Truth Test for Knees?

Orthopedic surgeons have identified a molecular biomarker that could potentially help people with knee injuries save time, and money and the risks of surgery.

According to a study just published in The Journal of Bone and Joint Surgery researchers from California, Florida, Pennsylvania and New York have identified a biomarker found exclusively in patients with  torn cartilage.  Potentially, this simple test could help patients avoid the time and cost of undergoing an MRI and identify those who are candidates for surgery rather than those who have less operable conditions.

By analyzing the synovial fluid surrounding the knee joints of 30 patients with meniscal tears, researchers found a protein complex called fibronectin-aggrecan that wasn’t present in 10 volunteers with normal, pain-free knees.  To date, fibronectin-aggrecan has not been found in patients with osteoarthritis.

An estimated 700,000 arthroscopic knee operations are performed each year in the U.S. based on the results of MRI scans, which can cost in the region of $2,500.

While surgeons can use MRIs to try to discern the root of a patient’s knee pain, MRIs often cannot differentiate between inflammations from natural degeneration and a full-fledged tear.

“Traumatic and degenerative injuries look the same on MRI,” said Gaetano Scuderi, Professor of  orthopaedic surgery at Stanford School of Medicine. “In a 50-year-old, we can’t tell the difference.”

However, correctly identifying a cartilage tear is only one obstacle. Sometimes, patients sustain pain  after corrective surgery because the tear is not actually the root of pain.

“Sometimes you would think you did a great job but the patient still had pain,” Scuderi said. “Why did this  person not get better when another person did?”

Previous studies have shown that surgery is only effective for a torn meniscus or cartilage. Knee pain caused by age-related osteoarthritis or injured hip ligaments can resemble a torn meniscus but isn’t helped by surgery. This distinction isn’t always clear on MRI scans.

In a clinical setting, this new biomarker could effectively differentiate knees with pain-inducing cartilage tears that are responsive to surgery from knees with only natural cartilage degradation.

This would be especially beneficial to older patient populations in whom MRIs always show degeneration. The biomarker test offers a cheaper and more specific identification of pathology. Better still, the researchers are hoping to image the molecule non-invasively as opposed to aspirating it for assay.

Don’t be a Clot when it comes to DVT!

Two weeks ago my orthopedic surgeon made me look him in the he as he repeated his warning “people die from DVT.”

This was his sobering way of saying “no” to my plans to immediately resume business travel after knee surgery. I’m ashamed to say, I ignored his advice, but pleased to report that I survived unscathed.

However, I’m now realizing how close I came to dodging a bullet!  Just last week we learned that super-fit tennis superstar, Serena Williams, was rushed to hospital suffering from a pulmonary embolus and then a day or so later the Vascular Disease Foundation released figures that suggest someone dies from a deep vein thrombosis (DVT) every 5 minutes!

According to the report, between 100,000-180,000 Americans die each year as the result of pulmonary embolism (PE.) The Vascular Disease Foundation is urging Americans, especially women, to learn about the risks of venous blood clots to help prevent these deaths. While men and women are at equal risk, the risk for deep vein thrombosis varies depending on where a woman is in her life-cycle, her hormone levels, and if she has a family history of clotting disorders.

“Every year, more people die from preventable blood clots than from breast cancer, AIDS and traffic accidents combined,” said Dr. Samuel Goldhaber, Professor of Medicine at Harvard Medical School and Chairman of the Venous Disease Coalition. “It is so important to raise awareness about DVT and PE because although blood clots are common, few Americans have sufficient knowledge about blood clots and how to prevent them.”

SRxA’s Word on Health is therefore pleased to bring our readers the knowledge that might just save their live.

DVT occurs when a blood clot forms in the deep veins, usually of the pelvis or leg. DVT can be dangerous in two ways. First, DVT can be fatal if a blood clot breaks free from the leg veins and travels through the heart and lodges in the lungs causing a PE. Second, because blood clots can permanently damage the veins, as many as half of DVT survivors can experience long-term leg pain, heaviness and swelling that can progress to difficulty in walking, changes in skin color and leg ulcers. This condition, called post-thrombotic syndrome (PTS) or “chronic venous insufficiency,” can significantly impair quality of life.

Certain individuals may be at greater risk for developing DVT, but it can occur in almost anyone.

Risk factors that are more likely to affect women include pregnancy and the six to eight weeks after giving birth, the use of birth control pills or postmenopausal hormone replacement therapy, cancer and its treatment, and major surgery.

Anyone may be at risk for DVT but the more risk factors you have, the greater your chances are of developing it. Knowing your risk factors gives you the chance to do something about it:

• Hospitalization for a medical illness or any illness
• Recent major surgery (especially orthopedic surgery) or injury or trauma
• Personal history of a clotting disorder or previous DVT
• Increasing age
• Cancer and their treatments
• Family history of DVT
• Extended bed rest
• Obesity
• Smoking
• Prolonged sitting when traveling (longer than 6 to 8 hours)

For more information about DVT, its risk factors, signs and symptoms or to take a free risk assessment quiz, click here.

Chastised and humbled, I for one, will be doing just that!