Former College Athlete Gives Unique Perspective on Knee Cartilage Injury

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It was a typical winter afternoon in southern California playing with his son at the park.

He stepped in a small hole, not unlike a hundred times before in the past without incident, so he brushed it off as just a temporary tweak or mild sprain. He then did a quick jog to the car and noticed a pinch of pain on the outside of his knee with every step forcing him to stop and walk.

Joshua grew up in Southern California playing about every sport imaginable sometimes playing hockey and football games in the same day. He was a varsity four sport athlete in high school, at one point even training with future professional Olympic and elite spartan runners running up ski slopes at the local resorts. In college, he ran under a coach who was an American record holder in the mile. No matter what sport or how many thousands of miles in training, he never suffered any major injuries.

The day after rolling his ankle he noticed he could not quite bend his knee as much and then when playing with his one-year old daughter his knee suddenly locked for a few minutes unable to straighten or bend at all. In the next couple days, Joshua was able to get a stat MRI.

He did know that since college he had put on about five pounds a year and this raised the risk of him having a knee injury or potentially damaging his cartilage.  With his ten years of experience as a Physicians Assistant (PA) in Orthopedic Surgery specializing in sports medicine, he started speculating on his diagnosis – quite possibly a bucket handle meniscus tear.

What he saw on the MRI scan immediately shocked him. He could see clearly that he had sheared off a chunk of his articular cartilage the size of a dime, which looked like a snow plow went through it. “I knew I was in big trouble,” Joshua explains, “…it’s such a bad injury because cartilage does not heal itself and doesn’t regenerate.”

Being dealt this curveball, Joshua started immediately reviewing and researching more about current cartilage surgeries to make the best decision on how to get it treated. Coincidentally, ten years earlier, while going through his graduate PA program, he chose as his master’s project “new treatment strategies in knee injuries for the prevention of knee arthritis.” As a PA in Orthopedic Surgery, he had scrubbed about a dozen cases throughout his ten-year career and knew the complexity of cartilage surgeries. After weighing the pros and cons, he eliminated a possible autograft or microfracture. He reached out to a renowned sports Orthopedic surgeon, Dr. Raffy Mirzayan, about performing a cartilage allograft transplantation.

A few months after the injury and finding a right match, Joshua went through with the two-hour outpatient surgery with no complications. Within six weeks he was walking with a cane and had full range of motion. Now, at five months after the surgery, he can walk normally and go up and down stairs; perhaps most importantly, he is able to play with is two kids again. His hope is to get back to running once his knee has healed (after about eight months) and to get back to running with his competitive college teammates.

He is eternally grateful to the donor and the family and he wants to do something special before he reaches out to them to thank them for the gift of donation. “I really enjoy helping others… I want to be able to pay it forward.

“I haven’t written a letter yet because I want to do something to thank them… I want to write a letter with me doing something (finishing a race) to show them how much of an impact it made for me.”

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Lake Zurich’s Panico produces the ultimate football comeback

Vinnie Panico's amazing recovery from serious injury has him ready to go for Lake Zurich's Friday season opener against Fremd.

The hosts of Sports Medicine Weekly discuss the comeback and remarkable medical transformation of Vinnie Panico, a senior at Lake Zurich and voted Wintrust player of the week.

Four weeks into the 2017 season, in a game against visiting Zion-Benton, on the 12th play from scrimmage, Panico, a junior defensive end for Lake Zurich, hurt his knee. He was chasing down the quarterback and a teammate fell on him from behind and Panico’s left knee violently went in a direction it shouldn’t have. He knew right away that something was terribly wrong.

Doctors feared blood clots, and also that the artery behind his knee could have been severed. A typical knee injury doesn’t produce the kind of swelling that Panico was experiencing. As he was being examined and options were being discussed, Panico was told that he probably wouldn’t play football again. Worst-case scenario, he was in danger of not walking again and possibly losing his leg altogether. Yes, losing it.

Doctors kept Panico in an MRI for two hours as they desperately tried to identify the source of the swelling. The good news after those two hours was that the artery wasn’t severed. The bad news was that Pancio’s knee and the area around it was essentially obilterated.

The posterior cruciate ligament (PCL), the medial collateral ligament (MCL), the lateral collateral ligament (LCL) and the menicus were all completely torn. The anterior cruciate ligament (ACL) was partially torn. The tibia was fractured and the top of the quad muscle was also torn. The inordinate amount of swelling was due to the comprehensiveness of Panico’s injury. Pretty much everything in his knee was compromised and his body was in all-out panic mode… Complete article from The Daily Harold.

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Ask the Doctor!

This regular segment of ‘Ask the Doctor’ addresses questions sent in by Sports Medicine Weekly followers. In this segment we are addressing questions about:

  • Koby Bryant’s technique involving Orthokine and how it compares to PRP.
  • How injuries establish scar tissue.

If you have a question to be addressed on an upcoming show, please click here to submit your question.

Sports Medicine Weekly on 670 The Score

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Bipolar Osteochondral Allograft Transplantation of the Patella and Trochlea

Purpose: To evaluate the outcomes of bipolar osteochondral allograft (OCA) transplantation in the patellofemoral joint.

Summary:

  • Limited studies are available pertaining to OCA transplantation in the patellofemoral joint, especially on bipolar OCAs to both the patella and trochlea
  • Follow-up was obtained on 15 knees that underwent a combined OCA transplant to address either trochlear dysplasia with patellofemoral instability or high grade chondral lesions
  • OCA plugs were harvested from patella and trochlear grafts from the same donor to provide a congruent anatomic surface
  • At an average follow-up of 33.2 months, significant functional improvements were observed in KOOS, IKDC, Tegner, Oxford, Cincinnati, VAS and SANE scores
  • While two patients did require further surgery to address postoperative stiffness and lysis of adhesions, no patient needed revision or conversion to arthroplasty and there were no patellar re-dislocations

JRF Ortho Take Away: While previous studies have shown that OCA transplantation to the patellofemoral joint can have an increased risk of failure compared to other areas of the knee, bipolar OCA transplantation to the patella and trochlea using tissue from the same donor can be a good option. At short to mid-term follow-up, this technique demonstrated significant improvement for recurrent dislocation and high grade chondral lesions.

Click here for the abstract or full article.

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