1. SAVE YOUR KNEES I.M. Doctor, M.D. My Office My City, State
Good [morning/afternoon]. I’m Dr. [Name], an orthopaedic surgeon at [office] and I’m here to today to give you the facts about scoliosis.

2. The information in this presentation was provided to the presenter by the American Academy of Orthopaedic Surgeons and may be modified.
Endorsement of this presentation by the AAOS is not implied or inferred.
The information in this presentation was provided to me by the American Academy of Orthopaedic Surgeons and may be modified. Endorsement of this presentation by the AAOS is not implied or inferred.

3. Save Your Knees Orthopaedics and the Bone and Joint Decade
Protecting your knees
We will begin our discussion today by discussing orthopaedics and the Bone and Joint Decade. We will then talk about your knee joints: How to protect them, and what to do if you injure them.

4. What is an orthopaedic surgeon?
MD who specializes in treatment and health maintenance of musculoskeletal system (bones, joints, ligaments, muscles, tendons, cartilage and spine)
An orthopaedic surgeon is a medical doctor with extensive training in keeping your bones, joints, ligaments, muscles, tendons, cartilage, and spine in good working order. Together, all of these parts of our bodies make up our musculoskeletal system.

5. What is an orthopaedic surgeon?
The expert in maintaining musculoskeletal health
The expert in treating the musculoskeletal system
Orthopaedic surgeons have the great knowledge of and experience with the wide range of conditions and treatment options available in musculoskeletal care, many of which do not involve surgery. However, if surgery is needed for recovery, the orthopaedic surgeon can expertly provide that surgical treatment.

6. Educating an Orthopaedic Surgeon
College
Medical School
Internship
Orthopaedic Residency
Fellowship (optional)
2 Years Practice
TOTAL
4 1 (1) 2 16 years!
As this chart shows, it typically takes 16 years or more of formal education and training to become an orthopaedic surgeon. Beyond that, special certification and life-long learning is essential, as orthopaedics is a field that is continually growing and evolving.

7. What do orthopaedic surgeons do?
Diagnose
Treat
Medication
Physical Therapy
Exercise
Brace
Surgery
Prevent
Orthopaedic surgeons use the most effective and efficient diagnostic tools along with experience in musculoskeletal treatment to determine the best course of treatment for our patients.

8. Save Your Knees Your Orthopaedic Surgeon Getting You Back In The Game
Now let’s talk more about how you can protect your knees and keep them working well for years to come.

9. Save Your Knees
Knee problems are one of the most common reasons for visiting an orthopaedic surgeon. In 2003, patients made more than 19 million visits to physicians' offices because of knee pain or knee injuries.

10. The Knee Joint
To understand how to protect your knees, it is helpful to understand how the joint works.
The knee is the largest joint in the body, and one of the most easily injured. It is made up of the lower end of the thighbone, or femur, which rotates on the upper end of the shinbone, or tibia), and the knee cap, or patella, which slides in a groove on the end of the femur. The knee also contains large ligaments which help control motion by connecting bones and by bracing the joint against abnormal types of motion. Another important structure, the meniscus cartilage, is a wedge of soft cartilage between the femur and tibia that serves to cushion the knee and it absorbs shock during motion.

11. The Knee Joint © 2009 Getty Images
The cartilage which lines the joint, called articular cartilage, is an important, and frequently damaged, part of the knee joint. This cartilage, like the meniscus cartilage, cushions bone and allows your knee (and other joints) to move smoothly and without pain. The knee is also protected by synovium, which is a fibrous envelope that encloses the joint and produces fluid that helps reduce the friction and wear on that joint. Finally, you have many muscles and tendons that power your knees and allow them to move.
© 2009 Getty Images

12. The Knee Joint Pain or damage often caused by: Injuries Osteoarthritis
Some of the most common occurrences that can lead to knee damage or pain are injuries or deterioration from osteoarthritis.

13. Save Your Knees
Sports and other physical activities, while good for your overall health, can be very hard on your knees even if you take steps to prevent injuries. Injuries from athletic activity generally come in two basic types, acute and overuse. Acute injuries are those that involve sudden trauma, such as sprains, bruises, and fractures. On the other hand, overuse injuries result from a series of repeated small injuries.

14. Knee Injuries Sprains Ligament (ACL, PCL, MCL, LCL) tears
Meniscus tear
Illustration reproduced with permission from
The Body Almanac, American Academy
of Orthopaedic Surgeons, 2003
Among the most common types of knee injuries are sprains, ligament tears, and meniscus tears.

15. Knee Injuries: Sprains
Ligament injury
Knee pain, tenderness, swelling
Sprains are acute injuries that occur when there is an overstretching or injury of the ligaments that support the knee. Symptoms of a knee sprain might include tenderness and swelling, and you may have trouble bending it or putting weight on it.

16. Knee Injuries: Sprains
R.I.C.E.: rest, ice, compression, elevation
Rehabilitation
Anti-inflammatory
Brace
Knee sprains can often be treated using that old standby, R.I.C.E.—rest, ice, compression, and elevation, with ice (not directly applied to the skin) recommended for minutes each hour. Anti-inflammatories may also help. If the sprain requires you to see a doctor, he or she may suggest rehabilitation to begin a few days after the injury, when the swelling has gone down. The goals of this rehabilitation are to restore motion and flexibility, and to restore strength and balance.
Generally, your physician will give you the go ahead to return to sports after you have full range of motion in all directions, good strength in the muscles around the knee, good balance, and no pain or swelling with exercise or activity. He or she may recommend, or you may find it is just more comfortable, to wear a brace or tape your knee when first returning to activity. However, braces and taping are meant to lend support to strong muscles, not serve as a substitute for them.

17. Knee Injuries: Ligament Tear
Direct blow to knee
Non-contact injury, with foot plant
Landing on straight leg
Making abrupt stops
In sports that involve running and jumping, the impact makes the ligaments of the knee vulnerable. You may damage one or more of your ligaments if you sustain a direct blow to your knees or suffer a non-contact injury (frequently a twisting injury) with your foot planted. In addition, landing on a straight leg or making abrupt stops can cause an injury to your knee ligaments. The knee ligament most commonly injured is the ACL, or Anterior Cruciate Ligament.
The ACL connects the front part of your shin bone to the back part of your thigh bone and keeps your shin bone from sliding forward. You often hear about ACL injuries in professional sports. Some signs of an ACL injury are feeling your knee give way (sometimes accompanied by an audible “pop”), moderate pain that makes it impossible to continue the activity, and swelling which occurs over several hours and makes it difficult to walk. The swelling and pain are usually the worst during the first two days following the injury.

18. Knee Injuries: ACL Tear
Normal anatomy
Hyperextension
Anterior
cruciate
ligament
Femur
Femur slips
Anterior
cruciate
ligament
tears
Patella
ACL injuries usually make you uncomfortable enough to seek out medical attention. Through a physical exam, your orthopaedic surgeon can usually tell which ligaments are injured. Further tests, such as an MRI or arthroscopy, may be needed to properly diagnose your ACL injury. Treatment of an ACL injury can include surgery and rehabilitation. You and your physician will want to consider your activity level, your expectations of your recovery, any associated injuries and the amount of abnormal loosening of your knee laxity as you decide whether or not surgery is right for you. If you choose not to have surgery, you will want to start rehabilitating immediately with exercises designed to restore your full range of motion.
If you have surgery, your physician will reconstruct your ACL by building a new ligament with your own tissue or a ligament from a tissue bank. With time, rehabilitation and hard work ACL surgery results in an average of 90 percent success rate. Following ACL injury, you should return to sports, with or without a brace, only after your leg strength, balance and coordination are near normal.
Tibia
Fibula
Illustration reproduced with permission from The Body Almanac, Rosemont, IL
American Academy of Orthopaedic Surgeons, 2003

19. Knee Injuries: ACL Tear
Incidence of ACL much higher among female athletes
Combination of causal factors
The incidence of ACL injuries among female athletes is significantly higher than among males, for some sports even four times as high! There are several theories as to why this is so, but it is most likely to be a combination of factors related to female and male anatomy, hormones, and brain/muscle interaction.

20. Knee Injuries: Meniscus Tear
Helps knee joint carry weight, glide, and turn
Twisting injury
Football and other contact sports
The other common type of knee injury is called a meniscus tear. As I mentioned earlier, the meniscus is a triangular shaped piece of cartilage that distributes your weight and lubricates the joint. It helps the knee joint carry weight, glide, and turn in many directions. It also keeps your femur (or your thighbone) and tibia (shinbone) from grinding against each other. Football players and others in contact sports may tear the meniscus by twisting the knee, pivoting, cutting, or decelerating.

21. Knee Injuries: Meniscus Tear
Pain
Giving way
Locking
Clicking
Swelling
You might experience a “popping” sensation when your tear the meniscus. Most people can still walk on the injured knee and many athletes keep playing. Symptoms of a torn meniscus include knee pain, swelling, giving way, clicking, locking, and catching.

22. When to See the Doctor Inability or decreased ability to play
Locking, popping, catching
Visible deformity
Severe pain or giving way
While many injuries are minor and can be treated at home with rest, ice, compression, and elevation, there are some telltale signs that will warn you that it is time to see your orthopaedic surgeon:
The inability or decreased ability to play following an acute or sudden injury;
Locking, popping, or catching of the joint;
Visible deformity of the joint; or
Severe pain or giving way in the joint that prevents its use.
By getting prompt treatment, you can often prevent a minor injury from turning into something more serious.

23. Knee Pain: Osteoarthritis
Nearly 21 million Americans age 25 and older have osteoarthritis
46 million U.S. adults report doctor-diagnosed arthritis
As the U.S. population ages, these numbers are likely to increase dramatically.
The number of people who have doctor-diagnosed arthritis is projected to increase to 67 million in 2030.
Osteoarthritis is also a very common source of knee problems. If we x-rayed everyone’s joints every year, we would see that nearly everyone eventually develops some osteoarthritic changes to their joints as they age. However, some people do not develop the symptoms of pain and swelling that we usually associate with osteoarthritis.
Nevertheless, nearly 21 million Americans age 25 and older have osteoarthritis. 46 million U.S. adults report doctor-diagnosed arthritis. As the U.S. population ages, these numbers are likely to increase dramatically. The number of people who have doctor-diagnosed arthritis is projected to increase to 67 million in 2030.

24. Knee Pain: Osteoarthritis
Inflammation
Avoidance of
Motion
Loss of
Motion
Arthritis is, simply put, inflammation of the joints. Inflammation is one of our bodies’ normal reactions to injury or disease. Inflammation in turn results in visible swelling, pain, and stiffness, because as the joint becomes painful, the individual avoids moving it, which causes the muscles to tighten, making it harder to use that joint. This results in more pain.
Usually this inflammation is temporary. But in an arthritic joint it may cause long-lasting and sometimes permanent disability. Osteoarthritis is a particular type of arthritis which affects the cartilage in the joints, causing it to break down and eventually be lost altogether.
Increased
Muscle
Tightness

25. Knee Pain: Osteoarthritis
Cartilage
© 2009 Getty Images
© 2009 Getty Images
Osteoarthritis of the knee usually occurs in knees, a weight-bearing joint, that have experienced trauma, infection, or injury, and results from deterioration or loss of the cartilage that acts as a protective cushion between bones.
As the disease progresses, the cartilage thins, becomes grooved and fragmented, while the surrounding bones react by becoming thicker, growing outward, and forming spurs. Additionally, the synovium becomes inflamed and thickens. The synovium may produce extra fluid, often known as “water on the knee,” that results in additional swelling.
A joint affected with osteoarthritis attempts to repair itself, and non-weight-bearing joints, such as those in your fingers, may be able to slow down the process. However, in the knee, the repair process is usually unsuccessful, and over a period of years, the joint slowly changes. In severe cases, the cartilage may no longer cover the thickened bone ends, resulting in rubbing and wearing away of the bone. Deformity of the joint may occur, and normal activity becomes painful and difficult.
Healthy Knee
Osteoarthritic Knee

26. Osteoarthritis Causes
Primary Osteoarthritis: Most Common
Thought to be result of aging
Decreased ability of cartilage to repair itself
Ligaments supporting joints weaken
Most cases of osteoarthritis have no known cause. These cases are classified as primary osteoarthritis, which is primarily a by-product of aging. Our cartilage is about 80 percent water. As we age, the water content decreases, and the ability of the cartilage to repair and rebuild after injury also decreases. Further adding to these developments, the ligaments and muscles supporting our joints are weakened with age so that the joint is less stable and more easily injured.

27. Osteoarthritis Causes
Secondary Osteoarthritis
Obesity
Trauma
Surgery
Abnormal joints
Gout
Diabetes
Hormone disorders
In contrast, secondary osteoarthritis is caused by another disease or condition. Obesity, repeated trauma, and surgery to joint structures are common causes of secondary osteoarthritis. In addition, abnormal joints at birth, gout, diabetes and various hormone disorders can also be a factor. Being female and age 45 or older also increases one’s risk of developing osteoarthritis.
Obesity not only puts excessive pressure on the joints—it also causes the production of enzymes that cause cartilage damage. Obesity is also a major risk factor in the development of gout and diabetes and is, therefore, a risk under patient control. Even if you have already developed osteoarthritis, losing weight can help reduce your pain and stiffness.

28. Treatment
The primary goals of treatment for knee damage are to relieve pain, increase motion, and improve strength. There are several different kinds of treatment and several options within each of them. The most conservative treatment measures include rest, exercise, weight reduction, and physical and occupational therapy. In addition, your physician may recommend medication. In some severe cases, surgery may be beneficial.

29. Treatment Drug therapy Intra-articular treatment Surgery
Experimental/alternative treatments
Health and behavior modifications
Parts of your treatment plan may include a combination of: medications and other drug therapies; intra-articular treatment, which involves injections directly into the joint; surgery; experimental or alternative treatments; modification of your activities, and behavior to improve your overall health, such as eating better, losing weight, or quitting smoking. Quitting smoking is especially important, because smoking has been shown to reduce bone density and prevent bone healing, making it especially dangerous for patients recovering from injury or surgery.

30. Treatment: Medication
NSAIDs are non-steroidal anti-inflammatory drugs
Aspirin
Ibuprofen
Naproxen
There are a variety of medications that can provide some relief from knee pain. Over-the-counter pharmaceuticals like aspirin, ibuprofen, and naproxen may be used to effectively control pain and inflammation. These medications are all nonsteroidal anti-inflammatory drugs, or NSAIDs. Even though they are over-the-counter, they are not risk-free when taken for prolonged periods of time. Acetaminophen may also be used to control pain, although it does not reduce inflammation, and in high doses can cause liver problems.

31. Vitamins & Nutritional Supplements
Vitamins and other nutritional supplements have offered some positive evidence to suggest their use in the treatment of osteoarthritis and other joint problems, but care should be taken, as they may interact with other medications. Always consult your doctor to be sure that any vitamins or nutraceuticals you take are safe for you. While some evidence suggests that the optimal intake of antioxidants--A,C,D and E-- and nutraceuticals glucosamine and chondroitin may help treat or prevent cartilage problems, there is some disagreement in the medical community about how effective they are. Always consult your doctor to be sure that any vitamins or other supplements you take are safe for you.

32. Treatment: Surgery Why? Alternatives Benefits and for how long?
In some cases, surgery may be warranted. If your orthopaedic surgeon recommends surgery, it’s a good idea to ask questions to be sure that you understand why the procedure is recommended, what your options are, and how you can expect to benefit from it.

33. Treatment: Surgery Duration of recovery? Assistance at home? How long?
Disability after surgery?
Physical therapy?
Return to normal activity?
Part of understanding the course of action your orthopaedic surgeon recommends is being aware of what your recovery will be. Some questions to ask are:
How long will the recovery take?
Will I need assistance at home? For how long?
Will I have any disability following surgery?
Will I need physical therapy?
When can I safely return to normal activity?

34. Treatment: Surgery Arthroscopy Surgical abrasion of cartilage
There are several surgical options for patients with knee injuries or other damage. Repair or partial removal of the damaged knee cartilage in arthroscopy is one of the less invasive procedures, as it is usually performed on an outpatient basis through the insertion of an arthroscope into a small incision in the joint. In some cases, surgical abrasion of the cartilage may stimulate a partial cartilage repair. You and your orthopaedic surgeon will discuss the best options for your circumstances, taking into consideration the latest research on effectiveness of each course of action.

35. Treatment: Surgery Pre-Osteotomy Post-Osteotomy
Realignment of joints and fusion of bone ends of the joint to prevent joint motion and relieve joint pain are also possibilities, but the long-term effectiveness of osteotomy, a procedure that involves realigning the bone by cutting and repairing it, is only about 50 percent.
Pre-Osteotomy
Post-Osteotomy

36. Surgery: Total Joint Replacement
Many patients with osteoarthritis or other significant damage to the knee now benefit from total joint replacement. We are receiving good to excellent long-term results for more than 90 percent of the patients who have total joint replacement. These surgical procedures involve the removal of the diseased or damaged joint and replacement with a prosthetic joint, made of a combination of metal or plastic materials. Many of the millions who choose this procedure enjoy a full return to their lifestyle before osteoarthritis limited their joint functioning, with only some modest modifications or cautions.

37. Preventing Sports Injuries
Know and abide by rules
Wear appropriate protective gear
Know how to use equipment
Never “play through pain”
Now, let’s talk about how you can avoid these injuries and damage to your knees. First, if you play a sport, know and abide by all of the rules, as they are designed partly to keep you safe from injury. In addition, wearing the appropriate protective gear and knowing how to use the athletic equipment in a given sport are key to playing it safe. This includes helmets, pads, wrist guards and supportive athletic shoes. Finally, don’t try to “play through the pain”—if something hurts, you should stop and address it.

38. Prevention: Exercise
In general, one of the most beneficial of the joint protection treatment options is regular exercise. Exercise strengthens the muscles that support the joints, prevents joints from “freezing up,” improves and maintains mobility, helps you lose weight, and promotes endurance. In general, exercise that focuses on improving your range of motion is recommended daily, with strengthening exercises daily or every other day, and endurance exercises about 3 times per week for minutes unless you are experiencing severe pain or swelling. If you have osteoarthritis or a previous injury, consult with your orthopaedic surgeon or physical therapist to develop an exercise regimen that is best for you.

39. Prevention: Exercise Strengthening exercises can help
Correct positioning is critical
Strengthening exercises can make use of small free weights, exercise machines, isometrics, elastic bands, and resistive water exercises to strengthen your muscles and help take some of the burden off of painful joints and provide the necessary strength to help prevent injury. Correct positioning is critical during strengthening exercises. Done incorrectly, these exercises can cause muscle tears, more pain, and more joint swelling.

40. Prevention: Exercise Strengthening exercises can help
Correct positioning is critical
A great balance exercise is to try to stand on one foot and then the other. Be certain to stand near a sturdy chair so if you lose your balance, you can grab the stable chair in support. 40

41. Prevention: Warm Up Warm- up: Marching Walk in place Jumping jacks
Mimic the sport you are about to do
Additionally, stretching before engaging in physical activity is one of the best things you can do to protect yourself from injury. However, the way you stretch is key to reaping its benefits.
Before you stretch, warm up your muscles. An efficient warm-up can include marching, walking in place while swinging your arms, jumping jacks, or mimicking the sport you are about to do.

42. Prevention: Stretching
You should NOT feel pain
Hold stretch 30 seconds
Relax into the stretch
After warming up, your basic stretching routine should cover all of the major muscle groups. The order of the stretches is not critical, but rather stretching thoroughly should be your focus. Depending upon the sport or exercise you choose, there are also specialized stretches you will benefit from. Stretching before physical activities promotes better performance and results in fewer injuries. Investigate the best stretches for your particular sport and add them to your basic stretching routine for optimum results.
Hold your stretch for 30 seconds; this gives the nerves enough time to adapt to the new length and alter the muscle tone. If you cannot hold the stretch comfortably for this long, then ease back. Do your best to stay relaxed and allow your muscles to relax into the stretch.

43. Prevention: Stretching
Breathe deeply & slowly
Avoid bouncing
Keep you shoulders, hands and feet relaxed at all times during flexibility and stretching exercises.
Don’t forget to breathe slowly, using deep, rhythmic breathing.
Avoid bouncing, but rather focus on lengthening into your stretches.
Be sure to stretch both the right and left sides of an area to maintain balance and symmetry.
Stretch both right & left sides

44. Prevention: Exercise DO:
Include flexibility, strengthening, and aerobic exercises
Exercise when you are not tired
Exercise when pain and stiffness lowest
Exercise when medication having greatest effect
There are some key dos and don’ts when it comes to exercise for Osteoarthritis sufferers:
Do:
Build a program that includes the four important kinds of exercise: Flexibility movements, strengthening exercises, aerobic exercise, and agility or balance exercises.
Exercise when you are not tired.
If you have a previous injury or osteoarthritis, exercise when you have the least pain and stiffness and when your medication is having the greatest effect.

45. Prevention: Exercise DO: Always warm-up and cool down
Start slowly, progress gradually
Avoid becoming chilled or overheated when exercising
Use heat, cold, & other pain reducers
Always include a warm-up and cool-down.
Start slowly, and increase your activity gradually.
Avoid becoming chilled or overheated when exercising.
Use heat, cold, and other strategies to minimize pain if necessary.

46. Prevention: Exercise DO:
Use aids like walking sticks, braces, or canes if recommended
Expect minor discomfort
Use two-hour rule: No more pain two hours after exercising than before you started
If you have experienced a previous knee injury or have osteoarthritis, use aids like walking sticks, braces, or canes if recommended by your orthopaedic surgeon.
Expect some minor discomfort.
Use the two hour rule: You should not have more pain two hours after exercising than you did before exercising. If you do, talk to your doctor or physical therapist about how to modify your exercise plan.

47. Prevention: Exercise Talk to your physician first
Consider athletic trainer or physical therapist
The first step in any exercise program is talking about it with your physician, even if you don’t have a previous injury or medical condition. If you have osteoarthritis, it is advisable to begin a new exercise program with the supervision of your physical therapist or a qualified athletic trainer.

48. Prevention: Exercise DON’T: Do too much too soon
Hold your breath while exercising
Take extra medication before unless your physician suggests it
Here’s what you don’t want to do when exercising:
Don’t:
Do too much, too soon.
Hold your breath when exercising.
Take extra medication before exercising to prevent joint or muscle pain, unless suggested by your physician.

49. Too Much Exercise
Consult your physician if these symptoms are present:
Unusual or persistent fatigue
Increased weakness
Decreased range of motion
Increased joint swelling
Continued pain 1 hour after exercising
Can you get too much of a good thing? Yes! If you are experiencing any of the following signs, you may be doing too much exercise and should consult your physician:
Unusual or persistent fatigue,
Increased weakness,
Decreased range of motion,
Increased joint swelling, or
Continued pain (pain that lasts) one hour after exercising.

50. American Academy of Orthopaedic Surgeons
Resources
American Academy of Orthopaedic Surgeons
6300 North River Road
Rosemont, IL 60018
orthoinfo.org
saveyourknees.org
For more information about your knees and treatment options, visit the website of the AAOS (orthoinfo.org). In addition, the Arthritis Foundation website (arthritis.org) as well as several other arthritis websites may provide you with a good resource for more information about arthritis.
arthritis.org

51. What are your questions and concerns?
Save Your Knees
What are your questions and concerns?
Do you have any questions or concerns that we have not yet addressed?

52. Save Your Knees Thank you for participating today
Remember, your orthopaedic surgeon can help get you back in the game
Thank you for participating today. I hope that you have each learned something helpful about your knees and how to keep them from harm. If you or someone you love suffers a serious knee injury, your orthopaedic surgeon is your best resource to guide you on the road to recovery and get you back in the game.