Getting Back in the Game: Athletic Knee and Hip Injuries · 2011-10-10 · Getting Back in the...
Transcript of Getting Back in the Game: Athletic Knee and Hip Injuries · 2011-10-10 · Getting Back in the...
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Getting Back in the
Game: Athletic Knee and
Hip Injuries
Raj Bazaz, M.D. Western Orthopedics
Denver, CO
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My Background
• Grew up Detroit, MI
• Medical School:
–University of Michigan
• Orthopedic Residency:
–Case Western Reserve University
• Fellowships:
–#1 Stem cell repair of cartilage
–#2 Minimally invasive-arthroscopy
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Common Athletic Knee Problems
• Over-use Injuries*
• Ligament Tears
• Meniscus Tears
• Cartilage Injury
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Knee Anatomy
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Knee Overuse Injuries
• Very common
• Patella tendon
– Basketball
• Quad. tendon
• Iliotibial band
– Cyclist / Runners
• Treatment:
– R.I.C.E.
– Therapy
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Ligament Injuries
• Ant. Cruciate Lig.*
• Post. Cruciate Lig.
• Medial Collateral Lig.*
• Lateral Collateral Lig. * Common
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ACL Injuries
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ACL Numbers -U.S.A.
• >95,000 tears / year
• >50,000 surgeries / year
• #’s increasing
– People more active
– Type of sports played
– More women athletes
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ACL Function
• Most important ligament for knee stability
• Important in activities where knee cuts / pivots
– Skiing
– Basketball
– Soccer
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Diagnosis
• History
– Non-contact sports
– Hear “POP”
– Knee swelling
– Stop activity
• Exam:
– Instability test
• Work-up:
– Sometimes MRI
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Treatment Options
• Non-operative:
– (+) no surgery
– (-) cartilage and meniscus damage
• Repair:
– (+) seem intuitive
– (-) poor results >1 year
• Reconstruction:
– (+) good long term results
– (-) Surgery and rehab needed
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ACL Treatment
– In-active patients
• Treat w/o surgery • Activity limitations
– Active patients • Treat w/
reconstruction • Prevents cartilage
& meniscus injury • Reconstruction
with graft
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When Can I Return to Sports??
– Takes 6 months of
rehab. – Graft acts as a
scaffold – Can return to high
level sports with a stable knee
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ACL Gender Differences
• Women have 2-8x more ACL tears than men when participating in same sport
– Lots of theories why
• Different jumping and landing patterns – different muscle recruitment
• Can we do something to prevent this?
– Training programs?
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MCL Injuries
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MCL Injury
• Most common knee ligament injury
• Runs from femur to tibia
• Functions as a side to side stabilizer
• Cause: – Valgus force – Hit outside of
knee • Present:
– Swelling – Pain inner knee – +/- instability
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MCL Injury Treatment
• Grade I, II, III
• If isolated injury can be treated w/o surgery
• Treatment:
– R.I.C.E.
– Motion
– Brace
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Meniscus Injuries
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Meniscus Anatomy & Function
• 2 C- shaped structure
• Act as shock absorbers
• Historical treeatment:
– Arthritis after complete removal
– Lesson: Preserve the meniscus
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Meniscus Tears Numbers
• Tears very common
• Cause:
– Abnormal rotation of the a bent knee during sports
• 2 Age Groups:
– Young
• Large force
– Older
• Minimal injury
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Meniscus Tears
• Present:
– Sudden onset of pain
– Twisting injury
– Knee swelling
– +/- knee locking
• Exam:
– Swelling / Pain
– +/- locking
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Treatment of Meniscus Tears
• Leave alone
– Tear will not heal
• Partial meniscectomy
– Remove torn tissue
• Meniscus repair
– Save torn tissue
Limited healing potential due to blood supply
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Partial Meniscectomy
• Treatment for the majority of tears
• Preserve as much as possible
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Mensical Repair
• Preserves shock absorber
• Most tears are not repairable (<5%)
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Cartilage Defects
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What is the Problem w/ Cartilage?
• No blood supply
• Cartilage cells can not divide
• Lacks healing ability
• How to fix cartilage defects?
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Treatment of Cartilage Defect
• Depends:
– Size defect
• Small Defect:
– Micro-fracture
– Carticel
– OATS
• Large Defect:
– No good answers
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Micro-fracture
• Break through bone under cartilage
• Allow bone marrow cells into defect
• Clot forms
• Repair is scar/cartilage
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Micro-fracture
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Carticel
• Obtain healthy cartilage biopsy
• Grow cartilage cells
• Place back in defect
• Repair:scar/cartilage
• Initial enthusiasm decreased
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Carticel
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OATS
• Take donor plugs of healthy cartilage
• Fill in defect
• Stealing from one place to fix another
• Repair: cartilage/scar
• Can do for small defects
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Cartilage Summary
• No good answers
• Repair scar / cartilage
• How long will repair last?
• My thinking:
–Micro-fracture first
–Other techniques as back up if micro-fracture fails
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Athletic Knee Injury Questions?
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Common Hip Injuries in the Athlete
• Groin pulls
• Hip bursitis
• Cartilage injuries
• Labrum tears
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Groin Pull
• Strain of Adductor Muscles
– Run inner pelvis to femur
• Cause: Rapid stretch of muscle leads to muscle injury
– Sports w/ quick starts & stops
• Presentation:
– Groin pain
– Swell / Bruise
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Groin Pull Treatment
• Treatment:
– R.I.C.E.
– Stretching
– Surgery rarely needed if an adductor tendon pulled off pelvis
• Prevention:
– Warm-up
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Hip Bursitis
• Bursa acts as grease pad
• Between G.T. and gluteal tendons
• Bursa can become inflamed in running athletes
• Presentation:
– Pain on outside of hip
– Pain w/ pressure on bursa
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Hip Bursitis Treatment
• R.I.C.E.
• Therapy –stretching
• Cortisone injection
– Diagnosis
– Treatment
• Surgery
– Remove bursa
– Very rare
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Sports Hernia • Abdominal muscles
attach to pelvis
• Hernia is an outpouching of tissue through area of thin abdomen
• Occur in athletes -?bent forward
• Present:
– Pain low abdomen / groin
– May worsen w/ cough
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Sports Hernia Treatment
• R.I.C.E.
• Surgery
– Often needed to repair weakened tissue
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Hip Cartilage Injury
• Hip is ball / socket joint
• Cartilage lining
• Athlete injury by:
– Joint impaction
– Joint subluxation
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Hip Cartilage Injury
• Presentation:
– Groin Pain
– Catching
• Treatment:
– Before large surgery
– Now hip arthroscopy
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Hip Cartilage Injuries
Remove Cartilage Flap Remove Loose Bodies
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Hip Labrum Tears
• Ring or washer around socket
• Cause of tears:
– Isolated trauma
– Repetitive use in athletes that adduct hip
•Golfers
• Tennis
•Soccer
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Hip Labral Tears
• Presentation
– Adductor athlete
– Groin pain
– Catching
• Evaluation
– Difficult area to examine
– MRI helpful
– Injection helpful
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Labral Tear Treatment
•Treatment w/ hip arthroscopy and labral debridement
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Athletic Hip Injury Questions?
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