Sports Illustrated—August 8, 2011
In this article Dr. David Altchek of Hospital for Special Surgery shares his thoughts on recent advances in treament for sports injuries.
1. PLATELET-RICH PLASMA THERAPY
In this procedure a patient's blood is extracted and spun in a centrifuge to separate the concentrated platelets, which are then injected at the site of an injury. "Nobody knows just what injuries respond to platelets," says David W. Altchek, MD, orthopedic surgeon at Hospital for Special Surgery in New York City and medical director for the Mets. "There's a very good case for tennis elbow, and we know if you cut yourself with a razor, platelets work [by clotting]."
2. ROTATOR CUFF AND LABRAL TEAR SURGERY
The rotator cuff (the muscles and tendons that stabilize the shoulder) and the labrum (the cartilage band that rings the sholder joint) often tear together. Surgeons used to trim the labrum or create a bony barrier to keep tendons from slipping out of place, but these days after a SLAP (superior labral from anterior to posterior) tear they aim to restore the original anatomy of the shoulder. "The Phillies looked at players who had SLAP repair throughout the organization," Altchek says, "and the return-to-sport rate was [about] 30 percent."
3. SPINAL FUSION
To relieve pressure on the nerves, screws and rods are used to anchor the spinal disks in place. "A lot of linemen need this when they're done playing," says Altchek. "When they drive forward off the line, they extend their spines, and they do this over and over. They end up with instability in the spine that compresses nerves, causing pain."
4. TOMMY JOHN SURGERY
In this procedure a tendon taken from elsewhere in the body is threaded through holes drilled in the arm bones to replace the ulnar collateral ligament. Twenty years ago just over half of Tommy John patients returned at least to the same level of performance, but now the rate is near 90%. "They used to move the ulnar nerve and make more holes in the humerus," Altchek says. "Now they don't move the nerve, and they make fewer and smaller holes to reduce the surgical injury."
5. ACL RECONSTRUCTION
The best procedure of repairing the anterior cruciate ligament (ACL) is using a graft made from part of the patella tendon or from a piece of hamstring tendon. "The science has changed dramatically over the last five years," Altchek says. "Now we restore the exact original anatomy of the knee, and osteoarthritis isn't inevitable."