I was so hoping for the miracle others

had gotten from Remicade by now.....oh, well, soon, time will tell....

Monsoons are supposed to be coming here tonight or in these next few

days...those are always a mixed blessing......we need the rain, but I had the

achiness with the humidity....but like I said we need the rain....I feel bad

for everyone who is getting flooded.....seems like we need to just find a

way to tip the axis of the earth just a little to the left ? We need to get

the fires totally out up north..they are contained but they say to get them

totally extinguished will take the monsoons....

Well, hope everyone has a wonderful day...and painfree , well, at least less

pain night. Judy in AZ

[Guest guest]

This is very interesting, a. I hope they research this angle more. I tore

the ACL in my left

knee in a high school basketball game, but, wouldn't you know it, my right knee

bothers me more. The

left is way more unstable, but, in terms of pain and stiffness, the right is the

worst.

[ ] Study Sheds Light On " Dark Side " Of The Knee

Source: Duke University Medical Center (http://www.mc.duke.edu/)

Date: Posted 7/8/2002

Study Sheds Light On " Dark Side " Of The Knee

ORLANDO, FLA -- As orthopedic surgeons come to appreciate the important role

of the so-called " dark side of the knee " in the failure of reconstructive

knee surgeries, laboratory research led by a Duke University Medical Center

investigator has determined the optimal surgical approach to improve the

outcomes of these reconstructive surgeries.

Knee damage is the most common sports injury and it usually occurs when

there is a tear or break in at least one of the four ligaments of the knee,

the most common being the anterior cruciate ligament (ACL). Orthopedic

surgeons will often reconstruct the joint using tissue from the patient or a

cadaver. While the surgery and subsequent rehabilitation returns about 90

percent of patients to normal sporting activity, surgeons are finding that

instability in a little-studied area of the knee -- the posterolateral

corner -- is a leading cause of knee reconstruction failures. The

posterolateral corner is the outside region of the knee just posterior to

the kneecap.

" To our knowledge, no one has studied the two accepted procedures for

dealing with the instability in this 'dark side' of the knee, " said Claude

T. Moorman III, M.D., orthopedic surgeon and director of the sports medicine

program at Duke, who led a team of researchers from the University of

land, s Hopkins University and University of Alabama-Birmingham.

" While both surgical approaches are effective, our analysis shows that a

simpler and quicker approach may be the better of the two. "

The results of the team's study were prepared for presentation today (July

1, 2002) at the 28th annual meeting of the American Orthopedic Society for

Sports Medicine (AOSSM). The study received the 2002 Aircast Award for Basic

Science, given annually by the AOSSM. The study was funded by University of

the land Sports Medicine, where Moorman served prior to coming to Duke

last year.

" This posterolateral corner has been referred to as the 'dark side' of the

knee because it is poorly understood and treatment for these injuries has

not been consistently successful, " Moorman said. " Now, as a result of this

comparison, we have a straightforward and predictable approach to

successfully restore knee stability to its normal state. "

The knee is a complex joint, in which a series of ligaments, tendons and

cartilage create a " hinge " where the femur, the upper leg bone, connects

with the two bones of lower leg, the larger tibia and the smaller fibula.

The kneecap, or patella, protects the joint. When the posterolateral corner

is not aligned properly after reconstruction, the tibia and femur rotate

more than normal, which puts undo forces on the joint and leads to the

failure of the reconstruction.

To compare the benefits of the two most commonly used procedures to address

this instability, the team used 12 pairs of fresh cadaveric knees. After

performing each of the two surgeries on one knee of the pair, the knees were

then attached to a device in the laboratory that can simulates the pressures

and torques experienced by the knee.

The first approach, known as the combined tibial and fibular-based

reconstruction, uses cadaveric tendon to make two attachments: from the

femur to both the fibula and tibia. In the second approach, called the

fibular-based reconstruction, a portion of patient's tendon is used to make

a figure-eight connection from the femur to the fibula. (See attached

drawings.)

" After testing both approaches in the laboratory, we found that both can

successfully restore stability to the knee, but the fibular-based has the

advantages of being an easier procedure, taking less time in the operating

room, and causing fewer surgical complications, " Moorman said.

Moorman added that the benefits of the cadaveric (allograft) source over the

patient (autograft) source of tendon are still a matter of debate among

surgeons. While the harvest of autograft tissue involves another incision,

the quality of the tissue is usually better and there is no risk of disease

transmission, Moorman said. Further clinical trials are needed to determine

the best source of tissue, he added.

" While many techniques have been considered and used in clinical practice,

few have been critically evaluated by biomechanical studies to determine

their ability to restore normal knee functions, " Moorman said. " Our study

provides guidance for orthopedic surgeons who treat this difficult injury

pattern. "

Other members of the team included Rauh, M.D., and Leigh Ann Curl,

M.D., of the University of land; Louis Jasper and Belkoff,

Ph.D., s Hopkins University; and W.G. Clancy, M.D., University of

Alabama-Birmingham.

[Guest guest]

Very interesting article, a! I had ACL repair of

my right knee, tendon graft, 2-1/2 years ago, as well

as patellar release, chondroplasty, and meniscus tear

repair. I am doing good since the surgery and am glad

I went with the tendon graft. My right knee still

gives me some pain at times but, all in all, I don't

fall down anymore! When I had the surgery, they did

the chondroplasty which is basically shaving the bone

and they said they took out any arthritis they found.

When I asked if RA would set in that knee sooner

because of the surgery I was told that it would not,

but that OA could show up there sooner. If it's not

one, it's the other!

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