Dr. Mark Galland Discusses Arthroscopic Rotator Cuff Repair

Written by admin on August 12, 2013 – 11:18 am -

RALEIGH, N.C. – Dr. Mark Galland, M.D., a physician at Orthopaedic Specialists of North Carolina (www.orthonc.com), has announced the release of a podcast in which he discusses the differences between arthroscopic rotator cuff repair and traditional rotator cuff repair. In the podcast, Dr. Galland describes the size of incision that is required for arthroscopic rotator cuff repair as well as its advantages compared to traditional rotator cuff repair.

Traditionally, surgeons have performed open rotator cuff repair when a patient suffers from a tear that requires surgery. In this procedure, an incision is made over the outside of the shoulder, usually about 6-10 centimeters in length, and the muscle beneath the skin is separated to expose the rotator cuff, which is then inspected and repaired.

To prevent significant pain and leave a much smaller incision, orthopaedic surgeons have begun performing arthroscopic rotator cuff repair, which leaves a much smaller incision through the use of small instruments to perform the procedure.

To listen to the podcast, visit: http://drmarkgalland.com/arthroscopic-rotator-cuff-repair-vs-traditional-rotator-cuff-repair/.

QUOTES:
“Arthroscopic rotator cuff repair is performed through multiple small incisions, usually a centimeter in size,” said Galland. “It is an outpatient procedure, so patients can expect to return home to the comforts of their own surroundings and sleep in their own bed the very same day of the procedure.”

ABOUT DR. MARK GALLAND:
Mark Galland, M.D. is an orthopaedic surgeon, sports medicine specialist and physician at Orthopaedic Specialists of North Carolina. Dr. Galland received his medical degree from Tulane University’s School of Medicine and completed his residency in the university’s Department of Orthopaedic Surgery. He began his career in orthopaedic surgery and sports medicine while serving in the United States Navy at a naval hospital at Camp Lejeune, N.C. There, he served as chief of orthopaedic surgery and was the recipient of numerous awards for both leadership and excellence in treating injuries common to sailors and marines. Since beginning with Orthopaedic Specialists of North Carolina, Galland has continued to treat injured athletes. He currently serves as a team physician and orthopaedic consultant to the Carolina Mudcats, the advanced A affiliate of the Cleveland Indians, medical director and orthopaedic consultant to the Louisburg College Athletic Program, medical director of the Barton College athletic program, adjunct clinical professor at Marietta College and team physician and Orthopaedic consultant to several area high schools.

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Anterior Cruciate Ligament Injuries in the Skeletally Immature Athlete…: Journal of AAOS(February 2013)

Written by admin on March 4, 2013 – 6:19 am -

Anterior Cruciate Ligament Injuries in the Skeletally Immature Athlete: Diagnosis and Management

Jeremy S. Frank, MD and Peter L. Gambacorta, DO

Abstract

Intrasubstance anterior cruciate ligament (ACL) injuries in children and adolescents were once considered rare occurrences, with tibial eminence avulsion fractures generally regarded as the pediatric ACL injury equivalent. However, with increased single-sport focus, less free play, and year-round training at younger ages, intrasubstance ACL injuries in children and adolescents are being diagnosed with increased frequency. As in the adult, a knee devoid of ligamentous stability predisposes the pediatric patient to meniscal and chondral injuries and early degenerative changes.

Management of ACL injuries in skeletally immature patients includes physeal-sparing, partial transphyseal, and complete transphyseal ACL reconstruction. Complications include iatrogenic growth disturbance resulting from physeal violation.

In the past 20 years, sports injuries in pediatric and adolescent athletes have dramatically increased. Approximately 38 million young athletes participate in organized sports annually in the United States. Of these, nearly 2 million high school students and almost twice as many athletes aged <14 years are treated for a sports-related injury each year. This new epidemic of sports-related injuries can be partially attributed to the dramatic surge in the number of participants since the passage of Title IX, along with increased emphasis on year-round competition, single-sport concentration, and more intense training.

Summary

ACL ruptures in skeletally immature patients are becoming more common with increased single-sport concentration, year-round participation, and less time spent in free play. It is the role of pediatric sports medicine providers to properly diagnose and manage these injuries. Nonsurgical management, including activity modification, bracing, and physical therapy, is best used for patients with partial tears involving <50% of the ACL diameter. In patients with complete ruptures, chronologic, physiologic, and skeletal maturity must be assessed to appropriately address the injury. Treatment options are predicated on assessment of the patient’s maturity and include physeal-sparing, partial and complete transphyseal, and adult-type anatomic ACL reconstruction. Postoperative management includes weight-bearing and activity modifications, bracing, and a progressive physical therapy protocol emphasizing ROM, closed-chain strengthening, and a gradual and measured return to sport-specific maneuvers. Surgical complications are rare.

Journal AAOS © 2013 (February)


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“Bad Romance” with the Hip

Written by admin on March 1, 2013 – 8:22 am -

Musician and song writer Lady Gaga recently underwent hip surgery to repair a torn labrum. Many fans were concerned and dismayed as she canceled the rest of her current tour. Fans should not be overly disappointed. Hip arthroscopy has a relatively quick recovery and return to a high level of activity is a realistic goal.

Many are unaware that the hip joint has a labrum. As with the shoulder joint, the labrum of the hip is a type of cartilage that provides stability while allowing a high degree of flexibility, and motion of the hip. While labral injuries are much more common in the shoulder, they are being diagnosed with increasing frequency in the hip. A tear in the labrum can be degenerative– which occurs as a result of over-use, or traumatic–due to a sports injury, fall, or accident.

A tear in the labrum of the hip can be difficult to diagnose as it may not be evident on magnetic resonance imaging (MRI). Additionally, many symptoms characteristic of a labral tear of the hip, such as groin pain, clicking, snapping, and decreased range of motion, are also common in other hip conditions including groin strains or sports hernias. To further confound matters, even if an MRI demonstrates a labral tear, it is not necessarily an indication that the tear is the source of the symptoms. Confused yet? Never fear, at the conclusion of a methodical workup and rehabilitation program, the answer is usually clearly obvious. Conservative management of labral injuries is thus, not only an option, but often a necessary part of the diagnostic process. Failure of conservative management, physical therapy or steroid injection, may ultimately lead to surgical repair.

Arthroscopy of the hip involves small incisions and use of a tiny camera to locate the damaged labrum and either repair or remove the damaged tissue. Full recovery after arthroscopic intervention may take 12 weeks or longer depending on both the individual and the extent of the damage.
Recovery can be accelerated with skilled rehabilitation from properly trained individuals such as physical therapists and/or athletic trainers.

Fans of Lady Gaga should remain optimistic that she will return to the stage and “Just Dance” her way to “The Edge of Glory.” Many professional athletes have received similar surgeries, including Alex Rodriguez, Mario Lemieux, and Kurt Warner. Warner, a Super Champion, NFL quarterback, was able to return to full workouts two months after his hip arthroscopy.

Matt Rongstad is an Certified Athletic Trainer, Licensed in the state of NC. Matt is currently training in the GOSM Fellowship.

Dr. Galland is a Board Certified Orthopaedic Surgeon specializing in sports medicine practicing in Raleigh, NC. He serves as the team physician and orthopaedic consultant to the Carolina Mudcats, Cleveland Indians Single-A affiliate as well as many other local high schools and colleges.


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Study: Autograft ACL repair better in young athletes

Written by admin on February 25, 2013 – 3:45 pm -

(FoxNews: May 3, 2012)

A new study suggests young athletes who need knee ligament surgery do better over the long run when their own tissue is used for the reconstruction procedure, rather than tissue from a donor.

The anterior cruciate ligament (ACL) connects the upper and lower leg bones and helps stabilize the knee. It gets the most use in athletes who play a sport such as basketball that involves quick cuts and changes in direction.

Those athletes are also the most likely to suffer a torn ACL — the same injury that took down Chicago Bulls player Derrick Rose in the first round of the National Basketball Association playoffs last weekend.

The new findings support past research suggesting that when those injuries occur, it’s better to use a person’s own tissue to repair their ACL — also known as an autograft, said Dr. Cassandra Lee, a sports medicine doctor at the University of California, Davis, who wasn’t involved in the new study.

Typically, the tissue for an autograft is taken from a person’s hamstring or patellar tendon. The alternative — an allograft — is donated tissue from a cadaver.

For the new study, researchers at the United States Military Academy in West Point, New York tracked members of their 2007 through 2013 classes who had ACL reconstruction before entering the Academy. The students ranged from 18 to 23 years old.

Dr. Brett Owens, the study’s senior investigator and chief of orthopedic surgery service at Keller Army Hospital in West Point, told Reuters Health the researchers started their study after noticing an increase in the number of reconstructions using donated tissue that had failed.

They identified 120 cadets who’d had a total of 122 ACL reconstructions. Of those, 106 had their ACLs reconstructed with autografts; the rest had donor tissue.

Since all cadets receive medical care at the Academy, the researchers knew 20 of the ACL reconstructions failed — meaning cadets had to have the surgery re-done. Those failures happened an average of a year and a half after students started at the Academy.

Of the reconstructions that failed, 13 were from surgeries using the cadets’ own tissue — about 12 percent of all autografts — and seven were from cadavers, accounting for 44 percent of reconstructions that used donated tissue.

The researchers reported that cadets who had ACL allograft reconstruction were almost seven times as likely to need a second surgery compared to when cadets’ own tissue had been used.

Owens and his colleagues also reported that ACL allograft reconstructions failed much earlier, on average, than autografts.

They wrote in the American Journal of Sports Medicine that they recommend the use of autografts in young athletes.

There are about 150,000 ACL injuries every year in the U.S., according to the American Orthopaedic Society for Sports Medicine. The cost of reconstruction surgery varies, but typically runs between $5,000 and $7,000.

Read more


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Soccer players often recover fully from ACL surgery

Written by admin on February 24, 2013 – 7:48 pm -

(FoxNews: September 28, 2012)

Most soccer players are able to return to the field after surgery to repair torn knee ligaments, a new study suggests.

But out of 100 athletes who had reconstructive surgery on their anterior cruciate ligament, or ACL, researchers found female and older players were less likely than younger men and boys to get back in the game.

And by seven years out, 12 of the athletes had undergone a second ACL surgery on the same or opposite knee.

“The good news is, you can get back to a sport like soccer after an ACL reconstruction,” said Dr. Robert Brophy, an orthopedic surgeon from the Washington University School of Medicine in St. Louis, who led the study.

But athletes who’ve had an ACL tear, he added, “need to have a sense of the fact that they’re going to be at risk for future injury.”

The ACL, located in the middle of the knee joint, is most commonly injured during sports that require jumping or quick changes in direction, or when the knee gets overextended.

Female athletes are known to be at higher risk of ACL tears. Regardless of gender, those are typically thought of as season-ending injuries because rehab takes months of working to regain strength and range of motion.

For the new study, Brophy and his colleagues interviewed 100 soccer players who’d undergone surgery to repair a torn ACL in 2002 or 2003.

At the time of surgery, those athletes ranged in age from 11 to 53 years and included high school and college players as well as recreational athletes. Forty-five of them were female.

After surgery, 72 of the athletes returned to playing soccer, usually after a year or so, with most reaching their pre-injury level of play. That included 42 male athletes and 30 female athletes who said they’d gone back to the sport.

People who were younger at the time of injury were more likely to return to the field.

Seven years after surgery, 36 out of the 100 initial athletes were still playing soccer, the researchers reported in The American Journal of Sports Medicine. By then, nine female athletes and three males reported having had another ACL surgery.

The American Orthopaedic Society for Sports Medicine estimates there are about 150,000 ACL injuries in the U.S. every year.

Brophy said there are many reasons why athletes may never return to their sport of choice after an ACL tear. They may not get their conditioning back to where it once was, or they may feel okay running but have trouble with the type of knee function required for soccer or football.

In addition, “they may be afraid of re-injury or feel like it’s not worth the risk,” he told Reuters Health.

That may be especially true for older athletes, he said.

“Life demands may make the rehabilitation more challenging and more difficult to get through, as well as make it more difficult to say, ”(It’s) worth it to go back and play.’”


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Rotator Cuff Tears

Written by admin on January 22, 2013 – 8:24 am -

Your shoulder hurts, but you cannot remember an injury. You are unsure of exactly when and how it began. It wakes you every night and may hurt with many routine daily activities. Sports are no longer possible. Huh?! What happened?

If you’re over the age of 40, your rotator cuff may be beginning to fail, causing discomfort and diminished function. The incidence of rotator cuff tears increases with age, and a specific injury is not required. The rotator cuff is comprised of four small muscles, the supraspinatus, infraspinatus, subscapularis and teres minor. These muscles are responsible for proper motion and stability of the shoulder joint.

Aging and repetitive use often results in weakening of the tendon which detaches from insertion point on the humerus. The process occurs in much in the same way as a blanket becomes threadbare or a rope begins to fray. Over head athletes and those of us with jobs requiring repetitive overhead motion are more susceptible to rotator cuff pathologies.

Symptoms of rotator cuff insufficiency include: achy pain at rest and particularly at night, pain with over head motion or reaching behind the body. Progressively worsening and more frequent pain is also a typical progression of rotator cuff pathology. An orthopedic surgeon specializing in shoulder conditions can help accurately diagnose a rotator cuff tear and initiate appropriate treatment. On occasion more extensive testing such as ultrasound or MRI may be required to better evaluate the condition of the rotator cuff tendons. Results of these examinations will help to determine the most appropriate treatment.

Recommendations may include activity modification (avoid activities that cause pain), physical therapy with elastic bands to strengthen the muscles, oral or topical anti-inflammatory medication, and steroid injections in the shoulder. This treatment will not necessarily reverse the damage, but rather will improve function of the muscles to lessen the daily wear on the remaining tendons, if successful, some healing of the damaged tendons may occur.

If symptoms persist after six weeks of diligent rehab and compliance with conservative treatment plan, more aggressive treatment, such as surgery, may be required. The surgical technique is intended to remove any damaged tendon that lacks adequate blood supply (and thus, is unable to heal) and to repair the viable, healthy tendon attaching it back to the bone. The procedure is arthroscopic (2-4 small incisions), outpatient, and usually performed without the need for general anesthesia. Return to daily living activities usually requires 2-6 weeks. Full recovery can be long and arduous, but excellent results are achieved more than 80% of the time.

Shoulder pain is never something to ignore, and should be evaluated by an orthopedic shoulder specialist to insure the proper course of treatment.

Dr. Mark Galland is a Board Certified Orthopaedic Surgeon specializing in sports medicine, practicing in Wake Forest and North Raleigh. He serves as team physician and Orthopaedic consultant to the Carolina Mudcats, High-A Affiliate of the Cleveland Indians of Major League Baseball, as well as several area high schools and colleges. Dr. Galland can be reached at (919) 562-9410 or by visiting www.orthonc.com or www.drmarkgalland.com or you can follow him on twitter: @drmarkgalland.

Kate Anderson, LAT, ATC is a post-graduate fellow at GOSM, Galland Orthopaedic and Sports Medicine. Follow her on twitter @kattethegreatt.


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The Relationship Between ACL Injuries and Physical Fitness…

Written by admin on December 31, 2012 – 8:15 am -

While “several physiological and physical variables, such as muscle strength, aerobic and anaerobic power, coordination, flexibility and the ability to sustain stress, are required (for physical activities/ exercise). Carter and Micheli stated in their review that poor physical fitness in youth athletes is a risk factor for sports-related injuries”

“This study contributes to the current knowledge of physical fitness as a modifiable ACL injury risk factor by identifying one main risk factor in young ski racers: core strength deficit. Coaches must understand the importance of core training and the strength and neuromuscular aspects of core training. The current findings provide evidence that the ACL injury risk was greater in female…”

For more information or to read the entire British Journal of Sports Medicine article by Christian Raschner, Hans-Peter Platzer, Carson Patterson, Inge Werner, Reinhard Huber, and Carolin Hildebrandt please click below.

skiier article


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Rotator Cuff Injury Pain vs. Biceps Tendonitis: Comparison

Written by admin on December 1, 2012 – 10:35 am -

How might you be able to distinguish Rotator Cuff Injury Pain vs. Biceps Tendonitis


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Josh Baker’s (NY Jets) ACL Injury

Written by admin on September 2, 2012 – 10:33 am -

Josh Baker

The NFL pre-season has yet to begin. Unfortunately for Josh Baker, a NY Jets tight end, the season has already ended. In only the third preseason game of the year; Baker received a blow to his right knee by an opponent’s helmet when attempting to catch a touchdown pass Sunday night in the Jets 17- 12 loss to the Carolina Panthers. The injury may be seen at http://assets.sbnation.com/assets/1316218/kneeinjury.gif
Baker was assisted off of the field. The results of the diagnostic tests concluded that Baker had torn the anterior cruciate ligament (ACL) in his right knee. The ACL is one of the commonly injured ligaments of the knee. Other ligaments of the knee include the posterior cruciate ligament (PCL), medial collateral ligament (MCL), and the lateral collateral ligament (LCL). Although not all ACL injuries require reconstruction; it is recommended that those who tear their ACL have reconstructive surgery if he/she plans to return to sports/activity in the future. If the individual does not receive surgery he or she may need to wear a brace for support and/or modify their activities to accommodate the instability of the knee, and Osteoarthritis of the knee is certain to follow.
Dr. Galland is Board Certified in Orthopedic Surgery and in Orthopaedic Sports Medicine., Dr. Galland recommends and performs the Anatomic-Double Bundle Technique over the traditional “trans-tibial” Technique. These techniques are very different as the traditional trans-tibial technique only reconstructs the anterior-medial portion of the ACL and ignores the posterior-lateral portion of the ligament. The double-bundle technique reconstructs both the anterior-medial and posterior-lateral portions of the ACL. Dr. Galland prefers this technique as it has been shown to improve stability, range of motion and performance while promising to decrease the risk of degenerative arthritis in the joint, and decreases the chance and severity of post-surgical complications.
Galland, M. (2012). Restoring the knee after anterior cruciate ligament (acl) injury using the anatomic-. Retrieved from http://www.orthonc.com/articles/DB_ACL_final_revision_vype.pdf
Posted by Caitlin Davis, ATC/LAT, resident, GOSM program.

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Dr. Galland Releases Podcast on Double Bundle ACL Reconstruction Procedure

Written by admin on August 28, 2012 – 8:55 am -

Dr. Mark Galland has released a podcast discussing the double bundle, or anatomic, ACL reconstruction procedure. In the podcast, Galland discusses what the procedure entails, what types of injuries require the surgery, candidates for the surgery and the proper patient treatment after the procedure.

To listen to the podcast, click here: Double Bundle ACL Reconstruction


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