LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

knee

Do You Need Surgery for a Torn Cartilage in Knee?

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Your MRI shows that you have a tear in the medial meniscus of your knee and you have resigned yourself to the fact that surgery is the only fix.

The belief has always been that the posterior horn (the back half) of the medial meniscus (the shock absorbing pad on the inside part of your knee) does not have a very good blood supply. For this reason, any tears that occur are not going to heal on their own. This means surgery is your only option.

I’ve never been one to believe in dogma.

From an anecdotal standpoint, I have had more than my share of patients with documented medial meniscus tears that do perfectly fine without surgery. I still remember one of my early ones. This particular patient was on track for surgery, but just did not have the time off of work needed for the surgery and recovery. So he waited. In the meantime, we treated his knee, thinking that anything we could do to restore balance to the knee prior to surgery would be a good thing. Turns out, he did really well and never had the surgery. Later, he even forgot which knee it was that used to bother him.

Over the years, I have seen patients with meniscal tears do very well. Typically, the patient that responds best is closer to an ideal weight and more active. Patients who don’t fit this mold don’t do as well and seem to be more likely to end up in surgery.

Of course, my personal experiences do have some backing in the medical literature. For example:

In case all this isn’t enough to sway your decision away from surgery, pay attention to this particular study.

In it, researchers looked at the outcome of patients with medial meniscus tears who had surgery and compared these outcomes to those who didn’t have surgery and instead did rehab for his or her torn cartilage. They were evaluated using the WOMAC scoring (0-100, with higher numbers equating to more severe symptoms). Here’s what they found:

  • At 6 months the surgical WOMAC score was 20.9 points.
  • At 6 months, the rehab group score was 18.5 (yes–better, if ony slightly).
  • At 6 months, 30% of those in the rehab group ended up having surgery.
  • On the flip side, 6% of the surgical group had not undergone surgery.
  • At 12 months the situation did not change from the 6 month scores.
  • Adverse events did not differ in the groups.

Overall, there was no difference in long term outcomes between the surgical and non-surgical groups. Although 30% of the non-surgical patients ended up with surgery, this seems to match up with what we see in our office–some patients (overweight, sedentary) just don’t seem to do as well.

Either way, it seems clear that, if you discover that you have a torn medial meniscus and you are told you have to have surgery, it’s a very good chance that this just is not true.

LEECH THERAPY VERY EFFECTIVE IN KNEE OSTEOARTHRITIS – (11-13-03)

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Effectiveness of Leech Therapy in Osteoarthritis of the Knee

Okay. I’m not saying I am going to start using this in my office, but I thought the article was quite interesting. Many times, gross, disgusting approaches are actually quite effective. Maggots have been used to save limbs that would otherwise have been lost to infection. I remember when my wonderful keeshound had severely injured his tail this summer. It did not look good and I kept it wrapped. To my dismay, several days later I unwrapped the bandage to replace it and maggots had infested the bandage. However, the wound was looking incredibly well.

Ann Intern Med — Abstracts: Michalsen et al. 139 (9): 724.

Read entire article here

Knee Osteoarthritis Symptoms: MRI Images of Knee of Little Benefit

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Everyone wants an MRI. It’s cool to take a peek inside your body without the downsides of autopsy. But for knee osteoarthritis symptoms does an MRI help anything?

Regular readers of the Rantings know how I feel about ordering imaging before it’s necessary. It doesn’t matter what region of the body it’s in; sometimes TOO much information is not a good thing.

We have already seen studies suggesting that the rates of knee replacements are increasing, but there has been no change in the amount of knee osteoarthritis seen on imaging. What this strongly suggests is that knee osteoarthritis may not be the problem in a large chunk of the cases of knee pain.

For those providers that treat the soft tissues (and no–I’m not talking about exercises and electric stim here–these techniques do NOT treat the soft tissues), this comes as no surprise at all.

I firmly believe, based on the research and my own clinical experience, that most knee pain does not come from arthritis, but rather from pain being created in the soft tissues (muscles, ligaments, tendons, fascia) surrounding the knee joint as well as the imbalance and altered stress placed upon the joint by these damaged soft tissues.

This particular study adds weight to my thought process. Researchers looked at a group of patients who were older than 50 and had no signs of knee osteoarthritis on X-rays. They then examined this group using MRI images of knee and looked for findings that are consistent with osteoarthritis. These included:

  • osteophytes (also known as bone spurs)
  • cartilage damage
  • bone marrow lesions
  • subchondral cysts
  • meniscal lesions (usually described as a torn meniscus)
  • synovitis
  • attrition (a wearing down of the joint surface)
  • ligament lesions

What they were basically doing was looking at MRI as a tool to see how well findings on an MRI compared with what the patient was experiencing.  Here’s what they found:

  1. 89% of the group had at least one abnormality noted above (osteophytes were the most commonly found at 74%,  followed by cartilage damage in 69% and bone marrow lesions in 52%.
  2. As expected, the higher the age, the higher the prevalence of abnormalities.
  3. The likelihood of at least one type of abnormality was high in both painful (97%) and painless (88%) joints.

The last point being the most important. Basically, over the age of 50, a MRI becomes less and less important, and may actually lead the unsuspecting physician to recommend a more invasive procedure (injection or worse–knee replacement).

The bottom line is that just because you have something wrong on your MRI, particularly as you get older, does not really mean anything. If you have knee pain, my biased opinion would be to find a chiropractor that specializes in soft tissue treatment (Graston, Nimmo / Trigger point, NMR, Active Release, Fascial Manipulation, etc…) before you do anything else.

It is always worth trying this approach first. If it does not help, you can still opt for more invasive procedures. But the reverse doesn’t work so well…

If you had a knee replacement, was soft tissue treatment recommended to you before the surgery?

GET RID OF OSTEOARTHRITIS WITH SOFT TISSUE APPROACHES – (12-03-07)

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Chondroitin for Osteoarthritis of the Knee or Hip

This review found minimal or no benefit to the use of chondroitin for arthritis of the knee. Before we jump to conclusions… How many people in these studies with knee/hip pain was actually coming from the joint itself? The answer, of course, is that we don’t know. Degenerative joint disease = pain in clinical studies but that just isn’t always true.

For a physician that addresses soft-tissue components of injuries, how often does a knee loaded with arthritis get complete relief with some solid soft tissue approaches? I can personally say that aggressive soft tissue techniques like Graston can sometimes bring complete relief for many OA sufferers. Did we fix the OA? Of course not–but in these cases the soft tissues were the primary pain generators. So we could assume that any type of joint support would not be effective in these cases.

So, in these studies, did they rule out non-joint related pain generators? More of a rhetorical question because of course they did not.

Read entire article here

MAKE SURE YOU TAKE THIS TO PROTECT YOUR JOINTS

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There has been much controversy over the use of joint support supplements like glucosamine, chondroitin and methysulfonylmethane (MSM) and their effectiveness for osteoarthritis.  Some studies find a protective effect, some do not.  This is yet another article supporting the use of chondroitin sulfate in osteoarthritis, demonstrating a protective effect on bone cartilage loss and bone erosions within 6 months of use for the knee.

The bottom line is that these supplements are very safe to try on a trial basis.  There is a wide variation in price, however, and, as the adage goes, you get what you pay for.  I always recommend to patients that they start with the more expensive brands, and one that contains a combination of all three compounds mentioned above.  After at least 3 months, if you find that it is effective for you, then you can try to substitute for a less expensive brand.  This way, you have established that it works for you and it was not a matter of quality.

And of course, couple this supplementation with an evaluation by a chiropractor that has a strong soft tissue focus–many times “arthritis” pain is NOT coming from the joint, but rather the soft tissues surrounding the joint itself.  Address this aspect of the problem and the pain goes away or gets significantly better.

http://ard.bmj.com/content/70/6/982.abstract