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!

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.

“Dunk Out” Injuries This Basketball Season

For more information, contact:
Dr. Joseph Guettler
Performance Orthopedics
248-988-8085

For Immediate Release
3/1/2014

‘Dunk-Out’ Injuries this Basketball Season
Dr. Guettler provide pointers to prevent basketball injuries

Photo: Kirby Lee/Image of Sport-US PRESSWIRE

Photo: Kirby Lee/Image of Sport-US PRESSWIRE

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!

Avoid Getting Sidelined This Winter

For Immediate Release
2/19/14

Avoid Getting Sidelined This Winter
Orthopaedic surgeon provides tips to prevent winter sports injuries

Bloomfield Hills, MI ⎯ At the sight of the first snowfall, kids and adults alike are eager to enjoy the variety of winter sports available. Hours of recreation are spent on activities ranging from sledding, snow skiing and tobogganing to ice hockey, ice skating and snow boarding. But according to the American Academy of Orthopaedic Surgeons, if the proper precautions are not taken to ensure warmth and safety, severe injuries can occur.

Winter sports injuries get a lot of attention at hospital emergency rooms, doctors’ offices and clinics. According to the U.S Consumer Product Safety Commission, more than 310,000 people were treated in hospitals, doctors’ offices and emergency rooms in 2012 for winter sports-related injuries. Specifically:
• more than 40,000 injuries were caused by sledding;
• 97,713 by snowboarding;
• 119,715, snow skiing; and,
• nearly 53,000 by ice skating.

“Countless numbers of winter sports injuries happen at the end of the day, when people overexert themselves to finish that one last run before the day’s end,” explained Dr. James Bicos, Orthopedic Sports Medicine Surgeon with William Beaumont Hospital. “A majority of these injuries can easily be prevented if participants prepare for their sport by keeping in good physical condition, staying alert and stopping when they are tired or in pain.”

The American Academy of Orthopaedic Surgeons urges children and adults to follow the tips below for preventing winter sports injuries:

Sledding
Numerous sledding injuries are caused by collisions at the end of sledding paths and/or sledding in improper positions. Click here to read a detailed list of safety tips to help reduce these injuries.

Snowboarding and Skiing
Many snowboarding and skiing injuries can be avoided by utilizing appropriate equipment, ensuring a safe environment and following all rules of these sports. Click here to read a full list of snowboarding and skiing safety tips.

General winter sports safety tips:
• Consider participating with a partner. If possible, skiers and snowboarders should stay with a partner and within sight of each other. Also, make sure someone who is not participating is aware of your plans and probable whereabouts before heading outdoors.
• Check the weather for snow and ice conditions prior to heading outdoors. Pay attention to warnings about upcoming storms and severe drops in temperature. Make adjustments for icy conditions, deep snow powder, wet snow, and adverse weather conditions.
• Dress for the occasion. Wear several layers of light, loose and water- and wind-resistant clothing for warmth and protection. Also wear appropriate protective gear, including goggles, helmets, gloves and padding and check that all equipment, such as ski and snowboard bindings, is kept in good working order.
• Warm up thoroughly before playing and exercising. Cold muscles, tendons and ligaments are vulnerable to injury. It’s important to warm up by taking it easy on the first few runs.
• Know and abide by all rules of the sport in which you are participating. Take a lesson (or several) from a qualified instructor, especially in sports like skiing and snowboarding.
• Always carry a cell phone in case of an emergency.

Click here to read more safety tips.

More tips:
Winter sports safety

For more information, contact:
Dr. James Bicos
Performance Orthopedics
248-988-8085