Here's an WebMd article about Manny's knee condition. It was published
in 1999. Let's hope there have beeen more medical advances
developed since then.

Lynne

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Severe Knee Tendinitis Can Be Alleviated With Surgery

Dec. 8, 1999 (Atlanta) -- One of the most common injuries in athletes
is "jumper's knee" or patellar tendinitis. This injury is especially
common in sports such as basketball, volleyball, football, soccer, and
track and field, where jumping is frequent. The tendon of the thigh
muscle -- the quadriceps -- when overused develops a series of small
tears in a condition called patellar tendinitis. Atlanta Hawks guard
Jim Jackson has suffered from this condition since he had knee surgery
last summer.

Although most sufferers of this condition can be treated
conservatively, occasionally the little tears in the tendon enlarge to
create an area of dead tissue within the tendon. British and Italian
researchers reported on a new surgical procedure in the current issue
of Medicine and Science in Sports and Exercise, which they believe
should be the first line of surgical treatment.

Those most likely to benefit from surgery are those who have damaged,
or torn, the main body of the tendon, according to the investigators.
"The ones who had the marked commonly occurring jumper's knee ... were
the ones in whom the procedure is not indicated or warranted," study
co-author Nicola Maffulli, MD, PhD, associate professor of orthopedic
surgery at the University of Aberdeen Medical School in Scotland,
tells WebMD.

The doctors used ultrasound to identify the damaged area of the knee
and to guide their surgery on 37 patients. "What we also found is that
given this procedure, it's not necessary to excise the area of
degeneration [or dead tissue]," Maffulli says. "It is sufficient to
perform just longitudinal tenotomies [cuts in the tendon]. So it
should make the procedure faster and less injurious to the remaining
part of the tendon. We think that by performing multiple ...
longitudinal tenotomies, we end up stimulating an acute healing
response from the remaining part of the tendon."

"It is a minimally invasive procedure that when performed in the right
patients and followed by appropriate rehabilitation, has a high chance
of returning them to active sports in a reasonable time," Maffulli
says. All the patients in the study were treated as outpatients.

Conservative treatment for jumper's knee includes strengthening the
quadriceps muscle and stretching the hamstrings, the muscles at the
back of the thigh. Pain medications, cryotherapy, and massage have
also been found to be useful. Cryotherapy involves freezing, usually
using liquid nitrogen or carbon dioxide, to destroy tissue. Most
doctors warn that good training in the preseason is a good way to
prevent this injury. After the injury occurs, however, it is important
to rest the muscle.

"[Once the injury occurs,] prevention is then the cure. Before getting
to the stage when they do warrant an operation, they should reduce
their training habits both in terms of intensity and time period of
training in order to give the tendon a chance to recover," Maffulli
tells WebMD.

Basketball forward Jackson, however, is currently undergoing another
new form of treatment in Canada. The treatment, called extracorporeal
sound wave therapy (ESWT), involves focusing sound blasts to the area
of pain. The treatment is being used in Canada and Europe to treat
chronic pain or pain over a small area, particularly near a bone. The
joint pain treated by this system includes the shoulder, elbow, ankle,
and, as in Jackson's case, the knee.

ESWT or Sonocur is not approved for use in the U.S. or Japan. It has
minimal side effects and does not require anesthesia or pain medication.


Vital Information:

* Jumper's knee, or patellar tendinitis, is a common injury among
athletes where a tendon of the quadriceps develops a series of small
tears.

* For most people, a conservative treatment including muscle
strengthening and stretching is effective, but in some cases surgery
is necessary.

* Another treatment, which is not approved in the U.S., is called
extracorporeal sound wave therapy and focuses sound blasts to the area
of pain.

Source: Aman Shah, MD / WebMD.com Medical News