undergoing knee surgery are especially vulnerable to developing
degenerative arthritis if the leg bones are not properly aligned
above and below the knee, according to researchers at Duke
can also lead to serious problems for knee surgery patients,
according to the researchers. They suggest that physicians
should closely monitor all young people who undergo reconstructive
knee surgery to ensure that the leg bones stay in proper alignment,
and in some cases surgically correct the bowleggedness. Such
preventive measures could prevent future development of severe
arthritis of the knee.
a relatively small malalignment in normal knees can cause
dramatic alterations in the pressures within the knee joint,
and this negative effect can be greatly magnified if the cartilage
within the knee has been damaged," said Dr. Joseph Guettler,
orthopedic surgeon and sports medicine fellow at Duke. "With
early recognition and intervention of the malalignment, we
can perhaps prevent the development of serious osteoarthritis
from occurring in the future."
developed a study to analyze the effects of malalignment on
the knee joints of patients who had suffered damage to the
cartilage within the knee. Specifically, they looked at the
pressures within the knee joint over the cartilage after the
creation of a defect in the cartilage and removal of the meniscus,
the fibrous cartilage within the knee that acts as a shock
human knees, taken from cadavers, were placed in an apparatus
that creates weight across the knee joint. The researchers
then measured the pressures created over the cartilage within
the knee joint.
found that even three degrees of malalignment, which can only
be detected by an x-ray, can lead to profound deformation
of the cartilage. Over time, this deformation can lead to
uneven wear and tear, leading to painful and debilitating
osteoarthritis, according to the study presented at the 28th
annual meeting of the American Orthopedic Society for Sports
studies have shown that between 20 and 50 percent of patients
who have had significant knee cartilage damage developed severe
arthritis," said Guettler. "What hasn't been shown
is why some patients do and some do not. Our studies would
suggest that a very important factor is the subtle changes
in alignment of the leg bones relative to the joint and the
pressure they place on the cartilage within the knee."
with significant cartilage damage and those who have had damaged
cartilage removed should be evaluated for correct alignment.
If any evidence of deterioration is seen, surgery should be
considered to correct it.
these cases, the surgery is seen more as a preventive measure
against future osteoarthritis, as opposed to a treatment for
a specific disorder," said Guettler. "This is an
invasive procedure with known complications, yet it should
be considered for these high-risk patients."
of July 7, 2002