Dr. Bicos on Channel 4 commenting on Olympics in Rio!!

What Olympic Sport Would You Play?

Dr. Bicos discusses the Olympics and comments on the common question: What Olympic Sport Would You Play…

Dr. Bicos talks with Channel 4 news on What Olympic Sport Would You Play

Dr. Bicos is a consultant for USA Gymnastics and the National Gymnastics Team.
He is on staff at William Beaumont Hospital in Royal Oak, Michigan.
He is also the Associate Director of the Sports Medicine Fellowship and an Assistant Professor of Orthopedics at Oakland University William Beaumont School of Medicine.

Dr. Bicos attended the Olympic Trials for Men's Gymnastics in St. Louis, MO

Dr. Bicos attended the Olympic Trials for Men’s Gymnastics in St. Louis, MO

Subchondroplasty Procedure for Knee Pain

Often times, patients come into the office complaining of knee pain without one specific injury. When discussing their case, many things “look” negative — such as their x-rays and even their physical examination. What we are finding is that something called Bone Marrow Lesions (BMLs) can be causing their pain, and we have a new minimally invasive technique, called the Subchondroplasty Procedure that can relieve their pain.

What is Subchondroplasty?
The Subchondroplasty® (SCP®) procedure is a minimally invasive surgery designed to access and treat bone defects associated with chronic bone marrow lesions (BMLs) by filling them with a biomimetic bone substitute material (BSM).

SCP® leads to healing as the BSM is resorbed and replaced with new, healthy bone.

How are BMLs diagnosed?
BMLs can only be seen on certain MRI sequences, where they are marked by edmatous or “inflamed” areas that have been shown to represent a healing response surrounding a microscopic insufficiency fracture within the subchondral bone. Below is an example of an MRI with a BMLs. Notice how there is a bright area in the center of the bone.

MRI of Bone Marrow Lesions (BMLs).  The bright white areas show stress in the bone that is a result of micro-cracks.  These cracks can be the result of early arthritis. (Taken from Zimmer Knee Creations Website)

MRI of Bone Marrow Lesions (BMLs). The bright white areas show stress in the bone that is a result of micro-cracks. These cracks can be the result of early arthritis. (Taken from Zimmer Knee Creations Website)

What is the procedure?
The procedure is based on standard theories of fracture healing. Since the BMLs are a sign of micro-cracks in the bone, the theory is to fill those defects with a natural calcium cement that stabilizes the micro-cracks so that your pain goes away. Then with time your body also resorbs the calcium cement.

Below is a picture outlining the procedure. The subchondroplasty is a same-day procedure done with minimally invasive techniques. Often times, you are left with only a couple of small “poke holes” in the skin.

This is a graphic showing the subchondroplasty procedure.  (Taken from Zimmer Knee Creations website)

This is a graphic showing the subchondroplasty procedure. (Taken from Zimmer Knee Creations website)

How do I know if Subchondroplasty is right for me?
Dr. Bicos is trained in the procedure, and as always he would be happy to see you for a consultation to evaluate your specific knee problem to see if you are a candidate. There are many options — even if you do not qualify for the Subchondroplasty procedure, there are usually other treatment choices you can consider.

More specifically for the Subchondroplasty:
Does this describe you?

    — I have experienced symptomatic knee pain for 3+ months
    — I have increasing discomfort when walking or standing
    — I have seen limited benefits from NSAIDs, bracing, injections or physical therapy
    — My symptoms returned after an arthroscopy

If you answered yes to the questions above, you may be a candidate for the procedure!

Subchondroplasty Quick Facts

    — Utilizes a minimally invasive technique
    — Performed in a outpatient setting
    — Requires a short rehabilitation period
    — Future treatment options remain open
For more information on Subcondroplasty — please visit their website.

Find Dr. Bicos’ Bio here.

Please call us at 248-988-8085 for an appointment with Dr. Bicos!

11th Annual Sports Medicine Conference!  Sports Medicine from Head to Toe…

Come to the 11th Annual Performance Orthopedics Sports Medicine Conference. The conference will be held on May 3, 2014 at the William Beaumont Hospital, in the West Auditorium in the Administration Building. Join us of a day of training and informative seminars.

11th Annual Sports Medicine Conference

11th Annual Sports Medicine Conference

Sports Medicine Flyer

Beaumont seeks participants for a research study of a cartilage tissue implant for knee injuries

Beaumont Health System is participating in a research study evaluating an investigational treatment called NeoCart®, a tissue implant made from a patient’s own cells, aimed at repairing certain knee cartilage injuries.

(Original article here)

A total of 245 patients will participate in the research of the surgical implant procedure in up to 40 sites across the United States. Approximately 20 patients at Beaumont will participate.

guettler_surgery
Beaumont orthopedic surgeon
Dr. Joe Guettler, principal
investigator of the study.

Orthopedic surgeons Joseph Guettler, M.D. and James Bicos, M.D. will be leading the study at Beaumont.

The research study will look at damage to the knee’s hyaline articular cartilage, the smooth, white tissue that covers the ends of bones where they come together to form joints. Damage to this cartilage may be caused by an injury or repetitive motion. It is a common problem that results in pain and symptoms, such as swelling, locking of the knee and loss of knee function. Damaged hyaline cartilage has limited capacity to repair or restore itself. Left untreated, the damage may progressively worsen and may lead to chronic conditions such as osteoarthritis.

To perform the procedure, the surgeon first obtains a sample of healthy cartilage from the patient’s knee. The small sample is treated and placed under special conditions in the laboratory that allow for cell growth. These cells are used to form a hyaline-like cartilage tissue implant that is in the shape of a small disc. The implant is then returned to the surgeon for surgical implantation into the patient’s injury site in the knee.

“The current standard of care for knee cartilage injuries is a cartilage-repair surgical technique called microfracture which works by creating tiny fractures in the underlying bone. This procedure is thought to create new cartilage-building cells from a so-called super-clot,” explains Dr. Guettler, principal investigator of the study.

“The purpose of the study is to evaluate the effectiveness of the tissue implant compared with microfracture. We will evaluate the pain and knee function in both treatment groups,” says Dr. Bicos, the study’s co-investigator.

“The possibility of implementing a preventive treatment aimed at undermining the inevitable consequences of degenerative arthritis could be a very significant advancement,” says Dr. Guettler.

Criteria
Patients 18 to 55 years old who have symptoms of knee pain in one knee may be candidates for this study. However, those who have previously failed other treatments or smoke more than one pack of cigarettes per week may not be eligible.

Patients accepted into the study will have a random chance of being treated with the implant versus microfracture. Neither the patient nor the physician may choose the treatment. Patients in each group will have a specific rehabilitation plan and will be evaluated periodically for three years after treatment.

The study sponsor is Histogenics Corp. For more information, visit www.clinicaltrials.gov keyword “NeoCart Phase III” or contact Beaumont Research Nurse Clinician, Lisa Stellon at 248-551-6679 or at lisa.stellon@beaumont.edu.

About Beaumont Orthpedic Services
Beaumont Health System provides a full range of specialized care in the diagnosis, treatment and rehabilitation of all orthopedic injuries and conditions. Beaumont’s department of Orthopedic Surgery offers leading-edge treatments and technology including minimally invasive surgery, implants and trauma surgery. Beaumont is Michigan’s most experienced orthopedic hospital specializing in surgeries of the back, neck, foot, ankle, hand and upper extremities; hip and knee replacement; scoliosis treatment; tumor surgery; pediatric orthopedics; and sports medicine. Beaumont Hospital, Royal Oak is Michigan’s top-ranked hospital for orthopedic care by U.S. News & World Report. Find out more at http://orthopedics.beaumont.edu/.

Dr. Bicos to Discuss Shoulder Pain — Free Lecture!!

Dr. Bicos will discuss the common causes of shoulder pain at The Community House in Birmingham, Michigan on April 23 from 6:30 to 8:30 PM.

Registration is free!!

If you have shoulder pain and want to know a little bit more about why you have it and what the treatment options are, please sign up for this informative lecture.

You can register here.

The Tommy John Injury:  Myths Debunked

With the baseball season in full swing (literally), we are seeing an increased incidence of elbow injuries…especially in pitchers.

Tommy John

Tommy John

The ulnar collateral ligament (UCL) is a ligament on the inside of the elbow that can get torn, stretched, or frayed with a significant amount of throwing. An injury to the ligament, also called the Tommy John ligament can be devastating to a pitchers career. Techniques to reconstruct the ligament have improved over the years and more athletes are returning to a high level of play.

Ulnar collateral ligament repair -- Tommy John Surgery)

Ulnar collateral ligament repair — Tommy John Surgery)

With the upswing in the injury of this ligament, there are also multiple myths that surround this injury and its treatment.

Here are the myths debunked by your very own Dr. Bicos…

1) If I play in multiple leagues, I just have to watch my pitch count for each league and not the total count combined.

    – Wrong!! First of all you should not play on multiple leagues. Studies have shown that athletes who play on multiple leagues have a higher likelihood for severe elbow injuries. Second, the pitch count is the total pitch count for both leagues combined. Just because you are under the limit for both leagues does not mean that you are OK. It is the total pitch count. The players, parents, and coaches need to be responsible and realize the importance of pitch counts and make sure that the athletes do not exceed them in total for all the leagues they are in.

2) If I have the Tommy John surgery, that will make me better than I was before.

    – Wrong!! Players believe that if they make the UCL tighter (“zipping up the ligament”), then this will add speed to their pitches. This is not true. Surgery should only be done when the ligament is torn or degenerated to the point that the player loses accuracy, speed, and has pain. In addition, surgery has its own risks such as infection, post-operative pain, and occasionally loss of motion. If you are not having pain, do not have the surgery.

3) The ligament tears with one bad throw.

    – Wrong!! Although athletes describe a pop at the elbow when the ligament tears, there are usually symptoms that have been at the elbow for quite some time before the tear. This means that you should take elbow pain very seriously because it could be the start of a pathway the leads to UCL rupture. Being proactive can save you a surgery and a year’s worth of rehab.

4) Full recovery after the Tommy John surgery is over a year.

    – Correct!! Full recovery from the Tommy John surgery is typically 12 – 16 months.

Take home point…

Elbow injuries are on the rise in overhead throwing athletes. It is typically because of overuse and the superman (or superwoman) mentality that “I cannot get hurt.” These injuries are real and they do not discriminate between sports or talent. Give your self time to rest and let someone know if you are having elbow pain when throwing. Remember that the physicians at Performance Orthopedics are here to keep you in the game, whatever your game may be.

Play Ball!!

Justin Verlander

Justin Verlander

How to get your child started in sports

This is a great article on how to get your child started in sports.

Remember that the main reason for starting children in sports is for the lifelong benefits from exercise.

Kids_and_sports

Listen to your child for clues of burnout from sports!

The article is from In Motion: Active Living for All Ages.

You can read the article here.

Detroit Tigers Jose Iglesias Out With Stress Fractures — Why?  Dr. Bicos talks Stress Fractures…

Spring is in the air. The snow is melting, and as we wrap up the basketball March Madness, the only thing left is opening day of baseball – hot dogs, peanuts and popcorn, the crack of the bat. But the Tigers will be without Jose Iglesias for the ENTIRE 2014 season due to stress fractures in his legs! How can this be? What are stress fractures and are they that bad that he cannot play the entire season?

Let’s go back to March 31, 2013, almost one year ago, in the first half on an Elite Eight matchup between Louisville and Duke during the NCAA tournament in Indianapolis, IN. A player by the name of Kevin Ware attempted to block a 3 point shot, landed awkwardly, and broke his shin bone in half on prime time TV. Not only did he break his leg in half, but the bone came protruding out of his skin.

Massive traumatic sports injuries like that, after just landing from a jump, are almost always caused by a stress fracture or a stress reaction to the bone. It is as if the bone is “hanging on by a thread” and it just takes that one awkward maneuver for the whole thing to go.

This is why Jose Iglesias is benched for the entire season and basically has to do non-weightbearing conditioning (i.e. he can’t put weight on both his legs) for the next 3 – 6 months. Stress fractures are real, stress fractures are dangerous, and stress fractures can lead to devastating injuries.

How do stress fractures happen?

A stress fracture is the last part of a chain of injuries that can happen to a bone. Most of the time, we never reach a stress fracture because the body tells us that it is in pain, so we limit our activities. It is in situations where we do not listen to our body and ignore the pain, that the injury progress down the pathway that leads to a real fracture.

Our bones are alive, and even though they don’t look like they do much except support our body, they are constantly being replaced by new bone. When we are very young, that new bone growth adds to our height, but when we stop growing, our bones need to be maintained. There is a constant balance between the body removing old bone and replacing it with new bone. That is why we are better than machines – we can technically heal ourselves with new bone or skin, while machine parts can only wear out.

As we place stress on our body, you can think of it as wearing down some bone. That is actually healthy for our bodies, because we put down new bone in response to stress. Hence, we recommend an active lifestyle as one of the preventers of osteoporosis (or brittle bones). But…and this is important…you can do too much damage to the body so that the body can’t keep up with the amount that it has to repair. This is technically the beginning of the chain of events that lead to a stress fracture. The chain of events has many “checkpoints” that our body builds in. There is pain to let us know that we have done too much. There is swelling also to let us know that we have done too much. But if we disregard these clues, bad things can happen.

The chain of events is broken down to normal bone, painful bone, stress reaction, and stress fracture.

If you ever have a chance to look at an old foundation of a house, you see cracks. The cracks are usually small enough that the house does not collapse. The smaller cracks are the same as a stress reaction on a microscopic level. There are certain situations that the cracks develop into a size where part of the house actually collapses – this is a stress fracture.

A stress fracture of the shin bone.  (Red arrow points to stress fracture)

A stress fracture of the shin bone. (Red arrow points to stress fracture)

What is the treatment for a stress fracture?

REST!!! What a stress fracture or even the precursor to a stress fracture is telling us is that the balance between making new bone and taking new bone away is off. The easiest way to correct that balance is rest. Often times, this is the hardest thing for athletes to do, because they are either in season, training in the off-season, or competing in too many sports. I routinely hear the words, “I can’t take any time off because…”, and the excuses are many, ranging from “If I take time off I will lose my position”, “If I take time off I will be kicked off the team”, or “If I take time off I will fall behind the other kids”.

But my point of view is that if you do not take time off you can end up with a catastrophic injury like Kevin Ware, where you have your shin bone sticking out of your skin. These injuries are not made up, they are real.

Your sporting career is not a sprint, it is a marathon. And from that standpoint, you need to give your body adequate time to heal.

Even though Jose Iglesias has stress fractures in both legs, what is he doing? Resting!!

One can say that he has already made it in his profession and that as a high school kid there is even more to prove, but if the pain you have is not letting you reach your true potential, then you are not doing your self any favors.

Bottom line?

Seek out someone who understands athletes and what the pressures are that they face. This is typically a fellowship trained sports medicine physician, such as the ones found at Performance Orthopedics. From there, listen to what they say, because the only thing we want to see is for you to get back in the game, what ever your game may be.

Catch Dr. Bicos on BCTV!

Dr. Bicos does an interview with The Community House on his upcoming shoulder lecture in April.

You can catch the show this week:

Tuesday at 7:30pm
Wednesday at 8pm
Friday at 2pm

Comcast Customers:
In Bloomfield Hills and Bloomfield Township BCTV is on Channel 15. In Birmingham, Beverly Hills, Franklin and Bingham Farms BCTV is on Channel 18.

AT&T/U-verse Customers:
In Bloomfield Hills, Bloomfield Township, Birmingham, Beverly Hills, Franklin and Bingham Farms BCTV is on Channel 99.

WOW! Customers:
In Birmingham, Beverly Hills, Franklin and Bingham Farms BCTV is on Channel 18. BCTV is not available to Bloomfield Customers on WOW!