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.

Share this:

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.

Share this:

MCL Injury Basics with ATI’s Hockey Injury Expert

 MCL Injury Basics with ATI’s Hockey Injury Expert

By Brian Rog with Contributions by: Andrew Grahovec and Katie Christopherson, ATC for ATI Physical Therapy.

To compete at the professional level in any sport requires the most athletic, highly skilled and mentally acute individuals in the world. With constant training, practice and exhibitions throughout a season, pushing your body to the utmost physical limits can take a toll on the body over time. In ice hockey, players, by nature, are regarded as some of the toughest athletes on a mental and physical level.

As one of the fastest sports, the conditions during play are dangerous and require sharp focus, balance and grit to compete at a high level. With the speed and physicality of the game, the risk of injury is significantly increased. It’s no surprise that one of the most common types of injuries sustained during play involve the knees.

To get a better feel for the inner workings of the MCL (Medial Collateral Ligament) and MCL injury insight, we teamed up with ATI athletic trainer and hockey injury expert, Katie Christopherson.

The role of the MCL

Considered one of the four primary stabilizing ligaments in the knee, the MCL is the innermost ligament of the knee designed to protect the knee joint’s stability and strength. It also plays a key role in preventing the leg from over-extending inward. For hockey players, the MCL is crucial in helping the knee manage the on-ice demands of skating, planting for contact and more.

Symptoms of an MCL injury

When an MCL becomes injured, you may experience pain on the inside edge of the knee, along with swelling and tenderness. Several hours after the injury, this discomfort may be coupled with difficulty moving and increased levels of pain. It’s also not uncommon to feel a ‘loose or wobbly’ feeling in the knee when walking. At this point, we recommend getting in touch with your primary doctor or local physical therapist to further assess the injury.MCL Injury assessment with ATI

Grades of MCL injuries

Since the MCL’s primary role is preventing the leg for overextending inward, naturally, it assumes a substantial amount of the body’s weight. Because of this, an athlete is more susceptible and likely to experience an injury to the MCL, rather than the LCL (Lateral Collateral Ligament), which is located on the outer side of the knee – opposite of the MCL.

MCL injuries are classified according to three different grades including:

·         Grade 1 (minor): results from a force strong enough to stretch the ligament, but not tear it.

·         Grade 2 (moderate): stretched ligament with some tearing involved

·         Grade 3 (severe): completely torn ligament – and most sever of the three grades

Which sprain is the most common among hockey players?

Given the fast-paced, high-contact nature of the sport, hockey players are at an increased risk of injuring their lower body structures. When looking at the MCL specifically, it’s more common to see Grade 1 MCL injuries resulting from less abrasive blows to the knee or mild twisting motions at the knee. For Grade 2 and 3 MCL injuries, we tend to attribute those to the more nefarious blows or extreme twists to the outside of the knee, which still happen, but not as often as the former.

Rehabbing an MCL Sprain

Among the three grades, a Grade 1 treatment is a more straightforward than the others. A Grade 1 sprain can take typically one to two weeks to heal, whereas a Grade 2 and 3 injuries may take two to four weeks and four to eight weeks, respectively.

MCL Physical TherapyIn rehabbing an MCL sprain or tear, your physical therapist or doctor first determines the grade of the injury and the effect it has on the knee during weight-bearing (the body’s ability to resist or support weight). They’ll also note how the knee joint moves through flexion (bending motion) and extension and how that force displacement is on the MCL. This will ultimately decide what treatments and strengthening methods to use.

Initially, an athlete’s treatment should consist of pain-free, range of motion exercises, such as knee slides on the table, wall slides, assisted slides and riding a stationary bike.

As pain subsides and range of motion increases, this usually indicates that an athlete is ready to incorporate flexion and extension exercises – like open-chain strengthening (hands or feet are not in a fixed position). But that’s not to say that an athlete should shy away from closed-chain strengthening (hands or feet are in a fixed or stationary position), as these are also effective exercises to build into a program.

Once an injured athlete progresses to the more advanced stages of rehabilitation, a concentration on functional activity will be introduced. This may include plyometric exercises and functional activities to ensure dynamic stability of the knee.

At this stage, a great tool for rehabbing a hockey player is a slide board, which is a slick surface that can mimic the motion of the athlete’s leg on ice.  

Dealing with a knee injury?

ATI experts strongly encourage athletes to take care of any minor aches and pains before they compound and get worse. This can be as simple as heating for 20 minutes before activity and icing for 20 minutes after activity when the athlete feels soreness in one particular area. If the pain persists, it might be a good idea to call your physician or visit your nearest ATI physical therapy clinic. In fact, at ATI, we offer complimentary injury screenings, so stop in and see what we can do for you.

Share this:

Aging Atletes and Their Joints.

Steve Kashul talks with Dr. Craig Della Valle from Midwest Orthopaedics at Rush about aging athletes and their joints. Are we getting joint replacements at a younger age and what factors in a more active lifestyle contribute to joint problems.

Dr. Della Valle is a native of New York and received his undergraduate and medical degrees from the University of Pennsylvania in Philadelphia.  He completed his residency at the Hospital for Joint Diseases in New York City.  During his residency he spent a full year devoted to clinical and basic science research in the field of adult reconstructive surgery.  Dr. Della Valle completed a fellowship in adult reconstructive surgery at Rush University Medical Center and Central DuPage Hospital.

He is presently the Aaron G. Rosenberg Endowed Professor of Orthopaedic Surgery and Chief of the Section of Adult Reconstruction at Rush University Medical Center in Chicago, Illinois.

Dr. Craig Della ValleDr. Della Valle is a busy clinician who specializes in primary and revision total joint arthroplasty.  A respected researcher, he has more than 180 peer reviewed publications on topics including unicompartmental, primary and revision total knee arthroplasty as well as total hip arthroplasty, hip resurfacing and revision total hip arthroplasty.

Dr Della Valle is a member of The Hip Society, The Knee Society and The International Hip Society. He currently President for the American Association of Hip and Knee Surgeons, Member at Large for the Knee Society and Secretary of the Hip Society.

Share this: