Arthroscopy is a minimally invasive technique where small incisions are made at the shoulder, knee, or ankle. One incision is for the arthroscope, a small flexible tube that allows the surgeon to see inside the joint, and the other incision is gives access for the surgical instruments. Compared to the traditional open surgical procedure this technique involves less trauma to the muscles which allows for better joint stability and quicker, less painful recovery.
Elbow Ligament Reconstruction
Repetitive overhead throwing can damage the elbow Ulnar Collateral Ligament (UCL). The UCL is one of the main stabilizers of the elbow during the throwing motion. It is located on the inside (or medial aspect) of the elbow. Throwing a baseball places a tremendous amount of stress on the ligament. In fact, research has shown that the stress generated by each pitch approaches the maximum load that the ligament can withstand. The reason why it doesn’t tear more frequently is that other muscles of the forearm help stabilize the elbow. Additionally, the larger muscles of the body including the legs, core and shoulder help protect against injury.
When the ligament tears, players will get pain on the inside of their elbow. Sometimes, if it is an acute injury, the player will describe hearing or feeling a “pop” on the throw. More commonly, these injuries are chronic or acute-on-chronic in nature. Baseball players may complain of decreased throwing velocity, poor control or the feeling that it takes longer to loosen up. A physical exam performed by a sports medicine specialist will typically make the diagnosis. It is confirmed with an MRI. Imaging studies can assess the degree of injury, which can range from a minor sprain to a complete tear. While sprains and even small partial tears can frequently be treated with rest and physical therapy; complete tears typically require surgical intervention.
The surgery is often referred to as Tommy John Surgery, named after the first player to undergo the procedure. Since that time, it has saved the careers of thousands of baseball players. The procedure typically involves taking a tendon from one’s wrist or knee. This graft is fed through drill holes made in the bones of the forearm (the ulna) and the upper arm (humerus) in the same locations as the native ligament to reconstruct the torn ligament. The surgery itself only takes about 45 minutes. Unfortunately, it is the rehabilitation process that causes the long time necessary for complete recovery.
Recovery focuses on improving motion and strength in both the shoulder and elbow. Flaws in throwing mechanics that may have contributed to the ligament damage are addressed during this recovery period. Athletes typically begin throwing at about 4 months after surgery. They progress to throwing off a mound by about 7 or eight months. Professional pitchers typically take about a year to get back to their previous level of play. Both Dr. Dines’ routinely perform this procedure on high-level throwing athletes. Additionally, they have written dozens of articles and book chapters on the topic and are frequently asked to lecture at local and national meetings on the topic.
Platelets are blood cells that help the body clot blood and stop bleeding. They also contain numerous growth factors and cytokines that stimulate healing in bones and tissue. In the use of Platelet-rich Plasma, a patient’s own blood plasma is concentrated with platelets and used to promote healing of soft tissues – damaged tendons, ligaments, muscles and joints.
PRP injections are prepared by centrifuging the patient’s own blood to concentrate the platelets. They are then injected into the injured area containing the damaged or abnormal tissue. PRP injections are prepared and injected by Dr. Dines right in the office. Dr. Dines typically uses PRP to treat overuse injuries, most commonly those affecting tendons.
PRP was initially though of as a last effort for conservative treatment before considering surgery. However, because PRP can potentially heal injuries as opposed to just decreasing inflammation (which is what a cortisone shot does), it is now being used earlier and more frequently to treat certain injuries. Conditions that respond well to PRP injections include Lateral epicondylitis (Tennis elbow), medial epicondylitis (golfer’s elbow), Achilles tendonitis, patellar tendonitis and elbow ulnar collateral ligament injuries. Rest and a progressive stretching and strengthening program are usually recommended after having a PRP injection.
Sports Injuries of the Ankle
Injuries to the ankle, especially sprains and strains, are common in athletes. Conditions of the ankle that may be helped by surgery include cartilage damage (occurs in about five percent of ankle sprains), removal of bone spurs, removal of debris or scar tissue, and tendonitis or tendon tears.