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FirstHealth of the Carolinas
The knee By Dick Broom
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The knee is the largest joint in the body, but it is made up of only three bones: the thigh bone, the shin bone, which is the larger of the two bones in the lower leg, and the kneecap.

Most people think of the knee as a hinge joint, but the thigh and shin bones are not interlocked like a true hinge. Instead, they are held together by muscles, tendons and ligaments.

There are 10 different ligaments—tough, elastic cords—that connect bone to bone. Some of these ligaments, such as the anterior cruciate (ACL) and oblique popliteal, are particularly susceptible to injury when the knee is twisted or otherwise subjected to extreme stress.

The three bones that comprise the knee are all covered with a thick layer of cartilage that helps absorb some of the stress from the weight the joint bears and the pounding it sometimes takes.

A more pliable, rubbery type of cartilage, the meniscus, is situated on top of the shin bone. It forms a gasket-like ring around the knee that helps protect it and provides support when the legs are in motion.

A membrane called the synovium excretes a fluid that helps lubricate the knee to keep it moving smoothly.

Given the way our knees are put together, they are remarkably strong, but they are also vulnerable to injury. There is so much they can do, but we sometimes ask them to do too much and normal, everyday wear can take its toll over time.

Arthritis is the most common problem of the knees, especially among older people.

John Moore, M.D.
Neil Conti, M.D.

“As we age, the cartilage on the bones in our knees loses some of its water content and starts to become thinner,” says John Moore, M.D., an orthopaedic surgeon with Pinehurst Surgical. When too much of the cartilage wears away and the bones in the knee start rubbing directly against each other, the surrounding tissue becomes painfully inflamed. Some people are genetically predisposed to develop arthritis, while obesity can bring on arthritis or make it worse.

“I have had patients who, with weight loss, have been able to avoid surgery because of decreasing the load on the knee,” says Neil Conti, M.D., also an orthopaedic surgeon with Pinehurst Surgical.

Certain types of exercise can relieve the pain and stiffness of arthritic knees, according to Dr. Moore.

“An exercise bicycle, for example, gives you motion in the joint without the impact of walking, even on a treadmill,” he says.

The cartilage that covers the bones in the knee is smooth, but rather hard. A spongier type of cartilage called the meniscus lies between the thigh bone and shin bone and acts as a shock absorber. It, too, can wear out over time, Dr. Conti says.

“The meniscus has a very poor blood supply, so it isn’t able to repair itself very well,” he says. “It starts to deteriorate with continued wear and eventually will give way and tear.

Meniscal tears can be precipitated by an athletic-type injury such as a twisting of the knee, but more commonly the meniscus just wears out with normal activities of daily living.” Meniscal tears can occur at any age, but they are more common in people who are middle-aged and older.

“If I took an MRI of 100 people over 60 who had knees that didn’t hurt, we would see cartilage tears in 60 of them,” Dr. Moore says. “So they aren’t always associated with pain. It depends on the size and location of the tear.”

Torn ligaments are frequently sportsrelated. The anterior cruciate ligament (ACL), which crosses over the front of the knee, seems to be particularly susceptible to tearing.

“Sometimes you can tear the ACL by hitting something hard with your knee, but it’s usually caused by vigorous activity, trying to turn quickly or move in a certain way,” Dr. Moore says. “We see it most in people in their early 20s.”

Women athletes are five times as likely as male athletes to suffer a torn ACL, according to Dr. Conti.

“It’s really an epidemic among female athletes,” he says. “There are some anatomical factors involved, but leg strength and conditioning seem to play a role. A number of strengthening programs have been developed for what’s called ‘neuromuscular education’ to help decrease the incidence of ACL tears in women.”

Hayes Corbett
Is it any wonder that Hayes Corbett’s knees started giving him trouble?

During 20 years in the Army, he did more running and jumping than most people do in a lifetime. Then he spent 15 years as a deputy sheriff and ABC (Alcohol Beverage Control) enforcement officer in Cumberland County. He also was a member of the Sheriff Department’s SWAT team.

Hayes Corbett had both knees replaced in February 2007 and says the experience left him feeling “like a new person.”

“All the training I had to do for that involved a lot of running, jumping and rappelling,” Corbett says. “Over time, my knees began to hurt.”

Now 64, Corbett is retired from law enforcement. A couple of years ago, he and his wife went on a Caribbean cruise.

“I wasn’t able to do a lot of the walking that you do when you’re sightseeing,” he recalls. “So I decided then that when I got back home, I was going to see about having knee replacements.”

Corbett, who lives in Fayetteville, had previously been to Neil Conti, M.D., an orthopaedic surgeon with Pinehurst Surgical.

“I had asked Dr. Conti when he thought I would need a knee replacement, and he said, ‘I won’t have to tell you; you will be able to tell me,’ and that was very true,” Corbett says.

Corbett had both knees replaced at the same time, in February 2007.

“It was one of the best things that ever happened to me,” he says. “It really was a life-changing experience. I felt like a new person.”

Now, he and his wife walk a couple of miles every morning. “I enjoy walking,” he says, “and I have no pain at all.”

James Lanter
James Lanter of Rockingham started having severe pain in both of his knees around the end of September last year. By the end of October, he had two new knees.

James Lanter, a retired teacher who enjoys archery, started having pain in his knees around the end of September last year. By the end of October, he had two new knees.

The cartilage in his knees had probably been wearing away for a long time, but he wasn’t aware of it until the cartilage was almost gone and the bones were rubbing against each other. Along with the pain, Lanter could feel his knees “jumping out of joint,” he says.

Lanter went to see John Moore, M.D., an orthopaedic surgeon with Pinehurst Surgical who, like Dr. Conti, has an office in Rockingham. Both surgeons perform knee replacement and other orthopaedic procedures at FirstHealth Moore Regional Hospital in Pinehurst and FirstHealth Richmond Memorial Hospital in Rockingham.

“Dr. Moore said the pads in both my knees were worn out and I needed them both replaced,” Lanter says.

Three days after his surgery, Lanter was back at home. A rehabilitation therapist worked with him for three weeks and taught him exercises he could do on his own.

“I didn’t miss a day, and I think that is a big reason I got along so well,” he says. “The sooner you can get back into your regular routine after having surgery, the better off you are. Now I’m back to doing everything I want to do.”

That includes working in his yard and occasionally playing golf. Lanter, who especially enjoys fishing and hunting, is a retired teacher who taught “principles of technology” at Richmond Senior High School for many years.