Question
i played hockey for thirteen years and i have a knee that clicks and grinds over time it is bent to a 90, i had injured my knees a few times doing fast hockey stops. although the pain is not bad at all could it be a meniscus tear, that has healed? or what do you think?

Answer
Dear Matt,

This is a difficult question because the causes of clicking in the knee can be quite varied.

Many times, clicking means absolutely nothing at all.

Sometimes it can indicate a meniscus tear, a knee cap tracking problem, a ligament tear, or a "joint mouse".

If the knee is not locking up, and if the pain is not that bad, I would try some simple strengthening exercises to make sure that the joint is as stable as it can be. I would not use heavy weights because I would not want to expose the knee to undue risk of additional injury. My goals would be strength and endurance, not muscle mass.

By strengthening the muscles that support the joint, you are making a much more stable environment for the knee, regardless of the cause of the clicking.

Remember, surgery is always a last resort in most situations. Also remember that surgery of the knee doesn't "fix" anything, it shaves or trims off portions of the meniscus... or it drills and glues in an alternative/cadaver based ligament graft.  None of this ever returns the knee to pre-injury status.  So if you can function without pain or with minimal pain, surgery shouldn't even be on your list of alternatives.

I once went to an orthopedic surgeon for an Anterior Cruciate Ligament tear from basketball. I was near 40 years old. He said "yep, its torn... and we can replace it..."  I asked him, "If this was your knee Doc, what would you do?"  He grinned, and told me that he had a knee just like mine from football in college... and that he would never have the surgery!  He told me to strengthen it and to wear a brace when skiing or playing other sports.

That is exactly what I have done.   The damage from my basketball injury was already done, and whether or not I had surgery, nothing was going to change that fact. I didn't like it, but that was reality.

The damage to your knee from hockey is already done. Surgery will never give you a brand new knee.  It is a fact.  If you can manage with simple stabilization exercises and common sense, you are much better off.

Get yourself to a good orthopedist for an evaluation, if you would like, to help you to better understand what is truly going on. (an MRI is about the only thing that would ever show a meniscus tear or ligament tear. X-rays are pretty much worthless except to rule out fracture, bone cancer/infection, or some arthritic changes). But, if you have little or no pain and the surgeon wants to cut on you... grab your pocket book and get another opinion. Ask what the long term and short term goals and risks are both with and without surgery. Ask for alternative treatments, with their risks and goals.

I hope that this helps you out Matt. Sorry about your knee, and hope that you feel better.

Keith Biggs, DC
http://www.eastmesachiropractor.com