By Albert Samaha
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Athletes Joe Namath, John Starks, and Emmitt Smith, and dancer Mikhail Baryshnikov, embody power, speed, and agility. But they've all paid a price. Each of these star players has sustained knee injuries. Donald J. Rose, associate attending orthopedic surgeon and founding director of the Harkness Center for Dance Injuries at the Hospital for Joint Diseases and New York University Medical Center, says, "There are a thousand ways to injure a knee: slipping, twisting, landing from a jump, deep pliés. The most common procedure I do on athletes and dancers is for torn meniscus: I do eight to 10 surgeries a week."
When Baryshnikov, who is 55 years old, was rehearsing his solo program in late September, he tore the meniscus in his left knee. Christina L. Sterner, his manager, said during a phone interview, "It's just a minor tear. His other knee is much more complicated." Baryshnikov, who has been dancing for more than 40 years, had three arthroscopies on his right knee in the 1980s. His international tour, "Solos With Piano or Not," with pianist Koji Attwood, scheduled to begin September 29 in Burlington, Vermont, and conclude November 23 in Madrid, Spain, has been postponed. It has already been rescheduled for January through March of 2004.
Born in Riga, Latvia, in 1948, Baryshnikov became a star of the Kirov Ballet in spite of his relatively short stature: five feet seven inches. In 1974, while on tour with the Kirov, he defected and joined American Ballet Theatre, later performing with New York City Ballet, then directing American Ballet Theatre until his resignation in 1989.
Baryshnikov is no newcomer to injury. In 1975, when he was recuperating from a sprained ankle, he was a guest of Howard Gilman, the wealthy businessman and philanthropist whose company owns White Oak Plantation on the Florida-Georgia border. In 1990, with support from Gilman, Baryshnikov and Mark Morris founded the White Oak Dance Project. That company recently disbanded, and Baryshnikov is now involved in building a dance center in Manhattan. He continues to perform and is currently appearing as Carrie's boyfriend on Sex and the City. His work with White Oak brought wide public attention to many postmodern choreographers, drawing audiences on the strength of his name for a range of seminal experiments.
This enormous contribution to the contemporary dance world might never have happened had he not had
so much trouble with his knees, specifically his menisci. The meniscus is a crescent-shaped disk of cartilaginous tissue found in several joints of the body: the knee, wrist, and jaw. The meniscus in the knee acts as a shock absorber, reducing friction between the end of the thigh bone (femur) and the top of the lower leg (tibia). Injuries to the meniscus can range in severity from a minor tear to complete disruption or a complex fragmentation of one or both of the menisci. Damage to the meniscus reduces the knee's ability to absorb shock or maintain correct positioning of the tibia and the femur.
"Meniscal tears are common because the knee is a structure that's put under a lot of stress," says Dr. Rose. "The best analogy is a washer in a sink. With a brand new washer, the faucet operates well. The washer acts likes the meniscus in the knee. If the washer is 15 years old, and the metal parts of the sink are a little corroded, it's not going to work as well."
Dr. William G. Hamilton, Baryshnikov's physician of many years, said, "He has a degenerative tear of his left medial meniscus and cannot perform. Baryshnikov has never had trouble with this knee, therefore it is especially sturdy. Even though the damage is not catastrophic, it will require surgery. I have every expectation that his recovery will be swift and complete."
Meniscal tears usually result from twisting, repetitive rotatory stress, or compressive stress. In dancers, the torque of the turned-out positions, in which toes face in opposite directions, creates abnormal stresses. The most problematic result of meniscal tears is that the knee can become locked when a piece of torn meniscus gets stuck in the joint of the knee.
Dr. Hamilton has worked with dancers of New York City Ballethe said George Balanchine invited him to "take care of his company"and has been a consultant for the Redskins, the Dolphins, the Knicks, the Nets, and the Cowboys. He has operated on Emmitt Smith, the all-time leading rusher of the NFL.
Hamilton agrees with Rose that the knee is a particularly vulnerable spot for dancers because of the torque of turnout. "Turnout has to come from the hip and not from the foot. If it doesn't, then the knee is caught in between. The knee is supposed to work as a hinge joint, meaning it bends, but doesn't rotate. The other big category of knee injury in dancers is tendinitis." Tendinitis, an inflammation of the tendons, affects the tendons that support the knee. Hamilton says this condition, known as "jumper's knee," occurs in both dancers and athletes.
Although he calls Emmitt Smith "a prince of a guyone of the nicest athletes I have ever met," he says that dancers are better than football players when it comes to recovery and rehabilitation. They're more concerned with the aesthetics of performance than with winning next Sunday, and they're interested in investing the necessary time to rehabilitate completely.
Injuries sustained by dancers and athletes appear similar, but, Hamilton says, "of paramount importance about ballet dancers is that they are athletic artists. They are first and foremost artists. There are athletic aspects to their injuries, but there are vast differences between them. When athletes are getting paid a great deal of money to get in there and produce, they are under a great deal of pressure to play when they shouldn't. Dancers need to be 98 percent normal to perform: The last thing they want to do is to get out there and dance poorly."