Knee Joint Injury

How a knee joint injury leads to knee arthritis

With Dylan Hartley being ruled out of the Six Nations with what his club called ‘grumbly knee’ and his doctor pinpointed as something worse, the spotlight shines once again on sporting knee injuries – and their knock-on effects. And a new study bears out the undeniable link between knee injuries of today and the problems it can bring on tomorrow; pinpointing the effect that knee injuries can have on the joint, and why it can lead to knee osteoarthritis later in life.

The study – a collaboration between the University of Eastern Finland and the Massachusetts Institute of Technology – demonstrates that articular cartilage degenerates specifically around injury areas when the fluid flow velocity becomes excessive. The findings, which were reported in Scientific Reports, presented a new mechanobiological model for cartilage degeneration, by implementing tissue deformation and fluid flow as mechanisms for cartilage breakdown when a normal dynamic loading – such as walking – is applied to the joint.

A new model that could make a real difference

The researchers discovered that different mechanisms, such as fluid flow and tissue deformation, have the potential to cause cartilage degradation after a knee injury. According to the research team, fluid flow and tissue deformation are plausible mechanisms leading to osteoarthritis, but increased fluid flow from cartilage seems to be better in line with the experiments.

Why is this important? Because this new model could be used to predict osteoarthritis in personal medicine, which would be a huge boost to the medical community: if doctors can be armed with more refined data, they could have a better shot at mapping out the best possible rehabilitation protocol. Furthermore, this model could identify high and low-risk lesions in the cartilage for osteoarthritis development and suggest an optimal and individual rehabilitation protocol.

“Our findings indicate that after an injury in the knee and subsequent tissue loading, osteoarthritis is caused by easy leakage of proteoglycans through the injury surface by high fluid outflow,” Gustavo A. Orozco of the University of Eastern Finland explains.

Taking a knee to long-term problems

Obviously, this isn’t going to help Dylan in the short term – and, like other athletes who have succumbed to knee injury, he is highly likely to suffer the consequences of arthritis as a result of his injury. In a 2017 study of retired rugby players studying concussion, the secondary outcome was that there was a high prevalence of arthritis, due to the fast, hard-contact nature of the sport and the stress it places on the knees.

And as we know, not only do knee injuries have the potential to cause osteoarthritis in the future, but so can the operations to put knee injuries right, including cruciate ligament repair and meniscectomy procedures.

Therefore, any new developments in the field of knee treatment are to be welcomed in both the short and long term – not only for the benefit of the sport, but for the athletes concerned when they are long into their retirement.

stem cell treatment for knee osteoarthritis

Could your knee heal itself?

With an ageing population that doesn’t – or isn’t allowed to – slow down as they get older, there’s never been more time, expertise and effort being exerted into the problem of knee osteoarthritis. Barely a month goes by these days without a new development in this area, but the latest research has raked up a whole new approach – a device which sweeps up stem cells from the joint lining and then ‘brushes’ them into blood clots. Why? Because stem cells have the ability to form new tissue and have the potential to let the knee heal itself.

The study, from the University of Leeds, has not only demonstrated that the treatment increases the number of repair cells in the area by a hundredfold, but it also casts doubt upon arthroscopy – the keyhole procedure which examines and clears out knee damage – as it may actually inadvertently sluice out the resident stem cells that are capable of repairing knees.

Break up to make up

The key discovery made by the Leeds research team involved the technique of microfracture, which involves using a drill or pick to make small holes in the bone surfaces inside the joint to release stem cells which are trapped in blood clots, and contribute to the repair of the cartilage. The downside to this is that it had been assumed that the number of repair stem cells in the knee is low.

However, the research team discovered that the synovial fluid – which lubricates the joints – contains stem cells too, but the self-same lubrication was stopping the cells from bonding to injured cartilage, and the standard knee procedures were washing them away. So, they’re currently trialling a procedure which creates a microfracture, which results in a clot – followed by a specially designed device which ‘rakes’ the stem cells into the clot, which is inserted through a small hole which has been made in the joint.

A new trial forthcoming

And according to the study, which was published in The American Journal of Sports Medicine, the researchers found that the brush resulted in a 105-fold increase in the number of stem cells. The results have been so encouraging that a new trial is already being prepared, which will involve twenty patients undergoing the microfracture procedure, with ten of them having the stem cell ‘raking’ procedure as well.

Unsurprisingly, the knee OA medical community are sitting up and taking notice, while also striking a note of caution that self-healing knees are still a way away.“Stem cells still represent an exciting area of research for providing a biological solution to knee injury and arthritis,” explains Mr Jonathan Webb. “Several lines of treatment are being studied but it remains an enormous challenge to reliably replicate the complex structure of articular cartilage. For younger athletes with an injury to an otherwise healthy joint, there is more promise, whereas in the older population the damage goes deeper than just the layer of joint surface and so stem cells have not yet proven to be as reliable.” But it’s fair to say that this development is an interesting step forward for knee OA treatment, and one that will be followed with great interest.

skiing knee injuries

The silver skier: how to keep skiing in your sixties and beyond

More and more people over 60 are taking to skiing, and there are more reasons for that than you’d first assume. People in that age group nowadays tend to have the time and money to be able to ski – and what’s more, they’re far more active than earlier generations of that age group. There are legitimate health reasons for taking up skiing late in life, too: it can be a huge boost to upper-body and core strength, as well as helping with memory and brain health – and it’s a far better way to spend your golden years than being stuck on the sofa.

And the good news for the older skier – whatever your level and experience – is that you are clearly not alone. The skiing industry is well aware of the boom in older skiers, with websites, clothing, kits, and lessons aimed at the more mature end of the market, with plenty of ski clubs in that age range, meaning you don’t be discouraged from taking to the slopes and enjoying the physical, mental and social benefits of skiing.

However, it can’t be stressed enough: skiing can be a risky pursuit, and it doesn’t get any safer as you age. And when you’re at an age when you feel less indestructible than you did before, those injuries can mount up if you’re not careful. According to recent statistics, the majority of injuries on the slopes happen to older skiers, and when you’re older, the recovery times get longer.

(Oh, and before we talk about how to get over the hill without permanently retiring from the piste, the obvious question is: Is it too late to start skiing? In a word, and according to the experts, no. As long as you’re reasonably fit – or at least not massively unfit – and not carrying any debilitating injuries or ailments, it’s never too late to take the sport up.)

Get checked out

Your first step is to visit your GP, state your intentions, and listen to them. They’ll be able to advise you on your current level of fitness, and either give you the go-ahead, help you draw up a plan of action to get you ready to ski, or rule it out completely. Don’t be afraid to bring your intentions up: by and large, they’ll be glad to hear you intend to take up skiing, as they know what comes next…

Get ready to exercise

Whatever your experience level, you can’t just walk off the street onto the slopes: you’ll need to embark upon a low-level exercise regime that’ll include, stretches, half-squats, lunges, leg curls and crunches, with light, low-rep weight training thrown in. Avoid the heavy stuff – the goal is to ease your joints into coping with the bending and balance issues that skiing throws up.

Get the right gear

If you’re a beginner, this is necessary. If you’re returning to the sport after a long break, it’s equally necessary, because the gear has got better and safer. Try out the shorter, wider skis – they help enormously with turning. Get acquainted with the new boots, because they’re far better in preventing injury than the ones you wore twenty years ago. And make sure everything fits.

Be realistic

Sad to say, whatever your level of experience, the days of going off-piste may be over. Your first experience at a resort should be in an instruction workshop, to get (re)acquainted with the right techniques

Fatigue, loss of concentration and alcohol consumption can all increase the risk of incurring an injury, one-third of which affect the knee, so it is important that you don’t overtire yourself or enjoy the social aspect of skiing too much. If you do suffer from a knee injury – typically a meniscal or anterior cruciate ligament tear – it doesn’t mean that your skiing days are over, but seeking treatment from a knee specialist as soon as possible is a must.

massage and knee arthritis symptoms

Could a whole body massage improve knee arthritis symptoms?

We’re all aware of the many benefits a session with the masseuse can bring, whether you’re coming off an injury or not: as well as reducing pain and stiffness, it can improve the circulation, reduce stress, anxiety and depression, remove dead skin cells and even provide a boost to the functionality of the immune system. But according to research from North Carolina, a full-on rub-down can also have beneficial properties for those suffering from knee osteoarthritis.

According to the study, which was conducted by researchers from the Duke University of Medicine in Durham, NC, a weekly, whole-body massage for two months could help knee OA sufferers experience ‘significant improvement’ in pain and mobility, and that massage could offer a safe and effective complement to the management of knee osteoarthritis, at least in the short term.

Could a knead improve your knees?

The study – which lasted a year –involved 200 patients who suffered from knee osteoarthritis, who were randomly divided into three groups – one group which received a one-hour, weekly Swedish massage for eight weeks (a technique which uses long strokes, circular movements of applied pressure, and kneading in order to relax muscles, reduce soreness, and increase oxygen flow), one group which received a light-touch control treatment, and one group which received no extra care other than their usual regimen.

After eight weeks, each of the groups were again randomised into three separate groups, to continue with massage or light-touch every other week, or to receive no treatment for the remainder of the study, for the rest of the year. Every two months, each study group was medically assessed for pain, stiffness and functional limitations, including how well they could climb stairs, stand up from sitting or lying down, bend, walk or get out of a car.

There’s the rub

The results? After just eight weeks, the group undergoing massage had significantly improved scores over the other two groups, with a marked improvement in pain reduction, stiffness reduction, and physical function. And by the end of the study, the twice-monthly massage group maintained the improvements observed at eight weeks, but did not provide an additional benefit, with no significant differences between the groups at 52 weeks.

Why could regular massage relieve knee OA? The jury is still out on that one, but America’s Arthritis Foundation speculates that a session on the table can take the edge off all manner of arthritis ailments due to the fact that it’s a proven stress reliever, which has the potential to reduce cortisol levels, as well as boost the production of endorphins. Having relaxed muscles as a result of massage could be a key point, but the links between massage and reduced knee OA are still a mystery to the medical community.

Whatever the reason, a regular massage session could be the ticket for the reduction of knee pain, but you should be cautious if you have very damaged arthritic joints, a flare of inflammation, severe osteoporosis or high blood pressure. Your knee surgeon can advise you on whether massage is an appropriate treatment for you.

knee injury risk

Why your cushioned trainers might actually be increasing your knee injury risk

Thinking of kickstarting a healthier lifestyle through running this year? Planning to ramp up your fitness regime? Or just looking to upgrade your kit? When it comes to running, footwear is often the most important consideration and there are a lot of options out there when it comes to trainers. The most tempting options on the market can be those with highly cushioned soles, as at first glance, the benefits are obvious: more cushioning in the sole means less jarring on the knees, right?

Well, according to a study recently conducted by Finnish researchers, extra-cushioned trainers may be doing more harm than good: not only did the researchers find any evidence that proves bouncier soles prevent injuries, but they can also lead to an increased risk of knee damage over time.

More spring, more sting?

The study, conducted by a research team from the University of Helsinki, took a dozen dedicated runners – all healthy, and all with a professional background – and put them through a 3D running analysis while wearing two different trainers: the Hoka Conquest (which has a 43mm cushion beneath the heel), and the Brooks Ghost 6, (which boasts a 33mm cushion). The study group jogged at both 10km per hour and 14.5km per hour.

According to the results, which were published in Scientific Reports, the difference between running habits in both trainers was literally striking: they revealed that the runners’ feet hit the ground harder when they were wearing the cushioned trainers – particularly at the faster speed of 14.5km per hour, where the load impact in the more cushioned trainer was 12.3 per cent greater than in the less cushioned pair.

It doesn’t get better in the long run

When the video analysis was consulted, the reason why was clear: it demonstrated that the runners bent their knees and ankles less when they wore the cushioned shoes, which caused their bodies to slow down quicker and placed extra stress on their legs. In other words, the feeling of extra cushioning lulled the runners into a false sense of security, caused them to subconsciously unlearn good running technique, and essentially altered the natural spring-like mechanism in their legs which ensures we bend our knees and ankles to create a bouncing movement.

This ‘unlearning’ causes runners to land with a stiffer leg, which ramps up the risk of knee injuries, and can store up a welter of problems for runners of all experience levels. For the professional, it can unravel a technique which has taken years to perfect and hone: for the beginner, it can set you on the path to poor fundamentals right from the off. In all cases, stiffer leg technique ramps up the risk of stress fractures.

While the research team is keen to stress that further studies are needed to confirm and refine their current findings, and that there probably isn’t an across-the-board ruling on cushioned soles, this makes a lot of sense so far. Our advice is to always remember the fundamentals when trying out new footwear, and don’t be afraid to go back to what you know if you feel your new trainers aren’t working out for you. Seeking an assessment from a knee specialist is also important – with almost half of all overuse injuries affect the knee joint, it’s not surprising that there’s even a condition called ‘runner’s knee’.

persistent knee pain

Greater pain sensitivity found to increase risk of developing permanent knee pain

 There’s very little in life worse than constant, nagging pain in a certain part of your body, and if you’re not aware of that yet, consider yourself very lucky, because it can impact upon your entire lifestyle. And if the part of your body that’s affected happens to be your knee, you already know the obstacle it presents during your day-to-day routine.

We know the role that pain plays in body mechanics, and how it acts as a vital signifier that something has gone amiss. And while many people react to pain by getting themselves checked out and seen to at the earliest opportunity, others will either ‘tough it out’ and try to work through the pain, or shy away completely from the risk of aggravating it. And according to a recent study, compiled by researchers in Montreal and Boston, the latter group are jacking up the risk of their condition becoming permanent.

The study, which was conducted by study teams from Université de Montréal, the Maisonneuve Rosemont Hospital Research Centre (CRHMR), and Boston University, analysed the data of 852 adults aged between 50 and 79 who were diagnosed with or at risk of contracting knee OA, but who weren’t suffering from persistent knee pain at the beginning of the study.

 

Tolerance to pain essential for avoiding knee arthritis

The research teams scoured each subject’s sociodemographic data and pain sensitization measurements, as well as looking for risk factors traditionally associated with knee pain such as psychological factors, widespread pain and poor sleep. They were then monitored for the development of persistent knee pain over the course of two years.

After crunching the data, the research teams managed to place members of the study group into four distinct subgroups which they called ‘pain susceptibility phenotypes’ – in other words, graded by their varying degrees of pain sensitisation, and discovered that those with the highest degree of sensitisation had the highest risk of developing persistent knee pain.

Out of those in the high-risk group, the biggest sociodemographic predictors were females, non-Caucasians and people aged over 65.

The researchers believe identifying these pain susceptibility phenotypes could be a very important development in understanding the complex pathology of knee OA – and that helping potential kn
Bristol: ee OA sufferers to build up their tolerance to pain or help them avoid pain altogether is crucial in improving their quality of life.

How can a low tolerance to persistent knee pain aggravate and even accelerate the onset of OA?

It’s simple: the instinctive response to knee pain is to not do anything to bring it on, which leads to a sedentary lifestyle – which can lead to an increased risk of developing factors that bring on OA, such as obesity and underuse of the joint mechanism. Medication can help to a certain extent – but both doctor and patient need to be aware of the risk of relying on painkillers to get through the day.

A more prudent approach may be to work out and adhere to an exercise programme geared towards safely and effectively strengthening the muscles around the knee.

walking could delay need for knee replacement surgery

A brisk walk a day could delay need for knee replacement surgery

If you suffer from knee OA and you’re worried that walking across the park or leaving the car at home when you nip to the shops is going to make matters worse, then think again: a new study from America claims that if older adults with the ailment added a mere five minutes of brisk walking to their day, the odds of them needing knee replacement surgery could drop by as much as 16 percent – as long as the walking pace is a notch up from a mere saunter.

The study, which was conducted by scientists at the University of Delaware, provided portable tracking devices to over 1,800 older adults with knee arthritis and monitored their walking intensities for at least four days, in an attempt to examine the effects of replacing non-walking time with time spent walking at different intensities. Their findings?

Substituting just 5 minutes of downtime with moderate-to-high intensity walking was linked to a 16 percent decline in the odds of needing knee replacement surgery. By ‘moderate-to-high intensity’, they mean a brisk walk which takes in over 100 steps per minute.

Why does walking work? There are four key reasons;

Walking rebuilds the joints

Cartilage – the joint tissue which acts like a shock absorber for your knees – can become damaged and worn, which brings on knee OA, resulting in pain, stiffness, and difficulty in moving. But cartilage can also repair itself and can absorb the nutrients from the compression and decompression of your body weight as you walk, meaning that a brisk yomp can speed up that repair job.

Walking strengthens the legs

…and stronger leg muscles can not only take a level of pressure off your joints, but they can also handle more of your body weight, resulting in less knee pain.

Walking helps to lose weight

One pound of weight lost equals four less pounds of pressure on your knees – and less pressure equals less pain. And the best low-impact method of losing weight is to commit to a more intensive daily walking distance.

Walking can help boost mental well-being

Like all exercise, walking is one of the best natural ways of getting your endorphins to kick in.

The great thing about the results of the study, according to the research team, is that for the majority of people, it’s not going to be that much of a lifestyle change. Furthermore, it wouldn’t require the expense of a gym membership or any equipment other than a pair of comfortable shoes or trainers. As they point out, the best exercise programmes are the ones you can actually stick to – and when the only sacrifices a person has to make is to get off the bus a stop earlier or actually get leave the house a bit more, there’s an opportunity for the physical activity to snowball.

The moral of the story? Every journey begins with a single step – as long as it’s a brisk one.

knee replacement risks

Aspirin found to be effective for preventing blood clots after knee replacement surgery

It takes the edge off headaches, dulls toothache, makes period pains more manageable, helps you tackle colds and flu, and even be used to help prevent heart attacks and strokes. And according to a recent study from the University of Michigan, there’s a new use for the humble aspirin: as a cheap and effective replacement for expensive anticoagulant drugs to prevent the knee replacement surgery complication of blood clots.

Anticoagulant medication is a crucial component of the post-knee surgery recovery period because although the chances of a blood clot after knee surgery isn’t at all commonplace, it’s still something you really don’t want, as it could be fatal. There are plenty of anticoagulant options available to the medical community, but they all ‘up there’ in cost and make an expensive procedure even more expensive. So, finding a cheaper alternative with the same benefit would be a huge fillip to the global health community.

A cheap and accessible solution?

The study, which was published in JAMA Surgery last month, combed through the medical records of 41,537 patients in the US who had undergone knee surgery between 2013 and 2015, with a firm eye upon the medication they received after the op and the incidences of thrombosis – the medical term for a blood clot.

Among those who received no medicine post-surgery, the rate of thrombosis was 4.79 per cent. For those who were given prescription anticoagulants, the rate was 1.42 per cent. For those who were prescribed both an anticoagulant and aspirin, 1.31 per cent developed clots. But for those who used nothing but aspirin, the rate was 1.16 per cent. The research team deemed the statistical differences as ‘insignificant’.

The other key finding involved bleeding complications – a regular although comparatively rare consequence of using blood-thinning drugs – but the researchers found no difference between aspirin and the prescription drugs in the risk for that side effect either.

Is this the beginning of a switch away from expensive medication and a move towards something we can pick up from the supermarket for pennies? Not necessarily so, according to Dr Brian R. Hallstrom, an associate professor of surgery at the University of Michigan and the senior author of the study, who went to great pains to point out that the patients in the study had their medications selected by their doctors, and that the study itself was not a randomised trial. For example, if he were treating a patient who had experienced a blood clot in the past, he would still use anticoagulants. But he added; “Most people can get aspirin alone without much concern.”

In the meantime, it makes sense to touch upon what you, as a post-op patient, can do to avoid blood clotting. Two of the biggest risk factors for blood clotting is a previous history of blood clots, and if the patient is currently undergoing treatment for cancer. While you can’t do anything about either of those issues, you can take steps to avoid cutting by avoiding the other danger areas: excess weight, sedentary lifestyle, and a smoking habit.

Also, if there’s a family history of blood clotting or you’re taking hormonal medication (such as birth control), your knee replacement surgery specialist will establish this when taking your medical history prior to surgery.

Blood clots are a risk after any orthopaedic surgery, but preventative measures adopted by Mr Jonathan Webb and his team have greatly reduced this risk.

total knee arthroplasty

Walking could be key to avoid total knee arthroplasty

When it comes to knee OA – along with every other medical issue – prevention is always better than cure, and anything which can keep people off the operating table is always worthy of attention. And a new report – from a study team at the University of Delaware – is another firm endorsement to the power of walking to prevent total knee arthroplasty.

The study – which set out to determine if there was a link between walking intensity and the risk of total knee arthroplasty, be it positive or negative – studied the data of 1,854 participants who were marked as ‘at risk’ on the Osteoarthritis Initiative (the American data repository which monitors and tracks all potential and actual knee OA cases). This meant they had not undergone a total knee arthroscopy over the research period, which was 48 months.

The study team also quantified and tracked the walking habits of each participant, first by giving each participant an accelerometer and tracking their steps over four days, and then by breaking the amounts of steps per minute down into four groups: non-walking (no steps per minute), very light walking (1 to 49 steps per minute), light walking (50 to 100 steps per minute) and moderate-to-vigorous walking (over 100 steps per minute).

The results determined that an extra five minutes of moderate-to-vigorous walking instead of non-walking can reduce the risk of total knee OA by 16%, while the same five minutes of very light or light intensity walking has no overall effect.

So why is this? Well, there three established points of view about the benefits of walking:

Walking rebuilds the joints

Cartilage is the tissue in your joints which acts as a shock absorber for your knees. Unfortunately, they can become damaged and worn, which can bring on OA, resulting in pain, stiffness, and difficulty in moving. Because cartilage acts like a sponge, it can absorb the nutrients from the compression and decompression of your body weight as you walk, meaning it can attempt to repair itself faster.

Walking strengthens the legs

This is very important: walking, like all exercise, helps to build leg muscles and stronger leg muscles can take a level of pressure off your joints and can handle more of the weight themselves, resulting in less knee pain.

Walking helps lose weight

Studies prove that one pound of weight lost removes four pounds of pressure on your knees – and less pressure equals less pain. That’s a huge difference, and the best low-impact method of losing weight is the extension of your daily walking distance.

“Walking may exacerbate knee pain and further make things worse, but on the other hand, walking is helpful to build and maintain strength and may prevent the development of difficulty functioning,” said study co-author Hiral Master, PT, MPH, during the presentation of the study in Chicago last month. “Small changes in walking behaviour could delay the need for total knee arthroplasty in people with or at high risk of knee osteoarthritis.”

knee replacement surgery specialist

Could a glass of wine a day keep knee pain away?

If you’re unfortunate enough to be suffering from knee osteoarthritis, you know all too well that you’ll try anything to take the edge off the pain – and a new study from the Al-Rafidain University College in Baghdad attracted a lot of attention last month, as it claimed that a compound called resveratrol has the potential to bring a substantial amount of relief to osteoarthritis sufferers.

As resveratrol is chiefly found in red grapes, and red grapes are used to make red wine, it’s not surprising the story got a hefty amount of headlines.

The study – which involved 110 patients – investigated the potential of red wine as an OA symptom alleviant by splitting up the study group into two, and giving one group a resveratrol treatment and the other half a placebo. In the end, the research team discovered that the group on resveratrol not only reported much less pain than the placebo-taking group, but also measurably showed less physical markers of inflammation.

Red red wine goes to my knee

We’ve known for a while that red wine – taken in moderation – boasts a welter of health benefits. For starters, it’s a natural antimicrobial agent – which can help our immune system fend off the likes of Staphylococcus aureus, Clostridium perfringes, Bacillus sp. and Klebsiella sp. More importantly, it’s very good at attacking S.aureus, which is the leading cause of septic arthritis.

Moreover, it’s been demonstrated that red wine is very effective in preventing cartilage damage and protecting our bones, preventing disease progression in osteoarthritis, fending off the onset of gout and improving metabolic health – and can even aid weight loss. The more you look into it, the more you believe that this stuff should be on the NHS. However, there’s a catch…

…you’d have to get legless

The bad news is that a glass of wine contains a tiny amount of resveratrol, and to receive the full benefits of it, you’d have to get through a glass big enough to contain eleven litres of plonk a day to get the recommended amount used in most studies – which would definitely go some way towards alleviating knee pain, but would cause far more health problems.

No doubt there’ll be more studies about the potential benefits of resveratrol and, maybe, one day scientists will work out how to deliver enough of it to fend off the effects of knee OA – but until then, we’re going to have to rely on the very real benefits of knee replacement surgery – be it total or partial replacement.

It’s a procedure which can become necessary at any age, due to ageing, injury or disease, and is required when the current knee has deteriorated to the point where your mobility has been sufficiently reduced and you are experiencing pain.