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ACL Suture Repair For Adolescents: High Failure Rates

What if it was possible to repair the torn ACL by using stitches rather than replacing it with tissue removed from another area in the body? This is attractive as it would theoretically lead to an easier rehab, and avoid possible injury to the growth plates in adolescents. However, a recently published study showed a 49% failure rate at 3 years, compared to a 5% failure rate for traditional ACL reconstruction. This is an unacceptably high failure rate, and ACL repair with stitches is not advised for young athletes.

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Can Hip Resurfacing Save Your Athletic Life?

“Wear and tear” of the cartilage in a joint is a common issue, especially in active people as they age. This type of arthritis is called osteoarthritis. As the cartilage wears away, it becomes frayed and rough, and the joint space between the bones decreases. This can result in bone rubbing on bone.

Osteoarthritis develops slowly and the pain it causes worsens over time. If you are an active person in your 40s or 50s and you have hip arthritis you’ve traditionally had a limited number of options. You could modify activity, lose weight, maintain proper exercise, or take medication. And when all else fails you could consider surgery.

A “total hip replacement” is an outstanding operation for individuals with hip arthritis, but the problem is that it’s not recommended for younger people. Also, almost all surgeons recommend against high-impact activity after a total hip replacement. And that’s where hip resurfacing enters the picture. This procedure may offer the chance to save the athletic life of the very active adult with hip arthritis.

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Shoulder Instability Surgery- Reliable Results For Most Athletes

I wrote last week about improvements in ACL surgery over the last 25 years and this week I’d like to explore improved results from another commonly performed sports medicine surgery- stabilization surgery for the dislocating shoulder. The results here mirror those of ACL surgery in many ways.

Many young athletes dislocate a shoulder from trauma, typically a dive with the arm outstretched overhead. This can happen in any sport involving that kind of motion, and any contact sport.

Most surgeries were performed through a large “open” incision 25 years ago, but nowadays can be performed arthroscopically in most cases. For uncomplicated stabilization of shoulders that have had a small number of dislocations from trauma, we should expect 90% of shoulders to remain stable and satisfaction rates upwards of 80% out to about 5 years with current methods, for recreational athletes.

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When Can I Play Again: Finger Fracture

A broken finger (“finger fracture”) is a pretty common sports injury, often seen with direct impact to the tip of the finger or from a twisting injury. It’s easy to dismiss these as “minor” injuries, but all finger fractures need to be managed properly to allow for normal function to the hand. Mismanaged fractures can lead to significant issues with grip and hand function. Fortunately, proper management of finger fractures will typically allow return to sport in 3-6 weeks, depending on specific factors.

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When Can I Play Again: Tibia Stress Fracture

A stress fracture is an overuse injury that occurs when muscles become fatigued and eventually are unable to absorb the shock from a sport or fitness activity. Rather than being absorbed by the muscle, the stresses are instead transferred to the bone causing an injury to the bone itself. The bone injury is called a stress fracture. It can range from deep bruising within the bone to more severe type of injury where the outer surface of the bone is cracked. The most common site for a stress fracture is in the lower extremities in the tibia or in the foot but can also occur in other areas such as the spine. In this post will cover stress fractures to the tibia and typical return to play times.

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New Treatment For Elbow Ligament Injury: Possible To Cut Rehab Time In Half

The ulnar collateral ligament in the elbow is a critical stabilizer, and one that gets stressed during the baseball pitch. We’ve seen a substantial increase in tears of the ulnar collateral ligament in all age groups but especially in teenage pitchers. The standard of care for those athletes choosing surgery is a ligament reconstruction commonly known as “The Tommy John” procedure. The traditional surgery has undergone refinements over the years and has a high success rate, but the downside is that return to competitive pitching takes more than a year, often around 16 months (that’s two seasons of sport…). But a new procedure offers the chance to potentially cut the rehab time and return to play time to less than half.

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Making The Game Day “Go” Or “No Go” Decision

The decision whether an athlete should be allowed to play or should sit out after injury is always an interesting one to observe from afar. These decisions are particularly difficult for team physicians at the professional level when there is a critical need for an athlete to compete, as I wrote about last week with Egyptian soccer player Mo Salah. (I got that one wrong…).

I’d like to outline below the basic framework that a team physician would take when making this decision. These principles were nicely outlinedin an article co-authored by my former Stanford partner, Dr. Gord Matheson.

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Bone Bruise: What It Is And How It’s Managed

Many people are surprised to learn that bone has a blood supply. It’s every bit a living tissue as skin, your brain, or your heart. And like any of those other tissues with a blood supply, a bone can be bruised.

Lots of people are familiar with a bruise on the skin. If you bump the outside of the skin hard enough it will cause tiny blood vessels in the skin to break, leading to some bleeding in the skin. This causes the common black/blue/green discoloration. If you hit a bit harder the force can be transmitted deeper, to the underlying muscle. And if you hit harder still that force can go straight to the bone.

A bone bruise is an injury to the interior of the bone (the bone marrow) with enough force to disrupt the internal blood supply but not enough force to crack the outside of the bone.

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Rotator Cuff Repair For Young Athletes: An Uncommon Operation With Excellent Results

By Dev Mishra, M.D. President, Sideline Sports Doc Clinical Assistant Professor of Orthopedic Surgery, Stanford University Key Points: Rotator cuff tears requiring surgery are uncommon in young athletes Surgery typically leads to excellent function and very high return to sports at the same level or higher, although overhead athletes may need to change positions The…

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When Can I Come Back From: Collarbone Fracture

By Dev K. Mishra, M.D. President, Sideline Sports Doc Clinical Assistant Professor of Orthopedic Surgery, Stanford University Key Points: Collarbone (or “clavicle”) fractures are common in all age groups, especially in contact sports Most collarbone fractures can be treated without surgery and typically result in excellent function You should generally expect to return to sport…

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