Clinical Trial to Repair Articular Cartilage Defects of the Knee

Dr. Brian Cole talks with Chris Zlevor, a patient who experienced three knee surguries before participating in the Aesculap Novacart 3D Clinical Trial. This discussion covers the process of participation and followup experience as a patient in the study. Aesculap Biologics focuses on the manufacturing of tissue engineered products for the regeneration of diseased or damaged joint tissues.

A Phase 3 clinical trial is currently being conducted for NOVOCART 3D, a tissue engineered cell-based product designed to repair articular cartilage defects of the knee. If you believe you or your patients might qualify for one of our clinical trials or wish to be evaluated, please contact our research administrator, Kavita Ahuja, MD at (312) 563-2214 or kavita.ahuja@rushortho.com or inquire at your next visit.

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DEVELOPING THE YOUNG FEMALE ATHLETE

In 2011, Naomi Kutin broke a world powerlifting record, squatting 215 lbs. She was in the 97 lbs weight clas…and was just nine years old. She broke a record previously held by a 44 year old German woman. Since then, Naomi has become a prodigy with the nickname “Supergirl” in the lifting community. Now, at 16, she has continued to astound, deadlifting 365 lbs in the last Pan American Championships with Team USA.

As you look at your own daughter, you’re probably thinking, “Thank goodness my daughter wants to play softball… “Aren’t girls like Naomi a special case?” And…most importantly, “Is what Naomi doing in that video EVEN SAFE???” As parents, coaches, trainers…we all walk a fine line. We want to keep young athletes from the life-long consequences of injury but we still want to help them be their best. Especially if they LOVE their sport. No one wants to put out the fire of a young athlete. But when is it our responsibility to draw the line? How can we prepare our young athletes for the risks of their sport?

Until recently, strength training and young athletes has been a taboo subject. Even more so for females. Most parents have no problems signing their daughter up for softball or soccer, but strength training? It just doesn’t happen that easily. Here’s the problem: Our girls are getting hurt.  In soccer. In softball. In volleyball. And, our girls are getting hurt more often- and worse -than our boys.

With more females participating in sports over the last decade, science has devoted a greater focus to female athletes and their development. Currently, data for gender-matched sports show females present a higher incidence of injuries than male athletes. And when we think about it….it makes sense!!! We KNOW that male athletes have more muscle mass and a baseline of strength due to their hormonal makeup (hello higher testosterone!).

YET in gender-matched sports with similar rules (ie softball/ baseball, basketball, soccer, lacrosse, volleyball, etc), males and females are exposed to the SAME FORCES on the field or court. But we keep throwing our comparatively weaker females on to this field or court.

It’s no wonder our female athletes keep getting injured!

Girls are seeing an increase in injury in sports, particularly

  • stress fractures,
  • ACL tears,
  • and other knee injuries like PFPS (patellofemoral pain syndrome)

What’s the solution? How can we prepare young female athletes for a healthy athletic career?

Strength Training.

The science is clear: strength training is not just a necessary training tool for football players; it is a necessary tool for all ATHLETES to help prepare their bodies for the forces imposed in sport. And based on the current research, it is CRUCIAL we start making strength training a PRIORITY for today’s female athlete. (1)

In this article we are going to discuss:

  • When should females begin strength training programs
  • The ‘neuromuscular spurt’ girls need for athletic development
  • Common injuries and training techniques that reduce risk
  • How CULTURE has created a dangerous myth surrounding strength training for girls

Lifting the Myth: How Young is Too Young?

“The young bodies of modern day youth are often ill prepared to tolerate the demands of sports or physical activity.”

READ MORE AT: http://relentlessathleticsllc.com/2018/12/developing-the-young-female-athlete/

Contributed by: Emily R Pappas, MS Exercise Physiology

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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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