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New Ideas for Care After Knee Surgery

July 21, 1987|ALLAN PARACHINI | Times Staff Writer

To professional and recreational athletes alike, knee-ligament injury has long been known as one of the most onerous--carrying with it the almost-automatic prospect of weeks or months of immobilization of the affected leg and serious atrophy of its muscles.

While there is no denying that tearing or straining a knee ligament is still very serious, it has become clear over the last few months from a flurry of new research reports--signifying, a prominent Los Angeles sports-injury expert says, a major new development in knee-ligament treatment--that treatment of such injuries has significantly changed.

New Hinged Cast

No fewer than four studies published in the latest issue of the American Journal of Sports Medicine have amplified on the trend, which includes two major developments:

- Use of a new hinged-cast technique, which does away with rigid plaster holding the entire leg straight for weeks after corrective surgery. The new hinged cast permits at least some ongoing use of the thigh muscles, which, it turns out, are vital to recovery after ligament damage.

- Increased reliance on electrical stimulation of the quadriceps muscle group so electric current can be used--starting the day after surgery--to maintain muscle tone in the thighs throughout the recovery. Keeping the quadriceps in shape helps the eventually healed knee withstand stresses placed on it and can significantly reduce wasting common to muscles confined inside a cast.

Often-Damaged Ligament

The articles in question all focus on injuries to the anterior cruciate ligament, one of the most frequently damaged of connective tissues in the knee. Reports on new cast techniques, the role of immediate quadriceps exercise-therapy and electrical stimulation came from such diverse centers as the University of Tennessee and Louisiana State University Medical Center.

Dr. Frank Jobe, an internationally known expert at Centinela Hospital in Inglewood, said the new reports help establish that knee-ligament-injury treatment has reached a new frontier, with hinged casts and electrical muscle stimulation coming into their own as standardized treatment for such injuries.

New Oil for Taco Bell

Taco Bell, the nation's largest chain of Mexican fast-food restaurants, has announced it will discontinue use of coconut oil for frying sometime this fall--a move that comes in the wake of vocal consumer group criticism of the use of the oil, among the fattiest cooking oils known.

The strongest critic of the Taco Bell frying practice had been the Washington-based Center for Science in the Public Interest, which opposes use of coconut oil because, of all common vegetable oils, it is highest in saturated fat and generally considered least healthful. The consumer group said Taco Bell is test-marketing a corn oil-based frying blend, but a Taco Bell spokesman at the firm's Irvine headquarters refused to confirm the report.

Taco Bell, which operates 2,200 outlets, had previously been unresponsive to attempts to seek confirmation of its use of coconut oil, which some health experts say is more fat-laden than beef fat. Asked why Taco Bell decided to drop coconut oil, a Taco Bell spokesman said: "We don't have any further comment at this time."

Exercise and Osteoporosis

Today's women are increasingly aware of the hazards and risks of osteoporosis--and they are equally interested in ways in which they can minimize their prospects of sustaining the sometimes debilitating bone loss associated with the disease. Highly promoted risk-assessment clinics and the ongoing dispute over whether taking calcium supplements has any preventive effect are two early entries on the list of controversies as osteoporosis awareness increases.

Now, new questions have been raised about yet another of the tenets of the osteoporosis-prevention faith--that regular exercise in pre-menopausal adulthood can avert later damage to the skeleton from the disease. Writing in the Journal of the American Medical Assn., four UC San Francisco researchers have cautioned that while the exercise theory remains an inviting concept, proof is still lacking.

The researchers emphasize that regular exercise is, beyond question, still a good idea. And they say it may well turn out to be true that exercise--especially load-bearing exercise--is an osteoporosis preventive.

The problem, however, they say, is that serious flaws have marred the few studies thus far that have observed the exercise/bone-deterioration-prevention link. It is a classic case of how results that seem to reach an inviting conclusion can lead to enthusiasm over changes in behavior that may be, at best, premature. The researchers urged design of new investigations to resolve the issue.

"But until the results of these and other studies are made available," they said, "we must refrain from indiscriminately counseling individuals to undertake programs of exercise with the hope of preventing osteoporosis."

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