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

The last time, we discussed what’s really involved in arthroscopic knee surgery. My thesis is that you’re far less likley to be afraid of necessary, needed surgical procedures, if you understand what’s actually done. Otherwise, your imagination creates a lot of nightmares that are much more intimidating than the real thing–by far!
 
Although the procedure I described was for treating a painful, degenerative kneecap, the same basic techniques are utilized when dealing with torn menisci, loose bodies, inflamed synovium and even ACL ruptures and tibial plateau fractures. The specifics are different for each type of pathology, but the basic approach is the same.
 
Let’s look at torn menisci first, for today. As I point out in the section on menisci in my LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN    http://drbillsclinic.com/eliminate_knee_pain.html   these cushions have no blood supply, except for the peripheral 25-30%. So many tears on the inside of the knee simply won’t heal. Therefore, treatment is basically removing the loose, torn fragment. 

After inserting the arthroscope into the joint, as we discussed yesterday, and identifying the loose torn piece of the meniscus, the surgeon uses small nippers, called “basket forceps” to nibble away the offending fragment. The little pieces of the meniscus float around inside the joint, until they’re sucked out by a power shaver (basically a tube with a rotating blade, attached to suction).  This shaver is also used to cut away overgrown and/or inflamed synovium (joint lining membrane), or shredded, fragmented articular cartilage (a process called debridement, or “house cleaning”).
 
Loose bodies, usually fragments of bone coated with cartilage, which have “fallen out” of the articular surface by disease, have been grown inside the synovial membrane, or have been “knocked out” of the joint surfaces by trauma, are removed by long grasping forceps. These are basically “grabbers” that the surgeon uses to capture the loose body and extract it. If it’s too big to pass through the arthroscopic portal (the little incision used to introduce the scope into the knee), either the incision can be enlarged, or the loose body can be broken up into smaller pieces and remove them, one by one.
 
Anyway, as you can see, you can do lots of different things through the arthroscope, but since nearly all the stuff inside the knee is devoid of nerves (or blood), the minimal disability is about the same, no matter WHAT you do inside. And THAT’S what the arthroscopic revolution is all about. And that’s why the pain is so minimal and recovery so rapid after this type of surgery. Pain and disability are functions of the size of the incisions and the amount of internal bleeding.  Minimal incisons, minimal disability. Simple, no? Pretty cool, too. It’s really transformed surgery!
 
Now, you know the worst of it. Not so scarey, is it? But that doesn’t mean you want to have surgery if it isn’t really necessary. That’s the key: you don’t want to be irrationally afraid of surgery, because there ARE times it’s needed. But you DO want to AVOID the UNNECESSARY surgery. This is a common sense, rational approach and the same one I used for lo those many years in practice, which resulted in my treating over 90% of my patients, WITHOUT SURGERY.
 
If you want to give your body the chance to heal naturally, if you want to stay OUT of the operating room, if you want to improve the odds of conservative treatment working, or use alternative methods to relieve your pain, then you need my newest healing program, HOW TO AVOID KNEE SURGERY, which you can see at   http://drbillsclinic.com/avoid_knee_surgery.html
 
Now, I had planned to continue with a description of joint replacement — what it is and what it isn’t–with the same idea: you will be less afraid if you understand what it really is. But I have a special treat for you instead. My friend, Fred Nicklaus, a veteran of 30 years in the martial arts and a guy who has HAD a hip replacement himself, is going to have a special offer on his Combat Endurance course, a proven method to give you a core of steel. But more about that tomorrow…
 
Meanwhile, if you have knee pain and you’re keen to stay out of the O.R., try HOW TO AVOID KNEE SURGERY at
http://drbillsclinic.com/avoid_knee_surgery.html  Til next time, 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