The WSMC was a first of its kind focused on women and sports medicine and was co-founded in 1997 by primary sports medicine physician Lisa R. Callahan, MD, and sports medicine surgeon Jo A. Hannafin, MD, PhD, who served as co-directors ever since. The multidisciplinary center now consists of a team of sports medicine-trained clinicians including physicians, nutritionists, exercise physiologists, physical therapists and sports psychologists.

 The change in leadership comes as Dr. Hannafin has recently retired her clinical practice while continuing to be active in the WSMC and as vice chair of the Institutional Review Board at HSS, which is responsible for the evaluation of current and newly submitted research projects. As a practicing physician, Dr. Callahan will also continue to be actively involved in the WSMC while serving in her role as chief medical officer of Madison Square Garden Sports.

 “The WSMC is a key reason why I feel excited to go to work each day. I am constantly inspired by my colleagues and the patient care that they provide, which motivates me to take the very best care of my own patients,” said Dr. Goolsby.

 Approximately 80,000 recreational and elite athletic patients a year receive collaborative care through the WSMC. Every clinician aims to empower each patient to achieve success based on his or her individual goals.

 “Being part of the WSMC has helped me in all facets of life. It’s been invaluable for my career, provided spectacular comradery, and guided me to find a work/life balance,” said Dr. Shubin Stein, who noted how Drs. Callahan’s and Hannafin’s successes have opened so many doors for all women. “They have helped us all to dream big.” 

 Drs. Callahan and Hannafin have led distinguished careers and have served as team physicians for numerous professional and Olympic teams. Notably, Dr. Callahan was the first female head team physician in the National Basketball Association and president of the NBA Physicians Association. Dr. Hannafin was the first female president of the American Orthopaedic Society for Sports Medicine (AOSSM).

“We want to ensure we carry on the legacy and support all of the work that Drs. Callahan and Hannafin have done as true pioneers in our field,” added Dr. Goolsby, who explained that she and Dr. Shubin Stein have spent time individually with all members to determine new, impactful goals for the group.

 WSMC clinicians have provided care for numerous Olympic and professional teams and organizations including the New York Knicks, Westchester Knicks, New York Liberty, TCS New York City Marathon, Champions Series Tennis, USA Basketball, USA Gymnastics, UFC, US Biathlon, US Rowing and US Lacrosse.

 “First and foremost, our priority is patient care. We strive to take care of the whole person, not just their knee or stress fracture. Our biggest advantage is that we have experts across many disciplines who can help keep our patients active through all phases of life,” said Dr. Shubin Stein.

 “I am incredibly proud of the fantastic physicians and surgeons we have recruited over the years as well as the outstanding specialists in physical therapy and sports performance, sports psychology and sports nutrition,” said Dr. Hannafin. “We place a large emphasis on developing and training the next generation of female leaders in sports medicine, so it is truly humbling to see so many of them as team physicians for professional, national and Olympic sports teams.”

 Mentorship formally occurs by training residents and fellows within the HSS Sports Medicine Institute as well as the WSMC summer internship and research assistant programs. Launched in 2000, the summer internship program is highly competitive, with more than 150 applicants each year for three spots.

 Of the more than 200 women mentored by members of the WSMC, 80 percent have pursued a career in medicine, physical therapy, psychology or nutrition. Five women have started sports medicine programs while others have joined the faculty at existing women’s sports medicine programs, fulfilling the critical need to expand expert care to active girls and women everywhere.

“I’m proud of the integrated legacy of care, education and research that has formed a strong foundation for the future of the WSMC,” said Dr. Callahan, who oversees the care of the New York Knicks, New York Rangers, Westchester Knicks and Hartford Wolf Pack. “Drs. Goolsby and Shubin Stein have the experience, knowledge and compassion to lead the next phase of growth and advancement. I look forward to their future accomplishments.”

Current research within the WSMC focuses on a variety of issues that impact women athletes, such as the female athlete triad, anterior cruciate ligament (ACL) injuries, vitamin D and bone health, patellofemoral disorders, frozen shoulder, postpartum care and more.

 According to Dr. Hannafin, there is a need for continued research into gender- and sex-specific issues in injury prevention, sports-specific injuries and response to treatment. Through this research, the WSMC can continue to optimize patient care with specialized treatment for each individual patient.

 “The center’s impact on the national landscape of women’s sports medicine is immeasurable. Their selective and immersive summer internships alone work to shape the future for women in the field,” said Andrew D. Pearle, MD, chief of the HSS Sports Medicine Institute. “We are proud to have them as part of our team.”

Reconstruction is the current standard of care surgical treatment for tears of the anterior cruciate ligament (ACL). This procedure typically uses a graft, or a piece of tissue, placed in the knee minimally invasively, using small incisions. About 300,000 ACL reconstructions are performed annually in the United States with well documented rates of success.

ACL repair is an older technique that involved suturing (sewing) torn ACL tissue, not rebuilding it with a graft. ACL repair was performed in the 1970s at select institutions, including Hospital for Special Surgery, but was abandoned due to unacceptably high failure rates of up to 50%.

Today, ACL repair has been modernized and can be performed through a minimally invasive approach. Proponents suggest that modern ACL repair techniques may be performed safely and may lead to a quicker recovery than ACL reconstruction. However, the limited studies to date raise questions that must be discussed in detail with your surgeon.

1. It is critically important to get ACL surgery right the first time.

When ACL surgery fails, surgeons must do a revision procedure to correct or revise the problems that were not fully addressed the first time. Revision requires reconstructive ACL surgery with a graft. (ACL repairs cannot be done as revisions.) Redoing ACL surgery may result in higher rates of failure, lower rates of return to sports, and increased risk of osteoarthritis.

The importance of successful initial ACL surgery holds true for people of all ages, but it is particularly critical for young athletes, for whom a failed surgery can have devastating consequences, including years lost from sport in the short term as well as chronic pain and loss of function in the long term.

2. Failure rates for ACL repair appear to be significantly higher than those for ACL reconstruction in people of all ages.

Current studies suggest that modern ACL repair techniques have a failure rate that may be five to ten times higher than that of ACL reconstruction^1,2,3. One major recent study in a prominent sports medicine journal found that arthroscopic ACL repair has unacceptable outcomes in young athletes, with short-term failure rates of close to 50%².

It has been suggested that ACL repair may be appropriate for older adults who have a type of ACL tear called a proximal avulsion and who do not participate in “cutting and pivoting” sports such as basketball, volleyball, and soccer. For these patients, failure rates in the short term appear to be much higher than ACL reconstruction in this age group^1,2,3.

3. There is still much we don’t know about ACL repair.

There has been no scientific evidence that shows a difference in postoperative pain between ACL repair and reconstruction. Rehabilitation and return-to-play protocols for ACL repair have not yet been established. Proper guidelines for rehabilitation and return to sports are essential to keep people safe from re-injury.
 

Andrew D. Pearle, MD

Chief, HSS Sports Medicine Institute

Bryan T. Kelly, MD

HSS Surgeon-in-Chief and Medical Director

Answorth A. Allen, MD

David W. Altchek, MD

Struan H. Coleman, MD, PhD

Frank A. Cordasco, MD, MS

David M. Dines, MD

Joshua S. Dines, MD

Stephen Fealy, MD

Andreas H. Gomoll, MD

Lawrence V. Gulotta, MD

Jo A. Hannafin, MD, PhD

Anne M. Kelly, MD

John D. MacGillivray, MD

Robert G. Marx, MD, MSc, FRCSC

Michael J. Maynard, MD

Moira M. McCarthy, MD

Danyal H. Nawabi, MD, FRCS

Stephen J. O’Brien, MD, MBA

Anil S. Ranawat, MD

Scott A. Rodeo, MD

Howard Anthony Rose, MD

Beth E. Shubin Stein, MD

Sabrina M. Strickland, MD

Karen M. Sutton, MD

Samuel A. Taylor, MD

Russell F. Warren, MD

Thomas L. Wickiewicz, MD

Riley J. Williams III, MD

References

1. Jonkergouw A, van der List J, DiFelice G. Arthroscopic primary repair of proximal ACL tears: outcomes of the first 56 consecutive patients and the role of additional internal bracing. Knee Surg Sports Traumatol Arthrosc. 2019 Jan;27(1):21-28.

2. Gagliardi AG, Carry PM, Parikh HB, Traver JL, Howell DR, Albright JC. ACL repair with suture ligament augmentation is associated with a high failure rate among adolescent patients. Am J Sports Med. 2019 Mar;47(3):560-566.

3. Wright RW et al. Risk of tearing the intact ACL in the contralateral knee and rupturing the ACL graft during the first 2 years after ACLR: A prospective MOON cohort study. Am J Sports Med. 2007 Jul;35(7):1131-4.

For more information visit https://www.hss.edu/condition-list_torn-acl.asp.

Beth E. Shubin Stein, MD, sports medicine surgeon at HSS, explains alternative options for arthritis pain including hyaluronic acid, platelet-rich plasma (PRP) and stem cell injections. 

She notes that none of the existing treatments can regrow cartilage and all have some drawbacks. But they can be helpful in at least delaying joint replacement surgery in many people.

Read the full article at BottomLineInc.com.

Researchers at Hospital for Special Surgery in New York City have found that very few patients who underwent the ligament procedure -- called medial patellofemoral ligament reconstruction (MPFL) -- showed signs of recurrent instability of the kneecap up to two years later. Roughly 85 percent of them also had returned to their sport and were playing at the same level as before their injury.

"At least for right now, ligament reconstruction is a very reliable, highly reproducible way to get people back to their sport," said Beth Shubin Stein, MD, sports medicine surgeon at HSS, who led the study. "But the procedure is not right for everybody." Dr. Shubin Stein presented the findings at the 2018 summer meeting of the American Orthopaedic Society for Sports Medicine.

The MPFL connects the inside part of the kneecap, or patella, to the femur. Dislocation of the patella is a common sports-related injury in the United States, particularly among young athletes. The result of excessive twisting at the knee, patellar dislocations are estimated to occur in about 23 per 100,000 people per year, typically among youth ages 14 to 18.

Although the damaged ligaments often heal over time, the patella tends to be looser than before the injury -- and therefore more vulnerable to another dislocation. Knee instability also is a risk factor for the development of arthritis, as the cartilage prematurely erodes. (Some people have unstable knee ligaments even without a traumatic injury; they also can benefit from MPFL reconstruction.)

Sports medicine surgeons group MPFL injuries into two categories: those involving trauma to the ligament in the setting of a fairly normal knee anatomically, and those who have significant misaligned or misshapen bones in addition to the damage to the ligament from the injury of the dislocation. In the latter cases, extensive surgery is required. For the rest, a simple reconstruction of the ligament -- a short procedure performed with a localized nerve block and sedation -- generally is appropriate. During the operation, surgeons replace the damaged ligament with a tendon harvested from the patient’s own hamstring or a donor. The tendon is threaded through the patella and used to anchor the bony structure to the side of the femur.

[An animated video of the procedure is available here: https://www.hss.edu/conditions_medial-patellofemoral-ligament-reconstruction-mpfl.asp]

Although still relatively new, the MPFL has become the most common way to stabilize dislocated kneecaps, Dr. Shubin Stein said.

The current study and related research will help to identify patients likely to have a successful MPFL reconstruction and those who are likely to do better with a combination of ligament reconstruction and what are known as "bony" procedures -- more complex surgeries that require reshaping the groove or track or realigning the tibia to decrease the forces on the patella that can lead to a dislocation. The recovery period for these operations is between nine and 12 months, compared with four to six months for ligament reconstruction alone, according to Dr. Shubin Stein. Patients who undergo MPFL can bear weight on the affected knee immediately, whereas those who require more intensive surgery may have to stay off the joint for six weeks or longer.

"The goal of the study is to follow these patients and to find out if there are specific features that make their risk of dislocating over time higher — meaning those patients should probably have their bone moved," Dr. Shubin Stein said.

Dr. Shubin Stein presented data on 90 patients in the ongoing study. Patients were between the ages of 14 and 25 and had undergone MPFL at HSS between 2014 and 2017. Of those, 70 were available for assessment at the one-year point of the study; 47 were evaluated at the two-year mark.

One patient experienced a re-dislocated patella 3.5 years after the initial surgery. However, 96 percent and 100 percent of those who reached the one- and two-year points, respectively, were free of patellar instability, according to the researchers.

Patients also expressed a high degree of satisfaction with the MPFL procedure, rating their experience more than 9 on a 10-point scale, on average.

Side effects were rare, occurring in four patients (three at six months; one at one year); none required hospitalization or a second surgery. 

Dr. Shubin Stein and her colleagues are adding patients to their study pool and extending the follow-up time beyond the two-year point to gather more data.

"The cause of the painful condition is not fully understood, but it can result from immobilization of the shoulder while recovering from a fracture or surgery," Dr. Shubin Stein explained.

Additionally, Dr. Shubin Stein noted that treatment options typically include anti-inflammatory drugs, cortisone injections and physical therapy.

"If these measures don't help within eight to 12 weeks, talk to your doctor about noninvasive or minimally invasive procedures to break up scar tissue and "unfreeze" your shoulder," added Dr. Shubin Stein.

Read the full article at bottomlineinc.com.

According to the article, common shoulder injuries are typically caused by inflammation and can be treated with pain management as well as physical therapy.

If you feel pain in your shoulder and movement is restricted, Dr. Shubin Stein recommended seeing an orthopedist to rule out a rotator cuff tear. She said as long as your rotator cuff is intact, you have a good chance of treating your shoulder effectively without surgery.

Dr. Shubin Stein pointed out the importance of managing your pain before starting physical therapy.

"Ice your shoulder for 20 minutes at a time, two or three times a day," she said.

From wall crawls to side stretches, Dr. Shubin Stein highlighted exercises that will strengthen the rotator cuff.

"You can complete this stretching and strengthening program in 15 minutes. Do it twice a week. It's also great for anyone who wants to avoid shoulder problems," said Dr. Shubin Stein.

This article appeared in the April 1, 2018 print issue.

Read the full article at beckersspine.com