Thursday, September 3, 2015

Lower Injury Rate on FieldTurf for Football and Soccer ?

Two studies, both by Michael C. Meyers, PhD., found a lower rate of severe injury in college football and college soccer players when the games were played on FieldTurf vs. Natural grass playing surface.  Specifically, there were 24 % fewer ACL knee injuries and 11 % fewer concussions.

Friday, August 28, 2015

Weight Change After Total Knee Replacement

Patients often state that after they have their knee replaced they will "get healthy", meaning eat better and lose the extra weight.  A study published in the June, 2015 Journal of Bone and Joint Surgery looks at data to provide us with the insight as to what really happens.

So here is what they concluded:  69 % of total knee replacement patients demonstrated no change in body weight.  Patients more likely to lose weight after surgery included female gender, and those with higher bmi preop.

Patients that did lose weight had better clinical outcomes scores and patients that gained weight had worse outcomes.

As a surgeon we can help our patients.   But we can not do it alone.  The surgeon and the patient form a team.   Patients also need to participate in their own health improvement and this study shows that without a positive effort by the patient surgical outcomes suffer.

Friday, August 21, 2015

Infection Prevention in Total Knee Replacement Surgery

The following patient factors are associated with  higher than normal surgical site infection rates:

Malnutrition, uncontrolled diabetes (Hemaglobin A1c >7%), Obesity (body mass index greater than 40), surgical time longer than 210 minutes (normal surgical time for Dr. Tarlow is 75 minutes), rheumatoid arthritis, MRSA carrier, and cortisone injection in the months prior to knee replacement surgery.  These factors are all controllable and patients with this risk factors should delay surgery until the risk factor can be mitigated or reversed.

Friday, August 14, 2015

ACL Tears in Children: Knee Surgery Can Be the Optimum Treatment

Growth plate sparing surgical techniques have evolved over the last 20 years.  The risk of growth disturbance is low with these newer methods.  ACL reconstruction should be strongly considered in growing children.  Surgical management provides knee stability allowing return to activities and sports.  Non surgical treatment may put these children at risk for additional injury.   Delays of greater than 3 months result in higher rates of meniscal tears and joint surface damage that may subject these young athletes to premature knee degeneration.  Dr. Mininder Kocher, a leader in the field, believes that physeal sparing ACL reconstruction may be the optimum treatment choice for many young patients.

Friday, August 7, 2015

Return to Sports After ACL Surgery

ACL knee injury continues to be the most common major knee injury sustained by athletes.   The surgical reconstruction methods are greatly improved compared to the 1990's. Return to sport rates are approximately 75 %.

What is still uncertain is the optimum safe time period for the injured athlete to wait until returning to competitive sports.

What is a certainty is that at the 2 year mark most knees are completely healed and the patient can safely return to sport. Return prior to 2 years carrries a 9% risk of retearing of the ACL graft.  But 2 years is "too long" for most patients.

This review article discusses the complexity of deciding when an athlete may return to play.

The advice I commonly give my patients is this.  To return to play after an injury you must have full knee motion, normal strength and no swelling.  Additionally, most ACL injury patients should wait 1 year to engage in competitive activities.  It is the rare patient that choose to return to full play prior to 6 months due to the risk of reinjury to the ACL.