Allografts offer cost, healing benefits in sports medicine

From JRF Ortho News– “Allograft use is one of the hottest topics [in the United States] right now,” said Christopher Harner, MD, of Pittsburgh, U.S.A., in a special symposium on allografts at the 7th European Federation of National Associations of Orthopaedics and Traumatology Congress (EFORT). Harner was joined by fellow orthopaedic surgeons Gary G. Poehling, MD, of Winston-Salem, U.S.A., and René Verdonk, MD, PhD, of Gent, Belgium, a member of the Orthopaedics Today International Editorial Advisory Board.

“There has been an explosion in the use of musculoskeletal allografts in sports medicine, and last year more than 1 million graphs were distributed,” Harner said. “Although the tissues improved in safety in the last 10 to 15 years and disease transmission is rare, it still exists.”

Harner said the advantages of allografts include low donor site mobility, decreased operating time and less pain in the first six weeks. He called it the preferred procedure in complex cases such as multiple ligament revision cases. He said the disadvantages include disease transmission and slow incorporation.

Click here to read the entire article.

Bone Bruise: What It Is And How It’s Managed

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

Key Points:

  • A bone is a living tissue with a blood supply, and impact to the bone can cause bruising in the bone’s interior
  • Bone bruises are diagnosed on MRI scan
  • Bone bruises will predictably heal and allow the athlete to return to play, however the time frame for return is widely variable

Many people are surprised to learn that bone has a blood supply. It’s every bit a living tissue as skin, your brain, or your heart. And like any of those other tissues with a blood supply, a bone can be bruised.

Lots of people are familiar with a bruise on the skin. If you bump the outside of the skin hard enough it will cause tiny blood vessels in the skin to break, leading to some bleeding in the skin. This causes the common black/blue/green discoloration. If you hit a bit harder the force can be transmitted deeper, to the underlying muscle. And if you hit harder still that force can go straight to the bone.

A bone bruise is an injury to the interior of the bone (the bone marrow) with enough force to disrupt the internal blood supply but not enough force to crack the outside of the bone. A bone bruise is an injury that almost broke the bone but came up just short. There are several sports scenarios that can cause bone bruises. Common ones I see are direct impact injuries such as a fall onto a hard surface, or a bone bruise to the arm in a batter hit by a pitch. We’ll see a fair number from player to player contact, and there’s also a bone bruise pattern we see on an MRI of a knee with an ACL tear.

One of the key features of a bone bruise is that it can be extremely painful immediately after the injury. Severe pain after impact typically makes an orthopedic surgeon concerned for a fracture, and if the initial x-ray shows no broken bone a common next thought would be for a bone bruise. A bone bruise is diagnosed by MRI scan, and x-rays are typically normal.

The good news about a bone bruise is that the same system that causes the bruise- the internal blood supply- is also the system that creates the environment for healing. Like the bruise in the skin, the bone bruise will typically go on to heal. What’s usually required is limiting the impact loading that caused the problem. In the upper extremity the treatment may be and arm sling or brace followed by light activity until healing. In the lower extremity crutches, a brace, or a boot may be needed.

The tough part about a bone bruise is that they can be very painful, especially in the initial healing phase. The other key consideration for the athlete is that return to play can be highly variable, taking from a couple of weeks to several months.

There are several interesting variables about bone bruises. First, the long term implications of a bone bruise are unknown. We believe that the vast majority of bone bruises will go on to heal in the near term but there isn’t yet enough data to know whether there are any long term implications. Second, the extent of the bruise on an MRI is not necessarily correlated with pain. We see severe pain with fairly minimal bone bruising, and conversely we see some severe bruises on an MRI in people with only a small amount of pain.Logo

Because of the lack of clear correlation between bruising on the MRI, pain, and function, we will usually not repeat an MRI to assess healing but instead rely on how the injured athlete feels and how they are functioning. When pain is resolved and the function is restored we’ll usually allow the athlete to return to play.

From head to toe, swimmers must kick the injuries and pain to get to the top

By Julie Gardner for ATI Physical Therapy

From head to toe, swimmers must kick the injuries and pain to get to the top

While many probably consider swimming a relatively safe sport, injuries can still put these athletes in hot water.  Katie Varnado, ATC from the ATI Sports Medicine department knows about swimming injuries first hand from her work with these athletes.  Here’s what Katie has to say…

What injuries are common…

  • Swimmer’s Shoulder:  The shoulder is the joint most commonly injured, and may include rotator cuff impingement, biceps tendinitis and shoulder instability.  All can result from overuse, fatigue and weakness, especially when proper techniques are not used.
  • Swimmer’s Knee:  This injury occurs during the breaststroke because of the “whip kick,” which places all of the force of the kick on the outside of the knee. The inner ligament of the knee, called the medial collateral ligament, is put under stress.
  • Other Lower Body Injuries: Breaststrokers may experience pain from inflammation of the hip tendons. Lower back disk problems or spondylolisis, a stress fracture in the vertebrae of the spine, may be caused by the dolphin kick.

Prevention…

Katie recommends these tips to help prevent injury. In addition to stretching, there are specific things a diver can do to help ward off a repetitive injury:

  • Understand and focus on proper stroke techniques
  • Lessen repetitive strokes that are causing the  overuse injury
  • Perform core strengthening and cross-training exercises as part of pre and early season routines
  • Be sure to warm-up and cool down after activity and use periods of rest to recover
  • Focus efforts on rotator cuff and scapular strengthening for most shoulder injuries,  and pelvic and hip strengthening exercises for hip and knee injuries
  • Speak with a sports medicine professional or athletic trainer if you have questions  about injuries, exercises and  prevention

Start ACL Injury Prevention Programs When The Players Are Young

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

Key Points:

  • The FIFA 11 injury prevention warmup program has been proven effective in reducing lower extremity injury rates in soccer players
  • Pre-adolescent and adolescent female players are at particular risk for ACL injury, possibly due to risky movement patterns
  • A recent study shows that the pre-adolescent group may benefit most from training with the FIFA 11 program, although all groups show improvements in their movement patterns
  • This study suggests that starting the FIFA 11 program as early as possible would be beneficial

I’ve written and spoken about how much I believe in the value of the FIFA 11 program to reduce ACL and lower extremity injury rates, and make better soccer players. In fact the value of the FIFA 11 has been demonstrated in other sports too. I honestly can’t see why any coach wouldn’t implement this program. It’s part of the regular warmup you’d be doing anyway, and it’s better for your players. Please do it.

ACL tears tend to happen more frequently in teenagers rather than in younger players. Does that mean you should wait until the players are teenagers to start the FIFA 11? This recently published study suggests that the younger players will have greater improvements in body mechanics than the teenagers. The key study result: start the FIFA 11 program in the younger age groups.

This study was recently published in the American Journal of Sports Medicine. In the study, the authors investigated improvement in movement patterns and mechanics in two groups of young players from an 8-week FIFA 11 training program. They had one age group of female soccer players aged 10-12 and another group of female players aged 14-18. In each age grouping there were “intervention” players who participated in FIFA 11 and “control” who did not.  To be clear, this study evaluated the improvements in movement patterns and did not follow the players out to see whether they had reduced injury rates.

Some movement patterns have been shown to be particularly risky for possible ACL tear or lower extremity injuries. For example, landing in a “knock kneed” position is a risky pattern, as is landing with the knee fully extended. The study authors found that the preadolescent 10-12 year old age group started off with more of the high risk injury patterns than the older players. And the younger players had greater improvements in their movement patterns after the 8-week training.

I spoke with study author Dr. Jason Dragoo, who is one of my practice partners at LogoStanford orthopedic surgery. “A few earlier studies suggested that intervention training programs might have a greater effect on athletes classified as ‘‘high risk’’ for ACL injury (meaning that they had poor movement techniques to start with) as compared with those classified as ‘‘low risk.’’ What we found is that preadolescent athletes not only display riskier movement patterns than adolescent athletes but also benefit more from participation in the FIFA 11 program.  I’d start this as early as you can.”

For More Information:

FIFA 11+ poster ages 13 and up

FIFA kids poster ages 7-12