Tag Archives: sports medicine

What to Expect After a Meniscectomy

Injury knee painDr. Stickney, a Kirkland orthopedic surgeon, is an expert in total knee arthroplasty, total hip arthroplasty, exercise and health, and more.

When it comes to meniscal injuries, many patients have little knowledge about the types of treatment options available and their outcomes.  The meniscus, a significant cushion or shock absorber in your knee, is a c-shaped disc of soft cartilage that sits between the femur and the tibia.  When the knee meniscus tears, the cushioning effect diminishes and can cause knee pain and arthritis, eventually requiring treatment. One option is a meniscectomy, a surgical removal of all or part of a torn knee meniscus. A survey conducted by Brophy et al of 253 patients evaluated for meniscal pathology found 62 percent rated their knowledge of the meniscus as “little or none,” and another 28 percent had no idea that meniscectomy procedure–and not a meniscal repair–is the most common surgical treatment for surgical repair. Did you know that?

Since many meniscal tears can require surgical intervention, there’s a clear need to educate patients on options and postoperative considerations: overall outcomes, the risk of needing a subsequent surgery, the ability to return to sport (RTS), the postoperative risk of developing osteoarthritis (OA), the risk of progression to total knee arthroscopy (TKA). Meniscus tear can also affect knee stability, particularly when combined with an anterior cruciate ligament (ACL) injury. A group of doctors at the University of Colorado School of Medicine in Aurora reviewed the current literature on postoperative considerations to help orthopedic surgeons educate their patients on post-meniscectomy expectations.

The review found:

  • Successful return to sport after meniscus surgery was more likely with these circumstances: patients of a younger age, medial meniscectomy and a smaller meniscal resection. The amount of meniscus resected is a function of the size of the tear. All these factors affect the time until patients are able to return to sport.
  • Failure rates after meniscectomy are low when compared to meniscal repair and discoid saucerization procedures. Meniscus repair is done rarely for a large tear, most often in conjunction with ACL reconstruction. The majority of the meniscus has no blood supply and will not heal, so the majority of meniscus surgery involves removing the torn tissue and smoothing the remaining meniscus. Failure rates are increased in patients undergoing lateral meniscectomy.
  • Improved clinical outcomes for non-obese males can be expected in those undergoing medial meniscectomy with minimal meniscal resection. Conversely, if a preexisting angular deformity exists, varus or valgus, which results in an imbalanced load across the knee, the success rate is less predictable. Preexisting degenerative knee changes (damage to the articular cartilage attached to the bones), and anterior cruciate ligament (ACL) deficiency will negatively impact outcomes following a meniscectomy.
  • The risk of developing post-surgical osteoarthritis over the next 10-20 years should be discussed. Meniscectomy increases the risk of developing knee osteoarthritis, particularly in obese females who undergo a large meniscal resection. The development of arthritis after meniscectomy may lead to the need for knee replacement. However, leaving a mobile large meniscus tear clicking around in the knee will more likely result in early arthritis.
  • Meniscectomy is a viable and successful intervention for pain relief and functional improvement for symptomatic meniscal tears, but nonsurgical care should be used first in older patients with preexisting degenerative changes. These patients will likely end up with knee replacement, and an arthroscopic meniscectomy may be an unnecessary step along that path.

If you would like to learn more about meniscal injuries or understand post-surgical outcomes related to meniscectomy, please contact our office. We’ll help you return to your healthy, pain-free lifestyle.

The Potential and Pitfalls of Stem Cell Injections

stemcallcautionWhen it comes to stem cell therapy, it’s wise to be a bit wary. While stem cells can have enormous implications for treatment of injury and disease, many facilities offering stem cell injections are simply looking to capitalize on the buzz surrounding this therapy. If you’re considering stem cell injections for injuries, it’s essential that you learn everything you can about stem cell practices so you can identify the healing potential and possible scams.

This type of therapy involves repurposing self-renewing stem cells found naturally in your body by injecting them into damaged tissue. When you experience an injury, the body’s healing reaction sends undeveloped cells through the bloodstream to the injured area. When they arrive, they develop into repair cells as a response to their surroundings. The goal of stem cell injections is to expedite treatment of injury or disease by harnessing this natural capacity your body has for healing itself.

The procedure begins with stem cell harvesting, where a doctor extracts cells from points within the body, like fat or bone marrow. Alternatively, cells from a donor like blood from an umbilical cord, could be used, but they must be treated first to prevent negative reactions in the patient. The doctor then proceeds to inject this collection of cells, including rare stem cells, to the site of injury. In theory, this enhances the rate at which the body can heal after injury.

With further research and more advances in the field, stem cells will eventually be extracted from your body and separated in a lab to identify cells with specific capacity. For example, when healing an arthritic joint, stem cells for joint cartilage healing will be cultured to increase their numbers, then injected back into your joint in a quantity sufficient to repair it. While this is the ultimate goal, years of clinical research and trials are required first. In fact, the FDA does not currently allow cell removal from your body, processing them in any significant way, and then putting them back into your body, unless the practice is conducted as part of an approved clinical trial.

Many stem cell therapy offerings charge anywhere between $5000 to $10000 to simply take cells from your bone marrow or fat, spin them in a centrifuge to concentrate the cells, and inject them back into the area of injury. This process makes no attempt to identify the number or quality of stem cells harvested. There are no controlled studies proving this process is effective thus far.

As with any treatment, each patient reacts differently. The current literature surrounding stem cell injections states that the treatment is limited by the quantity and quality of stem cells initially harvested. Patients carry varying levels of stem cells, which may result in ineffective transfusions. Another limitation is physical blockages, such as blocked arteries, that inhibit the body’s ability to transport cells throughout the injured area.

Even when the outcome of stem cell therapy is recovery, establishing a cause-and-effect relationship is difficult because of multiple distinct processes taking place during treatment, and the high potential for placebo effects and natural healing. Some patients improve drastically while others show no substantial alterations.

The efficacy of stem cell injections is a point of contention among medical professionals, and because we are still in the experimental stage there’s still a lot we don’t know. FDA regulations for stem cell therapy are subject to change. Be cautious of stem cell treatments offered without regulatory approval or that have not been tested in a registered clinical trial.

When it comes to proven treatments, Dr. Stickney, a Kirkland orthopedic surgeon, is an expert in exercise and healthjoint replacement surgerysports medicine and more. Contact Dr. Stickney and return to your healthy, pain-free lifestyle!

Game Changers: Preventing Common Sports Injuries

soccerSummer 2018 has arrived and World Cup fever is in the air. While we certainly see our share of flops in these matches, many players endure legitimate injuries too. Those same injuries will be happening to people everywhere this summer as we spend more time being active outside. Reviewing these common sports injuries, their symptoms, and injury prevention tactics will ensure you know how to stay safe and keep the ball rolling.

Stay on Your Feet
Soccer players possess the remarkable ability to run nearly nonstop for 90 minutes. However, their effort often comes at a price, especially when warm weather factors in. Groin pulls, thigh strains, and calf cramps are among the most prevalent injuries we see, and they often result from overuse and dehydration. Make sure to stay drink plenty of water, wear the correct equipment, and listen to your body while exercising, especially in the heat.

Bend It
Bending your muscles, ligaments, and joints by stretching regularly will help you “bend it” like the pros. Injuries such as shin splints, ACL tears, and Achilles tendinitis aggravate when athletes don’t stretch or rush back into action too soon. Condition yourself by starting at a low-intensity level and gradually increasing to allow your body to adjust rather than straining its limits. Care for these injuries with rest, ice, and elevation – or call an orthopedic doctor for further evaluation if pain persists.

Tear Up the Turf, Not Your Knees
Soccer, like other summer activities, requires sharp cutting, quick stops, and pivoting. These sudden movements lead to some of the most notable injuries we see in World Cup matches and during summer– ACL tears and ankle sprains. They can occur without contact and may require surgery depending on severity. Take precaution by strength training, wearing the correct footwear, and practicing the proper technique for whatever exercise you choose.

Dr. Stickney, a Kirkland orthopedic surgeon, is an expert in exercise and healthshoulder replacement surgerysports medicine and more. Contact Dr. Stickney and return to your healthy, pain-free lifestyle!

How to Avoid Summer Workout Dangers

summerworkoutStaying safe during your summer sweat sessions is important, whether you’re doing laps in the pool, getting in touch with your inner yogi, or logging miles on the road. Read below for a few tips on injury prevention and how to avoid summer workout dangers.

  1. Stay Hydrated. It may seem like a no-brainer, but becoming dehydrated in the heat of summer is easier than you think. If you want to avoid the unfortunate side effects of dehydration, including light-headedness, heat exhaustion, and heat stroke, it’s crucial to properly hydrate. The National Athletic Trainers Association suggests aiming to consume 17-20 ounces of water two-three hours prior to exercise and seven-10 ounces of water every 10-20 minutes during your workout.
  2. Skip Mid-Day Outdoor Exercise. With peak sun and heat hours being from 10 a.m.- 3 p.m., it’s best to move your workout indoors during this time frame. Plan your bike rides, runs, or swims for early morning, late afternoon, or evening to keep cool and avoid exposing your skin to damaging UV rays. If it’s not possible to workout inside, look for shaded outdoor areas instead.
  3. Use the Buddy System. Heat-related illnesses, like heat exhaustion and heat stroke, can be easier to spot in someone else than they are to spot in yourself. Exercising with a friend or group could make all the difference in avoiding an injury or illness. Some signs to look out for include: confusion, headache, nausea, weakness, and blood rushing to the surface of the skin.
  4. Dress for the Heat. Working out in warm weather means wearing clothing that’s breathable. Sweat-wicking fabrics are especially great because they move moisture away from your skin to the outside of your clothing, where it can evaporate. These types of fabrics also minimize chaffing and keep you feeling cool and comfortable.
  5. Be Sure to Cool Down. When it comes to avoiding injuries in the heat, making sure to do a proper cool down after your exercise session is vital. While many of us stretch prior to working out, the best time to stretch is actually after you exercise, when blood is flowing to the skeletal muscles, your tissues are more pliable, and the risk for injuries is lowered.

Dr. Stickney, a Kirkland orthopedic surgeon, is an expert in exercise and healthjoint replacement surgerysports medicine and more. Contact Dr. Stickney and return to your healthy, pain-free lifestyle!

Middle-Aged Women Who Exercise Could Delay Dementia

exerciseFor middle-aged women, physical fitness may do more than give the heart a boost; it may also benefit the brain in a big way. Recent findings out of Sweden show that middle-aged women with a “high degree” of cardiovascular fitness are 90% less likely to develop dementia later in life than those who had just a moderate fitness level.

The study, published in the journal Neurology, also discovered that if the middle-aged women who maintained a high fitness level did develop dementia, the symptoms tended to emerge 11 years later (on average) than they did for the women who had a moderate fitness level.

To conduct this study, a team of researchers from the Center for Aging and Health at the University of Gothenburg studied the health data of 191 local women, ages 38-60, from 1968-2012. At the beginning of the trial, the participants were given an exercise test in which they cycled on a stationary bike until they felt exhausted.

After tracking the health of the women for 44 years, the researchers found that the initial fitness test scores helped predict whether the participants would be diagnosed with dementia later in life. The results showed that 32% of the women with a low fitness score developed dementia during the study period, compared with 25% of women with a moderate fitness score and just 5% of the highly fit women.

The highest dementia rates were seen in women who started the exercise test but couldn’t complete it: a whopping 45% of these women went on to develop dementia later on in life.

Though this singular study doesn’t fully prove a direct link between exercise and a lowered risk of dementia, it’s clear that exercising frequently (aim for 150 minutes per week) is extremely beneficial for both the body and brain. In years to come, studies like this one will allow researchers to provide clearer recommendations for exercise and other lifestyle modifications to reduce the risk of dementia and more.

 Dr. Stickney, a Kirkland orthopedic surgeon, is an expert in exercise and healthjoint replacement surgery, sports medicine and more. Contact Dr. Stickney and return to your healthy, pain-free lifestyle!

The Link Between Distance Running and Arthritis

marathonAlthough distance running is often associated with numerous health benefits, the impact on hip and knee joint health has been inconclusive up to this point. Long-distance running has been linked with an increased prevalence of arthritis in some studies, but others have shown an inverse association or no association at all.

In a recent study published by Journal of Bone & Joint Surgery, authors Ponzio et al. investigate hip and knee health in active marathon runners, including the prevalence of pain, arthritis and arthroplasty (joint replacement) and associated risk factors.

To conduct their research, Ponzio et al. distributed a hip and knee health survey internationally to marathon runners from 18-79 years old, divided into subgroups by age, sex BMI and physical activity level. The survey questions assessed pain, personal and family history of arthritis, surgical history, running volume, personal record time, risk factors and current running status. The results were then compared with National Center for Health Statistics’ information for a matched group of the US population who were not marathon runners.

What the authors of the study found is that while age, family history and surgical history independently predicted an increased risk for hip and knee arthritis in active marathoners, there was no correlation with running history. In the researcher’s cohort study, the arthritis rate of active marathoners was below that of the general US population.

While the authors conclude that longitudinal follow-up is needed to determine the effects of marathon running on developing future knee and hip arthritis, it’s a hopeful and encouraging finding for long-distance runners.

Dr. Stickney, a Kirkland orthopedic surgeon, is an expert in joint replacement surgerysports medicine and more. Contact Dr. Stickney and return to your healthy, pain-free lifestyle!