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Bill Klaproth (Host):  Marin in Sonoma are active communities and joints are key to not only moving and getting around but to enjoying the amazing outdoor activities we have. So, let’s talk about a common issue, knee injuries. So, what are the most common knee injuries and how can you avoid them? So, let’s find out with Dr. Michael Brown, an Orthopedic Surgeon at MarinHealth.

This is the Healing Podcast from MarinHealth. I’m Bill Klaproth. Dr. Brown, thank you so much for your time. So, when it comes to staying active, our knees take on a lot of wear and tear. So, what knee injuries do you see often?

Michael Brown, MD (Guest):  I see a variety of knee injuries that could be fractures, dislocations, ligament tears, torn meniscus tears, and tendon tears are probably the most common ones that I see.

Host:  So, with those injuries, are those mostly because of sporting and athletic types of activities or are they because of injuries or accidents like tripping or falling?

Dr. Brown:  With fractures, they usually come in some form of trauma or falls. Dislocations can come in a variety of different ways, sporting activities especially. The knee specifically, patella dislocations are the most common kind of dislocation that can occur in sporting activities such as soccer and other types of activities. Ligament injuries usually are a combination of sporting activities and also some type of traumatic fall or injury. Meniscal tears can come in a variety of different ways. And tendon tears are usually seen more in the middle aged people that usually come in falls or jumping type of activities.

Host:  And let’s talk about prevention. What are some ways people can avoid knee injuries?

Dr. Brown:  Yeah, the most important way to try to avoid injuries is just staying active, getting some exercise on a regular basis. I think also balance is a huge issue and that seems to be a big deal in people as they get older. I certainly can feel for my patients because I at times will feel balance issues that I didn’t feel when I was younger. So, I think that’s really a key thing. And with balance, that can be helped with yoga, physical therapy to try to get people instruction with that. So, maintaining their balance is very important to try to avoid injuries.

Host:  Yeah, that’s good advice. And then let’s talk about osteoporosis. Can that impact knee degeneration?

Dr. Brown:  Yes, it can. Secondarily, osteoporosis is lack of bone substance. It can actually impact knee injuries from the standpoint that you have less bone substance and if you suffer simple falls, then it could lead to fractures or other types of injuries that maybe you didn’t have if you had bones that were stronger and had better bone substance.

Host:  And then when it comes to injuries again, what can be done to avoid surgery when you have a knee injury?

Dr. Brown:  I think the best way is really, to assess your knee injury with the usual RICE which is rest, ice, compression and elevation, immobilization if necessary, to try those kinds of things. Physical therapy, nonsteroidal anti-inflammatories such as Advil. You seek treatment if you have a severe pain, you can’t move the leg. If your knee is popping or feels like something snapped and if you’re noticing swelling or bruising, I think that’s the time to seek treatment.

Host:  Well speaking of seeking treatment, can waiting and not dealing with a knee injury cause other injuries? Can you affect the other knee or overcompensate and what about hips or feet? Can you affect them by delaying having your knee looked at?

Dr. Brown:  All the above is true. No question about it. I think if you wait too long, and you truly are having a problem, you can’t walk because of knee injury, then it certainly will cause you to have what’s called an antalgic gait or a painful gait which can cause pressure specifically on your back, your other leg and hip and of course, you mentioned the feet; and that can also lead to foot problems because you’re walking in an abnormal fashion.

Host:  Speaking of injuries again, is there a way to manage injuries through non-pharmacological methods such as pain protocols, physical therapy, ice or things like that?

Dr. Brown:  Ice is still nature’s best anti-inflammatory. If you have an injury where you feel like you can deal with it and even after having it assessed, often physical therapy will be prescribed that will help you restore your range of motion and your strength and try to achieve an non-operative solution.

Host:  If you do have an injury or situation that requires knee surgery, what are the usual options?

Dr. Brown:  The options are varied of course, and it really deals with the type of injury for sure and there are certain types of injuries that surgery is the best treatment for sure such as if you’ve torn your patellar tendon or your quad tendon; then there is no solution other than surgery. It requires repair. Certain fractures that are displaced, they require an open reduction and repair. And then finally, anterior cruciate ligament injuries which are among the most common, if your knee is unstable, and it feels loose, and you cannot trust it; and you have an ACL tear; then surgery is usually recommended. And of course, this depends on your age and activity level for this particular ligament injury.

Host:  and there has been advancements in knee replacement as well, is that right?

Dr. Brown:  Yes. There very much has and I’ve been fortunate enough to be able to see knee replacements, how things were many years ago, back in the early 90s to the present day. And it is changing quite frankly from the standpoint of the implants themselves and more specifically, in the way that these implants are put in.

Host:  And now we have partial replacement options too, is that right?

Dr. Brown:  That’s correct. We do. Partial knee replacements have been around for a long time. It’s just that their track record has not been very good up until the past ten to fifteen years. Now, it is a very viable option for the person that would be a candidate for this.

Host:  And then is there a range of minimally invasive options as well?

Dr. Brown:  Yes, there is and minimally invasive was really big in the early 2000s where they made very small guides, so the incisions could be very small. There was a problem with that because doctors where having difficulty seeing what they were doing and this lead to some certain complications. And so, now I think we’re taking much more intelligent approach to minimally invasive surgery. And so we’re actually benefiting from that experience.

Host:  If someone does need a knee replacement, how are knee replacements planned and executed to ensure that they fit and work best for a patient’s needs, lifestyle, et cetera?

Dr. Brown:  We’ve got really two different types of knee replacements way that I look at it. One is a knee replacement which is what you might call of the shelf which means knee replacement that comes in all kinds of different sizes that’s determined at the time of surgery. And then there are the knee replacements that are predetermined which are computer generated knee replacements which are becoming very popular. This is preceded by a CAT scan or a CT scan that’s sent to a company that makes the knee replacement and ensures that it will fit and then that knee replacement is used for that person.

Host:  That is fascinating. So, it’s like a custom designed knee.

Dr. Brown:  It is. It’s a company that I’ve personally been working with for the past eight to ten years. they’ve been out for about fifteen years. The implant quality is equal to the major companies and it is an implant that I feel it’s been very beneficial for my patients.

Host:  So, if someone is suffering from knee related issues; what is the first thing they should do to get a good assessment and diagnosis?

Dr. Brown:  Speaking as an Orthopedic Surgeon, that’s pretty easy. I guess I would say, go see your orthopedic surgeon but to get a good assessment and diagnosis and I think that’s what we’re all searching for. What do you have? What is your diagnosis? That’s the most important thing especially if you have an injury that is just not getting any better.

Host:  Yeah, that makes sense. Well Dr. Brown, this has really been fascinating and informative. Thank you so much for your time. We appreciate it.

Dr. Brown:  Thank you very much. I appreciate the opportunity.

Host:  That’s Dr. Michael Brown and to learn more please visit www.mymarinhealth.org. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is the Healing Podcast brought to you by MarinHealth. I’m Bill Klaproth. Thanks for listening.