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Sports Medicine

AVP-Poster-13As the trend to participate in sports activities and exercise continues to grow, so do the injuries that result from these activities. OICJ offers a comprehensive sports medicine program to accommodate just about anyone’s injuries. Whether it is a torn ACL in a high school football game or a shoulder injury by a “weekend warrior”, OICJ will provide the proper treatment with highly skilled orthopaedic physicians using the latest, state-of-the-art equipment.

OICJ continues to increase their involvement in Central New Jersey’s athletic community by providing medical coverage for area high schools, collegiate, and professional athletes in need of orthopaedic care. The physicians at OICJ serve as the area’s most highly regarded Sports Medicine specialists.

Muscle Sprains/Strains

Muscle strains and sprains are extremely common conditions, especially in this age of greater recreation and fitness. The injury is usually minor and heals over the course of 2-6 weeks without special treatment or intervention. The initial treatment involves rest, ice, elevation and avoidance of the activity that caused the injury. It is not uncommon for severe sprains and strains to lead to swelling and visible bruising. Muscle strains can benefit from gentle stretching during the healing process, and applied heat before activity, ice after activity. Obvious deformity of the muscle, severe swelling and pain, or other confusing symptoms should be brought to the attention of your orthopaedic physician.

Joint sprains vary in severity from:

  • Grade 1 – Mild Sprain
  • Grade 2 – Partial Ligament Tear
  • Grade 3 – Full Ligament Tear

Injuries that make it very difficult to walk or function deserve orthopaedic evaluation, as certain patterns of ligament injury will benefit from bracing, physical therapy, or even surgery. In general, the initial treatment should include; rest, ice, elevation, and anti-inflammatory medications.

Overuse Injuries

“Overuse injuries” is a general term used to describe symptoms caused by repetitive activity or trauma. Examples include: tendonitis, bursitis, stress fractures, muscle soreness, shin splints, tennis elbow, etc. Most of these conditions can be successfully treated without surgery and warrant orthopaedic evaluation when non-surgical treatments like anti-inflammatory medications, rest, ice, and time do not relieve the pain.

Fractures

Broken bones (fractures) are very common for all ages. The active patient is susceptible to higher-energy injuries, and the elderly are subject to the fragile nature of their osteoporotic bones. Not all fractures require surgery. The treatment depends on a number of factors including: which bone is injured, whether the bone has displaced or angulated (moved out of place), whether it can be adequately stabilized and immobilized in a cast or brace, other associated injuries, etc. When surgery is recommended, there are many implantable devices, most made of stainless steel or titanium, that help stabilize fractures and encourage them to heal in an optimized position. Few of these devices ever have to be removed, but in certain circumstances are removed at a later date. Such devices include: external fixators, plates, screws, pins, rods, etc. The healing time for fractures can be effected by many variables such as patient age, medical condition, severity of injury, diabetes, infection and tobacco use. In general, most fractures will progress through the healing process over 6-12 weeks.

Hamstring Injury

Hamstring injuries can be painful and disabling. The hamstring muscle group is comprised of the following three muscles: semitendinosus, semimembranosus, and biceps femoris. These muscles are important for bending the knee, straightening the hip, and help to stabilize the knee. They are also important for running and jumping. These muscles can be injured from proximal to distal. Injuries to the hamstrings are graded. A Grade 1 strain is characterized by microscopic tearing without loss of strength and the muscle-tendon unit at the correct length. A Grade 2 strain is the tearing of fibers within the substance of the muscle or tendon or where the tendon meets the bone or muscle. The length of the muscle-tendon unit may be increased, and there is usually decreased strength. A Grade 3 strain is a complete rupture. Bruising may follow the injury 48 hours later and track down the lower extremity. Acute injuries are treated by targeting pain, swelling, and bleeding. Most injuries are managed conservatively. However surgery is sometimes needed.

Calf Muscle Injury

Calf muscle injuries can be painful and disabling. The gastrocnemius and soleus muscles are typically referred to as the calf muscles. These muscles are primarily responsible for allowing you to stand on your toes and push off while walking and jumping. Injury to the medial head of the gastrocnemius muscle is commonly referred to as “tennis leg” due to its high incidence in tennis players. This injury is not exclusive to tennis players but highlights an underlying mechanism of injury due to repetitive weight-bearing push off and direction change. Sometimes the athlete reports an audible pop or feels they were kicked in the back of the leg. Swelling and bruising may present 48 hours after injury. The distal most aspect of the gastrocnemius muscle transitions to the Achilles tendon. An examination is required to confirm that the Achilles tendon in not injured as this injury needs more urgent attention. For a gastrocnemius tear, treatment is initiated by targeting pain, swelling, and bleeding. Most injuries are managed conservatively with early aggressive physical rehabilitation.

Concussion Injury

A concussion is defined as a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces. A direct blow to the head, neck, or transmitted force to the head may cause a concussion. Typically a concussion involves the rapid onset of neurologic impairment with resolution of symptoms over a short period of time. Often, a concussion is characterized by symptoms of clouded or loss of consciousness, headache, emotional lability, cognitive impairment with slowed reaction time, drowsiness, and other manifestations of general cognitive insult. A concussion reflects a functional disturbance of the brain without anatomic damage to the brain. Therefore, there are typically no abnormal findings on standard structural neuro-imaging studies. Symptoms gradually improve over time, although some individuals may have prolonged symptoms. Treatment generally includes rest, avoidance of activities that make symptoms worse, and protecting the athlete from the possibility of catastrophic brain injury due to overzealous return to play.

Anterior Cruciate Ligament (ACL) Injury

Your anterior cruciate ligament (ACL) stabilizes your knee to prevent unwanted movement of the bones that meet to form the knee. When the ACL is injured, it can be surgically repaired to restore the knee’s stability and normal function.

The knee, which is the largest joint in the body, is considered a “hinged” joint since it is designed to allow the knee to flex (bend) and extend (straighten). The knee is formed by the femur (thigh bone), tibia (shin bone) and patella (kneecap). Each bone is covered with a layer of smooth cartilage, called articular cartilage. The knee maintains its stability through a series of ligaments that act like rubber bands to allow motion while maintaining proper orientation of the bones. The demands placed on the knee sometimes exceed its limits. In fact, the knee is the most commonly injured area for athletes.

ligamentBoth the anterior cruciate ligament, or ACL, and the posterior cruciate ligament (PCL) stabilize the knee. The ACL and PCL cross each other in the center of the knee. The ACL is tightest when the leg is straight, and the PCL is tightest when the leg is flexed. The ACL, which runs from the front of the tibia to the back of the femur, prevents the tibia from gliding forward. The PCL prevents the tibia from gliding backward.

If these ligaments are stretched too far, they can tear or separate. This injury can require replacement of the torn ligament with tissue from other locations to make a supporting structure similar to the original ligament.

Injuries to the anterior cruciate ligament are often associated with athletic endeavors. There are several ways these can occur. Many times, it is during a deceleration maneuver or one in which direction is changed quickly. Patients cannot continue with athletic participation and often require assistance with ambulating immediately after the injury. Significant swelling is a common finding, and once pain subsides, patients will describe a feeling of the knee being “unstable,” or they will describe a lack of confidence in the knee. Some patients have repetitive giving way episodes. Explaining to your doctor what movement caused your injury helps your doctor determine which part of your knee was damaged.

The anterior cruciate ligament, along with its companion, the posterior cruciate ligament, helps to control movement of the lower leg, or tibia, on the femur. A knee without an anterior cruciate ligament is at increased risk for meniscal injuries or articular cartilage degeneration in the future. Many patients choose to have their ACL reconstructed to allow return to the activities of daily living as well as sports or work-related activity.

There are several graft options to reconstruct an anterior cruciate ligament. Grafts can be from the patient’s tendon tissue (autografts) or from a cadaver donor (allograft). There are advantages and disadvantages, as well as risks and benefits, to these different types of grafts and these should be discussed with the patient’s surgeon in order to choose which graft is best for each individual.

Postoperatively, the patient will require a course of physical therapy that will usually last several months. The goal of the procedure is to return patients back to their pre-injury level of activity.

Meniscus Tears

There are two menisci in your knee. One is medial or on the inner side of the knee. The other is lateral or on the outer side of the knee. These structures provide cushioning, stability, and support for the articular cartilage (surface cartilage which covers your bone). They are among the most important structures of the knee.

Over time, these cartilaginous structures lose some of their flexibility, and become more brittle. In younger patients, they often tear from an identifiable traumatic injury. In patients over 40, they tend to tear with much less trauma, and often occur in the course of what we would consider daily activities such as climbing, kneeling, or crouching.

Meniscal injuries commonly cause pain along the joint lines (where the femur and tibia meet), as well as swelling and stiffness. The more severe injuries cause the knee to lock, catch, or give way.

Not all meniscal tears require surgery. Meniscal tears are sometimes found on the MRI studies in patients without meniscal symptoms. Your surgeon will use information from history, physical examination, and imaging studies such as x ray and MRI, to make an informed decision as to whether a meniscal injury requires a surgical treatment, rest, physical therapy, and possibly arthroscopy.

Arthroscopy is used to remove unstable portions of the meniscus, or repair meniscal tissue in patients who are younger and have a better blood supply to the meniscus. The meniscus has blood supply to only a certain portion of its structure and only certain types of tears are eligible for meniscal repair.

Articular Cartilage/Chondral Injuries

The articular cartilage is the surface cartilage that covers the ends of our bones as they meet to form a joint. It is the smooth white surface you see on the end of your chicken bone. This articular cartilage is only a few millimeters thick. It is a tissue that has little regenerative potential. It changes at the microscopic level over our lifetime, and these microscopic degenerative changes accelerate with wear and tear and injury. There are other conditions which also cause the articular cartilage to erode, including rheumatoid arthritis, an inflammatory conditions such as gout or chondrocalcinosis.

In certain traumatic injuries, the articular cartilage can be chipped off or fractured. In these patients, if they have failed conservative treatment, it may require surgical arthroscopy and debridement, or removal, of loose articular fragments.

More recently, procedures such as microfracture, chondrocyte transplantation, and/or articular cartilage transplantation have been used in the more severe cases. Each of these procedures has it own risks and benefits as well as optimal candidates, and these options can be discussed with the surgeon at the time of your visit.

Patellar Dislocation

The patella is often referred to as the kneecap. It is a round bone, which is purposely very mobile in order to allow our knee to assume different positions. Unfortunately, along with this mobility, it has a tendency in some people to dislocate. This often happens with a twisting-type injury. Sometimes the kneecap “self reduces,” or moves back into place on its own. Other times, it has to be put back in place in the emergency room. This injury can be associated with fractures of the articular cartilage or the bone beneath the articular surface. An MRI is usually useful to discover these type of injuries. Patients often require a period of conservative treatment, physical therapy, rest, and ice. Strengthening of the muscles around the kneecap is important to prevent recurrent dislocations. Unfortunately, some patients experience recurrent dislocation even with conservative treatment. It is more common in female athletes and in patients who have generally lax ligaments. In this subset of the population, ligament reconstruction can be indicated.