March 17, 1997
Too much "mileage" can weaken a tendon
By Tim Friend
Whether the patient is the president of the United States or an NFL quarterback, full recovery from a tendon above the knee takes four to six months.
The two most important elements for evaluating a patient's recovery time are the condition of the tendon and how well the sutures that reconnect it to the kneecap hold up.
"If the surgeon has confidence in the repair as well as in the quality of the tissue, then you can move the rehabilitation process more aggressively," says Robert Nirschl of the American Orthopedic Sports Medicine Society and the American Academy of Orthopedic Surgeons.
The tendons a person is born with are in some ways like tires on a car. Some can get 30,000 miles and some get 60,000 miles, says Nirschl, who trains fellow orthopedic surgeons in sports medicine at Arlington (Va.) Hospital and Georgetown University Medical Center in Washington, D.C.
"If you have 30,000-mile tires and you are a little old lady from Pasadena, then that's fine," Nirschl says.
"But if you have 30,000-mile tires on a cab in Manhattan, you have a problem."
President Clinton's case is like the cab because he is a 50-year-old runner who weighs more than 200 pounds. The impact on the knee while running is two to three times the body weight, Nirschl says.
Athletes call the injury basketball knee or runner's knee.
Clinton's surgeons repaired the tendon using a standard procedure in which holes are drilled through the patella, or kneecap. Thick, non-absorbable sutures are pulled through the holes and sewn to the tendon.
Newer procedures drill only partially into the kneecap. That keeps it from being weakened, which could slow recovery.
The immediate goal is to keep pressure off the injury by keeping the knee from bending or bearing weight. Clinton will use a wheelchair and crutches.
Light exercise in water also is recommended. The water takes weight off the knee while providing resistance and mobility.
Many people, without proper recovery, lose 10 degrees to 15 degrees of flexion in the knee. The loss of flexibility can hinder running and even cause a slight limp.