6 tips on how to prevent knee injury on the slopes

skiing-and-knee-injuriesThe news that Lindsey Vonn has crashed out of this year’s ski season – for the third time in four years – puts the spotlight on skiing and knee injuries.

At the beginning of the month she was racing in Andorra, holding her position as the woman’s overall World Cup leader, when a nasty fall resulted in three hairline fractures in the tibial plateau. Vonn announced on her FaceBook page that they were significant enough to mean that her leg would not be “sufficiently stable to permit me to safely continue skiing”.

Since 2013, the list of injuries Vonn has suffered while competing is impressive, with three torn knee ligaments resulting in two knee reconstructive surgery ops and she has also broken her tibia twice and her ankle once. Vonn has pulled out of this year’s season as her aim is to race in the world championships in St Moritz in 2017 and the Winter Olympics the following year, but even for those that enjoy less competitive skiing, this is a sport that has a high risk of incurring knee injuries.

The most common knee-ski injury is damage to the anterior cruciate ligament. The ACL is one of the ligaments that hold the knee together and a severe twist – easily incurred when skiing – can instantly result in a partial or complete tear. Quick-release bindings on skis have helped but here are some tips on how to minimise incurring a knee injury on the slopes:

# 1 Be prepared

Being near or at your ideal weight and being fit and strong in advance of your ski holiday will lessen the chance of incurring an injury.

# 2 Book a ski instructor

Even if it’s not your first time, a ski instructor can improve your technique, therefore putting less pressure on the knee.

# 3 Make sure you’re set up properly

Badly-adjusted skis or bindings are more likely to cause injury so be honest about your ability – and weight – when hiring skis.

# 4 Beware skiing slowly!

Whilst you need to be vigilant at all times, people naturally concentrate when they are going fast and, in reality, most injuries occur when skiing slowly because the bindings don’t release, especially in slushy snow. So be extra careful and maintain concentration at all times.

# 5 Don’t overstretch yourself

When muscle fatigue sets in then you’re more likely to injure yourself so ensure you get plenty of rest. However, don’t opt for the apres-ski; alcohol or a hangover will slow your reaction times.

#6 Or take up snowboarding…

Although studies have found that learner boarders are more likely to occur injury than beginner skiers, the knees are less likely to be affected because both feet are strapped onto one board and they are pointing in same direction which prevents the knee from twisting. Snowboarders are actually more likely to occur injury to the upper limbs; shoulder injuries as a result of falling forward or wrist fractures and head injuries from toppling backwards.

The best advice for those that have incurred a knee injury on the slopes is to immediately seek expert advice. To book a consultation at either Mr Jonathan Webb’s London or Bristol clinics call 08450 60 44 99.


New study finds no value in vitamin D and fish oil in treatment of osteoarthritis

fish-oil-and-osteoarthritisAnyone suffering from pain and lack of mobility as a result of knee osteoarthritis will be keen to explore treatments that could possibly alleviate discomfort and restore full movement without the need for extensive knee surgery. One complementary approach which is widely thought to be useful in reducing inflammation and slowing down the disintegration of knee cartilage is the use of vitamin D and fish oil supplements, but in a study published this week these supplements were found to have no distinguishable impact on knee osteoarthritis.

Published in the Journal of the American Medical Association (JAMA), the study was performed by a team of Australian researchers at the University of Tasmania. Half of the group of 413 osteoarthritis sufferers were given vitamin D supplements and the other half were given a placebo. When re-examined two years later, using MRI scans for cartilage volume and the WOMAC pain score to measure knee pain, researchers found no marked difference between the the two groups.

Ding Changhai, the lead researcher, stated that: “This data suggests a lack of evidence to support vitamin D supplementation for slowing disease progression or reducing knee pain in osteoarthritis.”

This follows on from an earlier study performed by the same group into the efficacy of fish oil that found it to be ineffective for both relieving pain and increasing knee mobility.

How is fish oil and vitamin D thought to help alleviate osteoarthritis?

Fish oils (either body or liver oil) are rich in omega-3 essential fatty acids. These are required by the body to boost the immune system and they help to fight inflammation of the joints by blocking production of protaglandins, as well lowering levels of cholesterol and triglyceride in your blood. Fish oil is also rich in vitamin D which is needed for maintenance of our joints, in particular the production of proteglycan in cartilage.

Anecdotal evidence suggests that fish oils may improve rheumatoid arthritis symptoms but its use in alleviating osteoarthritis has not been clinically proven and this study further undermines its claims.

What are the treatment options for knee osteoarthritis?

Pain killers, either analgesics or non-steroidal anti-inflammatory drugs (NSAIDs) are typically prescribed for those suffering from knee osteoarthritis, thought to affect approximately 10 per cent of men and 13 per cent of women over the age of 60. They can help to relieve pain and stiffness, but will not be able to repair damage. Steroid injections are sometimes prescribed. When other treatments are not providing adequate relief, joint replacement surgery may be advised. For advice on knee osteoarthritis, book a consultation with Mr Jonathan Webb at either his London or Bristol clinics.

Knee Surgery Patient Testimonial

“I felt looked after by Mr Webb throughout”

We talk to one of Mr Jonathan Webb’s previous patients about her experience. An enthusiastic rock climber, she suffered a torn meniscus that was repaired by Mr Jonathan Webb at the Fortius Clinic, London.

“The video was recorded in November, two months after my surgery. The video was shot during the female Boulder eliminator. I started very slowly trying to have every move under control. The roof section was the most demanding one but someone I managed to climb further than my three other rivals and so I won the eliminator!”

I am a 27-years-old journalist working as implementation consultant. I have always been a very active person. I hiked in the mountain every time I had an opportunity and, as a kid, I practiced tennis, handball, judo, swimming, table tennis and for the last ten years, I’ve enjoyed canyoning and rock climbing.

I’ve been living for the past three years in London. London is a rushed, fast-paced city, but my routine is pretty much 40 hours a week sitting at my desk, so in my spare time I climb between two to four times a week. My session in the climbing centre lasts between one to three hours. Climbing makes me feel alive and I love the muscular effort that the sports requires. I generally feel energetic, fit and strong. I also like to do climbing competitions and that requires a regular training practice.

A week before I tore my meniscus I had been climbing in Sardinia. I believe the continuous physical strength and endurance that those days required meant the beginning of my knee deterioration. Then I was doing rope climbing in London with a friend and everything was going fine but when he was belaying me down with the rope and I touched the ground with my feet I instantly felt that my left knee wouldn’t stand my weight.

I sat down and looked puzzled at my friend as I hadn’t felt anything while climbing up and now all of a sudden I was unable to walk. I put some ice on the knee and went to A&E. At that moment the knee wasn’t swollen so their advice was to go home and follow up with my GP for a MRI. They sent me home with crutches.

The GP referred me for an MRI which revealed a torn meniscus. Options were to do surgery or not.

Surgery for torn meniscus

At the beginning I was unsure so I started doing some physiotherapy which helped to get my quadriceps stronger. From not being able to walk without limping, I was able to walk normally. However, as a rock climber I felt that if I didn’t have surgery, I would not be able to return to the same level of climbing, as climbing demands all sorts of contortion and weird angles.

I received the date of the surgery within a week of my decision and on the day of the surgery I was a little bit nervous but everything went really well. Mr Webb and his team were incredibly professional and at all time I felt looked after.

Rehab after surgery

The same day of the surgery I was home walking. I stayed at home for a couple of days icing and resting the leg as much as I could. I started physiotherapy straight away with the goal to improve quadriceps strength. My physiotherapist, Martina Kheoe, helped me to recover at the exactly right pace.

Returning to pre-injury activity level

I don’t have any pain in my knee and I was back to climbing after five months. I am weaker than before and it is taking me a little time to recover my strength. I’m climbing with a solid knee support and now that I know I have been fixed it is a case of trusting the knee and focusing on improving my climbing.

If you’re worried you may be suffering from a torn meniscus or other problem relating to the knee, book a consultation with Mr Jonathan Webb at either his London or Bristol clinics.

stem cell knee repair

Swedish scientists grow cartilage tissue from cow knee joints for possible future knee repair

stem cell knee repairCartilage is found on the surface of all joints in the body, cushioning them from shock and allowing the bones to glide smoothly over each other, but cartilage will deteriorate over time, particularly in those joints that are constantly in motion and as the knee joint bears the most load in the body, it can be the most vulnerable.

As the cartilage deteriorates it causes a condition called osteoarthritis, the most common form of arthritis, with 49% of women and 42% of men over the age of 75 in the UK having sought treatment for osteoarthritis.

Treatment options for osteoarthritis

Unfortunately, the cartilage does not have a blood supply so healing is compromised and surgical repair of cartilage is often either not an option or can have a low success rate. Often, the only solution for large-scale cartilage damage and deterioration is the replacement of the whole knee joint, yet that also has drawbacks. This is why stem cell repair of cartilage has received much attention from the media in recent years.

Scientists have been testing whether primary or stem cells – either transplanted from another area of the body such as the hip or from a donor – can halt the damage to the knee. One problem is that often the damage is quite extensive and just transplanting cartilage or stem cells from elsewhere will have little effect so scientists are also studying the option of growing cartilage cells in a laboratory before they are reintroduced.

Now researchers at Umea University in Sweden are using cartilage cells from cow knee joints to grow healthy cartilage tissue as a possible future treatment for osteoarthritis.

Using primary bovine chondrocytes or cow cartilage cells, the scientists have been working on methods to grow cartilage tissue that could mimic human cartilage tissue. The eventual aim of this type of stem cell engineering is to be able to produce unlimited amounts of material that could be used to replace damaged human cartilage and provide a permanent solution for osteoarthritis sufferers.

To discuss your options in treating osteoarthritis, make an appointment for a consultation at either Mr Jonathan Webb’s London or Bristol clinics.

As Roger Federer undergoes knee surgery, why tennis knee injuries are so common

roger-federer-tennis-knee-injuryDays after his defeat in the Australian Open semi-final against Novak Djokovic, Roger Federer underwent knee surgery to repair a torn meniscus which will take him out of action for a month. The surgery was reportedly a success and Federer announced that, “with proper rehabilitation, I will be able to return to the Tour soon.”

The media is full of stories of professional football, tennis and rugby players undergoing surgery to repair knee injuries, but these are just as likely to affect those playing at amateur level. Acute knee injuries, those that occur during activity, are thought to make up over half of all sports injuries. Why are they so common and is there anything that can be done to prevent them?

Sport and knee injuries

The knee is a key part of the body, as it supports more ‘load’ than any other joint as well as having to withstand more pressure when in motion. Athletes put their knees under immense strain during their playing careers so as well as hastening deterioration of the knee joint, compared to those that lead a more sedentary lifestyle, it can also cause sudden damage to the ligaments and cartilage that support the knee joint, dramatically increasing the risk of injury.

In most sports, athletes are often called upon to quickly change direction and position or have to exert energy to pull back or tackle an opposing player and it is this sudden movement that causes problems.

The knee joint is where three bones converge – the upper leg bone known as the femur, the lower leg bone called the tibia and the kneecap itself. Cartilage discs, or menisci, allow these bones to move smoothly and also absorb shocks to the knee. A torn meniscus is one of the most common knee injuries, particularly in athletes that play contact sports, and may require surgical repair.

The knee joint is stabilised by the attached muscles, tendons and ligaments. These ligaments are known as the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), lateral collateral ligament (ICL) and the medial collateral ligament (MCL). The anterior cruciate ligament runs through the middle of the knee and injury to the ACL tends to keeps people out of sport the longest as it provides rotational stability to the knee. Ligaments sprains are where the ligament stretches or tears, either partially or total.

Is it possible to prevent knee injury?

Although you may protect your knee from a sudden, acute injury by not playing sports, you will be missing out on the many physical, psychological and social benefits. Consultant knee surgeon and sports medicine specialist Mr Jonathan Webb explains how you can minimise the risk of incurring an acute knee injury:

  • Good support is essential; ensure that you wear supportive footwear that fits properly. If you’re unsure then specialist sports shops can give advice
  • Protect yourself; make sure you wear all the appropriate protective gear such as kneepads or shin guards
  • Prepare properly; always warm up and cool down before you start playing
  • Strengthen up; as well as your preferred sport, weight training and stretching exercises can improve your flexibility and strengthen the muscles supporting the knee
  • Flag up a potential problem; if you have knee pain or worries about knee stability, tell your coach or trainer as soon as possible so it can be assessed

Could depression medication relieve pain from knee osteoarthritis

Researchers at Arthritis UK recently announced the commencement of a clinical trial into the potential benefits of a medication commonly aimed at treating depression or anxiety for relieving knee pain as a result of osteoarthritis.

Osteoarthritis explained

Osteeoarthritis is a joint condition whereby the joints become painful and stiff as a result of deterioration of the tissues. All joints in the body can be affected, but osteoarthritis of the knee is very common and can have a drastic impact on mobility as well as causing a great deal of discomfort and pain.

Although osteoarthritis is often seen as an inevitable result of the ageing process, there are other factors that can influence your chance of developing the condition. These lifestyle factors are often the first to be addressed by your GP to try and improve your condition. These include losing weight and embarking on a programme of regular exercise.

Alleviating pain associated with knee osteoarthritis

For many people living with knee osteoarthritis, pain relief is an important component of how they manage the condition. The type of medication you will be prescribed will be based on an evaluation of the severity of your pain. Options include:

  • paracetamol; this over-the-counter medication is often the first step
  • NSAIDs; this stands for non-steroid anti-inflammatory drugs which reduce inflammation. These can be prescribed either as a topical cream or an oral medication and will reduce swelling as well as ease any pain and discomfort. You will have to closely follow the instructions of your GP to ensure no side effects
  • opoids; these include codeine and are a powerful painkiller but can also cause drowsiness and nausea
  • capsaicin cream; this topical preparation is applied directly to the area and blocks the nerves that send pain messages
  • corticosteroid injections; for very severe pain, you may require an corticosteroid injection directly into the affected joint to reduce swelling and pain

Now, researchers at the University of Nottingham pain centre are looking at how the drug duloxetine is able to effectively relieve pain and whether it will be of use to those suffering from a long-term condition such as osteoarthritis. Osteoarthritis sufferers recruited to the study will undergo MRI scans both before and after a six-week course of the drug to study how the pain relief mechanism works.

One patient who has already taken part in the trial reported: “My knees get very painful, even painkillers don’t work at times. During the trial my pain went away. I was able to swim further and walk quicker, and the tablets I took were much better than the painkillers I’d been taking.”

If damage to the knee joint is severe and pain relief is not working, then a partial or total knee replacement could be the solution. Knee specialist Mr Jonathan Webb can advise you on the potential benefits and limitations of knee replacement surgery so you can make an informed decision about your treatment. To book a consultation at either his London or Bristol knee clinics, call 08450 60 44 99.

Knee symptoms: beyond pain

Last month we looked at types of knee pain and what they can tell us about the different problems that affect the knee. However, if you are suffering from a serious knee condition then pain is usually accompanied by other symptoms, all of which will be assessed during your consultation with Mr Jonathan Webb.

The knee is composed of bones, cartilages, ligaments and tendons, all of which work in tandem to allow for full mobility. If any of these structures are affected, particularly as a result of deterioration over time, then ease of physical movement is undermined.

Swelling and the knee

Swelling is usually an immediate sign that there has been trauma in the knee and it should resolve itself as the tissues heal. Swelling that occurs in the minutes or hours after an injury will be due to bleeding, whereas swelling that presents over a period of 24 hours is typically due to excess fluid.

Make note of how the swelling presents as Mr Webb will be asking these questions during your consultation to aid his diagnosis. Rapid swelling, for instance, is usually a sign that there has been a tear to the cruciate ligament or meniscal. However, chronic long-term swelling is typically a result of an inflammatory condition such as osteoarthritis.

Knee instability

Does your knee suddenly ‘give way’? If there is instability in the knee, meaning it suddenly bends or twists causing you to seek support or even fall completely, then this can be a result of a injury to the ligaments, particularly the anterior cruciate ligament. Injury to the medial or posterior ligament is less likely to cause knee instability.

A clicking sound

If you are able to hear a clicking sound when you move the knee, often accompanied by a feeling of instability and discomfort, then it might be an indication that a piece of bone or cartilage or part of the meniscus has torn and become trapped in the joint.

Locking knee

Locking of the knee refers to an inability to either extend or bend the knee fully, often accompanied by pain when attempting full mobility. This is a mechanical problem affecting the knee joint and can be the result of a tear in the meniscus or a piece of bone and cartilage that is trapped in the joint.

This is a different issue to general stiffness that drastically reduces mobility and is more likely to point to a diagnosis of osteoarthritis.

By taking into account the description of your symptoms, Mr Jonathan Webb will have a clearer idea of the possible problem affecting the knee, allowing him to order the necessary scans that will support this diagnosis. If you would like to book an appointment at either Mr Webb’s London or Bristol clinics then call 08450 60 44 99.

Ouch! What your knee pain might mean?

Successful treatment of any problem relating to the knee depends on the correct diagnosis and appropriate treatment plan. Before ordering any necessary tests or scans, Mr Jonathan Webb will discuss your symptoms in depth and the location of your knee pain can be an important tool in diagnosing the problem, particularly if it involves a specific area of the knee:

1 Knee pain at the front

Known medically as anterior knee pain, the kneecap is a common place to experience discomfort. Conditions that can cause anterior knee pain include Patellofemoral Pain Syndrome (PFPS) or runner’s knee as the stress of running can cause irritation where the kneecap rests on the thighbone. The kneecap area is tender and you may feel a cracking sensation or the knee is about to ‘give out’.

2 Pain on the inner part of the knee

Medial knee pain is also very common if more pressure is put on the inner part of the joint rather than weight being distributed evenly throughout. Tears to the medial collateral ligament or the cartilage called the meniscus are also a common cause of pain on the inner side of the knee.

3 Pain on the outer part of the knee

Pain located on the outer side of the knee is less common and is usually the result of damage to the cartilage, tendons or ligaments that are positioned on the outside of the knee joint.

4 Pain behind the knee

Discomfort behind the knee can be the result of swelling from a knee injury. It is also often the result of arthritis that damages the bones and cartilage in the knee joint. Generally, arthritis is the result of ‘wear and tear’, known as osteoarthritis, or inflammation, such as rheumatoid arthritis.

5 Pain below the knee

If your knee pain is located just beneath the kneecap, it could be the caused by Patellar Tendonitis, often called Jumper’s Knee because it’s common in sports which involve frequent jumping, such as basketball. However, it is possible to develop patellar tendonitis even if you don’t participate in jumping sports – the patellar tendon works with the muscles in the thigh to extend your knee so you can run, jump and kick.

During your consultation with Mr Webb at either his Bristol or London knee clinics, he will discuss the location of your knee pain, but also how and when the pain developed and any other associated indications, such as popping noises or locking of the joint. Then any necessary scans can be ordered, before a treatment plan can be devised that tackles the cause of your knee pain.

The winter workout: how to keep exercising during the winter months

Even the most committed athlete can find it harder to get off the couch and exercise during the winter months. The temptation to hibernate indoors, bask in the central heating and eat carb-heavy casseroles is almost overwhelming, but it’s just as important to get outside and get moving during the winter months as the warmer ones.

Beat the blues

When the bad weather is giving you a case of the SADs, exercise can produce an instant boost to your mood. When you exercise, your body releases endorphins which trigger a feeling of positivity – that’s why it’s called the ‘runner’s high’. Exercising outside will also increase your levels of vitamin D.

Exercise can also help you weather the cold and flu season as it boosts your immune system and improves your lymphatic and cardiovascular circulation.

Regular winter workouts will also make you less likely to incur injury than those that throw themselves into rigorous exercise come spring. If you’ve piled on the pounds over the winter this will put more strain on your joints, the knees in particular, so maintenance of both a healthy weight and ongoing exercise routine is always preferable.

Consultant orthopaedic surgeon and sports injury expert Mr Jonathan Webb gives some tips on how to keep exercising this winter:

  1. Take it indoors; swimming at your local leisure centre or gym can be a fantastic winter workout, as it exercises your whole body and improves the function of your hearts and lungs.
  2. Join a group; whether it is a class at your local gym or a running group, exercising with others can turn an unpleasant chore into fun and you’ll push yourself harder.
  3. Take up a seasonal sport; embrace the cold and try skiing, snowboarding or ice skating, whether on holiday or at one of the indoor ski slopes in the UK.
  4. Keep hydrated; you might not feel the need to replenish liquids as often as you do when exercising in the summer, but the body needs fluid levels to be maintained in the winter as well.
  5. Stay safe; avoiding injury is a must all year round and there’s some important rules to remember when exercising during the winter months. Muscles and the connective tissues are less elastic when cold and therefore more prone to tearing and incurring injury so always do a short warm-up before embarking on a workout. Be extra aware of your surroundings, particularly icy patches or slippery surfaces.

When is it safe to drive? New study looks at driving after knee surgery

A new study, recently published in the American Journal of Physical Medicine & Rehabilitation, looked at driving after a knee replacement procedure. Researchers in Germany found that a knee replacement on the right leg can affect the patient’s ability to make an emergency stop for over a month after their procedure.

What was interesting was that they also compared patients who’d had a knee replacement on the left side and found that their ability to suddenly stop the car was also impaired.

The study took 40 patients who’d undergone a total knee arthroplasty – half of whom had received a right knee replacement and half the left. In a driving simulator, using an automatic function, the recruits were tested both before the operation and four times in the year post-procedure. On each occasion, they performed ten emergency stop tests and researchers recorded the response time.

In the first test after the surgery, performed eight days later, those who’d received right knee replacements were 30 per cent slower performing an emergency stop than beforehand. Those who’d received a left knee replacement only performed marginally better.

What is a total knee arthroplasty?

Consultant orthopaedic surgeon Mr Jonathan Webb specialises in treatment of the knee. Knee replacement surgery, also known as knee arthroplasty, replaces damaged bone and cartilage with an artificial joint with the aim of restoring function and relieving the pain that the patient may have been suffering with for many years.

The knee joint is divided into three sections and during a partial knee replacement, Mr Webb will try to retain as much of your undamaged bone, tissue and ligaments as possible. This typically means a faster recovery, but if two or more areas of the knee are affected then a total knee replacement may be required.

When is it safe to drive after a total knee replacement?

The study found that braking times were significantly reduced at the six week test and then at pre-operative levels at 12 weeks on average. Patients undergoing total knee replacement with Mr Jonathan Webb are advised to avoid driving for four to six weeks following a total knee replacement. He also advises practising driving in a quiet cul-de-sac before going out on the open roads and always inform your insurance companies beforehand,

For more information on all aspects of knee surgery please get in touch with Mr Webb’s private secretary or book a consultation at either the London or Bristol clinic.