“Platelet-Rich Plasma May Have Edge in Jumper’s Knee”

Written by admin on March 14, 2013 – 6:55 am -

By David Douglas: NEW YORK (Reuters Health) Mar 07

Platelet-rich plasma (PRP) injections might be more helpful to athletes with jumper’s knee than focused extracorporeal shock wave therapy (ESWT), according to Italian researchers.

Dr. Mario Vetrano told Reuters Health by email that both approaches “seem to be safe and promising as part of the treatment of jumper’s knee patients. However, both treatments share the same disputes: lack of hard evidence through randomized clinical trials and no standardized treatment protocols.”

To compare outcomes, Dr. Vetrano and colleagues at Sapienza University of Rome studied 46 athletes with tendonopathy due to overuse of the knee extensor mechanism.

They randomized their patients to receive either two autologous PRP injections over two weeks under ultrasound guidance, or three sessions of focused ESWT. Both groups then went on to a standardized stretching and muscle strengthening protocol.

Given minimal or no pain after four weeks, patients were allowed to gradually return to previous training activity. Complete return to sports took place in accordance with the patient’s pain tolerance and recovery.

A blinded reviewer made assessments before and up to 12 months after treatment. The findings were published online February 13th in The American Journal of Sports Medicine.

Both groups showed benefit, and there were no significant between-group differences in outcome measures at two months. No clinically relevant side effects were seen in either group.

However, at six and 12 months, the PRP group showed significantly greater improvement in Victorian Institute of Sports Assessment-Patella questionnaire and pain visual analogue scale. At 12 months, the PRP group also had significantly better modified Blazina scale scores.

Both approaches seem promising, but “given current knowledge,” say the investigators, “it is impossible to recommend a specific treatment protocol.”

Nevertheless, as Dr. Vetrano concluded, “The analysis of our study showed comparable results in both treatment groups at short term, with better results in the PRP group at six and 12 month follow-ups.”

Original Study Published in American Journal of Sports Medicine by Mario Vetrano, MD, Anna Castorina, MD, Maria Chiara Vulpiani, MD, Rossella Baldini, PhD, Antonio Pavan, MD, and Andrea Ferretti, MD.

Abstract available

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For more information on Platelet-Rich Plasma (PRP) therapy, please read my article at www.orthonc.com.


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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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Pushing Limits…

Written by admin on February 26, 2013 – 2:14 pm -

Younger Patients Choose Surgery; Some Sports Are OK, But Which Are Too Much?

(WSJ, April 19, 2011)

John Jeffries, a 49-year-old money manager in Dover, Mass., had hip-resurfacing surgery in 2008 and is now coaching his son’s basketball team and long-distance cycling.

Alex Douglas, a Wall Street software architect, had both knees replaced last year at 39 after years of sports injuries. He can’t wait to go kite-boarding this weekend. “I’ve been cleared to have fun,” he says.

Hard charging baby boomers and Generation X-ers are wearing out their joints at younger ages and turning to joint replacement surgery. But is it a quick fix? WSJ’s health columnist Melinda Beck discusses with Kelsey Hubbard.

Joint-replacement patients these days are younger and more active than ever before. More than half of all hip-replacement surgeries performed this year are expected to be on people under 65, with the same percentage projected for knee replacements by 2016. The fastest-growing group is patients 46 to 64, according to the American Academy of Orthopaedic Surgery.

Many active middle-agers are wearing out their joints with marathons, triathlons, basketball and tennis and suffering osteoarthritis years earlier than previous generations. They’re also determined to stay active for many more years and not let pain or disability make them sedentary.

To accommodate them, implant makers are working to build joints with longer-wearing materials, and surgeons are offering more options like partial knee replacements, hip resurfacing and minimally invasive procedures.

More younger people also need joint-replacement surgery due to obesity, and some orthopedists refer them for weight-loss surgery first to reduce complications later.

Even the most fit patients face a long period of rehabilitation after surgery and may not be able to resume high-impact activities.

“There is, to be honest, some irrational exuberance out there,” says Daniel Berry, chief of orthopedic surgery at the Mayo Clinic in Rochester, Minn., and president of the American Academy of Orthopedic Surgeons. “People may be overly optimistic about what joint replacement can do for them.”

One big unknown: How long will the replacement joints last? In the past, many doctors assumed implants would wear out in about 10 or 15 years, and they urged young patients to put off surgery as long as possible to minimize the risk of needing a costly and difficult revision surgery—or even two. (A total knee replacement typically costs $15,000 to $22,000. A revision can be $45,000 or more, with a higher risk of complications.)

Read more


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