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The commonest of all knee injuries are minor sprains, which involve slight tearing due to unnatural twisting or stretching of ligaments. The treatment for such sprains consists basically of rest, exercise of the quadriceps muscle and ice packs. Splinting is used, too, when necessary.
Many of the more serious knee injuries also involve ligaments. In these cases the fibrous bands may be so badly torn as to be shredded, or pulled clear away from their attachments to bone. Injuries of this severity require an operation, and the surgeon must stitch the torn ligaments, or overlap two of them to get a strong one, or reinforce them with tissue from elsewhere in the leg, or drill little holes in bone ends to get a firm anchorage—whatever is necessary in the light of what he finds when the damage is exposed to view. A football player who has had surgery for a major ligament injury will find few buyers at any price.
About equally common is a totally different type of injury involving a different structure. The heart of the knee hinge is where the bottom of the thighbone (femur) rests on the top of the shinbone (tibia). But the bone ends are not designed to fit closely together, and to make the whole assembly work better (perhaps to make it last longer), nature has stuck a couple of shock absorbers in between the two bone ends. These are made of cartilage, which is entirely distinct in its cellular and biochemical makeup from ligament.
The shock absorbers are called menisci, because they reminded some early anatomist of a meniscus or lens. The one on the outside is the lateral, and that on the inside, where the knees knock, is the medial. This medial meniscus is shaped so obviously like a half-moon that the anatomists have called it the "semilunar." But that is only the way the meniscus looks from above or below. Looked at edgewise, it is wedge-shaped, much thicker on the outside of the curve and gradually thinning toward the center. In a powerfully built man like Joe Namath each meniscus is about ? inch thick at the edge and thins down to about ? inch. The lateral meniscus is more nearly a complete circle than the medial.
It was toward the half in Alabama's Oct. 10 game against North Carolina State that Joe Namath rolled out to his right and started to cut back. At this moment his right knee simply "gave way on him" (even orthopedists know no classier way to describe what happened), and he fell to the ground in agonizing pain. No one had hit him.
Namath's knee was iced down at once. In the dressing room he continued to complain of pain, particularly on the outside and the back of the knee. After 48 hours the joint was swollen with "water on the knee," and the team surgeon, Dr. Ernest C. Brock Jr., inserted a hollow needle and relieved the pressure by withdrawing some of the fluid.
Namath was able to play about half the game against Tennessee on Oct. 17 and did well for another week. Then, in the first quarter of the Florida game, at the same point in the roll-out, the knee gave way a second time, and again no one had hit Joe. This time the abused knee swelled more markedly, and Joe began to complain of pain on the inside, too. And this time when the doctors aspirated fluid, it was mixed with blood. Joe was on and off the field for weeks, had his knee collapse a third time in late December, then crowned his college career with a memorable Orange Bowl performance in which he almost beat Texas singlehanded and one-legged (SI, Jan. 11).
With the Jets' more-than-generous contract signed, it was time for surgery. The pain on the outside suggested that the lateral meniscus was more likely the one affected. But at New York's Hospital for Special Surgery, Drs. Robert Freiberger and Paul Killoran used a recently perfected, ultrasensitive method for getting more precise X rays.
Joe was fully conscious when they administered a local anesthetic and then injected a radiopaque dye (containing iodine) and compressed air into the joint space of his knee. Under pressure, the air sought hollow spaces and found one in the place where the meniscus was torn. It proved to be the medial meniscus. The lateral looked all right. Joe's legs are like those of an oak piano, and the powerful bones showed no sign of chips or other injuries. But lurking behind the joint was a small, fluid-filled cyst.
Last week at Lenox Hill Hospital, Joe was knocked out with a general anesthetic (thiopental sodium) by 8 a.m., and at 8:11 a.m. the Jets' surgeon. Dr. James A. Nicholas, made a three-inch incision just below and inside the kneecap. He found that the medial meniscus had been shredded and torn away from its outer attachments. It was crumpled into a wedge. When Joe had tried to extend his leg, this extra thickness had kept his knee hinge from closing completely.