I was sitting in my study this afternoon, fielding calls, writing emails and other correspondance and perusing the Google Alerts I have in place for interesting topics. I came across an interesting article from The New York Times Health Section, dated 12/09/08 (you see, there are some uses for the NYT other than lining bird cages and wrapping fish) that reminded me of the many times I faced similar diagnostic dilemmas in my years of practice. 
 
The gist of the article was that, in the quest for better and ever more sensitive noninvasive methods of diagnosis, like MRI Scans, more and more pathology is being revealed. But, the pathology observed may have nothing to do with the patient’s symptoms. 
 
This leads to a number of unnecessary surgical procedures, as doctors try to treat the pathology revealed by the scan, even if that was not the actual cause of the patient’s pain. This is the paradox of the nonsurgical study–it may result in MORE surgery, not less.
 
A good example is the common finding of a torn meniscus, inside the knee, revealed by an MRI Scan. It’s now well known that many middle aged and elderly people are walking around with torn menisci, without any resulting pain or other symptoms. So they really don’t need surgery, just because they have a torn meniscus, UNLESS they also have very specific mechanical findings or very specific pain, localized to the area where there is an identified torn meniscus. And yet, that is exactly what was happening, until recently.
 
I always got an MRI if my patient had persistent pain that failed to respond to conservative treatments, like those I describe in my newest healing program, HOW TO AVOID KNEE SURGERY, which you can see at  http://drbillsclinic.com/avoid_knee_surgery.html
But they only came to arthroscopic surgery if they had identified pathology AND specific symptoms and signs, consistent with the observed pathology.
 
I remember once, when I was much younger, I had a young man who had very specific joint line pain. He failed to get better with all the conservative treatments I prescribed–medications, local heat, physical therapy, the works. So, we got an MRI Scan. WOW! He apparently had an enormous tear of the posterior horn of his medial meniscus. Lit up like a Christmas tree! So obvious, even a lay person could see it from across the room.

Now, in a young person, job #1 is to preserve the articular cartilage at all costs: in other words, prevent arthritis, which is what happens if an untreated, unstable torn meniscus is allowed to remain, without treatment. So, with this as our goal, the patient, his parents and I were all of one mind: this kid needed surgery, pronto!
 
With all best intentions, I scoped the kid, expecting to see and repair or remove this enormous tear. Only…there WASN’T ANY TEAR. I looked and probed everywhere.  Nope.  Nada.  Well, I wasn’t about to fix what wasn’t broken, so I shaved away some inflamed synovium at the medial (inner) joint line, and got out.
 
He had what we call a “false positive” MRI Scan, a diagnostic image that appears for all the world to be a bona fide meniscus tear, only the tear doesn’t really exist. Imagine my embarrassment when I had to tell the family that I didn’t find the expected pathology, other than the inflamed synovitis (swollen, reddened lining membrane of the joint, which can get caught between the moving bones, just like a torn meniscus).  

The family was very grateful that he didn’t have a tear and all turned out well, because the patient’s preop pain was relieved, probably because I cut away that inflamed membranous tissue. But you could very easily argue that this was a completely unnecessary surgery–I was chasing the chimera of a false finding on a scan. It taught me a lesson, that’s for sure.
 
The fact is, MRI Scans are, at best, only 90-95% accurate on the medial (inner) compartment of the knee joint. This drops to only 60-70% accuracy on the outer or lateral compartment of the knee, because of the more complex anatomy of the lateral meniscus. Bottom line: MRI Scans and other diagnostic tests are NOT 100% accurate. They are just one part of the puzzle and have to be interpreted, based on the physical findings and a patient’s response to treatment. 
 
There are lots of reasons for knee pain. You can learn more about them, in layman’s English, in my best selling LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN (see here at http://drbillsclinic.com/eliminate_knee_pain.html )
 
Many, if not most of them, can be treated with effective nonsurgical treatments, including alternative and complementary methods. The trick is knowing when surgery is really warranted–and when it’s NOT. That’s why I wrote HOW TO AVOID KNEE SURGERY, which you can see here http://drbillsclinic.com/avoid_knee_surgery.html
 
Remember, the very best surgery is the one you avoid. 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

Here’s something I’ll bet you don’t know about me: I’ve been a SCUBA diver, on and off since 1986. I wouldn’t dare go diving right now, because I’m out of training and it’s been a few years. But I’m still certified and still carry my C-card, which allows you to get your air tanks filled.
 
I got into this sport sort of through the back door. My brother-in-law John had gotten into it, and he was really pretty good, too. He was at Instructor or Master Diver level (same level of experience, but each has a different path of advanced training–the former, an emphasis on teaching; the latter, personal skill enhancement). And, as he worked for me as a kind of “Man Friday” or personal assistant, I guess he figured that getting me involved would be a good way to get some great diving vacations. He was right about that, as it turned out.
 
And, truth to tell, I needed some avocation for stress relief, after the daily grind of surgery and private practice, as well as my administrative duties as Chief of Orthopaedics, and occasional teaching duties. So, I went back to dive school. You have to complete a course of study, including practical courses that involve actual supervised dives, safety measures, the biology and physics of compressed air (partial pressures of gases, nitrogen narcosis, and other topics), and training for emergencies.
 
This last is pretty important. If something should happen to you 100 feet under water, and you’ve practiced dealing with it, you know what to do. You don’t panic or thrash around–that’s the easiest way to get killed, and it happens more often than you would think. No. You calmly assess your situation and then take the steps you’ve been taught. No problem. 
 
And, my favorite, you have to swim a mile in the pool–any stroke or style you want, take as long as you want, but you do this, or you don’t pass. It still amazes me, and it seemed to take forever, but I did it. In fact, I was the oldest guy in my class to successfully graduate.
 
There was one other guy a few years older than me, but he couldn’t trust the regulator–the mechanical valve that allows you to breathe under water. You have to trust the device and be able to inhale under water. He couldn’t do it–psychological block. I could. No problem. Anyway, I got my card and was officially a diver.
 
During the practice dives, I began to notice a dull ache on the inner joint line of my knees, when I kicked my legs with my fins on. The extra force on my knees from the resistance of the fins on the water apparently put a mild twist on the jonts, and I could feel it. 
 
I, of course, like most highly educated and clinically experienced physicians do, ignored this sign. After all, nothing ever happens to US, only to our patients. Right. Only, it continued to get worse and began to bother me when I wasn’t in the water.
 
Finally, I couldn’t ignore it any more. I suspected I had a low grade synovitis, or maybe even a small tear in my menisci. Got an MRI, but the menisci seemed to be intact. OK, synovitis, it is, then.
 
So, I took to the gym to work on my quads, with emphasis on my VMO muscles, with the resistance exercises I now teach in my PAIN-FREE PROGRAM, at   http://drbillsclinic.com/exercise_eliminate.html
 
And, you know what? It worked. As my strength increased, the ache decreased. No question about it. Without these exercises to alter the dynamics of my knees, no way could I have graduated. But I did the work and I did graduate. And that made a lot of adventures in diving around the world available to me.
 
So, if you have aching in your own knees, you can’t go wrong doing these specially modified exercises, yourself. They help to prevent or eliminate knee pain, FAST, regardless of the underlying cause. Go to  http://drbillsclinic.com/exercise_eliminate.html 
and see for yourself.
 
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

This past weekend, I was at a business/marketing meeting in Tampa. One of the attendees was a fellow I had advised in the past, and one who had used the recommended exercises in my PAIN-FREE PROGRAM  http://drbillsclinic.com/exercise_eliminate.html/.  He’s  a few years older than me, but in otherwise good shape.
 
Up to now, he had done pretty well. So well in fact, that he has written a testimonial for me, which I will post, once he sends me a photo of himself to run with it. But, like many of us (me too) he got a little bit complacent and slacked off the exercises. 
 
Sure enough, he started to develop recurrent symptoms. ”Hey, what’s that vague ill-defined knee pain?” he wanted to know. I shouldn’t wonder. 
 
Knee pain, especially low grade, achey pain, is often diffuse and ill-defined. That is, unless there’s a specific injury that causes a sharp, acute pain, associated with damage to specific structures. These would be things like a fall, twist or sprain of ligaments, or strain of muscles, a tear of the meniscal cartilage, a rupture of the ACL, degenerative diseases (like chondromalacia or it’s cousin, osteoarthritis), or inflammatory conditions, including rheumatoid arthritis (and its relatives, psoriatic arthritis, lupus, spondylitis, etc.)infectious arthritis (Lyme Disease, staph or strep infection).
 
Why do these conditions cause this low grade ache? In a word, SYNOVITIS. This is an inflammation of the lining membrane of the joint. Now, synovitis is a very non-specific response to ANY stimulation, regardless of what it is–IT HURTS. The membrane also becomes thicker and more swollen, actually grows in volume, becomes red (from dilated blood vessels) and produces an excessive amount of joint fluid (which it normally makes in very small amounts, to lubricate the articular cartilage and nourish the cartilage surfaces). Lay people call this “water on the knee.” 
 
Since I was there with him, I examined my friend’s knee, right there in the conference room. Very few findings, though. Some loss of the last few degrees of motion at the extremes of flexion and extension, maybe five degrees at each end, consistent with the thickening of the synovial membrane. And he had a little bit of pain under the kneecap, when pressure was applied. Pretty much, that was it. Of course, I had no x-rays or MRI images to examine.
 
My impression was that he had developed a recurrent case of chondromalacia patellae–softening of the cartilage of the patella. Either that,or it’s first cousin, osteoarthritis. So, what to do?
 
First, he needs to resume the exercises I teach at http://drbillsclinic.com/exercise_eliminate.html  Exercise is the overall best method for long term pain relief of the knee.
 
Next, he needs to get on the anti-inflammatory regimen I present in detail in my newest healing program, HOW TO AVOID KNEE SURGERY, at  http://drbillsclinic.com/avoid_knee_surgery.html
 
With luck and some work, he should get fast pain relief in as little as one week. If he does the work…
 
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

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 newswires were all abuzz yesterday with a study out of this week’s New England Journal of Medicine. The study was done by a group of Canadian researchers, looking at the results of treatment of arthritis pain in two groups of patients in North America, from 1999 through 2007.  One group was treated by arthroscopic surgery. The other was treated with conventional, mainstream non-surgical methods, including anti-inflammatory medications and physical therapy.
 
The headline from this study was that there was NO DIFFERENCE between those that were treated surgically and those who were NOT. This, of course, suggests that surgery done strictly for arthritis pain is not warranted. The trouble with this news flash is that it’s really not news, or at least it’s yesterday’s news.
 
In 2002, another study was done, comparing arthroscopic surgery with sham surgery (ie., a skin incision was made over the knee, that was sutured,  but instruments were not introduced into the joint, nor were any intra-articular manipulations done).  This study found similar findings among U.S. Veterans in the Veterans Administration Hospital System. Again, the use of arthroscopic surgery for the treatment of arthritis pain was discredited. Short term relief of pain in BOTH groups (ie., real surgery and sham or fake surgery) was the SAME! This was attributed to a placebo effect.
 
This prior study was so impressive that Medicare used it as a basis for determination in refusing to pay for arthroscopy for the treatment of arthritis pain. And this study was a reinforcement of an even earlier study that compared arthroscopic surgery with merely lavage (injecting and extracting saline, or salt water, into and out of the knee joint, to wash it out). Here, too, there was NO DIFFERENCE between the surgery and the wash-out groups. So here is more evidence of what you know instinctively–letting the body heal itself is the best course, except in advanced, or end-stage arthritic disease.
 
In my years of practice, it was my experience that if a patient had full-blown arthritis, there was little reason to ‘scope them, UNLESS they had a sudden increase in very specific joint line pain, or giving way (so-called mechanical symptoms) that suggested a displaced or entrapped tear of the meniscus, or a rip-roaring synovitis (as in Rheumatoid Arthritis) that would not respond to medical treatment, or needed relief but were a poor risk for major joint surgery, like a total knee replacement.
 
This is why I consider this “old news.” I used arthroscopic surgery for very specific mechanical or synovial overgrowth problems, NOT just as a “catch-all” treatment for arthritis pain. I always advocated a conservative approach first, letting the knee itself declare if and when it was ready for a major surgery.
 
I STILL DO.
 
Like I’ve said before, there are times when surgery is absolutely needed. To deny this, or make frankly STUPID statements that “surgery is NEVER warranted,” is to deny the facts. But surgery should be the last or the best option–not the first line of defense. In short, you want to AVOID the UNNECESSARY SURGERY. 
 
And to help you do just that, I wrote my newest healing program, HOW TO AVOID KNEE SURGERY
 http://drbillsclinic.com/avoid_knee_surgery.html   With conventional and alternative methods from across the entire medical spectrum, you have everything at your fingertips to relieve your knee pain, but stay OUT of the Operating Room.
 
If you want the very latest methods to get rid of that nagging knee pain for good, but want to do it WITHOUT SURGERY, then you need my program. Order it here:  http://drbillsclinic.com/avoid_knee_surgery.html
 
Have a great weekend, my friend, and be well. Til next time…
 
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

As you know, before the last few days, I’d been giving you the “Readers’s Digest” version of a number of different types of knee surgery. The purpose is to alleviate your fears, based as they are on misinformation, exaggeration, outright distortion and your own imagination, by telling you exactly what’s done. This gives the fears limits, as reality limits imagination, and helps you to cope, if you actually DO need one of these procedures at some time.
 
We’ve already covered basic arthroscopy, as well as patella debridement and realignment, partial meniscectomy for a torn meniscus, and, most recently, arthroscopically assisted ACL reconstruction. Today, I will finish up the description of other miscellaneous arthroscopic procedures, that are often done simultaneously. 

Bear in mind that once you’ve entered the joint through those tiny arthroscopic portals (mini-incisions), there’s almost no limit to what you can do in there. And the postop morbidity (pain, swelling, stiffness, disablity, etc.) is pretty much the same, regardless of how much you do inside the knee, UNLESS you cut, drill, abrade, puncture, or otherwise violate the bones. 
 
If you DO get into the bones, you automatically increase postop bleeding, pain and swelling–which makes sense, right? Otherwise, however much you do, the postop limitations are a function of those tiny portal incisions. That’s the great advantage of arthroscopy and why it’s been a transformative concept in modern surgery, that’s made outpatient surgery possible.
 
All these procedures are described in much greater detail, including the conditions that require them, in my LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN,  available now as a book and an audio CD, too, at  http://drbillsclinic.com/eliminate_knee_pain.html
But for now, let’s look at a few other conditions for which arthroscopic surgery is often recommended, how they are treated surgically and whether other options and NON-surgical treatments are available.
 
First up is SYNOVITIS, an inflammation of the lining of the joint (any joint that has freely moving parts, not just the knee). I alluded to this with a brief remark, last Wednesday. When the lining of the joint gets irritated, it gets bigger, actually grows, often in an irregular way, resulting in flaps, shelves, clumps and masses, that can flop around inside the joint, occasionally getting trapped between the moving parts. This entrapment causes pain, and further swelling and inflammation. The irritated membrane produces lots of joint fluid, resulting in “water on the knee,” as well as pain.
 
The arthrocopic removal, or resection, of this diseased membrane is executed with an electronic motorized shaver. This is a stainless steel tube, with a small window at its end. The window encloses a rotating (or reciprocating) blade, that nips off small morsels of synovium, which are then sucked out by a vacuum pump and collected in a trap, for pathological study. Using this technique, you can systematically resect almost ALL the lining, as in cases of Rheumatoid Arthritis, or Bacterial Infection, where you want to rapidly “debulk” the mass of diseased membrane. But guess what? A new membrane grows back very rapidly, hopefully in an uninflamed, relatively normal state.
 
DEBRIDEMENT is a French term, meaning “house cleaning,” and it’s pronounced “De-BREED-mont,” not de-BRIDE-mont. I had an Australian professor once, who use to say “Da BRIDE is whut walk down de aisle wit’ de groom. Gentlemen, it’s deBREEDmont.” This refers to shaving off loose shreds of degenerative cartilage from the articular surfaces, to smooth them out. It’s important to remember that you can only REMOVE tissue; you can’t put anything back. 
 
Normally, the shaver is used to do this and it’s combined with synovectomy and LAVAGE, essentially washing out the joint with irrigation fluid. This is controversial in the treatment of arthritis, but if you’re there for other reasons, you might as well “clean house.” Today, you can also do this with radiofrequency probes and lasers, too.
 
And, as I also mentioned last Wednesday, LOOSE BODIES and FOREIGN BODIES can be grasped by forceps and extracted through the arthroscopic portals.
 
Areas of bare bone, if they’re small enough, can be treated through the scope to restore some kind of cartilage covering, but as I mentioned above, the morbidity and pain is greater once you penetrate the bone surface. Arthroscopic awls are sharp, pointed steel spikes that are used to put multiple shallow punctures into the bone, a procedure called MICROFRACTURE. Another way to do the same thing is to use a high speed burr to “sand” the surface and stimulate bleeding. This is called ABRASION CHONDROPLASTY. Both these techniques result in blood clot, which is changed into fibrocartilage over the bare area.
 
An alternative is to restore actual hyaline cartilage, in one of two ways: CHONDROCYTE TRANSPLANTATION, in
which cells initially harvested from non-articular parts of the knee are cultured, then reimplanted to grow new cartilage; and OATS (Osteochonral Articular Transplanation ) which transposes plugs of bone, with its articular cartilage attached, into drill holes in the bare area. Pretty cool stuff, no?
 
And, really, NOT so scarey, now that you KNOW what’s involved, right? Whatever it is in your life, if you KNOW what you have to deal with, you can DO it, if you have to.
 
But, there are many times that you DON’T need any of these techniques. Those are the times that surgery ISN’T warranted, because conservative methods will work to relieve your pain and restore your function just fine, thank you very much. If you want to AVOID An
UNNECESSARY SURGERY, then you need my newest healing program, HOW TO AVOID KNEE SURGERY. Get it here, at
 http://drbillsclinic.com/avoid_knee_surgery.html
 
Next up, osteotomies and realignment surgeries. Talk to you tomorrow, my friend. Meanwhile, 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

Just yesterday, I came across an article on one of the sports blogs about the various knee injuries seen with a number of sports, including basketball, soccer and football. With the Olympics in full swing, it’s easy to focus on the more dramatic sports that get much of the press, when it comes to knee injurues, acute and chronic.
 
But surprisingly enough, one of the most frequent causes of chronic and acute knee problems is… GOLF! Now, golf is a gentleman’s (or gentlewoman’s) game, no doubt about it. And it looks like the players mainly walk around, when they’re not riding in their electric golf carts. They don’t even carry their own golf bags–a caddy does that for them. But if the knee problems generated by this sport aren’t as dramatic as some, they’re no less real. 

You see, golf applies more subtle forces across the knee joint, that are often internal. Walking on uneven terrain, rolling hills, even sand traps, induces the same irregular joint forces as walking on a beach. And the torque, or twisting forces, imposed on the knees with every drive are tremendous.  In fact, it’s that twisting stress, with full body weight on the knee, from every swing of the driver that’s responsible for most of the injuries.
 
You normally don’t even think in terms of golf injuries until some high profile player, like Tiger Woods, is knocked out of competition by his bad knees, or some specific knee injury. But the danger is always there, maybe especially for the average player, who isn’t conditioned as well as the professional athletes.
 
You go into any golf club or country club locker room and all you’ll hear about is aches and pains of shoulders and knees. Well, part of that is simple aging. Lots of boomers and seniors play golf, which aggravates dormant conditions, like arthritis, or synovitis, or chondromalacia patellae (for a complete run-down of the many problems of the knee, in layman’s language, see my LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN   http://drbillsclinic.com/eliminate_knee_pain.html ).
 
But part of it is newer injuries, like ligament sprains or ACL tears, or especially torn menisci, caused by that repetitive twist. Pain in the knee is so common in this sport that I call this chronic knee pain “Golfer’s Knee.”
 
While Tiger had a completely ruptured Anterior Cruciate Ligament, as well as a meniscus tear and articluar cartilage damage, all of which require surgery, in many cases, proper conservative treatment of Golfer’s Knee can avoid knee surgery. As it happens, my latest publication provides golfers and anyone else with all the tricks, tips and effective techniques from across the entire medical spectrum, conventional, alternative and complementary. It’s called HOW TO AVOID KNEE SURGERY  http://drbillsclinic.com/avoid_knee_surgery.html
 
Acute pain is treated first by anti-inflammatory measures and joint stabilization, while long term treatments focus on specialized exercises and stretches, to improve strength and stability. These are supplemented by nutritional measures, herbs and nutriceuticals, to enhance healing and retard the development of arthritic changes. 

Yes, there are situations where surgery is needed. But my goal is to teach you how to prevent an UNNECESSARY surgery, of which there are far too many. So, if you have knee pain, from Golfer’s Knee, or any other source, learn how to relieve your pain and restore your function, with the best conventional and alternative non-surgical methods. Go see how at   http://drbillsclinic.com/avoid_knee_surgery.html
You’ll be glad you did. 

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

The pool resurfacing and tile upgrade that I reported on last week really looks great. It’s amazing what a little change like that can do for the appearance of the entire back of the house. Anyway, it looks so good that we decided to seal and resurface the surrounding deck, as well. Anyone who’s ever done any home renovation will understand this perfectly–whatever you do is never enough; one improvement always leads to another, and another.
 
So, today, a team descended on the pool area, power washing off the accumulated mold and black algae that is typical of Florida, due to all the humidity and heat. Then, they actually filled and sealed any cracks and seams in the deck surface and the pool coping, to prevent future ingress of water, which is what promotes the growth of algae and mold. Finally, they then applied an acrylic colored stain, that will compliment the new tile and the stones that make up the pool’s waterfall.
 
After the power washing, the rest of this operation, all phases, is done by hand, while kneeling on the hard concrete deck. It’s tedious work, tough on the back and tough on the knees. With my back and my knees, I’m glad I’m not trying to do it myself. 

As it happens, we got a beautiful day today, after torrential downpours yesterday. So the guys out back were baking in the sun, as they worked. I went out to offer them some cold cokes when I noticed that one man had his kneepads on, but another one had none.
 
I asked the guy without the pads if he wanted a set of pads or a cushion to kneel on. “Oh, no, I’m fine so far,”  he said. Sounding dubious, I said, “Okay…” and went to the other man, with his soda. “I see you’ve got your pads on,” I said.”Oh yes, sir. Wouldn’t be without ‘em,” he
replied. “Well, you’d better talk to your friend over there,” I said. “He’s doing damage that he doesn’t realize, because it doesn’t hurt, right NOW. But if he keeps it up, he’s going to have trouble in the future.”
 
With that, I went back in the house, reflecting on how many times throughout my years in practice I faced this same problem. Working men who don’t realize what they’re doing to themselves by kneeling on hard surfaces, without padding or protection. I can understand if a guy isn’t
comfortable wearing knee pads. Let’s face it, they’re really not very comfortable. But then, they could carry a work pad, a folded towel, a gel pad, even a pillow, something, anything to avoid the punishment of direct pressure of their kneecaps, on a rock hard surface.
 
You see, the knee is designed to carry weight from top to bottom, NOT front to back. So concentrating force directly on the kneecaps, on a hard surface, is just begging for multiple problems, like prepatellar bursitis (“Housemaid’s Knee”), synovitis and effusion (water on the knee), chondromalacia patellae  (degenerative softening of kneecap cartilage) and eventually, arthritis.  Each of these conditions, and more, is described in my LITTLE GREEN BOOK. Go see at  http://drbillsclinic.com/eliminate_knee_pain.html
Not only will you learn about “the ills that flesh is heir to,” but you’ll learn how to prevent them and how to treat them, if you do get them.
 
Besides the preventive measures that will help you avoid pain and disability, the importance of properly modified exercises, like those I teach at   http://drbillsclinic.com/exercise_eliminate.html   cannot be overemphasized. If you had to choose only one preventative activity, for the maximum benefits, it would be exercise. That, and common sense, of course.  So, whenever you have reason to be on your knees, don’t
forget your knee pads.
 
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