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ARTHROSCOPY
To understand the theory (and folly) of
this seemingly "harmless" procedure, one needs to understand the
physiological composition of the joint. Most of the joints in the body
are synovial joints, which are flexible and self-lubricating.
The ends of the bones are covered with a
protective substance known as articular
cartilage.
These thin coatings are separated by a layer of synovial fluid, which
further cushions and lubricates them where they meet to form the joint.
Ligaments
add support and hold the joints together. Tendons secure the muscles,
which provide movement to the body. The whole structure is wrapped in a
capsule of tissue known as the synovial membrane, which also secretes
the lubricating and somewhat revitalizing synovial fluid.
The knee and the wrist joints also contain
pads of fibrous cartilage, known as menisci, which help these overworked
joints bear the extra stresses to which they are often subjected.
The articular cartilage which protects the
inner surfaces of the joints is a homogenous substance devoid of nerves,
lymphatic vessels or blood cells, made up primarily of water,
collagen
and specialized proteins (proteoglycans). Its structure is fairly
simple; it contains a small percentage of cells known as chondrocytes,
which are solely responsible for the maintenance and repair of the
articular cartilage, via their ability to synthesis collagen and
proteoglycans.
The high water content of the articular
cartilage, coupled with the innate compressibility of the proteoglycans,
give it the slick, cushioning properties so essential to maintaining
healthy, pain free joints, minimizing friction and stress between the
bones.
All the available evidence seems to
indicate that chondrocytes are fully capable of regenerating articular
cartilage throughout the course of a lifetime, which would account for
the healthy cell counts even in very old people. However, since they are
not fed by blood vessels, they are wholly dependent on nutrient delivery
from the synovial fluid; this lack of blood supply puts a damper on
their proliferative capabilities.
It is the movement of the joints that
loads nutrients into, and waste out of, the cartilage. Despite their
limited metabolic resources, chondrocytes can still churn out large
quantities of collagen and proteoglycans.
The invasive tools of arthroscopic surgery
are used to excise injured ligaments, cartilage and meniscus (which
leads to a further depletion of the articular cartilage because the
meniscus supplies nutrients to it)—either through shaving or slicing
with a high-powered electrical instrument. The immediate result is a
temporary respite from whatever pain existed before the procedure—
followed by more or less permanent weakness and instability in the
joint.
Unfortunately, such "collateral damage"
seems more acceptable to the industrialized medical establishment than
less invasive (and less profit-oriented) therapies like
trigger
point
injections and
Prolotherapy.
It would be somewhat comforting to know that such intensely destructive
procedures are falling from favor, if it weren't for the fact that
other, less obvious, but equally damaging techniques are still
widespread.
RADIO SHOW TRANSCRIPTS:
KNEE REPLACEMENT
CALLER: I have a knee that a couple
doctors told that I should have a knee replacement surge. IT is pretty
swollen and sore, I sure would like to avoid the knee surgery.
Dr. Darrow: With this
process of Prolotherapy there is a very good chance of building up
enough collagen and cartilage so that you can walk around, hopefully
pain free after a few series of
injections.
It’s an amazing thing. You know any doctor
that you go to will tell you that knee replacement is the way to go, and
it seems silly to me to jump into a surgery when there is something else
that can be done. Surgery is something, it seems to me, should be the
last option, and it is very rare for someone to come to our clinic and
then have to go onto surgery.
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