Alternatives to Knee Surgery

The scalpel is a last resort.

By Kevin RR Williams

HEALTH Noticing that my legs slightly bow backwards while standing, an elderly gentleman sternly warned me as a teen to bend them slightly — not letting them lock all the way back to avoid knee problems later. That advice was greatly appreciated. We may not realize how useful knees are until they become painful to use.

A knee is more than a simple hinge. Knees can bend and twist with much support from the quadriceps (front thigh muscles). Cartilage, tendons, muscles, and synovial fluid balance and support an order of magnitude more than our body weight. Climbing stairs increases patellofemoral force to 3.5 times body weight; jumping multiplies such force 10 times body weight. When working properly, we feel no pain. If rising out of chair or walking up stairs is difficult, don't jump to conclusions — thinking the solution must be an artificial knee replacement.

Knee Patellofemoral Syndrome

A number of conditions and injuries can cause kneecap pain. In many cases, it occurs when the knee is not correctly aligned. This abnormal alignment leads to pressure and friction between the kneecap and the thigh bone. The tendons and ligaments that attach the kneecap to the bones of the knee joint become irritated and inflamed, causing pain. Patellofemoral syndrome (runner's knee) is the most common cause of knee pain in people under 45 years of age. Women are more likely to develop the condition than men. Inflammation, to the sufferer, might feel as painful as a tear. But the actual ailment dictates the course of treatment recommended by a physician.

Symptoms of patellofemoral syndrome vary, and you may not feel anything until several hours after an activity that stresses your knee. Symptoms may include:

  • A dull ache under, or around, the kneecap
  • Localized pain at the front of the knee
  • A grinding sensation when moving the knee
  • Pain going up and down stairs, kneeling, squatting, or sitting with the knee bent for a long time

Barring dislocation or fracture, anti-inflammatory drugs, physical therapy, weight control, supportive footwear and devices are primary remedies offered by rheumatologists. If there is no improvement after a year, various surgical procedures may be considered. This includes arthroscopy or realignment of the kneecap. Belgian physicians recently discovered a previously unknown tendon in the knee called the anterolateral ligament (ALL). It aides in stabilizing the pivoting knee. Dr. Johan Bellemans, the lead surgeon on the study, says that about 80 percent of his patients with ACL tears also have an ALL injury.

Here is what Kaiser Permanente recommends to protect your knee and prevent injury:

  • Maintain your ideal weight.
  • Stay in shape by exercising regularly.
  • Learn exercises to strengthen your leg muscles.
  • Learn stretching exercises for your legs.
  • Increase your activity gradually.
  • Wear shoes with good support, which are designed for your activity.
  • Use an arch support if you have flat feet or high arches.

For additional information to remain A Bit More Healthy, see related sidebar articles.

Tags: orthopedics, osteopathy, rheumatology

References
  1. Knee Ligament Injuries patient.co.uk
  2. Knee Patellofemoral Syndrome. kaiserpermanente.org
  3. Surgeons Discover Quirky Knee Ligament All Over Again. ideastream.org
  4. Anatomy of the anterolateral ligament of the knee. wiley.com
  5. Photo by Dirima licensed from iStockPhoto.