If you’ve been a reader for a while, you know that I’m a long time comic book collector. I used to work as a professional artist for the comics, back in the 70′s for a brief stint and I’ve always maintained a serious interest in the art form, collected original art and kept up friendships with some of the best pros in the business.
 
This, of course, has always been a source of great embarrassment to my wife, who shares the opinion of many, who know no better, that comics are for kids, geeks and retards. I would patiently point out that there is an entire wing in the Louvre dedicated to graphic arts (ie., comic art)and many very highly creative, very wealthy and intelligent men, like George Lucas, Steven Spielberg and Clint Eastwood, to name but a few, have collected original paintings and drawings of some of the best modern illustrators, painters and comics artists. So I feel I’m in good company.
 
Anyway, as soon as I arrived back in town, in Orlando, I went straight over to my local comic shop, ACME SUPERSTORE in Longwood, to pick up the latest issues which had come out during my recent absence. While I was in there, seeing what else had come out that I might want to read, I overheard a middle aged guy talking to Penny, one of the store employees.
 
Penny had had arthroscopic surgery for her own knee in the past, after a number of conservative measures failed to relieve her very significant and disabling knee pain. I had reviewed her preop studies and her intraoperative photographs, and there’s no question she had a defined pathology that needed surgery to fix.
 
This guy knew about her experience and was asking her for advice. So, since she had come to me for advice herself and since I was there, she called me over to meet this man. Sure enough, he had episodes of pain and swelling that would come and go, after what he called a “blowout,” that is, a traumatic injury that ruptured his ACL (Anterior Cruciate Ligament) and gave him a torn meniscus.
 
Despite this, though, what bothered him the most was what he described as a sudden “shift” inside his knee and the insecure feeling this gave him. What he was actually feeling was the typical instability that results from a ruptured ACL. Naturally, he was concerned because he didn’t want ACL surgery, if he could avoid it.
 
I pointed out to him that there ARE ways to treat this condition nonsurgically, BUT there is a price to be paid–namely, if he doesn’t have arthritis yet, he soon will. The articular cartilage is damaged every time he experiences that “shift,” which is really a slippage of one bone on the other, that is usually prevented by an intact ACL.
 
However, if he is willing to accept that fact, and if his daily activities are not affected, then a number of conservative conventional treatments, combined with alternative methods, that help to relieve knee pain and resolve inflammation, appropriate bracing and vigorous specialized exercises, especially for the hamstring muscles, may be all he needs. 
 
He was amazed at this information, which was all new to him, and which is revealed in detail in my new healing program, HOW TO AVOID KNEE SURGERY (see here at http://drbillsclinic.com/avoid_knee_surgery.html )
 
He didn’t even realize that CRUCIATE means “crossed” in Latin, or that the cruciate or crossed ligaments, ACL and PCL, hold the interior of the knee together and prevent excessive, abnormal motions, front to back and back to front, between the femur and the tibia.
 
The anatomy and basic functions of these ligaments are presented in my LITTLE GREEN BOOK, together with lots of inside information on the many root causes of knee pain and disability. See what I mean at   http://drbillsclinic.com/eliminate_knee_pain.html
 
So, at the end of my “comic shop consult,” this man realized that he has options he didn’t know he had. I gave him my card and suggested he visit my website  http://drbillsclinic.com/avoid_knee_surgery.html  for more detailed information and advice. Hopefully, he’ll take my advice and get knee pain relief and joint stability back in his life.
 
At that point, I said, “My work here is done!”  Then I grabbed my comics and leaped out into the night…up, up and away……Heh.
 
Have a great weekend, my friend. I’ll be spending mine shooting the DVD version of my PAIN-FREE PROGRAM
 http://drbillsclinic.com/exercise_eliminate.html   Til next time, be well.
 
Yours for a pain-free tomorrow,
 
Dr. Bill

P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to http://drbillsclinic.com/eliminate_knee_pain.html
 
P.P.S. For DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, please go to
 http://drbillsclinic.com/exercise_eliminate.html
 
P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to
 http://drbillsclinic.com/advanced_masters.html
 
FREE BONUS CD with any order: THE HEALING POWER OF POSITIVE PAIN PERCEPTION
 
Copyright, 2008 by William Thomas Stillwell, MD
All rights reserved

So this morning in my study, I was going over a number of health related blogs, reviewing them for any potential for commentary and teaching points. A number were pretty good, most often involving the back injuries one sees in sports or exercises or stretches for general fitness or specific injuries. A few had to do with joint replacements of the hip and knee, which happened to be my specialty in practice. 
 
But then, I read one that was incredible. Not good incredible, as in ‘Wow! How amazing!” but incredible as in, “I can’t believe they have this thing out there on the web!” It concerned ACL injuries and rehabilitation and it was so full of factual errors and frank mythology that I couldn’t believe it.
 
I wanted to tactfully reply, correct the most obvious misconceptions, hopefully without insulting the author, or hurting his feelings. It wasn’t a scam, or a deliberate attempt to misrepresent facts for some nefarious purpose. It was obvious that the author was sincere. He was just wrong.
 
For example, one guy said that an ACL rupture wasn’t painful. In fact, it’s one of the most painful and disabling injuries you can suffer. What he meant was that a CHRONIC ACL disruption is painless–the damage has already been done. But the resulting instability, the “wobbly knee” that results from absence of the ACL, CAN indeed cause pain, from secondary tears of the menisci, synovitis, and arthritis.
 
Further, there ARE some people with an ACL injury who DON’T require surgery. This fact is almost entirely ignored in these articles. Specific exercises, especially leg curls and calf exercises, can often compensate for people who make low demands on their injuredknee. The point is, there are options that can be offered.
 
Unfortunately, it was a major pain to reply. First, you have to register in order to reply. Then, the registry doesn’t accept the information and erased all the info I had just input. Finally, I just gave up in disgust. Too bad. Some people are going to read that blog and accept what it says uncritically. As a result, they’ll absorb information that’s just incorrect. And who knows what the consequences will be?
 
Funny thing is, people will believe almost anything they read on the net, even though it’s well known that there’s no filter. That’s one of the internet’s chief charms. But it’s also one of its chief problems, when you really have a need to know the facts about a topic. Without a bit of comparative research on your own, there’s often no way to tell what’s fact and what’s fiction.
 
You may read it on a website, but “it ain’t necessarily so.” But the written word has power to persuade, whether it’s accurate or not. So, especially in seeking medical information, it’s best to go with a trusted source. Hey, that’s one of the major reasons for the existence of Dr. Bill’s Clinic. I’m here to try to provide some guidance and practical advice, based on my nearly quarter century in clinical practice in orthopaedic surgery. That’s why I wrote my healing programs: to help those of you with knee pain, grinding, instability, arthritis, water on the knee, deformities, and any other problems with a variety of treatments, conventional, alternative, and complimentary, from across the entire medical spectrum.
 
DR. BILL’S LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN is a concise, but complete guide to all the root causes of knee pain and the treatments that I know from experience, professional and personal, do work. You can get your own copy, including an audio CD, at  http://drbillsclinic.com/eliminate_knee_pain.html
 
But, just so you know, the LGB does NOT include the recommended knee exercises. Those are given in a separate companion manual: DR. BILL’S PAIN-FREE PROGRAM, a selection of exercises and stretches that helps to prevent or eliminate knee pain–once & for all! You can get it here, at this link:   http://drbillsclinic.com/exercise_eliminate.html
 
Most recently, based on what people seemed to want, I created my newest healing program, HOW TO AVOID KNEE SURGERY, in both written and audio CD formats. This is a blend of the former two programs, and in addition, adds a great deal of new material, especially on herbs and nutriceuticals and other alternative treatments to help you avoid the unnecessary knee surgery, or at least delay the most invasive procedures, like total knee replacement, in the case of end stage disease, like arthritis. 
 
If you’ve been thinking about having surgery, but would like to delay or avoid it, you can get it here: http://drbillsclinic.com/avoid_knee_surgery.html
 
So, above all, don’t believe everything you read. DO your due dilligence before you accept whatever is out there on the net. The right advice can make a big difference in your life, but you need to be sure of the facts, before you act.
 
Well, that’s it for today. Til next time, my friend, be well. And have a great weekend!
 
Yours for a pain-free tomorrow,
 
Dr. Bill
 
P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to http://drbillsclinic.com/eliminate_knee_pain.html
 
P.P.S. For DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, please go to
 http://drbillsclinic.com/exercise_eliminate.html
 
P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to
 http://drbillsclinic.com/advanced_masters.html
 
FREE BONUS CD with any order: THE HEALING POWER OF POSITIVE PAIN PERCEPTION
 
Copyright, 2008 by William Thomas Stillwell, MD
All rights reserved

The last few days, we’ve looked at a variety of arthroscopic surgical techniques, so you can have an idea of what’s really involved, if you ever really need one of them. And, more important, so you won’t magnify your fears of surgery, from ignorance and misinformation. I hope you’ve found these descriptions helpful and that they accomplished our purpose. 
 
For today’s excursion into the mysteries of modern orthopaedic surgery, I thought we’d discuss the joint realignment procedure, the osteotomy. This surgery addresses the angular deformities that result when advanced arthritis is more severe on one side of the joint than the other. In other words, they take a knee that is crooked and return it to the straight and narrow path of proper limb alignment.
 
This is really important, too. Because when the knee is curved with the leg inward (genu varum deformity) or with the leg outward (genu valgum deformity), it has a significant effect on the tracking of the kneecap and the ligaments on either side of the knee. In this way, the deformity may result in instability.
 
I have a very full discussion of this topic in my LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN, at http://drbillsclinic.com/eliminate_knee_pain.html  So, if you or someone you know has a painful knee that is obviously curved, bowed or knocked, then you need to know more, to see what your options are.
 
An osteotomy is a surgery in which a bone is cut, then reset in a new position, to restore the original alignment of the bones. When this is done, the body weight is shifted from the collapsed side of the joint to the other side, and tracking of the kneecap is centered, once again. This can be done in a few different ways.
 
The simplest is an HTO (high tibial osteotomy). This is often used in varus, or bowleg deformities. In this operation, the cut is made behind the patella tendon, through the very top of the shin bone, just beneath the tibial joint surface, or plateau, front to back. Then, a second cut is made below that, from the outside to the inner side, on an angle, so the two cuts meet on the inside of the tibia. From the front, this cut looks like a wedge. This angled wafer of bone is removed from the upper shin bone and the bone opening is then allowed to close. Then the two fragments of bone, the thin top segment and the rest of the shaft, are fixed, with stepped staples, or a plate with screws, to hold them together, while they heal. 
 
After surgery, weight bearing is allowed as pain permits. Again, you’ve essentially created a fracture, so it’s not surprising that in the beginning, right after surgery, IT HURTS. Pain medication, anti-inflammatory meds and other measures help to relieve that pain until it dissipates. It may take 8-12 weeks to heal, but eventually the two fragments become one bone, but with a new weight bearing axis.
 
The results of an osteotomy are usually an improvement, not complete relief of pain. And the operated leg may be a bit shorter than the other, from the loss of the wedge that was removed.  This deficiency can be avoided by using a different type of osteotomy. A single cut, parallel to the plateau can be opened on the inside (medial side) of the tibia, and wedged OPEN, by a piece of bone from the iliac crest (pelvis), or a bone bank. This does the same thing as the closing wedge, but DOESN’T shorten the leg. 
 
Another alternative is a curved cut, below the surface of the tibial plateau, which is called a barrel vault, or dome osteomy. The surgeon just “dials in” the amount of correction he/she wants and then fixes it in that position.
 
Finally, and usually for severe knock-kneed deformities, a wedge osteotomy can be done at the lower end of the femur (thigh bone) above the knee joint. Fixation is usually by means of a right angle screw-plate, similar to what’s used for a fractured hip, at the upper end of the same bone.
 
The bottom line is that by changing the alignment of the leg, the surgeon can improve pain by shifting the body weight forces and also influence patella tracking. BUT, it doesn’t get rid of the arthritis, it doesn’t improve motion and if you have arthritis in any other compartment, it won’t work. On the plus side, it also won’t wear out or break–you can even RUN on it. Much more popular in Europe, where people are apparently less demanding, it has limited use in the States, where people prefer the advantages of joint replacement.
 
So here again, not something you want to lust after, but not so scarey either, once you see it as what it is–a mechanical way to shift your body weight and delay the day you need a joint replacement. But, before you get to the point of a deformed knee joint, you may be able to do some things that will relieve your pain and slow down the arthritis, so you can delay or AVOID surgery. Learn how in HOW TO AVOID KNEE SURGERY at  http://drbillsclinic.com/avoid_knee_surgery.html
 
Next time, we’ll take a look at the various options for knee joint replacement. Til then, my friend, be well.
 
Yours for a pain-free tomorrow,
 
Dr. Bill

P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to http://drbillsclinic.com/eliminate_knee_pain.html
 
P.P.S. For DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, please go to
 http://drbillsclinic.com/exercise_eliminate.html
 
P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to
 http://drbillsclinic.com/advanced_masters.html
 
FREE BONUS CD with any order: THE HEALING POWER OF POSITIVE PAIN PERCEPTION
 
Copyright, 2008 by William Thomas Stillwell, MD
 All rights reserved