ACL tears are a common injury and being seen with greater frequency and at younger ages. Tears lead to loss of time from sport and activities and can lead to further joint deterioration without prompt recognition and treatment. The standard treatment is a reconstruction with autograft (patients tissue) or allograft (donor, cadaveric tissue). The choice of graft depends on several factors including age of patient and sports activity level. Currently, the time to return to sport has been shown to effect re-injury rates. Historically, 6 months after surgical reconstruction was considered an appropriate time to return to sports without restrictions. This notion has been challenged by recent studies noting lower re-injury rates by waiting 9 months or more to return to sports.
Newer surgical instruments and a retrospective look at studies from decades ago regarding primary repair have lead to resurgence in interest in primary repair instead of reconstruction. Failure rates have been high with this technique in previous studies that lead to the abandonment of this procedure. However, when evaluating the results or success of repair in specific tears, the results can approach that of a reconstruction. Specifically, proximal tears (from the femur) have better success when repaired. The advantage of a repair is that the ACL can be saved, less invasiveness and potentially faster return to sports. If the repair were to fail the standard options for reconstruction still exist. This is particularly attractive in pediatric patients where reconstruction techniques can injure growth plates.
Not every patient is a candidate but the option should be available for those patients inclined to have a repair over a reconstruction. I offer this to my patients who are appropriate candidates based on MRI appearance and surgical evaluation. Below is a short video demonstrating a repair I performed and the technique utilized.
Breaking the clavicle or “collarbone” occurs from a fall or direct blow to the area. Contact sports like football, rugby and ice hockey are common high risk sports. Falls while cycling, skiing and motor vehicle accidents are other common ways to fracture the clavicle. Immediately following the injury patients experience pain, swelling and limited use of the arm. X-rays are usually sufficient to make the diagnosis and initial treatment involves immobilization in a sling and use of ice and over the counter pain medications.
Treatment can be surgical or non- surgical. Non-surgical management simply lets the fracture heal in the position it is in and includes a period of immobilization. The immobilization period is typically 3-4 weeks until sufficient healing occurs so therapy can begin and pain is decreased. Non-surgical management has been the norm for a long time, however, surgical fixation or repair is gaining popularity for certain injuries.
Surgical repair can be accomplished with a variety of devices, but usually a plate and screws has some advantages. Repair can align very displaced fractures. When the fracture is very displaced and when fragments shorten or ride over each other patients who are active tend to complain of shoulder pain and sometimes weakness or dysfunction. This can be alleviated with surgical repair. In addition, fracture healing time is shortened with surgical repair and risk of fracture not healing is lessened by surgical fixation. Use of the upper extremity is allowed much sooner following surgical repair.
In summary, clavicle fractures can be managed with or without surgery. Treatment decision is made based on fracture type, displacement and shortening. Patients activity level, age and other risk factors are taken into consideration as well. Below is a short presentation on a clavicle fracture I treated utilizing sutures and a plate to restore the anatomy and fix the fracture anatomically.
Tennis elbow is a common problem for patients who play tennis or not. The #Tenex device offers a minimally invasive solution for patients not improving with typical treatments and those who do not want to wait any longer to return to activity. I combine this with PRP at time of the procedure.
Hello, this is my first attempt at blogging. My goal is to provide interesting(hopefully) and useful information about a variety of sports medicine injuries and orthopaedic conditions. The posts will be short, not overly technical and often have associated images and videos of work I have done or problems I have treated. I encourage anyone reading this to comment and ask questions, through a thoughtful exchange I can better understand what information my readers are looking for and what you get the most out of. These posts are not intended to diagnose, treat or give advice; rather to guide you about the injuries you may have and help you on your journey to recovery.
I have been a sports medicine orthopaedic surgeon for 20 years. I have cared for athletes of all levels, from the professional to the weekend warrior. I enjoy treating people of all ages and I welcome pediatric patients with sports injuries. My goal is to get you back on your field quickly, safely and confidently.