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Keeping Your Knees Healthy

Dr. Nicola Featured in AARP Magazine:

Three years ago Linda Morse tossed a tennis ball gracefully overhead, reached for it with her racket, planted her left leg on the hard tennis court for leverage, and felt something snap. “It was one of those ‘Oh, no’ moments,” says Morse, now 73. “Most people I know who play tennis have some kind of knee trouble, and now, I just knew, I did, too.”

In a typical year more than 6 million men and women 62 and older—and another 5 million between their mid-40s and early 60s—will visit a doctor because of knee pain. Knees are one of the most commonly injured joints and the most likely to be afflicted with arthritis. Strange twinges or clicking noises are familiar complaints as well, along with—more dramatically—pain, swelling, and a tendency for the joint to seize up.

Serious knee problems aren’t inevitable, though. The human knee, most experts agree, can outlast us, provided it’s not abused and receives some basic preventive maintenance. The right lifestyle and activity choices can help make your knees stronger, healthier, more pliant—and less likely to end your tennis game or any other sports.

When all is well inside your knee, it easily withstands loads equal to more than four times your body weight. It can also gyroscope in three dimensions, allowing your leg not just to bend, but also to pivot and twist. “It’s a remarkable construction,” says Charles Kenny, M.D., an orthopedist in Stockbridge, Massachusetts.

The largest joint in your body, the knee is a complex interweaving of ligaments (which attach bone to bone), tendons (attaching bone to muscle), bones (principally the tibia, or shinbone; the femur, or thighbone; and the patella, or kneecap), and cartilage, a specialized tissue that provides cushioning. You have two types of cartilage in your knees. The first is the meniscus, a small, crescent-shaped pillow of squishy material that sits between the tibia and femur and acts as a shock absorber; there are two menisci, one on each side of your knee. The second type of knee cartilage is articular cartilage, a grand-sounding name for the thin layer of cells that covers the ends of the bones, like socks, and serves about the same purpose: keeping the bone ends safe and giving them a smooth, frictionless surface to move against.

But the knee’s intricacy also makes it vulnerable. An injury, even one you suffered years ago and forgot about, can render your knee slightly unstable, like a car that’s rattled itself out of alignment. The tissues holding the knee together shorten, pulling the bones out of their ideal positioning. To imagine what happens next, think of your misaligned car’s balding, frayed tire tread. That’s what the cartilage looks like inside an unstable knee. If it wears away completely, you have bone-on-bone arthritis, a painful condition.

Aging doesn’t help. “By your 40s or 50s, the meniscus is becoming dehydrated,” says Frederic Nicola, M.D., an orthopedic surgeon in Marina del Rey, California. This makes it more prone to a tear. In addition, as you get older, cartilage cells don’t divide and reproduce as well as they once did, which causes the cartilage around your knees to grow thinner and less resilient. If you’re not careful, the same movements you’ve always made—walking, serving a tennis ball, going up and down the stairs—can tear or bruise the knee’s tissues.

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So how can you keep your knees agile and pain-free?

Move more
“I know it sounds counterintuitive, especially if your knee is sore, but the most important thing for knee health is to be active,” says Leigh Callahan, Ph.D., an associate professor with the Thurston Arthritis Research Center at the University of North Carolina. A knee that isn’t used stiffens; the muscles around it start to atrophy, and because these muscles would otherwise absorb some of the shock that moves up the leg with every step, a stiff knee has to take on more of the body’s weight than a supple one.

Strengthen your thigh muscles
In a 2009 study of 265 men and women with knee osteoarthritis, Mayo Clinic researchers found that those with the strongest quadriceps (thigh muscles) had less knee pain and better physical function than those with the weakest. But there’s a right way and a wrong way to build those muscles. If you’re an avid gym-goer, avoid the leg-extension machines, Kenny suggests. “They put far too much stress on the knee joint,” he says.

Stretch regularly
Maintaining flexibility is important, especially in the muscles and tendons that connect directly to the knee, such as the hamstrings and the quadriceps. If these tissues become overly taut, they can pull the knee out of alignment.

Lose the weight, finally
Losing as little as 5 percent of your body weight can dramatically reduce your chances of developing knee arthritis, the most common cause of knee pain, according to the authors of a study presented last November at a meeting of the American College of Rheumatology.
Take glucosamine/chondroitin. Many doctors recommend taking 1,500 milligrams (mg) of glucosamine and 1,200mg of chondroitin daily to strengthen aging cartilage. Their use is controversial because no studies have proven they work. But no studies have found a downside, either. “I firmly believe that this helps,” Nicola says.

Get to the doctor—pronto—if your knee is swollen
Likewise, a rattling, grinding noise, or a feeling of gravel moving around inside your knee, should prompt a visit to the doctor. These can be early warning signs of damaged cartilage. Fortunately, several techniques have been developed in the past few years to repair worn cartilage, including autologous chondrocyte implantation: a surgeon suctions out some of your living cartilage cells, grows millions of copies of them in the lab, then reinjects them into your knees. The technique is new—and is best used on tiny areas of worn cartilage. But researchers believe so-called tissue engineering could one day offer relief even for those with full bone-on-bone arthritis.

If your doctor recommends surgery right away, seek a second opinion
“I personally think there’s more knee surgery being done these days than is warranted,” says Kenny, himself a retired surgeon. Several major studies of arthroscopic surgery to remedy sore knees have found little or no benefit. Physical therapy, as well as anti-inflammatory medicines, can be just as effective—and less invasive.

After that fateful day on the tennis court, Linda Morse visited an orthopedic surgeon, who diagnosed a tear in her meniscus and scheduled her for surgery. But when he went into her knee, he found no tear—just a little arthritis. Since then, Morse has dedicated herself to protecting her knees. She exercises regularly, keeps her build lean, and doesn’t play on hard tennis courts anymore. “It’s made me diligent,” she says of her injury scare. “Today I feel like I have the knees of a 40- or 50-year-old.”