Top Docs: Understanding knee injuries

You don't have to be an athlete to hurt like one. Weekend warriors, older adults and kids who overdo it in their favorite sports are prone to knee injuries, including torn cartilage, pain under and around the kneecap and ligament damage.

Often, though, the problems can be successfully resolved without going under the knife.

"There are some things that absolutely do require surgery, but most orthopedic problems are elective, and they don't require, for the most part, immediate surgery unless it's like a fracture," said Dr. Eric A. Putterman, a Melville-based orthopedic surgeon who specializes in arthroscopic surgery, rehabilitation and sports medicine.

CAUSES

Knee injuries can occur as a result of a direct blow or swift movement that strains the knee, according to the U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases. A sudden twisting motion - common in basketball, football, soccer and skiing - can stretch or tear the anterior cruciate ligament, or ACL, for example.

Other times, knee problems can be caused by osteoarthritis, which results from wear and tear, or diseases that cause inflammation of the knee.

"I always tell people you should listen to your body," Putterman said. "If it hurts while you're doing it or it hurts shortly thereafter, you shouldn't be doing it. Your body is telling you it's not good."

TREATMENT

The first course of treatment for a wounded knee is to stop the activity that caused or aggravated the injury, according to the American Academy of Orthopaedic Surgeons.

People with mild injuries, such as runner's knee - a dull, aching pain around or under the kneecap - often find relief by using the "RICE" method, which stands for rest, ice, compression and elevation.

"If it's a problem persisting more than three or four weeks and seems not to be getting better, then they should probably have it looked at," noted Putterman, a runner himself.

CURRENT THINKING

A more serious injury, such as an ACL tear, might require surgical repair, but people shouldn't rush into the operating room, Putterman said, because studies show an increased risk of scarring and stiffness after surgery if it's performed too close to the time of injury. It may be better to wait for the pain and swelling to subside.

"It's like throwing gasoline on a fire," he said. "The joint is already damaged and inflamed, and the surgery just compounds that."

Danish researchers recently reported results of a randomized trial that involved 121 active young adults who had injured their ACL. About half of them had rehabilitation and early surgery - within 10 weeks after sustaining the injury. The others had rehabilitation with the option of having surgery later, if needed. Ultimately, 23 people in that group had delayed ACL reconstruction surgery.

After two years, there was virtually no difference in outcomes among people who had early surgery, those who required surgery later on and those who recovered with rehabilitation alone. Plus, more than half of those who waited to decide whether they needed surgery avoided it altogether, without ill effect. The finding, reported July 22 in the New England Journal of Medicine, underscored the importance of rehabilitation first.

For those who do have surgery, physical therapy is recommended afterward to help regain motion and strength in the joint. But recovery times vary.

"The 18-year-old kid may be back in six weeks playing sports," Putterman said. "The 50-year-old may be back in six months playing sports."

THE LONG ISLAND SCENE

To find a local physician who specializes in helping people recover from injuries that affect movement, visit the website of the American Academy of Physical Medicine and Rehabilitation (aapmr.org, click on "Find a PM&R Physician").

And if you've been told you need surgery, Putterman suggests getting a second opinion.

This is the 10th installment of a 26-week series in which Newsday presents Castle Connolly's list of top L.I. doctors. Today: orthopedic specialties: occupational medicine, physical medicine and rehabilitation, sports medicine, hand surgery, pain medicine

Who's who

OCCUPATIONAL MEDICINE

Dr. Sara Mendelsohn

800 Woodbury Rd., Woodbury, 516-682-9142

PHYSICAL MEDICINE & REHABILITATION

Dr. Jason Lipetz

LI Spine Rehab. Medicine, 801 Merrick Ave., East Meadow, 516-393-8941

Dr. Barry Root

Dept. Physical Med. & Rehab., 101 St. Andrews Lane, Glen Cove, 516-674-7501

Dr. Craig Rosenberg

Southside Hospital-Health Inst., 301 E. Main St., Bay Shore, 631-675-4550

PHYSICAL MEDICINE & REHABILITATION

Dr. Adam Stein

825 Northern Blvd., Great Neck, 516-465-8609

SPORTS MEDICINE

Dr. Stephen Kottmeier

14 Technology Dr., East Setauket, 631-444-4233

Dr. Harvey Orlin

36 Lincoln Ave., Rockville Centre, 516-536-2800

Dr. Eric Putterman

1800 Walt Whitman Rd., Melville, 631-293-9540

HAND SURGERY

Dr. Lawrence Hurst

SUNY Stony Brook Med. Ctr., Dept. Ortho, 100 Nicolls Rd., E. Setauket, 631-444-3145

Dr. Kenneth Kamler

410 Lakeville Rd., New Hyde Park, 516-326-2266

Dr. Lewis Lane

600 Northern Blvd., Great Neck, 516-627-8717

Dr. Thomas Palmieri

1901 New Hyde Park Rd., New Hyde Park, 516-822-4843

Dr. Glenn Teplitz

Winthrop Orthopaedic Assocs., 1300 Franklin Ave., Garden City, 516-747-8900

PAIN MEDICINE

Dr. Carole Agin

Pain Management Ctr., Stony Brook Univ. Hosp., 3 Edmund D Pellearino Rd., Stony Brook, 631-638-0800

Dr. Juan Gargiulo

365 County Rd. 39A, Southampton, 631-702-2300

Dr. Steven Litman

All Island Pain Consultants, 387 E. Main St., Bay Shore, 631-665-0075

Dr. Steven Pinsky

176 N. Village Ave., Rockville Centre, 516-764-4875

Dr. Philippe Vaillancourt

877 E. Main St., Riverhead, 631-727-0660

How they were picked

Castle Connolly Medical Ltd. is a health care research and information company founded in 1991 by a former medical college board chairman and president to help guide consumers to America's top doctors and hospitals. Castle Connolly's established survey and research process, under the direction of a doctor, involves tens of thousands of doctors and the medical leadership of leading hospitals.

Castle Connolly's team of researchers follows a rigorous screening process to select doctors on national and regional levels. Using mail and telephone surveys, and electronic ballots, they ask physicians and the leadership of top hospitals to identify exceptional doctors. Careful screening of doctors' educational and professional experience is essential to the committee. Newsday is not part of the selection process.

Doctors do not and cannot pay to be selected and profiled as Castle Connolly Top Doctors.

To see the whole list . . .

Who else is on the list of Top Doctors? More than 6,000 listings are in the New York Metro Area edition of "Top Doctors," published by Castle Connolly Medical Ltd. The soft-cover list price is $34.95. For more information, go to castlecon nolly.com or call 800-399-DOCS.