This Strange And Perilous Joint

The knee. It was for a long time misunderstood as being simply a joint made for bending. It was thought that it worked like a garden gate. Gray's Anatomy, that classic medical student's tome first published in 1858, pointed out this mistake, saying, "The knee joint was formerly described as a ginglymus or hinge joint, but is really of a much more complicated character."

Complicated character, indeed. Gray—Dr. Henry Gray, Fellow of the Royal College of Surgeons—was speaking only of the anatomical complications of the knee; he scarcely could have dreamed of the real complications—legal, economic, emotional, even sociological—that would befall that strange and perilous joint in the late 20th century.

The horror stories are endless, the statistics staggering. A roster of big-name athletes—superstars, stars, would-be stars—who have been crippled, slowed, weakened or forced to retire because of knee injuries in the past five years alone reads much like the list of names on a plaque at the base of a statue commemorating the dead of this war or that—young people cut down before their time. If you multiply the roster of famous crippled athletes by 10,000 or so, you will approximate the number of all the others—high school quarterbacks and YMCA forwards and commercial-league Softball shortstops—who were also cut down by bad knees before they were anywhere near ready to quit.

The knee is the single most abused joint in sports, particularly football. Two Saturdays ago, for sad example, senior Quarterback Gifford Nielsen of Brigham Young University, the nation's most effective college passer this season and a leading Heisman Trophy candidate (he had completed 62.8% of his passes, 16 of them for touchdowns), was cut down while releasing a pass against Oregon State. He suffered torn ligaments in his left knee and, as abruptly as that, his Heisman hopes and his college career came to an end. So far this year, more than 50 NFL players have had their seasons cut short by knee injuries. The average NFL career is 5.03 years. One of every five players who compete that long suffers knee damage. Last year the Miami Dolphins had a nightmarish knee-injury record: eight Dolphins had a total of 11 knee operations, and 21 hurt their knees one way or another. Coach Don Shula spliced together a movie reel of his players being injured so team doctors could study the causes. What the film showed merely added to the mystery and fear surrounding the knee—there was no common denominator to the injuries. Some players were hurt hitting opponents, others while being hit. One Dolphin hurt his knee when a teammate rolled over him in a pileup, another was accidentally blindsided by a teammate in an open field, and two defensive backs hurt themselves while running pass-coverage routes in which there was no contact at all.

The knee has generated its own lore. The scarred knees of Joe Namath, Bobby Orr, Gale Sayers, Willis Reed and E. J. Holub are enshrined in the annals of athletic injury. So, too, is the knee of Mack Lee Hill of the Kansas City Chiefs. Hill hurt the knee in 1965, his second pro season, when he was on the verge of stardom. But he was terrified of surgery and resisted it until he was convinced that it was his only chance to play again. Hill died during the operation. The cause has never been specified, but one theory is that he died of fright. Each year the Chiefs honor his memory with an award to their best rookie.

The knees of Holub, a middle linebacker and center for the Chiefs for nine years before he retired in 1970, will never be forgotten: while a player, he underwent 11 knee operations, six on the left, five on the right—and has since had two more. "I guess my biggest handicap," says Holub, "is that I don't lay off it long enough after I have the surgery. The minute I start feeling good, I start getting back on the knee. The doctors aren't exactly excited about the way I am." Did all those operations do any good? "They've all been good," he says, "but I am still in pain all the time. I've just learned to live with it. I've got scars all over both knees. A friend of mine saw my knees once, and he said it looked like I'd been in a knife fight with a midget."

If Holub's knees make the Hall of Fame for frequency of repair, then Dick Butkus' right knee ought to be honored for first producing top dollar in court. Butkus was awarded a record $600,000 in 1976 as the result of a suit against the Bears and a Chicago doctor. Dozens of similar cases are pending against pro teams and their doctors.

The knee is one of the few parts of the body to have a worldwide association devoted to it. Last May orthopedic surgeons from half a dozen countries gathered in Rome for the first meeting of the International Society of the Knee. So urgent is the need to develop a common nomenclature for the myriad forms of knee instability, as well as to communicate new techniques in diagnosis, surgery and rehabilitation, that it seems only a global organization of its own can do justice to the knee.

Says Dr. Robert Kerlan, the Los Angeles orthopedist, "The old trick knee has turned out to be a lot trickier than anyone ever suspected, hasn't it?"

All the tricks the knee is capable of remained unknown for so long because men didn't put it through the stresses and strains it undergoes routinely in present-day athletics. Dr. Kerlan says, "The joint itself hasn't changed in millions of years. It is as old as man. In the earliest skeletons found, the knee joints are pretty much the same as they are today. The fact is, the human anatomy is simply not constructed for the games men play today."