Bad Medicine

Meniscus Surgery: “Most Unnecessary Medical Treatment”

7 Oct , 2017  

JAMA … “The Journal of the American Medical Association” … has just released a paper citing the “Top 10 Most Unnecessary Medical Treatments.” Surgery for meniscal cartilage tears was found to be one of the top 10 most unnecessary medical treatments today. This study considered 2252 articles based on originality, methodologic quality, and number of patients potentially affected. The 10 most influential articles were selected by author consensus. The JAMA paper is pay-walled, but you can read a summary here:

http://www.sciencealert.com/researchers-list-the-10-most-unnecessary-medical-tests-and-treatments-in-the-us

Elsewhere on the kneelock.com site, you will find links to many other peer-reviewed medical papers which present the identical conclusion:  “torn meniscus” surgery, especially for mechanical symptoms, is very often worthless and unnecessary. I’ve communicated with scores of knee-lock sufferers and estimate that, of those who had meniscus surgery, fewer than 1 in 5 have seen any knee-lock improvement after meniscus surgery, perhaps closer to 1 in 10. The work of Drs. Kuhn and Sekiya points to an entirely different reason for hard, physical knee lock, having nothing to do with a “torn meniscus.”

http://kneelock.com/wp-content/uploads/2014/10/PROXIMAL-TIBIOFIBULAR-JOINT.pdf

Knee Lock Conversation

My Story (maybe your story, too)

13 Jun , 2017  

As I’ve learned, my story is identical to many other knee lock sufferers. It started in my early 40s. If I bend my right leg into a certain position for a certain period of time, typically the “ankle on knee” leg cross, the lateral and gravity forces on the “knee area” can cause a lock up. My knee physically locks in the bent position, as seen in this photograph.

JL 4-point front sm w textWhen my knee locks, it is truly, physically locked in place. Any attempt to straighten the leg is accompanied with excruciating pain. The harder I push against the lock, the higher level of pain. I’ve found various ways of unlocking (discussed later), and it takes on average 20-30 minutes of work to unlock a “locked knee”. Sometimes I’ve been locked for 2-3 hours.

When the leg / knee area finally unlocks, it feels like a large bone is sliding or moving back into proper position. The unlocking is often accompanied by a dull, audible “thunk” which can be heard by others in the room. Without question, there is a large mass or large bone involved with the locking and unlocking mechanism.

I went to see an orthopedic doctor and explained my symptoms. After an MRI, he said “you have a torn meniscus that’s interfering with knee movement.” I said, “but it’s clearly moving out of joint, like a big bone.” The doctor said, “that’s really not possible.” I insisted that it was “a big solid mass that I can physically feel moving into position with a massive ‘thunk’ that other people can hear in the room.” The doctor just smiled and said “you need to have that torn meniscus removed.”

I felt like telling the doctor “look, doc, I know my own body! There’s a LARGE BONE-LIKE-MASS in there that’s moving OUT OF PLACE, and then THUNKING BACK INTO PLACE!”

But instead, I had the arthroscopic “meniscus tear” surgery. The doctor later showed me a tiny piece of meniscus that he had surgically removed. But, alas, my knee lock condition did not change whatsoever. It was not a “torn meniscus” causing my knee lock. The surgery was worthless and unnecessary. A failure of diagnosis.

 

REALITY CHECK

This led me to the Internet, where virtually all of the large medical sites agreed that a torn meniscus is the primary cause of knee lock. But as I engaged in on-line conversations, I was dumbfounded to find scores of knee lock sufferers who reported having “torn meniscus surgery” that did NOT cure their knee lock. No change. Worthless surgeries. In fact, I would estimate the percentage of unsuccessful “meniscus knee lock” surgery reports at over 80%.

As I started digging deeper into the orthopedic literature on meniscus surgery, I found data that corroborated my on-line conversations. Arthroscopic surgery of the meniscus is THE MOST COMMON ORTHOPEDIC PROCEDURE in the USA. Meniscus surgery, alone, is a $4 billion industry, performed 700,000 times per year. If my years of on-line conversational evidence is anywhere near accurate, then over 500,000 of these 700,000 meniscus surgeries are unnecessary shams.

I’ve since found NUMEROUS PEER-REVIEWED ACADEMIC STUDIES all concluding that surgeries for torn and arthritic meniscus are generally worthless.

http://www.nejm.org/doi/full/10.1056/NEJMoa1301408

http://www.nejm.org/doi/full/10.1056/NEJMoa1305189

http://www.nejm.org/doi/full/10.1056/NEJMoa0708333

http://www.medscape.com/viewarticle/818399   (login required)

http://online.wsj.com/news/articles/SB10001424052702304244904579278442014913458

 

CAUSES

But the question remains: why is my knee locking up? It’s true, in a certain percentage of cases, torn meniscus is the cause of knee lock, and should never be ruled out. But, apparently, in a large majority of knee lock cases, the cause is something else.

A few years ago, I stumbled upon a medical research paper by Drs. Kuhn and Sekiya, entitled INSTABILITY OF THE  PROXIMAL TIBIOFIBULAR JOINT  published in the March 2003 edition of the American Academy of Orthopaedic Surgeons. This paper describes a “knee lock” condition that is often “confused with … torn meniscus.” In brief, the paper describes an instability of the fibular head connection to the tibia socket, the “tibiofibular joint.” This instability causes the fibular head to physically slip out of its normal seated position, literally moving “out of joint.” The instability might be caused by genetic malformation, degeneration, injury, irregularity of the Popliteus muscle, abuse over time, and so forth.

TF Joint sm

 

Soon after reading this paper, I experienced another knee lock. I immediately pushed and prodded in the area around the TF joint. Bingo! The pain, the lock, the noise …. It was all coming from the TF joint area. Certain leg positions were clearly causing my fibular head to move out of its normal position in the tibial socket. And when the leg unlocked, I could feel (and hear) the fibular head sliding back into its normal position. Thunk!

radiopaedia.org 3 sm 1 radiopaedia.org 4 sm 1

My body did not lie. It WAS a large bone “moving back into place.” My knee lock is caused by an instability of the tibiofibular joint. And as I relay this information to every knee lock sufferer I speak with, I would say that roughly 4 of 5 have confirmed this as the identical source of their problem. (click to enlarge images)

 

TREATMENT

Now the bad news. I spoke with Dr. Kuhn (now at Vanderbilt) some time ago and asked about treatment for TF joint instability. He said there are surgical methods to stabilize this joint, but that they are often unsuccessful, sometimes leaving the patient worse off than before the surgery. I believe he estimated that over 50% of such surgeries would not be considered successes. He discouraged me from a surgical solution and recommended management techniques such as leg muscle strengthening and leg position awareness management.

I’ve read more recently of some doctors at St. Elizabeth Health Center in Youngstown OH having success repairing types of TF joint instability via surgically implanted fasteners, but their research seems focused on the rare cases of complete TF joint dislocation, not the kind of temporary TF partial dislocation experienced by many knee lock sufferers. One commenter found a doctor treating unstable TF with ligament reconstruction plus peroneal nerve neurolysis. I cannot advise medically as to the efficacy of any treatment, but am simply offering links for your further study.

Based on what I’ve learned to-date, unless we’re dealing a really life-altering TF joint issue, I think we simply need to learn how to live with it – and be conscious of avoiding situations that would cause a lock-up. I’ve also found that leg press and leg curl exercises seem to help. Strengthening the leg muscles around knee seems to build in more preventative support and stability to the fibular head.

It’s my hope that other knee lock sufferers join the conversation here. Perhaps together we can crowd-source some innovative new methods for reducing the pain and incidence of knee lock. If you want to add a comment, scroll up and click on the title of this post.

– John L
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Resources

Resources & Tips for Knee Lock Sufferers + Site Disclaimer

18 Oct , 2014  

Many (most?) commercial medical sites focus on “meniscus tear” as the leading cause of knee lock. But in my conversations with other knee lock sufferers, meniscus tears account for perhaps a minority percentage of hard locks. The resources below focus mainly on non-commercial knee lock information. Some pages are intended for medical practitioners, while others are for a general audience. The kneelock.com site is just getting started — I will be adding new resources on a regular basis. Check back often. If you have tips for unlocking a locked knee, or preventing knee lock, or link to a medical paper, or can refer a doctor or clinic experienced in knee lock, please leave a comment below.  – John

Dr. Kuhn & Sekiya’s seminal paper on tibio-fibular knee lock: http://kneelock.com/wp-content/uploads/2014/10/PROXIMAL-TIBIOFIBULAR-JOINT.pdf

Knee Guru Online: www.kneeguru.co.uk/

One of the best knee-related resources on the ‘net. Great forum discussions, tutorials and papers.

Regenexx:  http://www.regenexx.com/2013/06/knee-locking-up/

“Interventional Orthopedics” providing non-surgical biologic therapies. Also Google “Prolotherapy for Knee” for a range of “tissue regeneration” resources that may (or may not) strengthen the Tib-Fib joint.

Prolotherapy: http://www.Prolotherapy.com

Short for “proliferation” therapy, Prolotherapy is a somewhat controversial nonsurgical ligament and tendon reconstruction, or regenerative injection therapy. “Prolotherapy works by stimulating the body’s own natural healing mechanisms to repair injured musculoskeletal tissue.” According to my correspondence with them, this medical group has “had some success” treating knee-lock symptoms.

Dr. Robert LaPrade: http://drrobertlaprademd.com/proximal-tibiofibular-ligament-instability

Anatomic proximal posterior tibiofibular joint reconstruction procedure

Arthroscopic surgery of the meniscus is THE MOST COMMON ORTHOPEDIC PROCEDURE in the USA. Meniscus surgery, alone, is a $4 billion industry, performed 700,000 times per year. If my years of on-line conversational evidence reflects anything close to normative, then a significant number of  meniscus surgeries are unnecessary shams. Indeed, there are numerous peer-reviewed academic studies all concluding that surgeries for torn and arthritic meniscus are generally worthless. Here are just a few.

http://www.nejm.org/doi/full/10.1056/NEJMoa1301408

http://www.nejm.org/doi/full/10.1056/NEJMoa1305189

http://www.nejm.org/doi/full/10.1056/NEJMoa0708333

http://www.medscape.com/viewarticle/818399   (login required)

http://www.sciencealert.com/researchers-list-the-10-most-unnecessary-medical-tests-and-treatments-in-the-us

https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2655246  (login required)

http://online.wsj.com/news/articles/SB10001424052702304244904579278442014913458

If you want to add resources, or comment on the post, scroll up and click on the title.

MENISCUS and POPLITEOMENISCAL

A locking / popping knee could be the result of meniscus and/or popliteomeniscal issues. After years of conversations with kneelock sufferers, I’ve noted a range of severity in how people characterize their locking symptoms. I’ve noted that reports of less severe locking and persistent popping symptoms are sometimes correlated with successful meniscus repair surgery, while severe locking conditions (the “large bone movement and thunk” sensation) more often have no improvement after meniscus repair. This is just a personal observation and does not in any way reflect a medical opinion.

Here are some medical resources covering a range of these meniscal issues.

“MRI of intermittent meniscal dislocation in the knee”  https://www.birpublications.org/doi/abs/10.1259/bjr/25044103

“Arthroscopic meniscus repair for recurrent subluxation of the lateral meniscus.”  https://www.ncbi.nlm.nih.gov/pubmed/28258328

“Reconstruction of the Popliteomeniscal Fascicles for Treatment of Recurrent Subluxation of the Lateral Meniscus”  https://www.sciencedirect.com/science/article/pii/S221262871630175X

“Displacing lateral meniscus masquerading as patella dislocation” – https://link.springer.com/article/10.1007/s00167-013-2729-z

DISCLAIMER

The information provided on this site is intended for general knowledge about locking of the knee area and is not a substitute for professional medical advice or treatment for specific medical conditions. You should not use the information herein to diagnose or treat a health problem or disease without first consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition.

As a courtesy and for the convenience of our site guests, some pages of our website provide links to other websites. While we think such linked sites may be relevant sources of knee lock information, the kneelock.com site does not endorse nor does it control or take responsibility for the content or information on any external or linked website. Use external / linked websites at your own risk and consult with your healthcare provider first before following the advice of any external / linked website.

The kneelock.com website provides sections for site visitors to leave comments about their personal experiences with knee lock. The kneelock.com site and its owner(s) do not endorse or assume responsibility for the accuracy or veracity of visitor comments to the site. Use the comments on this website at your own risk and consult with your healthcare provider first before following the advice of any comment. By posting any comment or other material on kneelock.com, you give kneelock.com the irrevocable right to reproduce, edit, and otherwise use your submission for any purpose in any form and on any media.

While email addresses are required to post comments to the website, your email address and/or contact information will never be knowingly shared with any third parties without your explicit permission.

The kneelock.com website does not accept any advertising money or other form of advertising compensation.  If this changes, it will be spelled out directly via a post to the blog/website and/or the podcast.

The contents of the kneelock.com website are copyrighted by John La Grou. All content of the kneelock.com site can be freely re-distributed via hard copy or electronic copy with proper attribution.

Why Is This Here?

About The Kneelock Site

4 Oct , 2014  

A few years ago, I found a knee lock conversation on the bettermednicine.com forum. I added my own story to the over 200 other stories from knee lock sufferers. Apparently, my story resonated with many of the participants as I began to receive private e-mail from literally dozens of people, with most of them saying “you described my symptoms perfectly.” These random people were seeking additional information, more insight, recent knee lock studies, and frankly just wanted to talk and empathize with someone who seemed to “get it.”

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Apparently, bettermedicine.com forums were recently purchased by HealthGrades.com, and the entire conversation was deleted. Vanished. Very, very sad that years of rich medical conversation was simply erased. It’s really mind-boggling that a company would buy a valuable community asset, and then destroy it. I’m a computer industry entrepreneur. I know that when you buy an Internet property, you are usually buying “eyeballs.” To destroy years of invaluable community discussion is not just a poor business decision, but (in this case) a breach of public trust.

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Anyway, that’s why I created this site. I’m passionate about helping people who suffer from knee lock, and (as I’ve learned), there are a LOT of people who suffer from knee lock. Moreover, there is a crazy amount of truly bad knee lock “medical information” floating around the Internet. As I’ve studied knee lock over the years, I believe to have pieced together a fairly accurate picture of the causes and possible cures for knee lock, and this picture looks surprisingly different than “for profit” knee lock resources on the Internet.

Please read “My Story” and then share your experience. To comment, be sure to click on the title of the post.

– John L

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