This Strange And Perilous Joint

Butkus went on to play another six years—often brilliantly—before he was forced to quit in 1974 at the age of 31. He went to court to win the fortune he wasn't able to make on the gridiron.

If athletes insisting on surgery have come to be a critical problem for orthopedists, even more so is the proliferation of lawsuits against the doctors who treat them. Dr. Kerlan says, "We are up to our necks in lawsuits from guys who forced us to do things for their careers. Sports medicine is new. Knee injuries are relatively new. We are learning so fast, maybe too fast. But we have to be allowed to continue our work in an orderly manner. This can't be done if there are aggressive attorneys waiting at every turn to sue us. We can't live in constant fear of being financially wiped out for life because we want to try something new, something better."

New techniques are exciting indeed. Doctors can replace ligaments. They can replace cartilage with steel and plastic connections. They can replace the whole knee joint. The artificial knee will not stand up to violent exercise, but as Dr. Kerlan says, "When some old guy from the Canton Bulldogs comes in with his trick knee, we can give him a new one so he can at least walk without pain. Just that chance to walk well is an amazing new lease on life for people who have limped in pain for 30 or 40 years."

Whatever magic the surgeon's knife and orthopedist's inventions may produce in a damaged knee, none of it is worth a plugged patella unless it is accompanied by a monumental post-operative program to rebuild the joint for further hard use. And it is here, in rehabilitation, that there seems to be a relative weakness in modern therapy—the Achilles heel of the knee, as it were. Dr. Slocum says, "Rehabilitation is a lot more advanced than it used to be, no question about that. But it is not carried out every place. At the university and professional levels, they do an excellent job. At the high school level, it is frequently inadequate just because they don't have the money for enough good trainers. I wouldn't say that rehabilitation techniques are lagging, they are just not widespread enough."

Hank Kashiwa of Steamboat Springs, Colo., the 1975 professional ski-racing champion, experienced the confusion and doubt that follow many knee operations. He had torn a ligament during a race in January of 1976, and reinjured it two weeks later while preparing for the Superstars. This time he tore the cartilage on both sides of the knee, as well as the anterior cruciate ligament. Nonetheless, he competed in the rowing, biking and boating events before dropping out.

Kashiwa was operated on by Dr. O'Donoghue, but there were complications—for one thing, it was found that one of his cruciate ligaments had deteriorated to the point of non-existence. And his tibia had a tendency to slip forward out of joint, then drop back into alignment with a disconcerting clunk.

"I had always prided myself on having good knees," says Kashiwa, "but now the doctors told me I'd never have a normal knee again. This was beyond my realm of comprehension. I went into a real depression. Finally I asked what I should do to get back in shape. They said, lift weights. That's all—lift weights. Dr. O'Donoghue said I should lift as much as I could. That was all I had to go on. I was in the dark when I started my rehabilitation. I lifted so much weight I could have moved a mountain."

Kashiwa's knee remained weak. There was a constant build-up of fluid. In the summer of 1976, the knee was put in a splint for six weeks. Kashiwa was disconsolate and confused. He contacted Tage Pedersen, long the trainer of the American ski team. "Tage reminded me that every knee is different," says Kashiwa. "He said the weaknesses in my legs from my knee injury were probably different from anyone else's, that the muscle groups involved could be different. And he reminded me that when you lift a weight, you can only lift as much and as long as your weakest muscles allow. So you end up exercising only those muscles to an ultimate extent. There had to be something that could adjust itself to the individuality of my own condition."

It was then that Kashiwa discovered isokinetic exercise equipment. Some of the apparatus looks a little like an electric chair. Its practical value is that it can simulate actual athletic movements through a series of exercises in which loads are moved under calibrated progressive resistance. Rather than the killing sensation of moving dead weight, workouts on these machines—the Cybex Leg Press, the Orthotron, the Fitron—allow a person to exercise every muscle group in the body separately and to keep an ongoing record of the amount of power generated in each group. A rigorous series of sets and programs can be created—each to suit the specific needs of the individual. The equipment is expensive. The three machines cost Kashiwa and his partner in the club about $5,000. But it was worth it. By the end of the 1977 pro season Kashiwa was skiing with all of his former abandon, and in the last series of the season he finished second to Henri Duvillard—which is what everyone else had done all year, too. Kashiwa was so enthused that he equipped an entire room in the Storm Meadows Athletic Club at Steamboat Springs with the apparatus and has opened a clinic for athletes and anyone else who needs this special treatment.

"Pro teams have some of this stuff," says Kashiwa, "and universities do, too. But a lot of them don't know how to use it, to adjust it to the individual's needs. That's the trouble—you can't generalize about knee rehabilitation. Every knee is as different as a fingerprint."