Arthroscopic Surgery Helps Athletes Get Back in the Game
“My primary goal is to allow my patients to return to the sports they love as quickly and safely as possible,” says Mills-Peninsula orthopedic surgeon Dirk Diefendorf, M.D.
One of Dr. Diefendorf’s primary tools is the art of arthroscopic surgery – a minimally invasive surgical technique that allows surgeons to examine and repair damaged joints through minute incisions. This is a huge advantage over traditional open surgery because the joint does not have to be opened up fully. This reduces recovery time and increases the odds of surgical success due to less trauma to the connective tissue.
Smaller Is Better
“A vital instrument for the procedure is called an arthroscope,” says Dr. Diefendorf, holding up a thin metal shaft, smaller than the circumference of a pencil. A slim metal tube, just slightly larger than the arthroscope, is inserted into tiny incisions or “ports” in the patient, he explains. Knee repairs typically require two ports; shoulders require three to four. But each port is no more than two to three millimeters wide, leaving tiny scars so fine that, six months later, few patients even notice them. The arthroscope, which includes a miniature camera and a light source, is inserted into the tube and moved from port to port as needed throughout the procedure. Images from the camera are then transmitted to large video monitors located throughout the operating room. These screens enable the surgeon and his or her team to visualize and manipulate the joint and make repairs by guiding their instruments entirely by watching the screens. Joints that are most commonly repaired with this form of minimally invasive surgery include the knee, shoulder, elbow, wrist, ankle, foot and hip. Arthroscopic procedures are often used to treat a variety of orthopedic conditions. Some of these include:
- Torn floating or surface cartilage
- Torn rotator cuff s (shoulder)
- Labral (shoulder) and instability reconstructions
- Reconstruction of ligaments (such as the anterior cruciate ligament, or ACL, in the knee)
- Trimming of damaged cartilage such as a torn meniscus (specialized cartilage also located in the knee joint)
Giant Leap Forward
“Arthroscopic surgery has allowed those of us practicing sports medicine to greatly improve our effectiveness and efficiency in treating these types of injuries, enabling athletes to return to their previous skill level,” says Dr. Diefendorf. In previous years, he says, operations that would take four hours can now be done in one to two hours, which also means the patient requires less anesthesia. “Most people go home the same day as their operation,” he says. “Best of all, the person experiences less pain and the post-operative recovery period is significantly shorter,” Dr. Diefendorf continues. “This greatly increases an athlete’s ability to get back on the field, the course or the court as quickly as possible.”
“Total joint replacement isn’t just about relieving pain in a joint,” says orthopedic surgeon, Paul Hazelrig, M.D. “It’s about getting a person back to living a normal, healthy life.” Over time, joint surfaces can be damaged through injury, old age, trauma or disease, he explains. The most common cause of joint failure is osteoarthritis, a degenerative disorder affecting close to 21 million people in the United States in which cartilage deteriorates, causing injury to the joint. People feel stiffness, pain and loss of movement as bone starts to rub against bone, most often in the knees and hips.
Total joint replacement is a procedure that replaces damaged joint surfaces with man-made materials. In a knee replacement, for example, the tops of the femur and tibia are each replaced with a metal cap. A piece of plastic is then inserted in between the two, along with a plastic component across the top of the kneecap. This allows the kneecap to slide easily, pain-free, against the femur. Dr. Hazelrig describes the procedure in this video segment from Healthpoint TV.
A Permanent Solution
“The results are remarkable,” says Dr. Hazelrig. “Patients go from a disabled state to a state of normal activity in as little as three months. For most people, their new joints last a lifetime. The failure rate for a total knee replacement is one-half of one percent per year. That means if a person lives for 20 years after his surgery, there’s a 90 percent chance that the replacement will last for the rest of his life.”
When he first started doing joint replacements more than three decades ago, Dr. Hazelrig recalls anchoring the components to the bone with cement. That changed 25 years ago as orthopedic surgeons began implanting joint components using a special carpentry technique. This allows them to shape and customize the materials to fit so perfectly into the bone it does not loosen over time and no cement is required.
“We’ve also seen incredible improvements in materials,” says Dr. Hazelrig, adding that cobalt-chrome alloy and ceramic joint bearings have replaced simple polyethylene bearings. “Minimally invasive surgical techniques are another significant advancement, allowing us to do smaller incisions than ever before,” he continues. “This helps the patient recover faster and leave the hospital quicker.” On average, patients are hospitalized for two to three days for a total joint replacement, followed by six or more weeks of physical therapy.
New Limbs, New Life
Dr. Hazelrig recommends the procedure for anyone who has a damaged joint that is beyond repair and does not respond to other treatments. “The majority of my patients are elderly, but many are younger people, too, who have injured their joints in sporting activities or because they are overweight,” he says. “Recovering mobility is also key to getting back to good cardiovascular health and, in general, regaining a brighter outlook on life.”
Brothers Matt and Mitch Labbie share a love of sports and a history of injuries and recoveries. They are among a growing number of young Americans who end up needing medical attention for sports-related conditions.
“I was playing pick-up basketball with friends,” recalls Matt, now a student at San Jose State University. “Another player crashed into me, I heard a big pop and the next thing I know, I’m on the ground screaming,” he continues. “I was in major pain. I found out later I had torn my ACL.”
A Growing Issue
Every year in the United States some 30 million people, primarily children and teens, participate in some form of organized sports. More than 3.5 million participants suffer sports-related injuries. While contact sports such as football, basketball and baseball result in the highest number of injuries, all sports have the potential for damage, whether from collisions or overuse of a body part.
Knees and Shoulders
According to Paul Abeyta, M.D., a Mills-Peninsula orthopedic surgeon, three of the most common sports injuries include damage to the anterior cruciate ligament (ACL) in the knee, the meniscus, also in the knee, and the labrum of the shoulder. “ACL injuries typically occur in stop-and-start type sports that require cutting and pivoting motions,” says Dr. Abeyta.
These injuries are prevalent in sports such as basketball, football, soccer, alpine skiing, martial arts, and certain forms of gymnastics and “ultimate” sports. The ACL is a major ligament stabilizer inside the knee joint. It can be torn in many ways, but is most commonly damaged when the knee is forced too much toward the back or to the side.
“When a patient comes in and says, ‘I’ve blown out my knee,’ typically they are talking about an ACL injury,” says Dr. Abeyta. Often the injury is accompanied by a “popping” sound after impact, as well as swelling and severe pain, and the affected knee usually can no longer support the person’s weight.
The Other Knee Issue
“Another common knee injury, particularly in basketball and soccer players, is a torn meniscus,” says Dr. Abeyta. The meniscus is a horseshoe-shaped section of specialized cartilage that serves as a cushion within the knee. A tear can result from squatting or twisting-type motions.
Common signs and symptoms of a meniscus injury are swelling, clicking, catching and locking. But while the joint feels painful when in use, the pain often goes away when the person is off his or her feet. “If these symptoms persist more than a few days,” says Dr. Abeyta, “you should be seen by a specialist.”
The Thrower’s Injury
“When baseball pitchers wind up to throw, they can tear the top part of the labrum ligament in the shoulder, which is often referred to as a SLAP tear,” says Dr. Abeyta. (SLAP is an acronym that stands for superior labral tear from anterior to posterior.) “Football players are often struck on the arm, and the shoulder can be levered sideways out of the socket,” he continues. “This causes a tear on the front part of the labrum.”
“I was playing football at San Mateo High School, running away from a defender,” remembers Mitch Labbie, now a sophomore at Canada College in Redwood City. “He started tackling me and I was trying to stay upright. I put my left arm down, jammed it into the ground and heard a pop.”
Two years later, Mitch was playing baseball, dove for a ball, tore the labrum in his shoulder, and had to sit out the game for a year.
Back in the Game
“We can get most people back to their sports,” says Dr. Abeyta. “But it can take time. Severe injuries requiring surgical procedures may take up to nine months to heal.”
Both Matt and Mitch have subsequently undergone surgery and physical therapy. Matt now plays shortstop in the San Jose Men’s Senior Baseball League and has also returned to his other love, snowboarding. “I went to Tahoe five times this past season,” he says. “The snow wasn’t very good this year, but my knee was completely pain-free.”
Since his injury, Matt even changed his major to kinesiology and is planning a career as a physical therapist. Mitch is back on the mound and pitched all last season for Canada College. He hopes to someday play baseball professionally.
“It’s been about two years since my surgery,” he says. “I’m back on the field playing the sport I love, and it feels great.”
“Orthopedics,” the latest episode of Healthpoint TV, takes you out on the playing field and into the high-tech operating room at Mills-Peninsula. You’ll hear from our orthopedic surgeons about the most common sports-related injuries and latest technologies to treat bones, muscles, joints and ligaments.
Find out how to warm up and cool down for a safe workout, and get some nutrition tips to help maintain a healthy weight. Read More about “Orthopedics” Airs on Healthpoint TV