Jan 29, 2015
Knee Studies Headline AOSSM

By Patrick Bohn

At the American Orthopaedic Society for Sports Medicine’s (AOSSM) Annual Meeting last week, studies were presented showing that early ACL surgery decreases chances of meniscal and cartilage tears and that tissue transplant surgery for athletes with knee damage can provide a return to sports.
The Institute for Cartilage Repair at Hospital for Special Surgery conducted a study on transplanted tissue in athletes with bone and cartilage knee damage and found that, contrary to a widely-held belief, athletes who undergo tissue transplants can return to high level sports.

“Most doctors have thought that by the time you get to this transplant surgery as an option, the expectation is that the patient is just going to be able to walk around and not do sports,” said Riley Williams III, M.D. and director of the Institute.

The study looked at 25 athletes from 2000-08 and found that, after a little more than four years, 15 of those athletes returned to high-level sports, and six others reported being able to participate in limited athletics.

Another knee-related study, led by Theodore J. Ganley, MD, Director of Sports Medicine and Associate Professor at the Children’s Hospital of Philadelphia, found that delaying reconstructive ACL surgery in adolescents for more than 12 weeks resulted in a four- to 11-fold increase in meniscal and cartilage injures.

“The timing of pediatric and adolescent ACL surgery has historically been controversial,” said Ganley. “The theoretical risks of growth disturbance in younger patients are balanced against the risk of further knee damage related to delaying treatment until closer to skeletal maturity.”

The study, which had two groups of 100,000 patients undergo either simulated early or delayed ACL reconstruction, also found that having the surgery early could save patients nearly $30 million in hospital charges.

Determining which athletes are at a higher risk for ACL injuries just got cheaper and easier, according to a study by Greg Myer, sports biomechanist at the Cincinnati Children’s Hospital. Traditionally, determining which athletes were at high-risk for ACL injuries required laboratory-based motion analysis systems.

In the new method, a measurement of an athlete’s tibia is combined with his or her weight and the motions of the knee during landing. This method, which can be done in a doctor’s office with a tape measure and camcorder, correlated strongly to the laboratory method.

“This method may be used as a training camp protocol in partnership with team clinicians or set up and run in the athletic training setting,” Myer said. “This tool can also be used to get high-risk athletes into appropriate interventions to further reduce their potential of injury risk.”

While identifying athletes at a high-risk for ACL injuries is now easier, according to another study, into the effectiveness of ACL and knee injury prevention programs. The authors of the study looked at 15 existing studies on ACL/knee injury prevention programs and evaluated their effectiveness on reducing injuries.

Although nine of the 15 studies showed a reduction in knee and ACL injuries, questions were raised about the way many of the studies were designed, which may have introduced bias into the results.

“There is evidence that injury prevention programs may reduce the risk of some knee injuries, but additional research in necessary,” said Kevin G. Shea, M.D., Intermountain Orthopaedics, Boise, Idaho. “Questions about the efficacy of some programs exist and additional well-designed research studies need to be conducted before we can definitively prove the value of these programs for ACL and other knee injury.”

An evaluation of Major League Baseball disabled lists from 2002-08 has filled a critical gap in injury research, according to the authors of a new study.

“There is very little information about the epidemiology, characteristics or distribution of injuries in Major League Baseball,” said Maj., Matthew Posner, MD, orthopaedic surgeon at the William Beaumont Army Medical Center in El Paso, Texas.

The research showed that pitchers are at a higher risk for injuries than hitters and that pitchers spend a much higher proportion of days on the disabled list. Additionally, a majority of injuries occurred before the All-Star game.

According to the study, prior to the All-Star game, pitchers had a 34 percent higher injury rate than hitters, and pitcher injuries accounted for 62 percent of all days spent on the disabled list. Upper-body injuries required players to spend more days on the disabled list than did lower-body injuries.

Patrick Bohn is an Assistant Editor at Training & Conditioning.

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