Getting Back in the Game

Your bones, joints and ligaments. Today's orthopedic surgeries restore activity faster and with less pain.
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Maybe it’s from the pivoting action of a thousand golf swings. Or maybe it happened all at once—in a single hip-twisting tackle on the football field. Or perhaps you’ve been weakened by osteoarthritis. Whatever the cause, you’ve torn the labrum—the lining cartilage—in your hip joint, and it hurts. Physical therapy may be one answer, and corticosteroid injections may ease pain and reduce joint inflammation. But thanks to recent advances, corrective surgery is also an option.

“Just a few years ago, we could tell patients they had a labral tear, but we really had no way to fix it,” says Mark C. Pinto, M.D., an orthopedist at Chelsea Community Hospital in Chelsea, Michigan, and a former physician for the U.S. team in the annual World Under-17 Hockey Challenge in Canada. “Now we can repair it with hip arthroscopy.”

Arthroscopy is a procedure in which a pen-sized instrument (an arthroscope) equipped with a tiny video camera and lighting system is inserted into a joint through a buttonhole- sized incision. It allows orthopedic surgeons to view—and often to repair—a wide range of injuries without making large cuts, and it amounts to a revolution in sports medicine. Some 1.5 million knee arthroscopies have been performed on patients in the U.S. since the 1980s. But hip arthroscopy is newer.

“It’s only been within the past three to five years that we’ve had the equipment to use it to treat as well as to diagnose,” says Dr. Pinto. “We have longer instruments and better anchors—devices that keep bone in place during treatment and healing. I suspect that in five years, most orthopedists who practice sports medicine will be doing hip arthroscopy.” The procedure, he explains, can be used to treat not just labral tears but also bone spurs and damaged cartilage in the hip as well as “snapping hip” syndrome, in which the hip audibly snaps or pops when flexed or extended.

But the technology’s application isn’t limited to the hip. “It’s amazing what we can do now with arthroscopy,” says William B. Stetson, M.D., an orthopedic surgeon at the University of Southern California Keck School of Medicine and a team physician for the U.S. Men’s Olympic Volleyball Team. “We can reconstruct complex ligaments in the knee and treat dislocated shoulders and almost all tears in the rotator cuff, the tendons around the shoulder joint.”

Recent years have also brought dramatic new treatments for a range of other orthopedic complaints. Consider a new “less is more” approach to treating arthritic knees: the increasing use of unicondylar, or partial, knee replacement. Today, says Dr. Pinto, “if arthritis affects only one side of the knee, it’s often possible to do less of an operation—take care of the arthritic side and leave the other alone. A smaller area of surgery means a quicker recovery and less overall impact on the patient.”

There’s good news, too, for people with degenerative disc disease, often the culprit in back pain. Between October 2004 and December 2007, four types of artificial invertebral discs (previously used in Europe and Canada) were approved for use in the United States—two for the lower spine, two for the neck.

In the past, when spinal discs became worn with age, causing mild to severe pain and stiffness, “the only option was to remove the damaged disc and fuse the two surrounding bones together,” says Dr. Stetson. “But the disc acts like a shock absorber between two vertebrae. When you remove it and bone rubs against bone, there’s always a risk of worsening arthritis. Now, implanting the artificial disc can create a cushion between the bones. Only a few centers currently are using this technology, but it’s likely to be very important in the future.”

Notable strides have also been made in repairing anterior cruciate ligament (ACL) tears, the bane of female athletes. These injuries, involving the ligament that connects the thigh bone (femur) to the shinbone (tibia), are far more common in women than in men, for reasons that are still being debated.

Now ACL is treated with a new procedure called double-bundle reconstruction that is likely to transform this medical field, explains Dr. Pinto. An attempt to better replicate the knee’s anatomy when repairing the ACL, double-bundle reconstruction takes into account that the ACL comprises two tissue bundles: one that controls forward movement, and another that provides stability when a person pivots, twists, runs or jumps.

Usually, when the ACL is torn, only one bundle is surgically reconstructed. New research, however, suggests that reconstructing both bundles may produce better range of motion, with some patients demonstrating postsurgical range of motion equivalent to that in their uninjured knee as quickly as one to three months after surgery.

“If we can make the technique reproducible and show that it improves patients’ function or the longevity of the reconstruction,” says Dr. Pinto, “this could prove to be a big positive for patients.”


ON THE HORIZON

FUTURE TREATMENT OF INJURIES MAY BENEFIT FROM THREE ONGOING OR EXPECTED BREAKTHROUGHS:

PLATELET-RICH PLASMA GEL is helping to speed healing in procedures for tennis elbow, rotator cuff repair and ACL reconstructions. The injectable gel is created by removing red blood cells from a sample of the patient’s blood, then reintroducing the resulting substance into the body. Clinicians hope to learn to inject it in a way that focuses it more effectively on the site of the injury.

MULTIPOTENTIAL STROMAL CELLS—those taken from the patient’s own body tissue, like bone marrow—also offers promise. In the right environment, these cells (sometimes known as mesenchymal stem cells) can become bone, cartilage, tendon or ligament cells. Orthopedists are experimenting with using them to heal fractures and regenerate torn cartilage.

BIOABSORBABLE ORTHOPEDIC ANCHORS melt into the body. As Dr. Pinto explains, “These anchors are screwed into bone where tissue needs to be attached. They have sutures on them that are threaded through the tissue and tied, thus reconnecting the tissue where it once anatomically adhered.” The anchors will dissolve over time, so if a revision operation is needed later, the surgeon won’t need to work around any hardware.


5 TIPS FOR HEALTHY BONES AND JOINTS

William B. Stetson, M.D., an orthopedic surgeon at the University of Southern California’s Keck School of Medicine, offers these suggestions:

1. If you’re 40 years old or older, get a duel energy X-ray absorptiometry (DEXA) scan for osteoporosis (softening of the bone). Get screened at a younger age if you have a family history of the disease.

2. All adults, regardless of gender, should take calcium supplements to avoid osteoporosis, since very few of us eat enough calcium-rich foods. Consult your physician about how much and what type you should be taking.

3. Limit carbonated and caffeinated beverages. Both steal calcium.

4. Exercise at least 30 minutes a day for bone, as well as cardiovascular, health.

5. If you have osteoporosis, ask your physician about prescription medicines that can help you rebuild bone, and consider taking supplemental glucosamine and chondroitin, which have been shown to have bone-protecting benefits.


Related Read: Conquering Chronic Pain

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