Older Patients with Knee Pain May Benefit from Allograft Transplant Technique

By JRF Ortho

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Knee pain in active patients over 40 is often difficult to treat but according to researchers presenting their work today at the American Orthopaedic Society for Sports Medicine’s (AOSSM) Annual Meeting in San Diego, utilizing a special kind of allograft may be a step in the right direction.

“Our findings note that patients older than 40 may benefit from using a fresh osteochondral allograft transplantation to treat focal cartilage defects, a common cause of knee pain in adults,” said lead author, Dennis Crawford, MD, PhD from the Oregon Health and Science University in Portland, Oregon.

Crawford and his colleagues looked at a total of 80 patients broken into two groups. The study group consisted of 38 patients, 10 women and 28 men who were at least 40 years of age and a control group with 42 patients (27 men and 15 women) who were 39 years of age or younger.

A statistically significant improvement for both groups was noted for the final follow-up for IKDC and all five KOOS sub-scores. Greatest changes were seen in the ability of patients to perform Sports and with improvement in healthful daily activity. Previous surgical treatment was performed on 31 of 38 knees in the study group and 37 of the 42 knees in the control group.


“This type of osteochondral allograft transplantation has traditionally been used in younger active patients with cartilage disorders. However, seeing this type of success allows sports medicine physicians another option in older patients and serves as a predictable biologic joint preservation technique,” said Crawford.


Four Questions to Ask Before Spine Surgery

back pain active adult

If you’ve been told you need spine surgery, it’s smart to get a second opinion. Here are questions to ask any surgeon to help decide where to be treated.


Q: Do they have spine surgery specialists?

A: “For any problem, you want a team that specializes in that surgery, because more experience leads to better success rates,” explains Christopher J. DeWald, MD, spine surgeon. “At Midwest Orthopaedics at Rush, we have the largest team of neck, back and spine specialists in the region. And our surgeons are leaders in their field, teaching the techniques and procedures we have helped pioneer.”

Q: Do they offer less invasive options?

A: “Two-thirds of patients who come here expecting surgery, do not end up having surgery,” says April Fetzer, DO, physiatrist. “At Midwest Orthopaedics at Rush, we have experts in non-surgical alternatives, including injections, pain medicine and rehabilitation options. And, if surgery is needed, many of our spine surgeries are done minimally invasive, because our surgeons invented techniques used throughout the world.”

Q: How experienced are they at this procedure?

A: “Once you know the type of procedure they recommend, the next question is how many have they done?” asks Frank M. Phillips, MD, spine surgeon. “Spine surgery teams at Midwest Orthopaedics at Rush perform the same type of surgeries day in and day out. In fact, no spine surgery team in the region has more experience. And for surgery- especially complex surgeries—the more experience the better.”

Q:What are their success rates?

A: “Hospitals and surgeons are required to report their success rates for every surgical procedure,” explains Kern Singh, MD, spine surgeon. “So, it’s important to ask your surgeon about his or her success rates. The spine surgeons at Midwest Orthopaedics at Rush are very experienced and our success rates are among the best in the country. Which is one of the reasons why the orthopedic program at Rush is ranked among the nation’s best by U.S.News & World Report.”


The section of spine, back, and neck surgery at Midwest Orthopaedics at Rush is comprised of board certified orthopedic doctors, physician assistants and registered orthopedic nurse specialists. Together, this team of leading experts can help diagnose, evaluate and treat patients with varying degrees of neck pain and back pain. Our spine doctors are among the best in Chicago—and the nation—and can help relieve your neck pain or back pain.

Coming Back From: Shoulder Separation

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

Key Points: 

  • A “shoulder separation” is a different injury than a shoulder dislocation
  • The shoulder separation involves a sprain to the ligaments of a joint at the point of the shoulder near the end of the collarbone
  • We will often see these injuries when a player is tackled or falls to the ground on the point of the shoulder, with the arm at the player’s side
  • Most shoulder separations from sports injuries can successfully be treated without surgery

This week I’ll offer up some pre-World Cup injury recovery info, inspired by Egypt/Liverpool brilliant playmaker Mo Salah. There’s been much speculation about the nature of Salah’s recent shoulder injury, and I haven’t been able to find a clear diagnosis in publicly available sources. But if I had to guess (and this is a pure guess), given the way the injury occurred and the evaluation from the physician in the accompanying photo, I’d say he likely sustained a shoulder separation.

First, let’s look at some confusing terminology.

I’ve written previously about shoulder dislocation, a serious condition in which the ball portion of the shoulder (humerus) becomes completely dislodged from the socket. This week we’ll discuss a shoulder separation, another common shoulder injury.

A separated shoulder refers to an injury to the ligaments of the acromioclavicular joint (commonly known as the AC joint), which is the joint between the end of your collarbone and the upper part of your shoulder blade. It’s located near the point of the shoulder.

Most shoulder separations occur during some type of hard fall or contact, such as a player being tackled on to his shoulder, or a cyclist falling and landing on his shoulder. When I see a hard fall to the ground I’ll be suspicious for either a shoulder separation or a broken collarbone if the athlete fell with the arm tucked in to the side, and I’m suspicious for a shoulder dislocation if the athlete fell on to the outstretched hand.

There are six types of shoulder separations. Types 1 and 2 are the most common ones we see in sports injuries and are treated without surgery. Type 3 injuries are also reasonably common, and most of these are treated without surgery (although there is some debate about early repair for the throwing shoulder of an elite athlete…).  Types 4-6 are not seen very often in sports injuries and these will require surgery. I refer to these as “types” although some surgeons will call these “grades”.

  • Type 1 – The ligaments have a mild sprain without a tear.
  • Type 2 – The AC ligament tears, leading to a partial separation.
  • Type 3 – The AC ligament and other associated ligaments tear, leading to a complete separation.
  • Types 4-6 – These are complete separations, serious injuries often requiring urgent surgery. I have seen one type 4 separation in a D1 quarterback during my 23-year career.

Here are typical return to play times for the common types:

  • Type 1:You can usually return to play 2-3 weeks after the injury, depending on your sport and position. You should be comfortable, with full motion, normal strength, and ability to do sport specific motions. Treatment includes rest and anti-inflammatory medication.
  • Types 2 and 3:A Type 2 injury takes about 3-4 weeks to fully heal, and a type 3 injury takes about six to eight weeks to heal. We’ll almost always treat these without surgery, and we’ll use the same return to play criteria as indicated above for the Type 1 injury. If you’re in a collision sport (such as football) I’ll usually recommend you return to play with an AC joint pad to minimize the chance of another injury.Logo

Whether Salah will play is still speculative but most media reports indicate him as “probable”. When it comes time to lacing up the cleats for a possibly once-in-a-lifetime event with the eyes of the country on him, my guess is that he’ll find a way to work his magic from game 1.

The Power of the Placebo

Dr. Cole and Steve discuss the psychological and physiological effects of using a placebo for recovery. Dr. Cole also explains the powerful effect the mind has on assisting the body in recovery.

Sports Medicine Weekly on 670 The Score