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Knee anatomy, pain, & treatment | Peter Attia & Adam Cohen — Whalespan

Content›Video›Knee anatomy, pain, & treatm…

Knee anatomy, pain, & treatment | Peter Attia & Adam Cohen

Peter Attia53m · 2023-08-03

Support Rate

77%

73 of 95 claims supported

Support rate

73 of 95 claims supported

73 supported22 partial / not

Claims from this content

80

✓Well SupportedRecovery from knee replacement surgery for a motivated patient can take up to a year, with significant improvements seen up to and beyond that point.✓Well SupportedHip and knee arthritis are more common in individuals with incongruent joint surfaces.✓Well SupportedYoung individuals with a meniscus tear that can be fixed should have their meniscus repaired, even if they have heard that sham surgery is equivalent.✓Well SupportedBucket handle meniscus tears are typically repaired by sewing the torn piece back into place.◐Partially SupportedUtilizing immune modulators in a personalized way based on the inflammatory environment at the time of surgery could advance knee replacement recovery.

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A. Volkovreader

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Bookmarking — the dossier-vs-overview split is the right call. Most of the time I want overview; sometimes I want receipts.

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◐Partially SupportedPeter Attia had an ACL and meniscus tear at age 14, underwent arthroscopic surgery, and was told the knee would be treated non-operatively.

◐Partially SupportedACL reconstruction is considered worthwhile despite the risk of arthritis because it protects the meniscus and allows for continued athletic activity.

◐Partially SupportedAllograft is a reasonable option for ACL repair in individuals in their 40s who are not participating in high-risk activities, despite higher re-rupture rates.

◐Partially SupportedChondrocytes respond to stress by producing more matrix proteins, which is beneficial for cartilage.

✓Well SupportedLosing five pounds can significantly reduce the load on the knee, potentially negating the need for knee replacement.

◐Partially SupportedCartilage health follows an inverted U-shaped curve with activity, where too much activity can be detrimental.

◐Partially SupportedThe menisci distribute force across the knee joint, protecting the cartilage from wear.

◐Partially SupportedDegenerative meniscus tears in older individuals often require trimming of the torn piece.

◐Partially SupportedFixing a meniscus tear should be strongly considered if arthritis is not present, as it can help prevent the development of arthritis.

◐Partially SupportedRunning can impose forces on the knee up to eight times the body weight.

◐Partially SupportedThe knee joint experiences arthritis more frequently than the ankle due to its mechanical position and potential for uneven weight distribution.

◐Partially SupportedThe knee joint is less stable than the hip joint.

◐Partially SupportedPeter Attia has no arthritis in his knee despite a past ACL tear and meniscus tear, and his standing alignment line is straight.

◐Partially SupportedSome meniscus tears and ACL tears can be managed conservatively if not participating in high-level pivoting or rotational sports.

◐Partially SupportedHigh molecular weight polyethylene in artificial joints wears down over time due to mechanical forces.

◐Partially SupportedExcess body weight increases the load on the knee joint.

◐Partially SupportedTotal knee replacement is indicated for individuals with advanced arthritis affecting all compartments of the knee.

◐Partially SupportedPhysical therapy focusing on hip strengthening, such as the gluteus medius, is recommended for patellofemoral pain syndrome to correct leg adduction mechanics.

◐Partially SupportedBlood Flow Restriction (BFR) training can be used to strengthen the quadriceps in individuals with patellofemoral pain at lower loads.

◐Partially SupportedFor individuals with specific lifestyle factors, a hamstring tendon graft may be a more appropriate choice for ACL repair than a patellar tendon graft.

◐Partially SupportedPatellofemoral pain syndrome is caused by overloading of the patellofemoral joint, often due to increased running duration, mileage, or frequency.

◐Partially SupportedA young patient aware of the increased risk of needing another replacement can run a marathon with a total knee replacement.

◐Partially SupportedThe patellar tendon is considered the gold standard for ACL repair, although it involves a harder early recovery and potential kneeling pain.

◐Partially SupportedSampling synovial fluid may correlate with recovery outcomes after knee or ACL injuries.

◐Partially SupportedPatellofemoral pain is difficult to reproduce with passive knee movement and torsion, whereas meniscal tears elicit pain with specific movements.

◐Partially SupportedLosing the meniscus is a significant factor in knee degeneration and the beginning of the end for knee function.

◐Partially SupportedRupture of the patellar tendon or quadriceps tendon requires surgical reconnection for the leg to function.

◐Partially SupportedBone-to-bone healing is more predictable when using patellar tendon autografts for ACL reconstruction.

◐Partially SupportedThe pressure behind the kneecap during a regular squat can be about seven times greater than the weight on your back.

◐Partially SupportedFemales are more likely to land with a valgus knee and adducted hip during jumps, indicating potential weakness in the gluteus medius and imbalance with adductors.

◐Partially SupportedBiologics may help shift patients from a catabolic state to an anabolic state in chronic inflammation following knee injuries.

◐Partially SupportedStrengthening quadriceps in physical therapy for patellofemoral syndrome can increase load on the kneecap and worsen pain.

◐Partially SupportedThe decision to resurface the patella during knee replacement surgery is variable, with studies showing no significant difference in outcomes.

◐Partially SupportedA traumatic event can trigger symptomatic arthritis in individuals with pre-existing, but asymptomatic, cartilage wear.

◐Partially SupportedAnkle joints have a lower incidence of arthritis compared to hip and knee joints, provided there are no injuries.

◐Partially SupportedDeviations from ideal mechanical alignment, such as knock knees or bow legs, increase force through specific knee compartments and raise the risk of degeneration.

◐Partially SupportedFifty percent of individuals who tear their ACL will require a total knee replacement within 15 to 20 years.

◐Partially SupportedInjury prevention programs require treating approximately 90 people to save one ACL.

◐Partially SupportedTotal knee replacement is a conversation to have when a patient has advanced arthritis in all compartments of the knee or two severely degenerative compartments, and has failed conservative treatments like PT, injections, steroids, hyaluronic acid, PRP, and bracing.

◐Partially SupportedACL reconstruction can be performed immediately with no adverse long-term effects.

◐Partially SupportedLanding in a valgus position can lead to condylar lift-off, stretching the MCL and causing instability.

◐Partially SupportedInjury prevention programs use tools like the Landing Error Scoring System to identify individuals needing neuromuscular training.

◐Partially SupportedA trunk leaning to one side during a plant can increase the force pushing the knee laterally, contributing to injury.

◐Partially SupportedThe majority of ACL injuries are non-contact or indirect contact.

◐Partially SupportedKnee joint loads can change permanently after an injury, even if the ligament is reconstructed.

◐Partially SupportedAllograft tissue takes longer to mature and strengthen compared to autograft tissue.

◐Partially SupportedTotal knee replacements can now be safely performed as outpatient procedures.

◐Partially SupportedHalf of people develop arthritis within 15 to 20 years after an ACL tear.

◐Partially SupportedFemales have a higher risk of ACL tears than men due to factors including strength differences, neuromuscular control, and hormonal influences during puberty.

◐Partially SupportedSome individuals, termed 'inflamma-type', remain inflamed after ACL reconstruction surgery, characterized by elevated IL-1 and IL-6 in synovial fluid that does not return to baseline.

◐Partially SupportedHamstrings help stabilize the knee when landing with a flexed knee.

◐Partially SupportedPatients with total knee replacements still struggle post-operatively, although technology is improving.

◐Partially SupportedTotal knee replacement surgery involves cutting the distal femur and proximal tibia to fit implants.

◐Partially SupportedArthritis is a whole joint disease involving cartilage breakdown, inflammation, synovitis, and bone changes.

◐Partially SupportedPerfect biomechanical alignment, with a line from the hip center to the ankle center passing through the knee center, is crucial for joint health.

◐Partially SupportedPerioperative pain management for knee replacement has improved with injections into the capsule, nerve blocks, and post-operative pain pumps.

◐Partially SupportedBlood Flow Restriction (BFR) can be initiated relatively soon after ACL repair to prevent muscle atrophy, provided swelling has subsided and it is tolerated.

◐Partially SupportedCartilage health follows an inverted U-shaped curve with activity, where too much activity can be detrimental.

◐Partially SupportedThe dominant source of pain after knee replacement is bone pain, not incisional pain.

◐Partially SupportedTotal knee replacement surgery typically takes one to two hours.

◐Partially SupportedRepeated knee instability increases the risk of developing arthritis.

◐Partially SupportedA shoulder dislocation increases the likelihood of developing shoulder arthritis by 10 to 20 times.

◐Partially SupportedReplacing the patella during knee surgery may help prevent post-operative pain, especially if significant arthritis was present.

◐Partially SupportedIf a meniscus tear occurs without a history of injury, it is important to investigate the underlying reason for its occurrence.

◐Partially SupportedAn ACL-deficient knee experiences substantially greater compressive force on its cartilage compared to an ACL-intact knee.

◐Partially SupportedPrehabilitation before ACL reconstruction can help patients prepare for the long-term implications and recovery process.

◐Partially SupportedPeter Attia prefers to perform ACL reconstruction surgery when the knee is quiet and initial inflammation has subsided.

◐Partially SupportedTreating 90 individuals with injury prevention programs is needed to save one ACL injury.

◐Partially SupportedHyperextension of the knee can cause similar problems to landing in a valgus position.

✕Not SupportedTotal hip and knee replacements allow for skiing but not contact sports due to the risk of catastrophic failure above the implant.

✕Not SupportedAllografts for ACL reconstruction are not recommended for individuals under 34 years old due to an unnecessarily high risk of re-rupture.

◐Partially SupportedACL reconstruction may be associated with a greater chance of developing arthritis later in life.

◐Partially SupportedA meniscus tear in the absence of arthritis should be strongly considered for repair to prevent the onset or progression of arthritis.

◐Partially SupportedKnee replacements have lower satisfaction rates than hip replacements and often do not feel like a normal knee.

◐Partially SupportedKnee replacement incisions are typically midline and can range from approximately 10 centimeters.