Golf
Doctor
(orthopaedics)
If Your Knee Clicks, Swells or Locks,
it's Time to Check it Out
Michael Leighton, M.D.
Dear Golf Doctor:
I am 39 and play golf twice a week. I get swelling in my right
knee especially after playing and find it very painful to squat down.
Advil seems to help. My knee is sometimes stiff in the morning and it
frequently locks and clicks. Do I have a "trick knee?" Should I get
it "scoped?" Should I get an MRI (I have a steel plate in my skull)?
When will I play golf again?&emdash;Chuck Sarkis, WPB
Dear Chuck:
You ask a lot of questions&emdash;and I appreciate that. I wish
more of our readers asked more questions. I've got two offices, a
phone and an e-mail address (KNEESURG@aol.com) so, if you have a
question, use one of them and I will answer you.
Back to your "trick knee." That's an outdated term that
probably refers to the "catching" or locking sensation experienced by
people with a loose body (fragment of cartilage) or torn meniscus
that gets caught between the femur and tibia. The femur is the top
bone in your lower extremity; the tibia is the bottom bone or your
"leg." Each bone is covered on the end by shiny, smooth and
Teflon-like cartilage (think about the end of a chicken bone). This
cartilage is the one that wears out in arthritic conditions; it is
not the cartilage that gets torn. The cartilage that gets torn is a
C-shaped fibrocartilage called a meniscus. When an athlete "tears his
cartilage" on ESPN, he's really torn a meniscus. The meniscus
functions to give the top of the tibia more depth and also helps
redistribute weight and forces at the knee joint. The most outer, or
peripheral portion of the meniscus is most crucial to its function.
Therefore, the more meniscus that can be saved after an injury, the
better off you are.
Before arthroscopic surgery&endash;torn
meniscus of the knee.
What are the symptoms of a "torn cartilage?" Well, Chuck,
you've named the big ones. Swelling, usually noted after activity can
be from a number of causes, but a meniscal tear is high on the list.
A locking or catching sensation, especially when squatting down,
frequently indicates meniscal damage. Pain at night and an inability
to sleep on one's side with the knees touching is often cited by my
patients. Physical examination is often diagnostic. A competent
orthopaedic surgeon will readily identify a knee with a torn
meniscus. X-rays are a necessary adjunct to the initial evaluation -
you don't "see" the cartilage, but plain x-rays give significant
helpful information inexpensively.
The role of MRI in the evaluation of the knee is somewhat
controversial. This is an expensive ($600-$1,000) diagnostic study
that should really be used only in the face of an equivocal history
and physical exam. It is not a test that should be done on knees over
age 60 looking for a meniscal tear. Because of the MRI's extreme
sensitivity, the natural aging process of menisci (loss of water
content, intrasubstance degeneration) frequently is read as a tear -
all the MRIs are positive! This (positive MRI) should not be
construed as an indication for arthroscopy. By the way, metal within
the body (i.e., steel plate) can be a contra-indication to MRI.
After arthroscopic surgery to remove torn
portion of meniscus.
The appropriate knee for arthroscopy (an outpatient procedure
where a 4mm lighted lens is placed into the knee and microtools are
used to remove tears) is one that has the previously mentioned
symptoms, has not responded to ice, rest and anti-inflammatory
medications. My patients are on crutches for a day, fully weightbear
and bend immediately, and are bicycling by one to two weeks after
surgery. Those with uncomplicated recovery and who are in good shape
prior to surgery, can get back to golf by two to three weeks post-op.
Each surgeon may differ slightly in their approach, but results are
very good. In the meantime, stop squatting down to line up those
putts.
Michael Leighton, M.D. is an avid golfer who specializes in
orthopaedic surgery and sports medicine. He can be reached at
Atlantis Orthopaedics, 561-967-4400 or by e-mail at
KNEESURG@aol.comMichael Leighton, M.D. is an avid golfer who
specializes in orthopaedic surgery and sports medicine. He can be
reached at Atlantis Orthopaedics, 561-967-4400 or by e-mail at
KNEESURG@aol.com
