Professional athletes and knee injury

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Professional athletes and knee injury

The human knee is a very crucial part of the body. It withstands the most load out of any joint. While knee holds the weight of the body at rest, the pressures in motion are much greater. In fact, the body can support as much as five times the body weight when a person is in motion. For everyday instances, this can be quite a lot of stress put into two joints. Compound this over the years, and the knee turns out to be a remarkable feat of evolutionary ingenuity. Despite countless years of biological craftiness, the knee does eventually breakdown. For most people, this occurs over the age of 65. The cartilage and the chondrocytes that once smoothed over rough surfaces between the tibia and femur deteriorate over time and leave the person hobbling and practically immobile. And this is for people who live relatively quiet lives. The worst debilitation occurs in athletes.

For most athletes, speed and quickness are essential to a winning season. An athlete must be agile and quickly change position running from one direction to the next. Some athletes go head to head and exert tremendous amounts of energy trying to push back, pull, or take down the opposing player. Marathon and cross country runners endure the repetitive stress of running incredible distances. Athletes place very high demands on their knees and dramatically increase the risk of injury at not only the present but well after the athlete stops competing. One perfect example is "Broadway" Joe Namath.

Namath's place in history was assured with his first pro football act, the signing of a reported $400,000 contract early in 1965 that gave the American Football League its biggest victory in the costly inter-league war of the 1960s. The National Football League's St. Louis Cardinals had also drafted Namath. "Broadway Joe," as he quickly became known, won a starting job in his third game on his way to AFL Rookie of the Year acclaim in 1965.

In 1967, he became the first quarterback to pass for more than 4,000 yard in one
season. In 1968, he capped off AFL Player of the Year and unanimous All-Pro selection with MVP honors in Super Bowl III. Namath's pre-game "guarantee" of victory backed up by his 206-yard passing production was a major factor in assuring the competitive viability of the AFL-NFL Super Bowl series.
Namath was plagued with knee injuries through much of his career. Despite having suffered a serious knee injury in his senior year at the University of Alabama, he still he completed 1,886 passes for 27,663 yards and 173 touchdowns in 12 seasons with the Jets and a final try with the Los Angeles Rams in 1977. This knee injury, which caused his knees to swell up with fluid and require periodic draining, plagued Namath for the rest of his career. On some occasions, Namath had to have his knee drained at halftime so that he could finish a game. He still enjoyed many exceptional days, one of which came in the 1968 AFL title game. He threw three touchdown passes to lead New York to a 27-23 win over the Oakland Raiders that set up the dramatic Super Bowl III confrontation.

Joe Namath's constant knee problems worsened as he grew older. Years of constant injury and stunted recovery time had damaged the cartilage in his knee. Despite not having played in a game for over twenty years, he opted for total knee replacement of both knees in April of 1992. It has turned Joe around from a severely debilitating state to seemingly complete rehabilitation. Everyone wonders what Joe Namath could have done had these treatments been available earlier, but to Joe, things have turned out well enough already.

Perhaps no other sport places such a high strain on the knees as basketball. The hard impact of the court does little to soften each blow to the knees. Knee injuries during the season can be a costly blow to the team and can take out a player for an entire season. Take for instance Allen Iverson. The Associated Press details Iverson's recent injury:

Allen Iverson is out for the rest of the regular season.
The Philadelphia 76ers announced Tuesday their all-star guard will miss the final eight games because of persistent pain in his right knee, the same injury that kept him out of 13 of the last 19 games. An MRI showed a small lesion under Iverson's knee cap, but there was no meniscal or ligament damage.
"It was better now to sit him down so it doesn't linger a lot longer," said team president Billy King. "It's probably best to get it where his knee is 100 per cent.
"It's not a situation where Allen doesn't want to play. His knee just keeps swelling up."
The injury comes with the Sixers in danger of being eliminated from the playoff race. Philadelphia is 10th in the Eastern Conference, but beat Golden State 95-71 on Tuesday night.
King said Iverson's health would be re-evaluated if the Sixers make the playoffs.
"Worst case scenario, surgery would be an option if it does not calm down," King said. "Rest and rehabilitation hopefully will do it."
The injury was diagnosed Monday by New York Giants team doctor Russell Warren, who Iverson consulted for a second opinion.
King said the swelling affected Iverson's movement and quickness.(1)

For an athlete, a knee injury can still be a devasting injury. Despite advancements in arthroscopic surgery and knee replacement, an athlete is still left in the dust. For athletes are not seeking daily routine, but rather the peak of physical performance. And for that, medical science has not yet come up with a perfect therapy. This will sometimes place a critical decision on an athlete's shoulders.
To play or not to play. The answer may seem simple for any athlete, yet the consequences are much more severe and long lasting. Often time's competitive athletes are pressured into playing over injuries. The reason can be pride, toughness, money, or anything that the athlete refuses to sit out for. While this is never a good thing to do, it has particular long term consequences on such a load bearing joint as the knee. A recent case today involves MLB all-star Mo Vaughn. ESPN news covers Vaughn's dilemma:

Mo Vaughn's career could be over -- especially if he undergoes major knee surgery.

Vaughn, 35, has an arthritic left knee. He has no cartilage in part of the knee, causing bone to rub against bone and pain that is too intense to play through. He was put on the disabled list on May 2, and has not played since. In 79 at-bats this season, Vaughn is hitting just .190 with three homers.

All six of the doctors Vaughn consulted recently recommend knee replacement surgery, which would certainly end Vaughn's career, ESPN's Peter Gammons reports. Vaughn is waiting for another month and will attempt to get his knee flushed (arthroscopic surgery) in the hopes that knee replacement surgery could be avoided.

"I'm 35, not 40, and if I have the knee replacement surgery, it's going to be practically impossible to come back," Vaughn told Gammons on Thursday. "I still want to play, so I'm going to wait a few weeks, see if I can have it flushed out and then determine if there's any chance I can come back. I have played through pain before, so pain isn't the issue. Of course, playing through pain is one of the reasons I'm in his predicament."

Vaughn and agent Jeff Moorad met with the Mets on Wednesday.

"My understanding is that he will need surgery just to walk normally, never mind play baseball," a Mets official told Gannett News Service on Wednesday.

The Mets released this statement after the meeting: "We had a very productive meeting with Mo and his representatives. We discussed all of the information that has been gathered and now Mo will take it into consideration and make a decision in the near future on how to proceed."

Vaughn is owed approximately $28 million on his contract. An insurance policy would pay 75 percent of Vaughn's contract once he spends 90 days on the disabled list, and that deadline would pass on July 31, according to Gannett.

Vaughn will earn $15 million next season and has a $2 million buyout for 2005.

Over the last four seasons, Vaughn has missed more than 200 games with injuries to his left ankle, left arm, right hand and now the left knee. In parts of two seasons with the Mets, Vaughn has hit only .249 with 29 homers in 166 games. He also has committed 19 errors at first base.

While with the Red Sox, Vaughn, the 1995 American League MVP, was selected to three All-Star teams.(2)

The decision is always a tough one and is never easy to solve. Mo Vaughn eventually retired in early January of this year. He stated that he had exhausted all medical therapies available and that his only choice was for total knee replacement surgery on his left knee. Although Vaughn will walk comfortably with his new knees, they simply don't perform on an athlete's level. The mechanical device simply does not have the long-lasting durability and repair capability of cartilage. Current therapies cover everyday people well, but athletes are still left with inadequate treatments.

Organ replacement and therapy have come a long way in providing people with suitable knee joints that return people to normal livelihood. Unfortunately, medical technology stops just short for most competitive athletes looking to return in full health. Of course one can argue for the development of better mechanical devices that are sturdier, stronger, and longer lasting. The best solution or maybe the most viable solution right now is to replace the cartilage itself. Regenerate the chondrocytes through stem cells, grow cartilage replacements using tissue engineering, or simply transplant the cartilage through xenotransplantation. The original cartilage worked well when it was healthy, so maybe the best course of action is to return to that state. Current organ replacement therapies are honing in on these techniques and the results may not be too far off. Athletes will always be at high risk for injury, but hopefully technology will catch up and we will never again wonder if Joe Namath could have won four more Super Bowls.