The ends of bones are soft, so they must be covered with a thick white gristle called cartilage. Many people suffer from knee pain because the cartilage is damaged. They may have osteoarthritis in which the cartilage wears away, or they may have damaged cartilage in an accident or by playing sports. Once damaged, cartilage can never heal; the person spends the rest of his life losing cartilage until the cartilage is completely gone and the knee hurts 24 hours a day.

Until recently, the only effective treatment has been to cut out the ends of the bones of the knee and replace the entire knee joint. Now for some people, a simpler procedure may be effective: partial knee replacement, called unicompartmental knee arthroplasty. The surgeon removes just part of the cartilages and bones on the upper and lower legs on one side of the knee.

However, this procedure is not for everyone. Since partial replacements are more fragile than total knee replacements and do not last as long, the patient should be over 60, not obese and not a vigorous exerciser. All of the knee ligaments should be intact, the other compartments of the knee should not be damaged, and there should be no disease, such as rheumatoid arthritis, that causes progressive joint damage. If a partial knee replacement fails, more extensive surgery will be required for a total knee replacement. If you think you may be a candidate for partial knee replacement, check with an orthopedist with experience in this procedure.

After any surgery on knee cartilage, you must protect that knee for the rest of your life. Running and jumping cause further damage, while pedaling and swimming usually do not.


Reports from

Sinus problems
Daytime sleepiness
Weight lifting and blood pressure


Dear Dr. Mirkin: What’s the latest in the debate on antioxidants?

Another study shows that taking antioxidant vitamins does not prevent heart attacks (Archives of Internal Medicine August, 2007). 8,171 women over the age of 40, all with a history of heart disease or with three or more risk factors for that disease (high blood pressure, diabetes or high cholesterol) were randomly assigned into groups and given either 500 milligrams of ascorbic acid (vitamin C) every day, 600 units of vitamin E every other day or 50 milligrams of beta carotene every other day. None of the antioxidant vitamins, either alone or in combination, helped reduce the risk of a heart attack. As of today, there is no evidence that taking antioxidants vitamin pills helps prevent heart attacks.

Instead of taking antioxidants, we now think you should aim to prevent your mitochondria from making excessive amounts of oxidants. The cells of your body have tiny chambers in them called mitochondria that help convert food to energy. When they do this, they knock of electrons from nutrients, and these extra electrons eventually end up attached to oxygen. Electron-charged oxygen, called reactive oxygen species or free radicals, then attach to the DNA cells to damage them and shorten your life.

At this time, scientists have only one practical way to reduce the amount of oxidants produced by mitochondria: exercise. Vigorous exercise helps the mitochondria burn food more cleanly with the production of fewer oxidants. The same effect can be accomplished with severe calorie restriction, or with chemicals such as resveratrol or dichloroacetate, but the results of these studies in animals have not yet been successfully applied to humans.


Dear Dr. Mirkin: What can I do about pain that goes up my leg from the back of my heel?

You’re describing achilles tendinitis, pain the large tendon that extends from in the back of your heel to your calf muscle. It hurts most when you get up in the morning and when you start to walk or run. It will heal only if you stop running and find another sport that doesn’t hurt when you do it, such as cycling, swimming, or pulling on a rowing machine.

The Achilles tendon is made up of thousands of individual fibers, like a rope with thousand of strands. The fibers can be broken if you apply a force greater than their inherent strength. No medicines hasten healing. As soon as the tendon stops hurting, doctors usually prescribe strengthening exercises, but you have to exercise against greater resistance to become strong and strong resistance prevents healing. If you want to return to running or jogging, start out by jogging very slowly daily until your tendon starts to hurt and then quit for the day. When you no longer have any pain, you can strengthen the tendon by learning how to run fast. You must stop immediately if you feel a pulling behind your heel and each intense workout will require several easy days to allow you to recover. Try to run very fast once or twice a week, never on consecutive days.


Recipe of the Week – fresh from the garden (or farm stand)

Tomato-Mint Salad

You’ll find lots of recipes and helpful tips in The Good Food Book – it’s FREE