Orthopedic surgeon at URMC discusses sports medicine treatments that should be going mainstream in the next few years — including biologic augmentation to repair the ligament — and says football, hockey and soccer are the sports causing the most injuries among athletes
By Chris Motola
Q: How are athletes generally injuring themselves these days? What are some of the stresses they’re under that the average person may not be dealing with?
A: Athletes these days are mostly injuring themselves through two different mechanisms. One is a contact mechanism, such as a twisting injury or someone putting weight or force on them; like from a slide tackle in soccer or a hit in hockey. Or it there might not be any impact and they’re trying to do a move or a cut and their knee or shoulder gives out. So those are probably the two most common ways, contact and non-contact.
Q: Which sports are the biggest offenders?
A: Right now football is probably the main sport I see patients getting injured with, but hockey and soccer are also up there. Lacrosse is becoming more common up here in the Northeast, so we see a lot of lacrosse players who get injured. A lot of weekend warriors are getting injured playing pickleball.
Q: What kinds of injuries are you seeing from pickleball?
A: Pickleball injuries are usually to the knee or the ankle. The most common of those would be an Achilles tendon tear or rupture, similar to that of the quarterbacks from the Vikings and Jets. So it’s Achilles tendon injuries and meniscus injuries in the knee.
Q: How easily can athletes return to previous levels of performance after sustaining one of these injuries?
A: It depends on the injury per se. We tend to do conservative treatments with physical therapy and bracing. A lot of the strains, sprains or tendinitis can be treated conservatively that way with pretty good returns to play, about 90% return to play from those. Certain injuries like ACL tears and acute rotator cuff tears and even Achilles tendon ruptures in our pickleball players need to have a surgical discussion. Luckily, the majority of them can get back to sports within six to eight months after the injury is repaired and rehabilitated.
Q: Muscle seems like very durable tissue, but the stuff that’s anchoring it less so. Why is it so much harder to heal ligaments and tendons?
A: The muscle is able to take a lot more force before it completely tears. The tendon sees a lot more of that acute force, where there’s a rupture rather a strain like there would be for the muscle. A muscle can be strained. The muscle’s fibers stretch quite a lot before they rupture. The tendons tend to take the brunt of the injury.
Q: How much does unbalanced muscle strengthening, hypertrophy play into injuries?
A: Yeah, I see a lot of patients where physical therapy would do them a lot of good in helping them rebalance and bringing them back to a more dynamic control of that knee or shoulder or whatever joint they’re having pain with. If we have muscle imbalances in our body, it puts more stress on our ligaments and tendons around that joint. I have patients come in all the time that I evaluate to help them get all their muscles balanced and working in fully functional condition.
Q: Do you apply osteopathic principles to sports medicine?
A: While I trained with MD physicians, being a DO [doctor of osteopathic medicine] can give you a little bit of a different perspective. It’s a more holistic approach that encourages looking at all the different factors, like nutrition or looking at joints above or below. Is the knee injury the result of an old ankle injury that was never rehabbed? Or maybe the muscle is out of balance at the hip and we need to evaluate the hip as well. So I like to make sure we’re not missing anything and getting tunnel vision. So we’re not just treating the injury, we’re trying to figure out why it happened and to prevent it from happening again in the future.
Q: Are there new developments in sports medicine that you’re excited about?
A: There are a few things in the sports medicine world that should be going mainstream in the next few years. One is biologics. So using the patient’s own stem cells or the cells that recruit those cells to promote healing, decrease inflammation and decrease pain. The first of these is platelet-rich plasma (PRP). It’s been used in many different joints to help the healing of ligament injuries. The data is still out and there’s still some controversy, but I expect more data will come out telling us which specific ailments we can use the PRP on to help patients. The next would be a bone marrow aspirate concentrate, which is a stem cell treatment made from your own bone marrow that we can inject to different sites to do the same kinds of things PRP does while really injecting some stem cells in there. There’s some controversial literature there too, but I look forward to seeing more supporting literature come in in the next couple of years. The next big advance is the bridge-advanced ACL repair, which uses a biologic augmentation to repair the ligament instead of replacing it with one from the patient’s body or a cadaver. I expect it to become more mainstream going forward. And the last one is advancements in rotator cuff repair and augmentation. Rotator repair has come a long way in the last 10 to 20 years, but right now we’re still striving to get better outcomes. Right now, about 80% of patients get back to everything in about six months after rotator cuff repair. But we still have 20% of patients who fail to heal or have a re-rupture. So right now we’re looking at augmenting that rotator cuff repair with either cadaver tissue or other biologic augmentation like PRP.
Q: Do you play sports?
A: Yes, I play hockey as much as my schedule will allow. Usually you’ll find me golfing in the summer.
Q: How do you apply your sports medicine principles to your hobbies?
A: I try to make sure I stretch appropriately before and make sure I have the appropriate nutrition before and after. And then just making sure I’m not putting myself too much at risk and make sure I have everything in dynamic control.
Lifelines
Name: Brent Sanderson, DO
Position: Clinical professor of orthopedics at University of Rochester Medical Center
Hometown: Rochester. He does surgeries at Thompson Hospital and Highland Hospital, part of URMC
Education: A.T. Still University
Organizations: American Academy of Orthopedic Surgery, American Orthopedic Society for Sports Medicine, Arthroscopy Association of North America, American Osteopathic Association
Family: Wife. 5-year old Australian shepherd
Hobbies: Hockey, golf