Tiger Woods is getting better

Check out Tiger Woods' swing.  It looks like he is feeling a lot better after multiple back surgeries.

Best of luck for a full recovery.  

Progressing nicely. pic.twitter.com/HKnnluR1OW

— Tiger Woods (@TigerWoods) February 24, 2016

Video of my own back surgery.


AM
Total Tendon 

Platelet Rich Plasma beats Surgery for Tennis Elbow

Treatment of tennis elbow using platelet rich plasma (PRP) resulted in an average of 83% improvement in pain scores at one year compared to baseline in a recently published study of 110 patients by Karaduman et al.  The surgery group had 46% improvement in pain scores.   Mayo elbow scores were also higher in the PRP group.  (See graphs below)  

The study used the Biomet GPS PRP device and the Nirschl surgical technique

This is an interesting study comparing the value of PRP versus a commonly recommended surgical procedure.  The data suggest PRP is a safe and effective alternative to the much more invasive and expensive surgical procedure.

AM

@bloodcure

Total Tendon

See abstract and reference below:

Karaduman et el 2016

Abstract

Purpose

To compare short and mid-term results in the treatment of chronic elbow tendinosis with platelet-rich plasma (PRP) or Nirschl surgical technique.

Method

A retrospective study was conducted on patients with chronic lateral epicondylitis, treated by Nirschl surgical technique (50 elbows) or PRP (60 elbows). Outcome was evaluated with Visual Analog Score (VAS), Mayo Elbow Scores and grip strength measurements.

Results

VAS and Mayo Elbow Scores of the PRP group had improved as a mean of 83% (p = 0.0001), 74% (p = 0.0001) over baseline and 34.2 pounds gain of grip strength.

Conclusion

The PRP seems to be better for pain relief and functionality in the short and mid-term periods.

Keywords

• Nirschl surgical technique; 
• Platelet rich plasma (PRP); 
• Chronic elbow tendinosis

Tiger Woods Spine Surgery

Tiger Woods just had surgery on his back for the second time and will be out for a indefinite amount of time.  Apparently, something was pinching on a nerve and causing him significant pain.

(ESPN Story)

Below is a video of my own spine surgery from several years ago.  Thankfully, I have done very well.
Let's hope his second surgery will allow Tiger to return in 2016 to an elite level of play.


AM
TotalTendon

Microfracture Surgery Jadaveon Clowney

The Houston Texans' Jadeveon Clowney recently underwent "microfracture" surgery on his ailing right knee.  (See ESPN report)

The report suggests the talented Mr. Clowney will be out for 9 months or more.  Just what is microfracture surgery and why does it take as long to recovery as it does for a baby to born?

Microfracture Surgery

Let's start with the basics.  There are two types of cartilage in the knee.  The surface cartilage which covers the bone.  This is known as articular cartilage and can be thought of a type of cap or covering of the end of the bone.  This cartilage is present in any joint.  In the knee, there is another type of cartilage, the meniscus cartilage.  There are two menisci in the knee--medial (inside) and lateral (outside).  When the surface "articular" cartilage is damaged, the knee can become quite painful especially with loading and twisting.  Think rushing a passer for example.  Similar symptoms can occur when the meniscus is torn.  It is often difficult to distinguish between the two in terms of which one is the pain generator.

Microfracture surgery is an attempt to create a tire patch over a cartilage defect by poking a hole in the end of the bone and creating an access channel to the bone marrow.  The bone marrow then leaks out via the holes that are created and forms a clot which over time can help cover the defect.  It takes time, many months, for this surgery to work because the "patch" needs to mature.  This technique is useful for small defects in the cartilage but hasn't proven to be great for larger defects.  We do not know the size of Mr. Clowney's knee cartilage injury.

Recent evidence suggests that the addition of platelet-rich plasma can enhance microfracture surgery results.  This has been shown in basic science, preclinical and now clinical studies.

This type of surgery at such a young age is clearly not a good sign.  In the long run, he may require further intervention.  Please read the post below for further information about why we need to accelerate our regenerative medicine efforts.  Mr. Clowney is one of tens of millions of people worldwide with symptomatic cartilage damage.  We need to maximize outcomes of today's surgical techniques and develop new procedures to help keep our athletes and patients in the game.

AM

TotalTendon

Golf, Back Pain and Disc Surgery

Tiger Woods had to withdraw from a golf tournament last week and is struggling as he starts the PGA championship today.  Just now, Matt Kuchar, another elite professional golfer had to withdraw from that same major tournament.

Hopefully, he won't have to have micro disc surgery.  See video of that procedure below.

The surgery can be quite successful.  We still, however, need better ways to prevent spinal disc degeneration especially in elite golfers.

AM
TotalTendon

QuadCrunch (TM) The Best Exercise for Your Knee

Quadriceps (Quad) muscle activation is crucial for both athletes and patients.  It is the foundation of any knee muscle development plan or rehabilitation protocol.  Too often neuromuscular activation is ignored or incompletely addressed.  

The QuadCrunch exercise is a simple and effective way to enhance muscle activation and to increase muscle tone.  If executed consistently, the entire quadriceps muscle and especially the VMO (Vastus Medialis Qbliqus) will be more functional.  

The QuadCrunch can be done alone or in combination with a variety of other leg stretches and exercises.  It can be done to simply improve knee strength or it can be used for patients with a variety of knee related problems such as arthritis, kneecap instability, tendonitis or after surgery.  

The video below outlines how and why the QuadCrunch can help both athletes and patients.

QuadCrunch Video
Try a set of 3, Hold for 5 Seconds Each, 5 Times per day

Please share this post with anyone who would like to enhance their knee function and post any comments below.

AM

TotalTendon.com

Please do not start any exercise program without consulting your physician first.

TIger Woods Back Surgery Video (Example)

Tiger Woods will miss the Masters for the first time in 20 years because of back surgery for a herniated disc.  He had the surgery on Monday in Park City, Utah and will soon begin rehabilitation.  There is no time table for his return.

Below is a video of my own back surgery for a discectomy that was done via small portal incisions about 5.5 years ago.  I was miserable prior to the surgery and am amazingly better.  Many thanks to my excellent surgeons and physical therapists.  View the video below to gain a better understanding of the mechanics of the surgery.

Video of Lumbar Disc Herniation Surgery


I wish Tiger the best of luck in his recovery.  I hope his surgery will allow him to return to the golf course soon but more importantly at a much higher functional level for a long time.

It is important to note that a variety of biologic treatments for this condition are presently in development.  Hundreds of professionals worldwide are working on these solutions.  For more information, visit:  BiologicOrtho.com

More info via a detailed story about Tiger Woods and his back.

AM
TotalTendon

Kobe Bryant Tears Achilles Tendon

Kobe Bryant last night in made a cut on the basketball court he has made a million times and felt like "somebody kicked" him.  He unfortunately sustained an achilles tendon tear.   See the video below of the injury:



He will likely have surgery in the near future.  The surgical takes about an hour.  Rehabilitation typically takes anywhere from 9-12 months.  Some surgeons are augmenting achilles repairs with platelet-rich plasma pointing to anecdotal evidence suggesting PRP could accelerate recovery.

Here is a video of how to clinically diagnosis an achilles tendon tear:



Below are some pictures that outline the steps in an Achilles tendon repair  
Torn tendon, suture repair, closure

If anyone can come back from this injury, Kobe can.  The NBA and all of basketball are wishing him the the best for his surgery if needed and for his full recovery.

AM
TotalTendon

Compound Tibia Fractures, Kevin Ware NCAA hoops

You may have heard about the nasty compound shin bone fracture sustained by Louisville's Kevin Ware in the NCAA Regional Final game on Sunday.  These fractures are also known as open tibia fractures.  In this post, I'll outline some of the details of this serious injury to help everyone understand it better.

For a compound or open fracture to occur without any contact is very rare.  I did a search on PubMed yesterday and couldn't find even a case report of one.  So, we need to try to better understand why his shin bone or tibia failed.  Is it because he jumped and then landed with a dramatic twisting force?  That is one possibility.  Another one is that he may have had some underlying weakness of his bone prior to the injury.  It occurred to me that these young men play a ton of hoops especially toward the end of the year with their conference tournaments and then immediately thereafter they participate in the NCAA tourney.  Did he have some stress injury to the bone due to playing so many games that may have predisposed it to failure?  Is it possible that he had a metabolic bone problem that resulted in it being weak?  Finally, was it simply one of worst cases of bad luck in a basketball history?  We may never know.

It is crucial that he was treated immediately by an elite trauma team.  Indy has some of the best in the country.  What he likely had to have done was a wash out of the area where the bone poked through the skin and then an insertion of a titanium nail to stabilize the bone.  He also sustained injuries to the skin and muscle around the bone.  These are known as soft tissue injuries.  These will also need to heal.  In addition to the surgery, he was likely given intravenous antibiotics to help prevent the onset of infection.

Mr. Ware's type of fracture usually takes several months to heal properly.  Occasionally, additional growth factors are given at the time of surgery to improve the chances the fracture consolidates.  Or, external devices that deliver ultrasound or electrical stimulation are used to enhance or accelerate the bone healing.  Even if everything initially is done perfectly as it seems to have been in this case, there is still a risk of bone not healing (delayed or non-union) or the possibility of late infection.

It is great to see Mr. Ware up and sending out pictures.  This young man dealt with a severe injury that was witnessed by millions of people on live TV with incredible courage and poise.  Hopefully his recovery will be uneventful and speedy.  I know we all would love to see him back on the court as soon as possible.


AM

View an excellent story about the injury from Dr. Jon LaPook and Scott Pelley from the CBS Evening News.

References

Melvin et al.  “Open Tibial Shaft Fractures:  I.  Evaluation and Initial Wound Management”

Journal of the American Academy of Orthopeadic Surgeons

Melvin et al.  “Open Tibial Shaft Fractures: II.  Definitive Management and Limb Salvage”

Journal of the American Academy of Orthopeadic Surgeons

Platelet Rich Plasma better than Shock Wave for Jumpers' Knee

Jumpers' knee also known as patellar tendinitis is a common problem for basketball and volleyball players among other athletes.  Patients treated with platelet-rich plasma for this condition when compared to shock wave treatment improved more at six and 12 months after treatment.  See abstract below.

This paper adds to the mounting data suggesting PRP is a valuable treatment for chronic tendon related problems such as Jumpers' knee.

MRI of Patellar Tendinopathy

Also Known as Jumpers' Knee

AM

TotalTendon

Am J Sports Med. 2013 Feb 13. [Epub ahead of print]

Platelet-Rich Plasma Versus Focused Shock Waves in the Treatment of Jumper's Knee in Athletes.

Vetrano M, Castorina A, Vulpiani MC, Baldini R, Pavan A, Ferretti A.

Source

Physical Medicine and Rehabilitation Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.

Abstract

BACKGROUND:Tendinopathies represent a serious challenge for orthopaedic surgeons involved in treatment of athletes. PURPOSE:To compare the effectiveness and safety of platelet-rich plasma (PRP) injections and focused extracorporeal shock wave therapy (ESWT) in athletes with jumper's knee. STUDY DESIGN:Randomized controlled trial; Level of evidence, 1. METHODS:Forty-six consecutive athletes with jumper's knee were selected for this study and randomized into 2 treatment groups: 2 autologous PRP injections over 2 weeks under ultrasound guidance (PRP group; n = 23), and 3 sessions of focused extracorporeal shock wave therapy (2.400 impulses at 0.17-0.25 mJ/mm(2) per session) (ESWT group; n = 23). The outcome measures were Victorian Institute of Sports Assessment-Patella (VISA-P) questionnaire, pain visual analog scale (VAS), and modified Blazina scale. A reviewer who was blinded as to the group allocation of participants performed outcome assessments before treatment and at 2, 6, and 12 months after treatment. Nonparametric tests were used for within-group (Friedman/Wilcoxon test) and between-group (Kruskal-Wallis/Fisher test) testing, and the significance level was set at .05. RESULTS:The 2 groups were homogeneous in terms of age, sex, level of sports participation, and pretreatment clinical status. Patients in both groups showed statistically significant improvement of symptoms at all follow-up assessments. The VISA-P, VAS, and modified Blazina scale scores showed no significant differences between groups at 2-month follow-up (P = .635, .360, and .339, respectively). The PRP group showed significantly better improvement than the ESWT group in VISA-P, VAS scores at 6- and 12-month follow-up, and modified Blazina scale score at 12-month follow-up (P < .05 for all). CONCLUSION:Therapeutic injections of PRP lead to better midterm clinical results compared with focused ESWT in the treatment of jumper's knee in athletes.

Platelet Rich Plasma and Rotator Cuff Repair

We now have published evidence that PRP is safe and may be useful in arthroscopic rotator cuff repair. This excellent study by Dr. Randelli and his colleagues will lead the way to larger trials.

Autologous platelet rich plasma for arthroscopic rotator cuff repair. A pilot study.

Here is Dr. Randelli's excellent rotator cuff video. (Thanks for sharing it.)

Randelli PS, Arrigoni P, Cabitza P, Volpi P, Maffulli N.

Dipartimento di Scienze Medico-Chirurgiche, Policlinico San Donato, Universita degli Studi di Milano, Milano.

Background and purpose. Arthroscopic repair of rotator cuff tears can produce excellent results. The application of platelet rich plasma during arthroscopic rotator cuff repair is safe, and produces results which do not deteriorate over time. Methods. A total of 14 patients undergoing arthroscopic repair of a rotator cuff tear received an intra-operative application of autologous platelet rich plasma in combination with an autologous thrombin component after tear repair. Following the procedure, patients were given a standardized rehabilitation protocol, and followed for 24 months. Outcome measures included a pain score (VAS) as well as functional scoring (UCLA and Constant scores). Results. Of the original 14 patients, 13 were seen at a final follow-up appointment 24 months after the index operation. Patients demonstrated a significant decrease in VAS scores and significant increases in the UCLA and Constant scores at 6, 12 and 24-month follow-ups compared to a pre-operative score. Conclusion. No adverse events related to this application were noted during the procedure. The application of platelet rich plasma during arthroscopic rotator cuff repair is safe and effective, and produces results which seem to be stable with time. A prospective randomized investigation will be necessary to ascertain the efficacy of platelet rich plasma application to improve or expedite the surgical outcome following arthroscopic rotator cuff repair.

Total Tendon

Apex PRP