Cold weather increases the likelihood of injuries to shoulders and to knees, due in large part to basketball and snow sports like skiing.

Dr. Hugh S. West, an orthopedic surgeon with The Orthopedic Specialty Hospital (TOSH) who treats both types of injuries, says there are some basic things people can do to protect themselves from being hurt in the first place.

The big one is preseason conditioning. Get in shape and work on flexibility before you hit the boards or the slopes. You need to respect the limits of your own abilities and only use good, functioning equipment.

Even so, the people who care for orthopedic injuries know that simple advice won't put them out of business.

West and TOSH physical therapist Beau Johnson will be featured on Saturday's Deseret Morning News/Intermountain Health Care Hotline, where from 10 a.m. to noon they will take phoned-in questions about orthopedic injuries.

There are two categories of orthopedic damage, according to West: those from an injury and those caused when part of the body simply wears out. There's some overlap between the two, since people become more fragile with age and a small injury can provoke bigger problems over time.

Not all injuries require surgery, West said. For instance, someone can get along with a torn anterior cruciate ligament (ACL), if that person doesn't have an active lifestyle. "Younger people tend to have more exposure to the types of activities that would create an instability."

It also depends on knee stability. Some knees, by their construction, are more stable than others with or without an ACL.

A person without a working ACL whose level of activity puts the knee at risk should have surgery done. An ACL injury "can begin a cascade of instability and injury and wear and degeneration that, if not remedied by making the knee stable, will continue," West said.

Knee damage can also create an arthritic condition. That refers to the degradation of cartilage, much like a tire tread degrades.

Types of ACL repair include autograft from the patient's own body, using either a central strip of the patella tendon or one or two of the hamstring tendons, or allograft, using a donor tendon, to replace the damaged ligament. About 90 percent of ACL repairs are autograft.

West also sees a lot of torn rotator cuffs, which tend to be "an age-dependent phenomenon" rarely seen in the 20s, occasionally in the 30s and increasingly common thereafter.

The past two years have revolutionized shoulder repair, West said. Previously, rotator cuff repair was usually an open procedure that included temporary removal of the deltoid muscle, which was replaced and repaired at the end of the surgery. Now, increasingly, the surgery is arthroscopic, through tiny incisions, the deltoid left alone. The smaller incisions result in fewer complications and an easier recovery.

Though nationally only about 25 percent of rotator cuff surgeries are arthroscopic today, West predicts the numbers will reverse themselves within the next five years.

After a healing period, physical therapy may be required after surgery. Physical therapy is standard for ACL repairs, torn rotator cuffs and many other procedures, Johnson said.

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E-mail: lois@desnews.com