Drs. Guettler and Bicos are part of a national study looking at Cartilage Restoration.
The goal is to use patients’ own cells to repair cartilage defects in the knee.
The story can be found here.
Drs. Guettler and Bicos are part of a national study looking at Cartilage Restoration.
The goal is to use patients’ own cells to repair cartilage defects in the knee.
The story can be found here.
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.
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.
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 firstname.lastname@example.org.
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/.
For more information, contact:
Dr. Joseph Guettler
‘Dunk-Out’ Injuries this Basketball Season
Dr. Guettler provide pointers to prevent basketball injuries
Royal Oak, MI—Whether participating in recreational outdoor games, playing on a school team or competing professionally, basketball is one of America’s most popular sport pastimes. With more than 28 million people of all ages taking part each year in this high-impact, extremely charged sport, the potential risk for injury is great. The American Academy of Orthopaedic Surgeons (AAOS) urges players to heed appropriate safety precautions and condition properly to minimize potential musculoskeletal injuries.
According to the U.S. Consumer Product Safety Commission, in 2011 more than 1.4 million people were treated in doctors’ offices, clinics and emergency rooms for basketball-related injuries. Among the most frequent are wrist or finger sprains and fractures, and twisting and impact injuries to the foot, ankle and knee.
“The majority of basketball injuries result from overuse, improper conditioning and trauma,” stated Dr. Joseph Guettler, Orthopedic Sports Medicine Surgeon with William Beaumont Hospital. “To avoid injury, it is important to stretch properly and participate in conditioning programs, such as cardiovascular training, core (abdominal area) strengthening and flexibility exercises.”
As part of the AAOS Prevent Injuries America! ® Campaign, orthopaedic surgeons would rather prevent injuries than treat them. Consider the Academy’s basketball safety tips:
• Wear appropriate equipment. Shoes should fit snugly and offer support. Ankle braces can reduce the incidence of ankle sprains in patients with a history of injury (this should be discussed with your doctor); protective knee and elbow pads can protect players from bruises and abrasions. Consider wearing a mouth guard. Do not wear jewelry or chew gum while playing. Other helpful equipment may include eye protection, ankle braces or sports tape.
• Ensure a safe play environment. Outdoor courts should be free of rocks, holes and other hazards. Players should avoid playing on outdoor courts that do not have appropriate lighting. Indoor courts should be clean, free of debris and have good traction. Baskets and boundary lines should not be too close to walls, bleachers, fountains or other structures. Basket goal posts, and the walls behind them, should be padded.
• Maintain fitness throughout the year. Ideally, players should maintain an exercise and training regimen during the basketball season, and throughout the year.
• Warm up before play. Consistent warm up and stretching exercises may reduce injuries. Warm up with jumping jacks, stationary cycling, or running or walking in place for three to five minutes. This should be followed by slow and gentle stretching, holding each stretch for 20-30 seconds. Stretches should focus on the legs, spine, and shoulders. A player should also stretch after their practices or games.
• Safe Return to Play. An injured player’s symptoms must be completely gone before returning to play. The player must have no pain, no swelling, full range of motion, and normal strength and should be cleared by the appropriate medical provider.
• Stay hydrated. Even mild levels of dehydration can hurt athletic performance. Ideally, players should drink 24-ounces of non-caffeinated fluid two hours before exercise, and additional 8-ounces of fluid or sports drink immediately before play. While playing, break for an 8-ounce cup of water every 20 minutes.
• Use proper passing and play techniques. Practice good technique. For example, when you jump for the ball, land on a bent knee rather than a straight knee. Play only your position and know where other players are on the court to reduce the chance of collisions. Do not hold, block, push, charge, or trip opponents. Use proper techniques for passing and scoring, and most importantly, don’t forget sportsmanship!
• Prevent overuse injuries. Because many young athletes focus on just one sport and train year-round, doctors are seeing an increase in overuse injuries. The AAOS has partnered with STOP Sports Injuries to help educate parents, coaches, and athletes on how to prevent sports injuries. STOP Sports Injuries recommends limiting the number of teams in which your child is playing on in one season. In addition, do not let your child play one sport year round; taking regular breaks and playing other sports is essential to skill development
Performance Orthopedics – Keeping you in the game, whatever your game may be!
What do the Olympic snowboarders, skiers, sledders, and hockey players all have in common? Win, lose, or draw – they all wear helmets.
If you have been watching the 2014 Winter Olympics as I have, you have seen some nasty skiing, sledding, and snowboarding “wipe outs.” I personally saw one of the athletes crack her helmet as she hit the ground. I bet it saved her life – even if she still got a concussion out of the deal.
With that being said, we’ve heard a lot about concussions lately. If you watched the Super Bowl and other NFL games this past season, you heard the word concussion plenty of times. In years past, we would often “blow off” minor head injuries that may have been true concussions, but these days, we take concussions much more seriously. And we do this for an important reason – the research has clearly shown that concussions need to be taken very seriously, diagnosed accurately, and treated appropriately.
At the “end of the day” we need to be doing everything in our power to prevent concussions in ourselves and our kids – and hence the column about helmets…
The Olympics – and most importantly the Olympic crashes and wipeouts – highlight the need for children – and parents – to wear their helmets when engaging in activities that could result in head injuries. We simply need to take the appropriate precautions when we engage in sports and endeavors that could place us in harm’s way. Your mother was right – it’s simply better to be safe than sorry.
Take it from a guy whose bonked his head a few times – and gotten very lucky – helmet use is very important. No matter what your age or level of experience, whenever you bike, inline skate, skateboard, ski, snowboard, sled, or engage in other activity where your head is vulnerable to injury, you should wear a helmet.
Why wear a helmet?
Cuts, bruises, sprains, and even broken bones will heal, but damage to your brain can last a lifetime. In an instant your head can smack the street, sidewalk, curb, a car, tree or anything else around you. Some of the most tragic cases that I have seen are closed head injuries and concussions. Sadly, many would have been prevented if a helmet was worn.
How do helmets protect you?
When you fall or crash the helmet absorbs much of the impact that would otherwise cause a bruise, concussion, skull fracture, or serious brain injury. Thick plastic foam inside the hard outer shell of your helmet cushions the blow. The helmet essentially “takes the hit” instead of your head.
Here are some keys to choosing an appropriate helmet:
Children and helmets
Young children are particularly vulnerable to head injuries. They have proportionally larger heads and higher centers of gravity, and their coordination is not fully developed. It is more difficult for children to avoid obstacles when biking, sledding, in-line skating, skiing, or doing other activities.
Tips to help children understand the importance of wearing helmets:
Oh, and parents – remember that it’s not just the kids who need to wear their helmet. Let’s all take a lesson from the Olympians and wear our helmets!
Enjoy the rest of the Olympics – and just like an Olympian – be a winner, first and foremost, by being smart and be safe.
These days I am seeing two groups of kids in the community, and we will simply call them the “haves” and the “have nots.” Let’s be clear – it really has nothing to do with socioeconomic status, but there really are two distinct groups of kids: 1) either the parents and kids are being pushed earlier and harder to excel in a particular sport, or 2) the parents and kids are simply disengaged all together from sporting activities.
With this being said, this column is directed at all kids, but I’m really trying to reach out to the parents of kids who just aren’t that interested in sports. Let’s be clear – there’s nothing wrong with playing the flute, starring in the play, or anchoring the debate club. These are noble and appropriate pursuits, but there are just too many disengaged kids these days when it comes to basic physical fitness.
Looking back to my own youth and young adulthood, I can clearly assert that nothing is as motivational as watching the Olympic Games. The “thrill of victory” at the Olympic level has no parallel in its ability to motivate all of us. As I write this column, I am looking up at my own signed team jersey from the 1980 USA Olympic Gold-Medal-Winning Hockey Team. It still gives me goose bumps when I think about that game. Let’s use some of this positive Olympic energy to highlight how we can better ourselves and our kids from a physical fitness standpoint.
Although the Olympics Games highlight athletic pursuit and achievement, they should also serve as a wakeup call for parents of kids who are not active. If you look at the statistics, youth fitness levels are dragging – it’s estimated that only one out of four American schoolchildren gets an adequate amount of physical activity each day. It’s no surprise that the number of overweight children is rising rapidly. Almost 13% of 6 to 11-year-olds are obese. Importantly, children who don’t get at least 35 to 60 minutes of walking or other exercise each day can also miss out on their chance to build the strong muscles and bones that they will need later in life.
The bottom line is that many kids need a lifestyle change from one that is sedentary to one that is more physically active, and that’s going to take some work on the part of you parents. Let’s face it, it’s easier to “plop” our kids in front of the TV or computer than it is to actually play with them. Your involvement in your kid’s play time is not only good for your family, but it can also often be good for your family’s over-all fitness. Exposing your children to the Olympics might be just the motivation that you and your kids need.
There are a lot of perks to your kids being active:
Bones, for instance, grow in size and strength during childhood. The peak bone mass that you gain through physical activity while you’re young helps to determine your skeletal health throughout life. In addition to building stronger bones and fit muscles, regular physical activity also strengthens the heart and lungs. It lowers blood pressure, improves muscle strength and flexibility, reduces stress and depression, helps control weight, and improves sleep. In addition to exercise, a healthy diet, not a junk food diet, is key to over-all wellness.
Get started with physical activity:
Making the switch to a healthy lifestyle isn’t always easy, and getting started is the toughest and most important step in any exercise program. Slow and steady is the best way to begin. Also, do a variety of different physical activities. Here are some tips:
The minimum 35 minutes of physical activity each day can be broken up into shorter periods, such as 15 minutes of walking and 20 minutes of sports.
Tips to get kids moving:
Finally, check out the 2014 Winter Olympic Games – and encourage your kids to watch them. While watching TV might not actually increase your fitness level in and of itself, seeing these athletes compete might be “just what the doctor ordered” to get your child – and perhaps you – off the couch and involved with something healthy.
You can feel the excitement building as the Winter Olympic Games approach. While the Olympic Alpine events are thrilling to watch, speeding down a hill on a ski, a snowboard, a sled – or some other contraption – has its risks. As you may recall, I recently wrote an article on “skiing safety,” and low-and behold – right about the same time – our iconic Olympic skier, Lindsey Vonn, blew out her knee. And many of us remember the Olympic sledder who tragically crashed and died during the last Winter Olympic Games.
On a brighter note, sledding is a great activity. It’s fun, it’s family-oriented, and it’s good exercise! With this being said, Olympic injuries and tragedies remind us that safety comes first when it comes to ourselves and our kids. Even though your sledding speeds won’t approach 90 miles per hour like in the Olympics, some precautions are still in order.
Although we have been bombarded by the weather this winter , it seems that some of our best sledding days may be upon us and our children. Rather than complaining about the snow, I truly believe that we should all have some fun with it! Perhaps we can learn from our kids who seem to find plenty of ways to have fun with the snow. Many of us adults simply drive through it, shovel it, and blow it. It’s no wonder that so many people in Michigan despise the snow and suffer from conditions like seasonal depression. Have we all forgotten about snow ball fights, snow men, snow angels, snow forts, and last but not least – sledding? I guarantee that if you spend some time with your kids out in the yard or on the sled hill, it will lift your spirits, give you a little exercise, and perhaps even give you a more positive view of one of Michigan’s seasonal gifts.
Of course, sledding is supposed to be fun, but it also needs to be safe. Every year, thousands of youths and adults are injured while sledding down hills in city parks, streets and resort areas. Most of these injuries are very preventable. Your kids probably won’t hurt themselves building a snowman or making a snow angel, but it’s worth taking a moment to discuss sledding safety.
Incidence of Injury
According to the U.S. Consumer Product Safety Commission, there are approximately 75,000 sledding, snow tubing, and tobogganing-related injuries treated at hospital emergency rooms and doctors’ offices each year. Believe it or not, the total medical, legal, and work loss-related costs exceed $2.3 billion! Luckily most sledding injuries are “bumps and bruises,” but some of the injuries, even on our hills in Michigan, can be serious enough to cause lifelong disability or death.
When a sled hits a fixed object such as a tree, rock or fence, the rider may suffer serious head and neck injuries. The majority of injuries happen to youths age 14 and younger, especially in the run outs at the end of the sledding path. Young children are especially vulnerable, as they have proportionally larger heads and higher centers of gravity than older children and teens. In addition, the coordination of youngsters has not fully developed and they can have difficulty avoiding falls and obstacles.
Sledding should be done only in designated and approved areas where there are no trees, posts, fences or other obstacles in the sledding path. The sledding run must not end in a street, drop off, parking lot, pond or other hazard. Do not sled on public streets – the first big snowfall of the winter season often tempts youths to sled down sloping streets where they may be hit by cars and trucks or slam into parked vehicles, curbs, and fences.
Parents or adults must supervise children in sledding areas to make sure the sledding path is safe and there are not too many sledders on the hill or at the end of the run at the same time. A little “sledding organization” can go a long way when it comes to avoiding collisions.
No one should sled headfirst! All participants should sit in a forward-facing position, steering with their feet or a rope tied to the steering handles of the sled. Some youths like to run with their sleds and leap forward in a “belly flop.’ This does not give them control of where they are sliding and can expose them to possible head and neck injuries.
Bottom line – Let’s take a few simple precautions and have both a fun and safe time sledding this winter! It’s truly one of the great seasonal activities that we Michiganders have the opportunity to enjoy.
“It became very clear that dangerous pitching behavior is occurring among pitchers as young as Little League all the way through their high school years. And, the blame doesn’t usually lie with the leagues or coaches. Most were found to be adhering to nationally recognized guidelines for pitch limits and rest. It seems much of the blame lies with behavior of parents and their kids,” Guettler said in a health system news release.
Contrary to national guidelines limiting pitches thrown, about 13 percent of pitchers pitched competitively for more than eight months of the year, 40 percent pitched in a league without pitch counts or limits, nearly 57 percent pitched on back-to-back days, and 19 percent pitched more than one game in the same day.
The study also found that nearly one-third of pitchers pitched for more than one team during the same season, one-third played only baseball, and 10 percent also played catcher on the same team. Catcher is another position that requires a lot of throwing.
“The most prevalent reasons for arm pain and tiredness can be boiled down to five major issues,” Guettler said. “The following behaviors can lead to arm pain and tiredness which can then lead to the most significant shoulder and elbow injuries.”
The first step in reducing the number of pitching injuries can be remembered with a simple, newly coined “Rule of Ones,” Guettler said.
It means one game a day, one day of pitching then rest, one position at a time during a pitched game, one team at a time, only one pitch before high school, and at least one season of some other organized sport. If a young pitcher says his or her arm is sore or tired, parents need to make sure the youngster takes some time off. One complaint of arm soreness or tiredness equals one week off.
It’s that time of year – many of us migrate to the snowy ski slopes of the west, or the icy ski slopes of Michigan, to enjoy the invigorating thrill of downhill skiing and snowboarding. When planning out our weekends, we choose Boyne Mountain over Somerset Mall, and when choosing our winter break, we forgo the relaxing “beach somewhere warm” and opt to tackle the mountains of Colorado, the hills of Northern Michigan, or the slope on the side of a landfill right up I-75. With this choice of activities, however, comes risk. We’ve all heard of someone “blowing out” their knee. Generally speaking, this refers to the tearing of one or more ligaments inside the knee. But before we go any further, let’s learn a little more about the ligaments of the knee:
The cruciate ligaments are two ligaments that are located deep inside the knee joint and connect the thighbone (femur) to the shinbone (tibia). They are called “cruciate” ligaments because they “cross” in the middle of the knee. They are instrumental in providing the stability that is needed for proper knee joint movement and stability when you torque on your knees and put them to the test. The cruciate ligament located toward the front of the knee is the anterior cruciate ligament (ACL), and the one located toward the rear of the knee is called the posterior cruciate ligament (PCL).
The ACL prevents the shinbone from sliding forwards beneath the thighbone. The ACL can be injured in several ways. Most often this involves a sudden change in direction during which the knee is twisted or during direct contact, such as during a football tackle. ACL injuries are quite common in skiers, particularly if you “wipe out” or “catch an edge” with your ski. Because your ankle is rigidly immobilized in the ski boot, it’s your knee that gets torqued, and if enough force is involved, ligament or cartilage injury can result.
If you injure your ACL, you may feel or hear a pop. The knee will swell and get stiff, and you will often feel pain when you try to stand. Over time, without a functional ACL, the knee may give out, especially when you attempt to change directions. When the knee gives way, this can lead to additional cartilage.
The diagnosis of ACL injury is based on the history, a good physical exam, and often, an MRI. A partial tear of the ACL may or may not require surgical treatment. A complete tear is more serious, and unfortunately, ACL tears do not heal. Complete tears, especially in younger patients, athletes, and active individuals, may require surgery to restore stability to the knee. Operative treatment is most often done arthroscopically and uses a piece of tendon, usually taken from the patient’s knee (patellar tendon), hamstring muscle, or from a cadaver. This “graft” is then passed through the inside of the joint and secured to the thighbone and shinbone. Surgery is followed by a rehabilitation program. Occasionally, complete tears may be treated conservatively in less active individuals or in individuals whose knees remain stable despite the injury.
The posterior cruciate ligament, or PCL, is not injured as commonly as the ACL. PCL sprains usually occur when the knee is twisted or from a direct blow to the front of the knee. Without a PCL, your knee sags, and there can be increased wear and tear on the cartilage inside the knee. Like the ACL, PCL tears do not generally heal. Fortunately, some patients with PCL tears often do not have as much knee instability as patients with ACL tears, and even high level athletes can return to their sport after completing a good rehabilitation program. For patients who continue to have pain, swelling, or instability of their knee, surgery may be necessary to reconstruct the PCL.
Collateral ligament injuries
The collateral ligaments are located at the inner side and outer side of the knee joint. The medial collateral ligament (MCL) connects the thighbone to the shinbone and provides stability to the inner side of the knee. The lateral collateral ligament (LCL) connects the thighbone to the other bone in the lower portion of your leg (fibula) and stabilizes the outer side. Injuries to the MCL are very common and are usually caused by contact on the outside of the knee and are accompanied by sharp pain on the inside of the knee. The LCL is rarely injured. If the MCL is torn, is does have the ability to heal. Remember the acronym RICE: Rest, Ice, Compression or bracing, and Elevation. Most MCL tears do fine with an initial period of RICE followed by a good rehab program.
Finally, when it comes to the treatment of ligament injuries, it’s a really exciting time in the world of research. We are using more and more growth and healing factors to get ligaments and tendons to heal better and faster. As a matter of fact, we use substances like Platelet Rich Plasma (PRP) to help tendons and ligaments heal faster almost every day over at Beaumont. Additionally, we recently carried out a study where we were able to stimulate ACL tears to heal on their own – in the lab – by adding a “cocktail” of growth and healing factors to the torn ligament. Wouldn’t it be cool if we could get ACL tears to heal without surgery someday? Stay tuned…We’re on it.
There you have it – the “inside scoop” on the ligaments inside your knee. So have fun this ski season, but know your limits. Hopefully, a little knowledge and a little common sense will give you “the edge” when it comes to avoiding knee injuries this ski season.