When I began my Orthopaedic Sportsmedicine practice in 1985 ACL reconstruction was generally reserved for young athletes. Over the years the acceptable age for reconstruction has gradually increased. Several studies have shown good outcomes in patients in their 50s. But what about even older individuals? There has been very little data in patients over 60 years of age. However a recent European study looked at a cohort of a dozen patients between 60 and 63 years of age with no significant arthritic changes in their knee at presentation. All patients had restoration of knee stability by ACLR, with no major complications. 10 of 12 patients resumed their prior sports activities. Follow-up was 2-6 years and there was no significant progression of arthritis. Ratings were greatly improved overall. While all patients in their 60s are not candidates this study shows that for a selected group in this age range ACL reconstruction is beneficial.
The sometimes development of arthritis at the base of the thumb – the 1st carpometacarpal or 1st CM joint near the wrist – is the price humans pay for having a thumb that can be apposed to other fingers. The base of the first metacarpal bone rotates with respect to the wrist bones to allow this apposition. However this is not a fully developed joint, lacks durability, and overuse of the hand by any repetitive manual tasks (carpentry, golf, guitar, frequent texting etc) can cause painful arthritis of this joint. While we have good success treating arthritis of this joint with PRP (platelet rich plasma) most patients can be treated by a simple activity modification regimen based on the so-called “simian grip.”. This refers to the fact that other primates either have smaller thumbs which they use much less often than humans or in the case of some, like the spider monkey, do not have a functional thumb at all. Instead of wrapping their thumb around objects they grip, they use only their four fingers to encircle objects. This mode of use works well for almost all activities in humans as well. In patients with mild to moderate thumb (1st CM) arthritis, in most cases the discomfort will go away completely or at least substantially such that no other treatment is needed by employing this simian grip method. It is important also though to discontinue use of any pain killers or anti-inflammatory medicines because they mask pain and can also interfere with healing.
Hot mineral baths have been used for millennia to treat arthritis, injury and the skin. The Roman baths were well known in antiquity and healing baths have been used worldwide in Asia, Europe and North and South America as well. Now an elegant scientific study published in a peer-reviewed medical journal has shown that they really work. Here is a link to the study which was done in Budapest Hungary. The picture below is of baths in Budapest. The study showed that after 15 baths 80% patients had substantial relief that listed for 3 months, whereas in the control group only 30% of patients did well. Their outcomes included multiple indices of improvement including pain and stiffness.
An interesting article in the May Journal of Bone and Joint Surgery found that those who took opioids (narcotics such as hydrocodone found in norco and Vicodin) had less pain relief after surgery.