Innovations That Will Drive Sports Medicine In 2019

By Dev Mishra, M.D., President, Sideline Sports Doc, Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • I see three innovations that are currently in use making huge advances in 2019. They are:
  • Increasing use of biologics in sports medicine injury treatment
  • An expanding range of options to treat knee arthritis in active adults
  • A growing role for algorithm based mobile assessments and telemedicine

It’s very easy to get caught up in moonshots, longshots, and fantasy in the world of medicine, but I believe there are three highly innovative technologies that will have an increasingly prominent role and impact sports medicine in 2019.

The first of these is increasing use of biologics in sports medicine injury treatment. Second is the rapidly expanding range of treatment options for active individuals with knee arthritis. And finally, I expect to see an exponential increase in telemedicine and mobile algorithms to provide initial injury guidance.

Let’s have a look at each of these areas.

I recently attended an instructional course on the use of Biologics in orthopedic sports medicine. The course was chaired by my colleagues and Sideline Sports Doc advisors Jason Dragoo M.D.and Brian Cole M.D.The overall theme of the course was that the world of biologic offerings for sports medicine injuries is exploding in terms of the types of treatments we can offer our patients.

In particular, look to see a huge increase in Platelet Rich Plasma (PRP) injections for many types of soft tissue injuries such as chronic tendonitis and muscle injuries. The last year has shown progress with outstanding scientific research into the exact formulations of PRP that work best for different conditions. Not all PRP is created equal; there are critical subtleties especially in the concentration of white blood cells and platelets that go into the different formulations.

Also expect to see a growing number of “stem cell” injections for sports medicine conditions. There is still some debate as to what exactly a stem cell is – which is why I have it in quotes – but current formulations use a person’s own bone marrow or subcutaneous fat, and then purify the tissue for use in the same person. The science lags our experience with PRP but expect to see an expanding role for stem cell treatments, for sure.

New Treatments For Knee Arthritis In Active Individuals

The best way to treat pain and functional limitation for active people in their 40s – 60s remains challenging. Most of these folks have arthritis that’s significant enough to cause them problems but not severe enough to require a total joint replacement. This is where we have an expanding roster of new treatments.

In the last year we’ve seen the approval of an ultra long-lasting cortisone injectable, and increasing evidence that PRP can be effectively used in some types of knee arthritis. The formulations of PRP used in knee arthritis are different than those used in soft tissue problems. Additionally, the stem cell injections mentioned above will likely have a more prominent role in selected cases, and there are also amniotic fluid injections coming into clinical practice.

These technologies will offer new avenues of hope for the huge population of active adults with moderate knee arthritis.

The Move Away From In-Person Initial Advice For Sports Injuries

 This prediction is a bit tough for me, as I’m in a profession that may face some attrition due to the technological advances around us.

In the early 20thcentury doctors routinely made house calls. Those days are long gone. Next to disappear: the initial face to face interactions for many common sports injuries.

At Sideline Sports Doc the algorithm that powers the decision trees in our online courses were developed into a mobile app (Good To Go) that allows an athlete or a parent of an athlete to make an initial triage decision anywhere, in less than 3 minutes. We believe the algorithm can be adapted to any number of conditions.

Outside the realm of sports medicine, I believe care will increasingly be delivered in a hybrid real world-virtual world model. There are multiple companies successfully developing telemedicine networks, artificial intelligence engines, and mobile technologies (including wearables) that have the potential to radically alter the patient-physician interaction.

The time it takes for appointments (including the hassles of traveling to the office, waiting for the appointment, etc.) will drop substantially. The convenience of advice from your home, office, or playing field are compelling.Logo

As I’m trained in the traditional way of orthopedic practice there’s a big part of me that looks at the move away from in-person advice with dread. But when viewed from the patient standpoint I can easily see this becoming a major trend in 2019 and beyond. These innovations, available here and now, are going to be big parts of the sports medicine toolkit in the coming years.

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Tips to Get a Good Night’s Sleep

By Karen Malkin Health Counseling 

In an ideal world, you’d simply drop off into a peaceful slumber every night, however, sleep—or a lack of good sleep—can often cause you to feel bad emotionally and physically. In fact, research shows that sleep is a complex state that affects a wide range of your body’s mechanisms, including:

• brain plasticity
• memory
• emotional processing
• cardiovascular function
• respiratory function
• cellular function
• immune function

A large study also shows the specific interconnectivity of insomnia and depression. It’s clear that sleep affects your overall wellness. [1]

About Insomnia
Today, with more than 40 million Americans struggling with insomnia, sleep disorders are at epidemic proportions. And they not only effect adults (they are especially common in women); up to 25% of children also suffer from sleep disorders! [2, 3]

Those who suffer from insomnia—which is defined as a having difficulty sleeping for more than 4 weeks—are commonly hyper-aroused and have an increased metabolic rate across the 24-hour circadian cycle. This may explain why they are less sleepy during the day by objective measures than “normal” sleepers. But what are some of the causes of insomnia?

Common Medical Conditions
  • Gastroesophageal reflux disease
  • Restless leg syndrome
  • Chronic pain
  • Sleep apnea and snoring
Other Common Contributors
  • Caffeine
  • Alcohol
  • Prescription and over-the-counter drugs
Quality Sleep: 10 Tips

To combat insomnia, here are some specific areas of sleep hygiene you may want to focus on:

1. Follow the rhythm of life.
Establish a regular bed and rising time, get exposure to early morning sunlight and dim evening light, and maintain regular times for meals and exercise. (Although napping has health benefits, it can worsen the effects of insomnia.)

2. Manage intake of caffeine, nicotine, alcohol, and other drugs. 
These are all sleep disruptors. Recommendations about caffeine may not be conservative enough given its significant half-life.

3. Avoid exercise before bed. 
Regular cardiovascular exercise promotes healthy sleep, but not 3 to 4 hours prior to bed (it raises your core body temperature, and can interfere with sleep).

4. Avoid high glycemic and hard-to-digest foods in the evening. 
Instead, opt for complex carbs; they may help transport tryptophan, a precursor to melatonin.

5. Create a healthy sleep environment. 
Keep your bedroom cool (about 68ºF), completely dark, quiet, and as “green” possible. If possible, use HEPA filtration to clean the air and choose organic and non-toxic bedding and mattress.

6. Limit screen time before bed. 
Blue light from your computer and phone screens can cause melatonin suppression and disrupt sleep. [4] Smartphones offer a blue light filter that can be enabled by the user and glass lenses now offer blue-light filtering.

7. Move your clock. 
Clock watching merely stimulates wakefulness. Ideally, position the clock away from the bed.

8. Use mind-body techniques to manage hyperarousal. 
Cognitive behavioral therapy (CBT) addresses sleep-related dysfunctional thoughts that trigger arousal. An excellent resource is a free app called “CBT-i Coach” that provides various relaxation techniques. For best results, couple that with modalities such as mindfulness meditation, muscular relaxation, self-hypnosis, breathing exercises, and guided imagery.

9. Using your bed only for sleep and sex. 
Minimize wakeful time spent there by going to bed only when sleepy. If more than 15-20 minutes of nighttime wakefulness occurs, get out of bed, do a non-stimulating activity, and then return to bed once you feel sleepy.

10. Consider supplementation. 
When discontinuing hypnotics or otherwise indicated, short- term supplementation with herbs like valerian, passionflower, lemon balm, lavender, chamomile, and/or hops can be helpful. Melatonin is useful in older populations or if you have circadian irregularities. Always couple this with other sleep hygiene recommendations.

Quantity of Sleep: How Much Is Enough?

According to Dr. Param Dedhia, MD, Director of Sleep Medicine at Canyon Ranch, it is a fallacy that we need less sleep as we get older. Most all adults need 7 to 9 hours of sleep a night. But it evolves throughout adulthood, with older people getting less deep sleep. They are also more arousable at night; however, they are able to better cope with arousals.[5]

Some of the consequences of poor sleep include decreased tolerance for pain and hunger, explains Dr. Dedhia.[6, 7] The following sleep and/or stress chemicals do double duty as hunger chemicals:

Cortisol   |   Signals stress
Hypocretin / Orexin   |   Difficulty staying awake
Neuropeptide Y   |   Carbohydrate craving
Gallanin   |   Fat craving
Ghrelin   |   Immediate hunger signal

To avoid cravings during the day, it’s best to do all you can to clock your 7 to 9 hours of sleep each night. But ultimately, it’s impossible to force sleep. We can set the stage and be receptive to it, but we cannot intentionally “go to sleep.” Letting go and succumbing to slumber may be the most important thing we can do to get that perfect night’s sleep.

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The Concept of Biological Surgery

Dr. Brian Cole of Midwest Orthopaedics at Rush and Steve Kashul talk with Christian Bezanar to discuss the Concept of Biological Surgery. Christian Bezanar is regional Manager of JRF Ortho-Central US and International. Christian has spent 15+ years working for non-profit organizations within the tissue banking industry.  

JRF Ortho specializes in providing orthopedic surgeons with the highest viability, most widely available cartilage solutions in the industry. Our goal is to provide innovative solutions for allograft joint repair to orthopedic surgeons who specialize in helping patients regain movement and improve their quality of life; thus, JRF Ortho is redefining the standard for allograft joint repair and maximizing the gift of donation.

Our mission is to improve quality of life through innovative solutions for allograft joint repair.

Our unique member relationship with AlloSource® and Community Tissue Services® (CTS) enables us to offer the largest selection of specialized high-viability fresh osteochondral grafts, tendons and menisci in the industry. Through innovation and a commitment to clinical results and positive outcomes, JRF Ortho is redefining the standard for allograft joint repair.

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Boy (12) becomes first in Ireland to have pioneering hip procedure

A 12-year-old boy has become the first person in Ireland to undergo a new transplant procedure to replace a damaged hip joint using a donor femoral head bone and cartilage.

The OFHAT procedure involves replacing the bone and cartilage surface on the femoral side of the hip joint with donor bone and cartilage.

Before the procedure, the usual option for children who suffered AVN has been hip fusion or hip replacement. Hip replacement often requires revision surgery after 10 years and further revision surgery is eventually not possible due to bone loss or infection.

In children of 10 or 11 years of age, hip replacement will have poor results in the long term requiring multiple revisions over their lifetime .

Explaining the OFHAT (osteochondral femoral head allograft transplantation) procedure, Dr Green said the size and shape of the child’s femoral head is mapped on MRI and they then go on a recipient waiting list .

Once there is a size match, surgery can proceed involving the hip being dislocated from the socket and the damaged cartilage and bone removed.

The shape of the removed bone is measured and the donor femoral head is used to replace the empty space. The result is the child has a biologic hip instead of an artificial hip replacement and it helps with their pain.

Click here to read the entire article, which is posted by The Irish Times.

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