What to do if your knee’s giving way

NEW DELHI: The good thing is that many people are taking up physical activities to keep obesity, diabetes and heart disease at bay. The not-so-good news is that in doing so, they may be putting their knees at risk. Orthopaedic surgeons that TOI spoke to asserted that 40% of

knee

injuries occur these days in people less than 40 years old. Fortunately, beside knee replacement, there are other ways out of the predicament now.

Dr J Maheshwari, director and chief of knee and shoulder services at Max Saket hospital, recalled a 40-year-old woman with debilitating pain in her knee. “She was a sports coach and had suffered knee injury around eight years earlier, but had opted for home therapy to alleviate the pain,” he said. “This led to further damage, necessitating partial knee replacement.”

While minor injuries get healed with physiotherapy and rest, the surgical approach is needed if the damage is significant. Such was the case of Rishabh Kumar, all of six, who had injured the ligaments. His father said that the doctors in Bihar told the boy not to play any longer and advised rest, but his condition did not improve. The family brought him to Safdarjung Hospital, where surgery had to be conducted to repair the damage.

“Rishabh is one of the youngest patients to have come here with ligament injury,” said Dr Deepak Choudhary, director, Safdarjung Sports Injury Centre. “But it is actually common among teenagers and adults who indulge in sports. We have also treated a few gym-goers.” He said that ligament damage, if ignored, can lead to damage of the soft tissues and even permanent disability.

The proclivity to have the troubling limbs X-rayed is often the reason why the damage gets aggravated. As Dr Balvinder Singh, orthopaedic surgeon at Safdarjung, pointed out, X-ray cannot pick up damages to soft tissue, ligament or the meniscus. “When nothing shows up, the patients take painkillers or opt for home therapies and the condition only aggravates,” Dr Singh explained, adding that MRI more efficiently diagnoses damage to the knee’s bone tissue, soft tissues and ligaments.

Advancement in technology has aided early diagnosing of knee problems. “We are able to pick up problems ranging from simple sprains around the joint to mechanical problems with the help of advanced diagnostic techniques,” said Dr Raju Vaishya, senior consultant orthopaedic and joint replacement surgeon at

Apollo Hospital

. “The focus is also shifting from simply treating the symptom to treating the cause itself as early as possible.”

Till about a decade ago, knee replacement was the most availed remedy. But several approaches to repair damages have since come up, including the less invasive keyhole surgery, or arthroscopy. It is used to reconstruct injured ligaments and remove mechanical blocks from the knee joint. Many surgeons also carry out cartilage restoration and transplantation to treat injuries. The use of platelet rich plasma (PRP) is also being tried. It is an experimental therapy that involves the injection of platelet-rich plasma derived from the patient’s blood to repair and regenerate soft tissue.

Research in the US suggested that surgeries for knee repair were actually unnecessary. A

British Medical Journal

study also revealed in 2015 that arthroscopic surgery was often over-prescribed. The study stated that arthroscopic surgery was routinely performed on middle-aged and older population to treat suspected tear of the meniscus when, the study claimed, such joint damage in middle-aged patients should actually be treated according to clinical guidelines for knee arthritis, starting with information, exercise and most importantly weight loss.

In India, while there isn’t substantial date on the matter, many experts advise patients not to rush into a surgical procedure. “While there’s considerable difference of opinion on the indication for surgical treatments, the decision to operate should be based on consultations between the treating doctor and the patient, taking into account the patient’s need for strenuous exercises,” suggested Dr Rajesh Malhotra, professor and head of orthopaedics, AIIMS.

Saying that prevention was always better than cure, Dr Malhotra emphasised training on how to avoid knee injury. “For sportspersons and gym-goers, it is important to adopt a graded increase in activity,” he said. “Also, one should identify his or her propensity to sustain a particular injury and the exercise programme should be designed to prevent such an injury.”