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June 16, 2008

If Tiger Woods has a Cartilage Tear in his Knee


From Yahoo Sports: The surgery on meniscus in Tiger Wood's left knee in April didn’t work as well as hope. One knee expert, while obviously not privy to the medical records, watched Woods this weekend and saw trouble.

This is not a story related to a "big future", but it is science and medicine related and could have big cultural impact if Tiger Woods has lasting health problems effecting his career.

UPDATE: Tiger Woods will have season ending ACL surgery on his knee Tiger Woods apparently has a double stress fracture in his tibia and a knee that will require reconstructive ACL surgery.

Step by Step ACL reconstruction

Key steps

4. To reconstruct the ACL, it is necessary to remove all of the existing damaged ACL. This is done with a motorized device which is called a shaver.


The graft harvest.

7. After making the skin incisions, the patella tendon is identified, and the central third is harvested with a bone block at each end of the tendon. Initially, the tendon is removed from the tibial tubercle area. The graft is then passed beneath the skin and retrieved from the superior incision. Harvesting is completed.

16. The graft is then placed through the tibia, through the knee joint, and into the femoral drill hole.

17/18. Screws are placed into the bones to hold the graft in place.
Although a number of different types of tissue have been utilized to reconstruct the ACL, the most common type of ACL reconstruction involves harvesting the central third of the patellar tendon with a bone block at each end of the tendon graft. After performing a diagnostic arthroscopic examination of the knee, the central third of the patellar tendon is harvested. The remaining tendon is then repaired. After harvesting the tissue, drill guides are used to place holes into the tibia (bone below the knee) and femur (bone above the knee). By placing the drill holes at the attachment sites of the original ligament, when the graft is pulled through the drill hole and into the knee, it will be placed in the same position as the original ACL. Typically, it takes the reconstructed ligament approximately 9 months to heal.


Future Technology

Researchers have used carbon nanotubes and electricity to coax the growth of stronger, bone-cushioning cartilage.

Researchers report in the Journal of Biomedical Materials Research Part A that they successfully grew cartilage around carbon nanotubes in their lab—and are optimistic that one day they will be able to duplicate the feat inside the human body. They may get a step closer in September, when they plan to implant carbon nanotubes in sheep joints to test—for the first time—their technique outside the lab. Researchers say they hastened new cell production by sending electrical surges through the nanotubes, which are also excellent conductors of electricity.

Webster has come a long way since his original experiments with in vitro bone tissue growth. Over the past decade, he added bladder, cartilage, central nervous system, and vascular tissue growth to his repertoire. The principle is the same in each: Growing cells are more likely to adhere to and thrive on a rough nanotube surface than on smooth bone or fraying cartilage.

"The use of nanotechnology in scaffolds to assist with regenerating cartilage is novel," says Constance Chu, director of the University of Pittsburgh Medical Center's Cartilage Restoration Program and an orthopedic surgeon specializing in cartilage regeneration and osteoarthritis, "and would be of high interest if it can eventually improve the functional properties of the regenerated cartilage."



CARBON NANOTUBE REINFORCED CARTILAGE: A cartilage-forming cell (known as a chondrocyte) interacts with carbon nanotube fibers in this image. The researchers' goal is to grow carbon nanotube-reinforced cartilage in the body that is stronger than the torn or worn cartilage it is replacing.
Courtesy of Brown University

Back to Tiger's Potential Problem
“Just so we’re clear, I have not seen Tiger’s operative reports, and I am not saying he’s done,” said Dr. Howard Luks, an orthopedic surgeon in Westchester, N.Y. who specializes in athletes. “But one has to imagine, with the amount of discomfort he’s experiencing this long after the surgery, that there are some degenerative symptoms or arthritic symptoms, or something that doesn’t respond well to pivoting, turning, and twisting.


Woods is having problems, which suggests the more serious and more difficult to treat hyaline cartilage problem, according to Luks.

There are two kinds of treatment for a cartilage tear

The most common procedure with pro athletes is called a menisectomy, which means we take out that portion of the meniscus that's torn. When you read in the newspaper that a player's meniscus has been repaired, most of the time that's not correct. It usually means that a portion of the meniscus was removed so that the knee would be functionally normal, but not anatomically normal.

Some of these tears can be repaired. The good part of the repair is that it extends the longevity of the knee's healthy function. The bad part is that it will take the player out of action for six months minimum. The blood supply to the meniscus is present throughout the outer 25 percent of it. Any tear that is in the substance of the meniscus and isn't located near the connection to the soft tissue won't heal because there's no blood supply to it.


The ongoing symtpoms include pain along the side of the knee where the meniscus is torn when he twists or flexes his knee or when there's a combination of flexing and twisting. He might have instability as well in which a piece of cartilage actually moves in the joint and gives him the feeling that his knee is going to give.

Long Term: You put the articular cartilage at risk when there's a deficit of meniscus cartilage. When the articular cartilage wears out, that's what we commonly call arthritis. When you take out meniscus, you put more load on the articular cartilage, which is more likely to wear out. But there are a lot of variables that make it hard to predict when the knee will become arthritic.

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