The knee is a complex joint, often considered the most complex in the human body. It also bears the body’s weight and wears out relatively quickly. It is no wonder that a quarter of people suffer from degenerative knee disease after the age of 50. Arthroscopic knee surgery is a common option for the mitigation of degenerative knee pain, however, growing evidence suggests that the method is not as effective as we have previously thought.

What Is Knee Arthroscopy

Arthroscopic knee surgery is a surgical procedure that allows physicians to assess the knee joint in a less-invasive manner. Traditional knee surgery requires a large incision before helpful diagnostic information can be ascertained. Knee arthroscopy allows surgeons to make small incisions with specialized instruments, often reducing patient recovery times drastically.

“Arthroscopy” refers to the arthroscope inserted for the duration of the surgery. It is a small tube containing a system of lenses, a light, and a small video camera. With the arthroscope inside the knee, a physician can use the images relayed to video monitors to perform minute surgery on the joint. More than two million such surgeries are performed each year throughout the world. 

Is Arthroscopic Knee Surgery Worth It?

The decision to undergo surgery is based on many different factors, including immediacy of need for treatment, the risks of the procedure, other treatment options available, and the patient’s own comfort levels of undergoing surgery. The dangers of arthroscopic knee surgery, in addition to the sheer burden of undergoing knee surgery, can be dramatic.

Risks

While the procedure is often purported to have a success rate over 90%, every individual case is different, and like any medical procedure, there can be complications. A surgeon assesses each case individually before going ahead, but unforeseen problems can arise. These may include infection and clotting, both of which lead to other major health challenges, and even nerve damage, which can negatively affect a patient’s lifestyle for years.

Recovery Time

Because the surgery requires such small incisions and utilizes such fine tools, recovery time for arthroscopic surgery is often markedly reduced compared to other knee surgeries. While patients do feel residual pain, stiffness, or swelling as their knees recover, it is, again, comparatively less.

Efficacy

When a physician says that a procedure has a 90% success rate, that number is highly encouraging. If the doctor quotes a figure closer to 15%, the appeal is dramatically reduced. Unfortunately, though initial pain relief after arthroscopic knee surgery is almost guaranteed, depending on the underlying cause of knee trouble, the results may not last. 

A study conducted by Siemieniuk, et al. and published in the British Journal of Sports Medicine in March 2018 found that improvements initially experienced by knee arthroscopy patients lasted at least three months in less than 15% of participants. For none of the participants was the benefit sustained for one year. While the incidence of complications is well-cited, there is no evidence of important lasting benefit.

How can this be? How can the values of initial success and lasting result differ so dramatically? While many people see marked improvement after arthroscopic knee surgery, the authors of the study suggest that improvements may be more associated with the natural course of degenerative knee arthritis, co-interventions, or even placebo effects than previously considered.

Unfortunately, that is the nature of degenerative knee disease. It is a chronic condition in which symptoms are known to fluctuate. While for the majority of patients, pain levels decrease over time with regular medical care and prescribed physical therapy, it can be difficult to wade through the process when pain levels are high. However, doing so and delaying knee replacement is encouraged when possible. Those for whom knee arthroscopy is truly beneficial are those who suffer from locked knees.

Alternative Treatment to Knee Arthroscopy

The study by Siemieniuk, et al. adds to the body of evidence suggesting that the benefits of knee arthroscopy simply do not outweigh the risks and recovery process. Though recovery times are shorter and the process is less painful than traditional knee surgery, for most cases, the need for surgery at all can be avoided by other non-invasive means.

Depending on the underlying problem in a patient’s knees, knee arthroscopy has proven to be no more effective than exercise therapy, and when the surgical burden, postoperative limitations, and rare serious adverse effects associated with arthroscopic knee surgery are weighed, the disheartening lack of lasting results makes physical therapy all the more appealing. Consult with both your general physician and chiropractor to know which treatment method is best for your knees.

Vitamin D is well understood to be vital in bone formulation and maintaining bodily calcium homeostasis. A growing body of research indicates a definite link role for vitamin D in autoimmunity prevention as well. This simple supplement may be key in preventing and treating autoimmune diseases.

Understanding Vitamin D 

Vitamin D is a fat-soluble vitamin that plays a role in both calcium homeostasis and overall bone health. Vitamin D promotes calcium absorption in the gut, maintaining adequate calcium and phosphate concentrations. Without sufficient levels of vitamin D, bones can become brittle, thin, or misshapen. Diseases such as rickets and osteomalacia are the result of vitamin D deficiency. Vitamin D-related calcium deficiencies can also lead to hypocalcemic tetany which causes cramps and spasming due to involuntary muscle contraction.

In addition to modulating cell and bone growth and initiating bone remodeling, vitamin D also takes part in the reduction of inflammation, metabolizing glucose, and modulating neuromuscular function and the immune system. The role of vitamin D in autoimmunity is still under scrutiny and is further explored below. 

Vitamin D is produced endogenously in human cells when the skin is exposed to UV radiation, particularly from sunlight. Vitamin D can also be consumed, and is naturally present in some foods, though some people (especially those who do not live in very sunny climates) require dietary supplements to bring their vitamin D levels to viable values.

What is Autoimmunity?

Autoimmunity occurs when the body mistakes its own tissues or organs for harmful intruders. The immune system sends out its defenses to attack itself. Autoimmunity arises in many forms, including rheumatoid arthritis, Crohn’s disease, and multiple sclerosis. Type 1 diabetes is a common autoimmune disease in which the immune system destroys the cells in the pancreas that produce insulin.

While the symptoms of immunity are dependent on its form, common examples include tissue damage, inflammation, and loss of functionality in compromised organs. Incidents of autoimmunity seem to be on the rise among Western countries, but emerging research indicates that introducing greater levels of vitamin D in autoimmunity cases may be an effective treatment method.

Increasing Vitamin D in Autoimmunity Treatment

Vitamin D deficiency has a clear association with many conditions and diseases, including poor bone health, cardiovascular disease, and even cancer. In fact, before the discovery of antibiotics, mycobacterial infections such as tuberculosis used to be treated with vitamin D. A continuously growing body of research indicates that vitamin D deficiency also plays a role in autoimmune diseases. 

In a study published in 2017, “Vitamin D in Autoimmunity: Molecular Mechanisms and Therapeutic Potential,” authors Dankers, et al. examine the role of vitamin D in autoimmunity’s progression. Working with the understanding that vitamin D deficiency is common in patients suffering from autoimmunity, the study examined the mechanism of vitamin D in the immune response.

How It Works 

Vitamin D exists in the body in an inactive precursor form: 25(OH)D3. Before it can perform its role in the immune response, 25(OH)D3 must be converted into its active vitamin D form. This conversion, previously thought to be conducted only in the liver, can be completed by many different immune cells, including macrophages, monocytes, B cells, T cells, and dendritic cells. Conversion of inactive 25(OH)D3 to active vitamin D by immune cells allows the concentration of vitamin D to be regulated locally at the site of inflammation.

Blood lymphocytes display receptors for active vitamin D which allow the vitamin to influence the body’s immune response. Nearly all immune cells express this receptor, making them prone to modulation mediated by active vitamin D. Initial binding to the receptor—a nuclear receptor—initiates a signaling cascade. If levels of active vitamin D are low, calcium in the body must be mobilized from the bone rather than from the intestines.

The Conclusion of Dankers, et al. 

While active vitamin D is best known for its role in facilitating calcium absorption into the intestine and thus maintaining calcium homeostasis, research continues to indicate that the vitamin has a larger part to play. Because immune cells are involved in the local activation of vitamin D and vitamin D receptors are found on all immune cells, the vitamin clearly has an important role in the work of the immune system. 

Dankers, et al. consider the available literature evidence sufficient to advocate for vitamin D supplementation to be included in the treatment and prevention of autoimmune diseases such as type 1 diabetes, Crohn’s disease, rheumatoid arthritis, multiple sclerosis, and systemic lupus erythematosus.

Proper Posture

Having proper posture throughout your day is essential not only for your health today but also for your future. Unfortunately, many people have developed poor posture habits over the years. At Utah Sports and Wellness in Millcreek, we can help correct bad posture and get you feeling great again!

However, correcting even small habits will help keep pain and future injuries at bay. Being mindful of your posture, especially while sitting at work, is a great place to start. Here are some helpful hints to help your obtain proper posture when sitting and standing.

Do

• Tuck your chin in
• Relax your shoulders and keep them down and back
• Sit with a curve in the low back. Roll up a jacket or use a lumbar pillow to prop between your back and the backrest on your chair
• Keep your hips, knees, and ankles at right angles with your thighs level with your knees
• Keep your head on top of your shoulders and in the midline of your spine
• Sit with your weight equal on both sides
• Sit back in your chair with feet flat on the floor

Don’t

• Poke your chin forward
• Hunch or roll your shoulders
• Sit in a C shape
• Sit with knees higher than your hips
• Hold your head forward off the shoulders
• Sit with weight to one side

Do

• Keep head on top of shoulders and in midline
• Tuck the chin
• Relax shoulders and keep them down and back
• Tuck your buttocks in
• Keep knees very slightly bent
• Keep your feet slightly apart and in line with the shoulders
• Keep weight equally divided between sides

Don’t

• Hold your head forward off the shoulders
• Hold your head to one side or the other
• Poke your chin forward
• Hunch or roll the shoulders forward
• Stick your buttocks out
• Lock knees straight back
• Stand with your weight on one side more than the other