New York knee surgery - Doctor Says Recovery for Giants’ Thomas Isn’t Sure Thing

New York Post – August 24, 2011

Terrell Thomas faces a more arduous journey back to playing high-level cornerback for the Giants than most ACL injury patients because his is a repeat injury in his right knee.

Thomas first tore his right anterior cruciate ligament in 2005 while playing for USC.

“Revision surgery is notoriously less successful,” Dr. Jonathan Glashow, a New York orthopedic surgeon and co-chief of Sports Medicine at Mt. Sinai Medical Center, told The Post yesterday.

Although a torn ACL is a major injury, it is fairly common and the success rate for a complete recovery is extremely high.

“The success rate isn’t what it’s said to be: 100 percent,” Glashow said. “It’s probably about 85-88 percent and it’s probably about 75 percent with a revision. Revisions clearly do not do as well.”

The difficulty Thomas faces is that he will have fewer options for how to best repair the damage caused when teammate Jason Pierre-Paul collided with him as the two were pursuing Bears quarterback Jay Cutler on a play late in the first half of Monday night’s preseason game.

“The ACL that’s in there, people think we actually fix; we don’t,” Dr. Glashow said. “You get a new piece of tissue.”

Where that tissue comes from is the issue. Typically, new tissue is harvested from the patella tendon, the quad tendon or the hamstring tendon in the same leg as the damaged ACL. A piece of tissue is taken to make a graft that replaces the original ACL. Dr. Glashow said the next step is to employ an allograft, a graft that uses tissue from another human body, which in this case would be a cadaver.

“The problem with a cadaver tissue is it takes much longer to heal and we don’t like players playing before a year to 18 months when you take a cadaver,” Dr. Glashow said. “You’re probably not going to use an allograft unless the player really wants it. I’ve done them, not wanting to, in professional athletes, and they’ve gone back. I have people playing in the NFL with cadaver graft in them. It’s not a first choice.

“The other option is to steal it from the other knee. If it’s his right knee and his left knee is healthy you can take the patellar tendon from the other knee.”

Dr. Glashow has not examined Thomas and does not know which procedure was used in 2005 to reconstruct Thomas’ right knee. As a New York knee surgery specialist Dr. Glashow regularly performs procedures for many types of knee injuries.

“Unfortunately it’s not so uncommon,” Dr. Glashow said of repeat ACL tears. “The problem is if he’s already taken his patella tendon, do you really want to weaken his front muscle more by taking his quad tendon on the same leg? You take some risks then. It’s a double-edged sword. In some ways you’re robbing Peter to pay Paul.”

Dr. Glashow also cautioned that other injuries in the knee that may have occurred in conjunction with the ACL tear — such as damage to the meniscus or articular cartilage — can affect the outcome of the surgery.

“If that’s been affected one has to fix that as well with microfracture or some kind of cartilage transplant technique,” he explained.

The prognosis remains that Thomas can make it back for the 2012 season, but the repeat injury is troubling.

“It’s not the same thing as having a virgin tear of your ACL,” Dr. Glashow said. “The odds of coming back are not as successful.”

knee injury - N.F.L. Sees Early Surge of Unexpected Injuries

With the N.F.L. lockout season ending and players entering into training camps after no supervised off-season workouts, many expected to see a series of the usual hamstring strains and quadriceps pulls. These are common early-season indicators of overexertion and uneven fitness.

However, so far it seems that the unintended winners of the lockout are orthopedic surgeons New York Times reported that even though training camps have been open for less than two weeks, unofficial counts have 10 players with season-ending Achilles’ tendon tears. Their latest victim, Mikel Leshoure, a rookie running back for Detroit.

According to figures compiled by Football Outsiders, a Web site that tracks every game of the season, nine players were on injured reserve with Achilles’ tendon injuries in the first week of last year’s season. And although the N.F.L. closely tracks injuries, it has not yet received injury data from trainers for training camps.

New York orthopedic surgery experts say that it is common to see spikes in particular injuries early on in the season then to see them drop back down the next. While it is average to see about 8 Achilles injuries during any give season, having 10 before the official start is something to note.

Generally, when there are unusual spikes in injuries, the N.F.L. takes a closer look at the workout programs and weight room regimens to try and figure out how to modify schedules and reduce injuries. Experts say that it is always usual to see muscle and tendon injuries earlier on in training camps, however usually it hamstring pulls are the culprit. One reason why the Achilles tendon injury number may have seen a spike this year is because teams are allowed to have more players than before.

Dr. Jonathan Glashow, a New York orthopedic surgeon and a co-director of sports medicine at Mount Sinai Medical Center in New York City, said the injury frequently happened to weekend tennis players who had not been on the court in months and then tried to play at full speed. He  suspects the frequency will taper off as the football season continues and players work themselves into better shape. The injury is season ending, but it is not usually career threatening, Glashow said.

“It usually happens to muscles that are out of shape or when the limb has other ailments like a knee injury,” said Glashow, who treats professional athletes. “Having had that lockout, maybe some guys didn’t work out. I think they’re more vulnerable.

“My intuitive sense is this injury usually happens in people who are not ready to function yet. It usually happens to people at the beginning of the season, due to a lack of muscle memory or preparation, or at the end of the season, due to fatigue.”

ACL Injuries New York - When is ACL Reconstruction Surgery is Necessary?

In New York orthopedic surgeons see hundreds of ACL injuries to various degrees of severity. Not all ACL injuries require surgical treatment, however. The anterior cruciate ligament (ACL) is a very important ligament in the knee. If the ACL is damaged or torn it can greatly impact physical abilities.  ACL injuries are mostly commonly found in athletes, as they are susceptible to knee and other joint injuries within the realm of high-impact sports.

Signs of a twisted or strained ACL can include a “pop” being heard, immediate onset of swelling in the area, intense pain, and a buckling or unstable sensation in the knee.  Before diagnosing ACL Injuries New York orthopedic specialists will perform tests such as the Lachman Test, Anterior Drawer Test, and Pivot Shift Test to see how much the tibia moves in relation to the femur. In some cases, an X-ray or MRI may be ordered in order to visualize and assess any internal damage to the surrounding soft tissues of the injured area.

Depending on the degree of the ACL injury, your New York sports injury doctor will recommend the appropriate treatment plan. He or she will immediately recommend the well-known rule of RICE:

• Rest the knee by using crutches and keeping weight off of it
• Ice the knee
• Compress the knee with a wrap
• Elevate the leg

Non-surgical treatment is generally recommended for less serious ACL injuries, as well as for those patients who can adapt to the lifestyle. While surgery is often the best cure, it does also require a rehabilitation period. Most older patients who can adapt to becoming less active, & avoid high-intensity sports will do fine with a non-surgical treatment, though they do run the risk of reinjury. Athletes and younger patients who wish to continue with high-intensity, pivoting sports such as soccer, tennis, basketball, football, etc, or who received more than one major ACL injury, or who continue to experience symptoms well after the non-surgical treatment, may be good candidates for ACL reconstruction surgery.

After ACL reconstruction New York patients will enter a structured rehabilitation program. From the time of the surgery it will take about 6 months before an athlete may return to supervised sports playing. Usually, about a year following surgery, the doctor will evaluate the knee to measure the final results of the reconstruction in these areas:

• Motion
• Stability
• Symptoms such as pain or swelling
• How well the knee functions in daily living
• Whether or not the patient has been able to return to sports

Some of these follow-up exams have shown that 90 to 95% of patients with ACL reconstructions have good to excellent results.

Although most specialists will say that surgery is not critical to every treatment process of an ACL injury, reconstruction surgery does provide incredible results. Whether or not a patient is considering a lifetime of high-impact sports playing, surgical treatment does get a person back on his or her feet quicker, and reduces the risk of reinjury.

New York sports injuries - New NonSurgical Procedure Treating Sports Injuries Involves Using Your Own Blood: PRP Therapy

As the co-director of sports medicine at Mount Sinai Medical Center, New York Orthopedic Surgeon Dr. Jonathan Glashow has been at the forefront of American doctors offering platelet-rich plasma (PRP) therapy, a new nonsurgical technique that improves healing from injuries.

In New York sports injuries are common among the best athletes in the world. For those with common sports injuries like sprained ligaments or strained muscles, PRP therapy can deliver remarkably faster healing. It involves injecting injured areas with a concoction of growth factors extracted from the patients’ own blood. “The basic idea is that we’re taking the body’s natural healing elements, concentrating them, and we’re putting them at the site of injury,” says Glashow. “We feel like it supercharges the healing process.”

Dr. Glashow who is a sports injury doctor in New York City has named four sports-injury situations where PRP therapy proves especially effective: post-surgery, ligament sprains where surgery isn’t called for but healing is slow, muscle tears/tendinitis and mild to moderate arthritis. Studies have found that in all of these scenarios, PRP therapy can cut recovery time drastically and even help healing to greater degree in areas known for slow recovery.

Hamstring tears for example are common in baseball players. Where normal healing time from a hamstring tear could take months, injecting those muscles with PRP can return benched players much more quickly. And though the therapy is still considered experimental, there is very little risk involved, since the treatment incorporates the body’s own platelets.  “The thinking with PRP is that if we can find a way to help the body heal itself more quickly, we can help patients return to their lifestyles earlier,” says Glashow.

While much research has focused on the mechanical aspects of healing, this is a potential breakthrough on the biological side. Major laboratory and clinical trials are striving both to deepen doctors’ understanding of how it works and how to best administer it. “Right now there are several lab studies going on that are showing that with PRP therapy, the healing process is being sped up at the cellular level,” says Glashow. “That is the laboratory science of it – showing that this is not hokey and really does work.”

PRP is such a new therapy that there isn’t easy to find a doctor with expertise in it. Glashow advises patients to ask their orthopedic surgeon or sports-medicine specialist if they offer this therapy; if these specialists don’t, they can give you a referral.

New York sports injury doctor - Oblique Injuries Plaguing New York Yankees

As reported by the Wall Street Journal, during spring training New York Yankees team members saw 4 separate cases of oblique injuries. Joba Chamberlain, Sergio Mitre, Greg Golson and now Curtis Granderson, have all been felled by the same condition.

The obliques are a broad, flat band of muscle that connects to the pelvis and helps to rotate the hip. Chamberlain, Mitre and Golson are on the mend with their oblique problems, but Granderson's injury could keep him out for a while.

In New York sports injury doctors are no strangers to oblique injuries, but with so many plaguing the same team at once the Yankees are asking themselves whether the issue might be caused by something about their training regimen. The Yankees had a similar problem in 2007 when a rash of hamstring problems knocked out players like Hideki Matsui, Chien Ming Wang and Mike Mussina.

Team manager Joe Girardi admits spring training is very serious business, with rigorous and intense training exercises. He says "Every year there seems to be one thing, in one camp. And a lot of years, you don't necessarily even change what you did the year before, and it could have been something totally different from last year. It just happens."

New York Orthopedic Surgeon Dr. Jonathan Glashow is co-chair of sports medicine at Mt. Sinai hospital. He said that he and the trainers he works with are seeing more oblique injuries of late, as a focus on core strength— primarily the abdominals—makes the obliques weaker by comparison.

"There's been a rash of focus on core strengthening, the generic core. But it's not so simple. If you strengthen part of the core more than another part of the core, it creates an imbalance and leads to these oblique injuries," Glashow said. "I don't know if it's this training regimen that's brought this rash of them on, because I never remember hearing about all these oblique injuries."

Glashow, who is a specialist in shoulder and knee surgery in New York says baseball players entering spring training may have done something offseason, like intense core training, or have upper abdominal and back muscles that are more developed than their lower equivalents. In either situation, the obliques aren’t always ready for the rigorousness of spring training so suddenly.

"Seeing players, it seems like what's happening is that the exercises they're doing preseason may be creating a little more muscular imbalance, and then they really push it with their first exposure to this explosive rotation. Baseball's an all-or-nothing sport, and when you go all out, you stretch these muscles that aren't perhaps quite ready yet," Glashow said.

One theory from the team was that the heat of AZ could make the players dehydrated, but Dr. Glashow said that heat actually would help the muscles, not hinder them.

"To the contrary, when it's warmer out, they're a little more flexible,'' he said.”If it was colder, maybe that could be a cause.''

Often deferred to for his opinion and treatment of elite athletes, New York orthopedic surgery specialist Dr. Glashow acted as a medical media consultant for ESPN Sports and was a frequent guest on their morning sport commentary “Cold Pizza.” For more information on Dr. Glashow please visit: http://www.glashowmd.com/.