Runner's knee injury

New study reveals perfect running technique to avoid runner’s knee

It might sound strange – particularly to the layperson – but the professional athlete knows how to run correctly. For most people, running – like walking – seems as it should be one of the most natural things in the world: if you’re not falling over, you must be running correctly, right?

However, a new study from Salford University has demonstrated that there is a correct style of running – and if you’re a regular jogger who isn’t adhering to the proper technique, you’re running the risk of developing myriad ailments and injuries down the line.  The study also revealed that, if you’re one of the people who doesn’t know what that technique is, you’re not alone.

Researchers at Salford University’s Running Performance Clinic, used 3D infrared cameras to analyse the running style of 72 joggers. Not any old joggers, though – all volunteers were sufferers of common running complaints, from patellofemoral pain (runner’s knee) to medial tibial stress syndrome (shin splints).

After the various techniques were analysed, the research team then switched their attention to a pool of 36 runners who had never suffered a common injury, filming their styles – and after running the rule over both groups, the research team discovered that pelvic drop (a positioning which lowers the pelvis, obviously) was the key factor: they found that for every 1° increase in pelvic drop, there was an 80 per cent increased chance of a runner’s knee injury.

“These running injuries are some of the most common experienced by runners and can lead to considerable time off the roads,” claimed Chris Bramah, who led the study team. “What we wanted to do with the study is identify whether there were aspects of running technique that may be contributing to these injuries. If so, we can hopefully use this information to help runners recover from injury, and prevent future injuries happening.”

How to prevent runner’s knee

Why would pelvic drop be the prime culprit for so many ailments? According to the study team, a posture with excessive pelvic drop creates extra stress throughout the entire body, meaning that the weakest part of the lower body – the knee, maybe, or the Achilles, or anywhere else – is the first to go. And while other poorly-performed techniques were also pinpointed, such as an outstretched leg, high foot angle at initial contact and a greater forward lean, the detection of pelvic drop as a major knock-on factor should be a wake-up call for all runners, be they professional or otherwise.

While the research team are now looking into the effects of step rate and cadence on a runner’s risk of injury, their latest study is a timely reminder that it always pays to keep tabs on the fundamentals. If you feel that your current technique could do with a tune-up – or you’re wondering if the way you’re currently running could be the cause of recent setbacks – it makes sense to turn to a knee injury expert for an MOT at your earliest convenience – and if you can get someone to video your next treadmill session, even better.

hip and knee replacement combined

Joint replacement of the hip and knee does not mean an increase in short-term complications

Although they’re two very separate parts of the body, our hip and knee joints have an uncanny ability to wear out at the same time. It’s not that much of a mystery when you think about it – the deterioration of one means we tend to put excess pressure on the other when we go about our day-to-day business.

Consequently, total hip and knee replacement procedures overlap more often than we think. Makes perfect sense from a medical point of view – if you’ve come in for one treatment, it saves time and money to get both parts replaced. However, concerns have been raised across the board by both practitioners and patients about the safety and quality of this scenario, and for good reason: they are two very distinctive and incredibly specialised procedures. And naturally, the risk of post-surgical complications automatically double – if one goes wrong, the patient will find it difficult to perform the necessary exercise regime required to bed the other replacement in.

Hip and knee replacement combined

However, a recent study compiled by the Department of Orthopaedic Surgery at Ohio’s  Cleveland Clinic and its counterpart at the SUNY Downstate Medical Center in Brooklyn, found there is very little risk involved in ‘joint’ joint replacements. And in many cases, there is a strong link between dual replacement procedures and a general improvement in patient quality of life.

The study, which aimed to compare the operative time and the incidence of 90-day complications between overlapping and non-overlapping total joint arthroplasties, as well as evaluating the effect of the duration of overlap on operative time, scoured the data of 9,192 patients who underwent primary total hip arthroplasty or total knee arthroplasty at a large academic hospital from 2005 to 2014.

Their ground rules for what constituted an ‘overlap’ procedure and what didn’t was simple: a procedure was defined as ‘overlapping’ if it had an incision to closure overlap time of at least 1 minute with any other surgery performed by the same surgeon. According to their findings, a total of 2,669 procedures fell into the ‘overlap’ bracket – which was 29% of all replacement procedures.

After examining the length of operative times and the incidences of complications within a 90-day period between both overlapping and non-overlapping surgeries – and adjusting for baseline characteristics – the research teams came up with the unsurprising finding that operative times were longer for the overlapping surgery group. However, when they examined the instances of wound dehiscence, superficial infection and wound hematoma, they discovered very little difference in the overlapping and non-overlapping groups. And when it came to instances of thromboembolic events and periprosthetic joint infections, there were fewer occurrences amongst the group who had had both procedures done at the same time.

So what conclusions can we draw from this? From the practitioners’ viewpoint, a dual joint replacement procedure isn’t the risk that many thought it was. Although overlapping surgeries are inevitably a more drawn-out procedure, they can save time and money in the long run, for many reasons. For the patient, the findings can be a reassuring factor. It’s clear that the medical community is more than capable of delivering a quality procedure while addressing two major problems at the same time, and one period of recovery is always better than two.

ACL Tears in Female Athletes

Gender difference in ACL tears identified in aim to improve outcome

With female sports continuing their rise to prominence, it’s no surprise that more and more women are beginning to participate. It’s also no surprise that more participants mean more sports injuries, and the race is on to understand the particular gender-related needs of injured athletes.

A new report, published in the July issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), has shed some light on the role that gender plays in the most common sports injuries and treatment outcomes. And the key points are interesting, to say the least.

We all know the key differences between the body structure of males and females: women have a narrower intercondylar notch and a smaller ACL, which makes them more prone to injury. They also have a wider pelvis, which applies more pressure to the inside of the knee, which can cause the ACL to tear. Their ligaments also tend to have more laxity than men’s, a microscopically slower response in knee-stabilizing muscles, and weaker hamstring strength.

More male sports injuries

However, the report discovered that male athletes still compromise the vast bulk of sports-related injuries (71% in all), due to greater exposure to high-risk activities. Fair enough – but this also increases the danger that the sports injury community are over-catering to the needs of male athletes, while saddling female athletes with treatment strategies that aren’t bespoke.
The study authors examined five common sports-related injuries – stress fractures, ACL tears, shoulder instability, concussion and femoroacetabular impingement – a condition in which extra bone grows along one or both bones that form the hip joint.

One particular study – which focussed on participants aged between 5 and 17 – threw up the following stats:

  • Females are more likely than males to sustain overuse injuries such as anterior knee pain, while males are at an increased risk of sustaining acute traumatic injuries such as fractures.
  • Females tended to demonstrate patterns of landing after a jump which are different from male landing patterns, and which are closely associated with ACL tears.
  • For both sexes, training programs can be used to teach at-risk athletes to modify landing patterns, in order to help prevent ACL injury.

Bespoke treatment is key

Lead study author Cordelia Carter, MD encapsulated the findings by stating; “Males and females have different risk factors for experiencing SRIs. Anatomic and physiologic characteristics such as skeletal structure, muscle mass, ligament laxity, and hormone levels differ between the sexes and may contribute to disparate injury risk.

“The best ways to avoid or treat a sports-related injury in a male may be different for a female. Understanding the sex-based differences can help orthopaedic surgeons be better equipped to care for patients with these injuries and improve their treatment outcomes.”

The moral of the story? One-size-fits-all treatments run the risk of destabilising injured female athletes, and we are still in our infancy when it comes to the role of gender in sports injury.

ACL injuries in young athletes

Fatigue is key risk factor in ACL injuries in young athletes

We’re all aware of the dangers of burnout in young athletes, but new research presented by the American Orthopaedic Society for Sports Medicine shows has added a new and even more dangerous factor: the increased risk of ACL injuries in young athletes.

We all know the damage an ACL injury can do to a sporting career: the anterior cruciate ligament is an incredibly vital component of the knee, playing a crucial role in the restraining force of the knee. If you’re playing a sport which requires a lot of lateral movement, such as tennis, football and volleyball, an ACL injury can be brutal. What’s more the long recovery period and achingly gradual recovery period from an ACL injury can be hugely demoralising on a young athlete.

Tiredness can kill a career

The research, conducted by researchers at the Henry Ford Health System in Detroit, studied 85 athletes over the course of 15 years in a range of sports – from track and field and basketball to volleyball and soccer. Utilising film of young athletes undergoing vertical and drop jumps, the researchers analysed the ergonomics of the jumping techniques, measured again fatigue levels.

Their conclusion: over half of the athletes who demonstrated over 20% fatigue showed an increased ACL injury risk, with female athletes and those over the age of 15 were more likely to demonstrate fatigued jumping that increased their risk of ACL injury.

Fatigue in young and potentially undisciplined athletes can bring on a lapse in concentration which affects the performance of the fundamentals a particular sport requires and is more than simple tiredness: symptoms of fatigue are similar to those of flu, and can be brought on by illness, depression, joint and muscle pain, stress, overextending, poor sleep, anaemia or a lack of physical activity.

There’s more to a movement than you think

Obviously we can rule out the last symptom, but the pressures endured by young athletes can easily mount up, and can easily play havoc (however momentarily) with the sensorimotor system – which helps us to sense our body position and formulate our next move, be it putting one foot in front of the other, coming to a stop, or – in the case of athletes – performing a series of movements a little bit faster and smoother than the average person. Think carefully about the mechanics of performing a jump: now think about them again. There are more elements involved in the performing a safe jump than you first thought.

While the sample size of the study was a relatively small one, it gives further guidance for coaches and how they should structure training sessions, taking into account the physical and mental state of their young athletes to prevent ACL injuries in young athletes.

London knee replacement surgery

As Queen reluctant to undergo knee surgery, what does recovery in older knee replacement patients entail?

The recent news story about the Queen turning down the opportunity for knee replacement surgery in order to carry on with her forthcoming engagements gives us the ideal opportunity to discuss knee surgery in older patients.

While most people the Queen’s age don’t tend to put themselves through the 200-plus engagements she goes through every year, we’re long past the stage where the older generation are expected to spend the rest of their lives sat in bath chairs – and today’s generation of seniors are certainly more active (and want to be) than their grandparents were. And when knee problems set in, many people in later life want to take advantage of new surgical advances.

A potential placebo effect

But is it worth it? A study conducted earlier this year by the John Hopkins School of Medicine in Baltimore looked into post-operation reports from people over 65 who had undergone arthroscopic partial meniscectomy – a procedure which involves shaving or cutting out damaged or torn tissue, which accounts for an estimated two-thirds of knee operations on the over-65s in the US.  And while the procedure is seen as a massively successful operation for younger patients who have suffered severe knee damage, the reports suggest it may not be the thing for seniors.

According to the study, which was published in February of this year, APM surgery only works on older patients as a placebo effect: the patient has had something done to their knee, therefore the knee must be better. In actual fact, studies prove that the procedure has little to no beneficial physical effect on patients over 65.

So, when is too old?

Then again, what the experts think about knee replacement surgery isn’t as important as what the patients feel after they’ve had it, and a few studies bear out the idea that it’s still worth it. A 2010 study found that patients aged 75 to 90 generally felt that knee surgery had improved the quality of their lives – out of the 48 people surveyed, all but one believed that having surgery was a wise decision.

A more recent study – conducted in 2014 – focused upon hip replacement surgery on people in their 90s and concluded that the results were comparable to a study group of younger patients – assuming that the older patient was generally in good health in the first place. However, and for obvious reasons, patients in their 90s stay in hospital for longer, and were more likely to be readmitted after three months – but infection rates were no different when compared to the younger study group.

So, in summary: it’s complicated, but not necessarily in a bad way. Some people of senior age will be happy to undergo London knee replacement surgery and feel better for doing so, while others will feel it’s not worth the bother and are willing to make accommodations to their lifestyle to work around their knee problems. Or, in the case of people like Her Maj, they’re just too busy to go through the downtime of surgery.

knee arthritis prevention

The importance of weight loss when living with knee osteoarthritis

We’re all aware of the main health benefits of controlled weight loss: the decrease in the risk of diabetes and heart disease. However, there is another significant benefit of maintaining a healthy weight – the impact on our joints.

It goes without saying that obesity can do serious damage to the joints, particularly the knee joints, and previous research has demonstrated that overweight and obese individuals with knee osteoarthritis can reduce pain by 50% and significantly improve function and mobility with a 10% or more weight loss over an 18-month period. Now researchers from the Wake Forest University in North Carolina have fleshed out those findings with more revelations.

The latest findings, which were published in Arthritis Care & Research, reveal that losing 20% or more of your body weight has the added benefit of continued improvement in physical health-related quality of life – along with an additional 25% reduction in pain and improvement in function.

Take the load off

The study, which involved 240 overweight and obese middle-aged adults who suffered from pain and knee osteoarthritis, divided the participants into four groups according to how much weight they lost over an 18-month period and put them through an assortment of interviews and tests.

The researchers found that the greater the weight loss, the better participants fared in terms of pain, function, 6-minute walk distance, physical and mental health-related quality of life, knee joint compression force, and IL-6, a marker of inflammation. Not only that, but when comparing the two highest groups – the ones which lost 10% of their body weight and the group which lost 20% – the latter group had 25% less pain and better function than the former, and a significantly better health-related quality of life.

There’s something fishy about knee arthritis prevention

The obvious explanation for this is that the less weight you put on your joints, there less chance there is of causing damage, which will lead to a welter of OA issues, but it’s not as simple as that, as another study into knee arthritis prevention from the University of Surrey bears out. According to their findings, a gram of fish oil per day could help reduce pain levels for osteoarthritis sufferers, as well as reduce inflammation in the joints – a key factor in knee pain.

Furthermore, the study thoroughly recommends a calorie-restricted diet for overweight and obese people with OA issues, for two main reasons: to speed up weight loss, and also deal with high blood cholesterol, which is a key factor in osteoarthritis.

With osteoarthritis, prevention is better than cure – mainly because there is no cure yet. And as both studies bear out, the best shot we all have in preventing an ailment which affects over 8,750,000 people in the UK and 15% of the entire planet is a healthy lifestyle and a sensible diet. Bottom line: the more you have to lose, the more you have to gain.

depression and knee arthritis

Depression risk higher the worse knee arthritis becomes

 When you’re struggling to perform everyday tasks due to aching, painful joints, it’s no surprise that your mood will suffer. Data shows that rates of depression and anxiety can be between two and ten times greater than the rates of the general population, depending on the type of arthritis you’re suffering from.

A new study conducted by the University of Maryland in the US and presented at the recent Annual Congress of the European League against Rheumatism, claimed that depression and its side-effects was becoming a stronger factor in the cause and treatment of knee OA.

According to the study, which evaluated 1,652 patients with knee OA but who were below the screening threshold for probable depression, the chances of developing depression can rise to 20% – double that of the general population. Not only that, but depression in knee arthritis is associated with a lower quality of life, a higher mortality rate, and a greater reliance on healthcare.

The knock-on effects of knee arthritis

After assessing OA disease severity at baseline and on three annual follow-up visits – where they examined patients for minimum joint space width, 20-metre gait speed and measuring pain levels on a pain subscale of the WOMAC Index – the research team focussed upon the risks of the onset of depression amongst the study group. Their findings concluded that greater structural disease severity and decreased physical performance are associated with a statistically significant increased risk of experiencing depression.

Knee arthritis and depression link

The two diseases become enmeshed closely; anxiety and depression can lower the pain threshold and chronic pain is known to aggravate anxiety and depression. Inflammation associated with knee osteoarthritis also plays a role: in a 2016 study published in The Journal of Clinical Psychiatry, over 10,000 patient cases were reviewed and those displaying the symptoms of depression were found to have levels of a particular inflammation marker 31% higher than those with no depressive symptoms.

Furthermore, those suffering from arthritis and depression typically find physical activity and normal function becomes limited and often struggle to follow treatment programmes and therefore are at risk of developing further health problems.

It’s the little things that count

This factor was clearly demonstrated by another study conducted in Japan earlier this year, which examined the link between knee pain and function and depressive symptoms – but this time zeroed in on an older sample group (573 adults aged over 65) and the activities which depressed them the most. The study, conducted by Tokyo’s Keio University School of Medicine, discovered that the most problematic symptoms were pain at night while in bed, difficulty getting in and out of a car, and difficulty in putting on (and taking off) socks. Again, it’s clear that being encumbered by pain and difficulty while performing the most mundane tasks – things that younger people take for granted – are more of a factor than losing the ability to run or climb.

As well as the personal effects of depression on the general population, we’re also becoming more aware of the detriment it has on the economy. It has been estimated that depression costs the UK economy 15.8 work hours per annum, with an estimated 21% of all sick days in the UK are caused by workplace stress. The NHS prescribed a record number of antidepressants last year – over double the amount it dispensed a decade ago.

The importance of treating knee osteoarthritis effectively, whether through the management of symptoms or surgical intervention in the form of knee replacement surgery, is essential for preserving quality of life.

golf and knee arthritis

Ditch the golf cart if you have knee arthritis

If you’re into sport, chances are you’ve played golf. It’s often the go-to pursuit for so many retired professional sportspersons, and for obvious reasons: it allows you to stay competitive well into later life with minimal strain and stress. The health benefits are manifold, as well: it’s been estimated that you’ll be walking for over six and a half miles while playing the average round of golf, which more than takes care of your daily recommended walking distance.

That is, of course, if you’re not using a golf cart. On the face of it, golf carts are an absolute boon, especially for those of us suffering from knee osteoarthritis. And if you’re already suffering from knee arthritis, wouldn’t forgoing the cart aggravate your ailment even further? According to a study into golf and knee arthritis that has recently been published in America, it seems that the answer is ‘no’.

Having a stroll won’t take its toll

Plenty of golfers suffering from knee arthritis seem to think that golf carts are a life-saver: in the late 80s, 45% of all golf rounds in America were played with a cart. Nowadays, that percentage has rocketed up to 69%. However, the new study – the first of its kind, conducted by the Shirley Ryan Ability Lab and Northwestern Medicine, and presented at the Osteoarthritis Research Society International Annual Meeting in Liverpool in April – demonstrates that playing a round on foot the course provides significantly higher health benefits. More importantly, walking is not associated with increased pain, cartilage breakdown or inflammation.

The study analysed the on-course habits of 15 participants – ten who had knee osteoarthritis and five who were of similar age, but were OA-free. The participants were invited to play 18 holes on foot one day, and then a round with a golf cart on a different day. The research team compared their heart rates to determine the intensity of exercise performed and took blood samples during each round to measure markers of cartilage stress and inflammation.

Dump the cart, exercise your heart

The researchers found that, prior to starting either of the rounds, the participants with knee osteoarthritis had an average pain score of 1.3 (on a scale of 0-10). When they played the round walking the course, they had an average 2.1-point increase in pain score. When they played the round using the golf cart, they experienced on average a 1.5-point increase – a difference that is deemed not clinically significant.

The research team also measured blood-based biomarkers of cartilage stress and inflammation. Although both methods of transportation caused an increase in these markers (as would be expected with regular walking), there was no difference between the rounds.

When walking the course, golfers with knee osteoarthritis spent more than 60% of the round with heart rates in the moderate intensity heart rate zone – which corresponds with other adequate exercise activities. When driving on a cart, however, golfers spent 30% of the round in that range. While this figure is lower, it still fulfils daily exercise recommendations.

So, while walking the course offers the most significant health benefits – and is not the aggravating factor on knee OA as first thought – the study found that riding the course with a golf cart during a round (and the walking that still comes with it) still offers cardiovascular benefits and helps fulfil daily exercise guidelines.

We know what excess body weight does to the joints, particularly the joints of OA sufferers, so the advice is clear: leaving the cart outside the clubhouse is a far better long-term option, because the idea that extended periods of walking is going to shorten your golfing lifespan is nothing to worry about. But the good news is that while walking is better than the cart, using the cart over not playing golf at all is still the better exercise option.

partial knee replacement

Partial vs full knee replacement examined

The argument between total knee replacement and partial knee replacement is one that has been raging for some time amongst the medical community. And so far, the battle is being won by the total replacement adherents: out of the 98,147 instances of knee replacement surgeries carried out in the UK in 2016, 91% of them were total knee replacements.

However, a new report conducted by researchers from Oxford University may start to turn the tide: according to their findings, many more people than first thought who are facing surgery for knee problems would be better off with a partial rather than total knee replacement.

As we know, partial replacements have long been seen as the suitable procedure for people who have suitable for people who have arthritis in just one side of the knee – usually the inner side, and only when the ligaments inside the knee are still strong. The benefits of partial knee replacement surgery are obvious: the patient has to contend with a smaller incision and minimally invasive surgery. However, the general rule of thumb has always been: if in doubt, take it all out in the form of a full knee replacement.

The case for partial knee replacement surgery

Recently, though, the research team – from the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS) – examined real data from a very large range of patients about their operations, their GP visit and their own reported quality of life outcomes, and concluded that partial knee replacements can be better for certain patients and could save the NHS a fortune.

The key finding was that the choice between a partial or total replacement varied from surgeon to surgeon – as did the success of the operation. And the surgeons who carried out more partial replacements had better outcomes from them than surgeons who performed fewer of them. As Co-Lead researcher Prof David Murray pointed out, this was a very important finding.

“If surgeons aim to use partial knees in a quarter or more of their knee replacements this will substantially improve the results of knee replacement and will save money,” said Professor Murray. “In addition, more partial knee replacements will be done and more patients will benefit from this procedure.”

One size knee op may not fit all

According to the research team, the next step is to investigate the potential benefits of partial knee surgery in more cases. However, they are keen to stress this shouldn’t be an across-the-board mind-set: they went to great lengths in the report to stress that while their research demonstrates that partial knee replacements can be better and cheaper for patients over 60, the long-term benefits for partial surgery in the under-60 bracket are less clear when compared to those of total knee replacements.

The cost benefits offered by partial knee replacement surgery are obvious – less theatre time, less equipment needed, and a patient occupying a hospital bed for an average of one day less. The benefits for the patient are similarly clear: less time in theatre, a quicker recovery time, and the fact that the patient feels more like they still have their own knee, instead of a ‘bionic’ one.

The lesson to be learned from this study is that surgery should always be tailored to the patient’s individual requirements which is the hallmark of Mr Jonathan Webb’s approach.


ACL tears in women

Why are women more susceptible to ACL tears?

It’s a conundrum which has bothered sports experts for years, and it’s borne out by statistical weight: women are two to four times more likely than men to tear the anterior cruciate ligament. But why? A recent study conducted by Duke University in Durham, North Carolina endeavoured to solve the mystery, and their findings make interest reading.

According to previous research, the reason why women are more susceptible to ACL tears pointed to an assumption that it was because their knees move differently – but the team at Duke weren’t so sure. So, they deployed a forensic approach to reconstruct injuries by examining bone bruises on the knees of 15 men and 15 women with torn ACLs.

While other studies have deployed patient interviews and slow-motion replays, the Duke team realised that video footage was ineffective in determining the precise position of the knee and the time of injury through footage. Instead, they used MRI scans taken within a month of the ACL rupture, identified bruises on the surface of the two large bones that collide when the ACL tears – the femur and the tibia – and then used 3D modelling and computer algorithms to reconstruct the position of the knee when the injury occurred. Their findings? Males and females actually have the same position of injury.

The team at Duke have been using their advanced imaging and modelling technology to great effect over the past decade in the field of ACL research, including debunking the notion that an inward buckling of the knee was the cause of an ACL tear, discovering that landing on an extended knee was the prime culprit. So, when they make a statement, the sports medicine world takes notice.

However, this current report still leaves us in the dark as to why women are more susceptible to ACL tears than men. Here’s what we know so far:

  • Women tend to have a narrower intercondylar notch – the groove in the femur through which the ACL travels – and a smaller ACL, which makes them more prone to injury.
  • Women typically have a wider pelvis, which makes the thigh bones angle downward more sharply than in men, which leads to more pressure applied to the inside of the knee, which can cause the ACL to tear.
  • Women’s ligaments tend to have more laxity, or ‘give’, than men’s, leading some experts to conclude that the excessive joint motion could be a factor in a higher ACL tear rate.
  • Research shows that the muscles stabilising the knee may take a millisecond longer to respond in women than in men, leading experts to speculate that this minuscule difference in contraction time could lead to a higher rate of injury.
  • Female athletes typically have weaker hamstring strength when compared to male athletes, leading to the hamstring having difficulty in balancing the power of the quadriceps, which in turn can lead to injury.

As with all athletes, regardless of sexual orientation, conditioning, strength training and proper coaching are your best defence against an ACL tear. Therefore, if you feel your training programme is lacking any of those factors, it’s time for a rethink.