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magazine 2012/2
or MRI findings,” explains the physician,
“but the findings are not always associated
with symptoms. And vice versa!”
Although the extremely varied clinical
picture associated with osteoarthritis raises
many questions, there are a few hard facts
as well: we each walk around five million
steps every year, reckons the orthopedic
specialist. There can be no doubt that this
involves some wear and tear. The picture
is far less obvious for another causative
factor, although Professor Kohn believes its
effects can be serious: “We tend to underes-
timate the many small instances of trauma.
Think about footballers, not the top players,
but those who play and train for five hours
a week and always tend to pick up knocks.”
The typical scenarios involve strains and
sprains. “It’s frightening how many cases I
see of men between 40 and 55 with severe
osteoarthritis of the knee, despite being in
good physical condition through sports-re-
lated training. They all tend to have played
a lot of sport during that physically active
period between the ages of 15 and 30.”
Prevention – the earlier the better
“If only I’d known...” is the reaction of many
an (amateur) athlete when diagnosed with
osteoarthritis. “I would advise any young
athlete with what they believe to be a sprain,
bruising, or strain injury to see a specialist.
And I would advise my colleagues to take
these seriously.” Professor Kohn has been
“in the knee business”, as he calls it, since
1982. He knows what he is talking about: “If
patients are experiencing chronic symptoms
and an MRI following a ‘nothing injury’
shows visible signs of damage, there will
definitely be consequences. But the conse-
quences, which may not necessarily involve
surgery, cannot be left to chance. They must
allow the injury to heal and adjust their
activity levels accordingly. There’s no point
getting people fit again, by only dealing with
the warning pain while ignoring the lesion
and the stress involved. This would inevita-
bly mean progression from the preliminary
stages, through a period of wear, to eventual
With the knee, matters are complicated by
the high risk of injury to ligaments. “You
often hear the term ‘isolated rupture of the
anterior cruciate ligament’ in this context,
but this is misleading,” explains the expert
with some frustration. “The forces which
cause a ligament to tear are invariably suf-
ficient to cause bony avulsions or cartilage
damage as well, no matter how small they
are. It’s nonsense to talk about an ‘isolated’
rupture,” he affirms. By implication, talk of
“isolated” treatment seems out of place too,
since the predominant type of dysfunction
is now instability. The orthopedic specialist
uses biomechanics to highlight the hid-
den risk of osteoarthritis associated with
instability: “If the knee loses a key ligament,
the kinematics are completely out of kilter.
The stress on the cartilage increases with
every movement. Shearing forces cause tiny
new traumas to the cartilage with every step
that is taken. We need to eliminate these by
restoring stability. The quicker the better.”
Orthoses can do a lot of good in such cases.
Professor Kohn cites the SofTec Genu knee
orthosis as a case in point. He particularly
tends to use this for medial ligament tears.
“My experiences of this have only been
positive,” he points out. “As movement is
guided by the orthosis splints at the side, it
becomes possible to stabilize the joint.”
The problem: osteoarthritis reveals
few early symptoms
It is absolutely critical to take early measures
to counter osteoarthritis of the knee. Profes-
sor Kohn is quite clear about this, from both
the physician’s and the patient’s perspec-
tive. Instability or excessive strain, lack of
exercise or poor diet – all these factors need
to be remedied. The trouble is that osteoar-
thritis does not tend to hurt during the early
stages. This makes education all the more
important. Osteoarthritis is synonymous with
extensive, poorly defined cartilage defects.
Once the articular cartilage has been com-
pletely lost, the only remaining treatment
option in many cases is resurfacing with
an endoprosthesis. “We need to remember,
however, that we still have a range of options
before we get to this stage,” emphasizes
Professor Kohn. For example, reconstructive
surgical procedures like repositioning opera-
tions can improve joint function and thereby
delay the need to implant an endoprosthesis
for resurfacing purposes. “Foot orthoses
also provide an effective means of relieving
the stress on parts of joints,” says Professor
Kohn. “Before I decide that a joint prosthesis
is called for, I always check whether all op-
tions for keeping the natural joint have been
Hjelle, K., Solheim, E., Strand, T., Muri, R., Brittberg,
M.: Articular cartilage defects in 1,000 knee arthroscopies.
Arthroscopy 2002; 18: 730-734.
SofTec Genu: Multifunctional orthosis for
stabilization of the knee.