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Health & Wellness
Presented by Barnes Jewish Hospital & Washington University Physicians

With professional athletes as our biggest investment, it's important to have doctors and physicians we can count on. It's because of that principle that the Blues work with doctors from Washington University and Barnes Jewish Hospital. Below, you'll find video and articles from one of our team physicians about common athlete injuries, how they can be treated and how well these injuries can heal. [ TEAM PHYSICIAN INDEX ]

  Matthew Matava, MD
Associate Professor of Orthopaedic Surgery
Washington University School of Medicine

Dr. Matava serves as a team physician for the St. Louis Blues and is also a team physician for Washington University athletic teams. Dr. Matava is a Washington University orthopedic surgeon who specializes in sports medicine. He practices at Barnes-Jewish Hospital & the Washington University Outpatient Orthopedic Center in Chesterfield, Missouri.

VIDEO: High Ankle Sprains | Meniscus Tears


ACL RECONSTRUCTION
The anterior cruciate ligament (ACL) is one of the four main ligaments of the knee. It is the primary restraint that provides rotational stability to the joint. It is often injured during cutting, twisting, or pivoting-type maneuvers. In addition, it is often associated with meniscal or articular cartilage injuries in a significant number of patients. Females are up to eight times more likely to be injured than males, primarily due to firing patterns of the thigh musculature following a strain to the joint. Once the ACL tears, it is not able to heal itself. Anterior cruciate ligament reconstruction is one of the most common operations performed in orthopaedic sports medicine with approximately 200,000 reconstructions performed in the U.S. annually.

Treatment options consist of either conservative (non-surgical) or surgical treatment. Conservative treatment involves modification of those activities that involve cutting, twisting, jumping, or pivoting. In-line activities can typically be resumed once pain and swelling subsides. A physician may prescribe anti-inflammatory medication and physical therapy to regain normal knee motion and strength. Bracing may also be prescribed for certain at-risk activities. Some patients may be willing to reduce or eliminate those activities that may cause instability episodes.

Surgical treatment consists of reconstruction of the ligament as its direct repair is not feasible due to the inability of the torn ligament to heal. This surgery involves the placement of a reconstructive graft taken from the patient’s knee’s patellar tendon (the tendon located beneath the knee cap) or from the hamstring tendons. Alternatively, your surgeon may choose to use a donor graft, known as an allograft, to reconstruct the ACL. The surgery itself takes approximately one hour and is performed on an out-patient basis with less than 1% percent risk of complications.

Extensive physical therapy is recommended following the surgery in order to regain full knee motion and strength, and to return to athletic activity. Most patients are able to return to play following ACL reconstruction approximately 6 months postoperatively. The overall success rate of ACL reconstruction using present-day surgical techniques is well over 90%.


AUTOLOGOUS CHONDROCYTE IMPLANTATION
Autologous chondrocyte implantation (ACI) is a relatively new, state-of-the-art procedure used to treat isolated full-thickness (down to bone) articular cartilage defects of the knee. It has been approved by the Food and Drug Administration for cartilage defects located at the end of the femur bone (thigh). ACI has also been performed for defects of the patella (knee cap) in addition to other joints of the body. Autologous chondrocyte implantation is a two-stage operative procedure.

The first procedure is performed arthroscopically in less than 30 minutes. The surgeon will harvest a small piece of articular cartilage from the patient’s knee, typically the size of one or two Tic-Tacs. This cartilage biopsy is then sent to a laboratory where the biopsy is enzymatically treated in order to isolate the chondrocytes, which are the cartilage-producing cells of the body. Once these chondrocytes are obtained, they are then expanded in number and sent back to the surgeon approximately 6 to 8 weeks later for implantation.

The second-stage operation is an open procedure whereby a small patch is sewn over the articular cartilage defect. The chondrocytes that have been harvested and expanded are then injected underneath this patch where they adhere to the patient’s knee to form what is known as hyaline-like cartilage which resembles the native joint cartilage. Following implantation there is a period of restricted weight-bearing for up to 8 weeks. During this time, physical therapy emphasizing range-of-motion of the knee and strengthening activities is prescribed. A surgeon may also recommend the use of continuous passive motion (CPM) machine to improve the graft’s success. Return to light sports activities is typically allowed at approximately 6 months with return to full sports activities between 9 and 12 months following the procedure based on the recovery. The overall success rate of ACI is approximately 85% in allowing patients to return to pain-free activities.


MENSICAL TRANSPLANTATION
There are two C-shaped cartilage semi-lunar (moon-shaped) discs within the knee that act as shock absorbers between the end of the thigh bone (femur) and the upper part of the shin bone (tibia). These two structures are known as the medial and lateral meniscus. The menisci are vital structures that help to provide shock absorption and cushion to the knee joint with weight-bearing activities so as to dissipate the compressive stresses over the articular cartilage surface. Tearing of the meniscus is very common during athletic activities and typically can be treated by either removing just the torn fragment or stitching the tear together. This decision is based on the size, location, and configuration of the tear. For meniscal tears that are extensive and are not amenable to repair, meniscal transplantation may be warranted prior to development of osteoarthritis. This procedure involves the placement of a donor meniscus graft that is matched specifically to the side and size of the recipient’s damaged meniscus. The surgical implantation is done through a small incision using arthroscopic methods. Following meniscal transplantation, there is a period of restricted weight-bearing in order to allow the meniscus to heal and incorporate into the patient’s own knee. The surgery is usually performed on an out-patient basis with the risk of complications (such as infection) at less than 1%. There is a graduated return to athletic activity over the subsequent 6 to 8 months. Strenuous weight bearing activities are not recommended in order to preserve the transplanted graft, though some athletes have been able to return to high-level sports. Unlike other tissue transplantations, there is no significant rejection of a meniscal graft; therefore, anti-rejection medications are not necessary. The overall ten-year success rate for meniscal transplantation is approximately 70%.


POSTERIOR CRUCIATE LIGAMENT RECONSTRUCTION
The posterior cruciate ligament (PCL) is one of the four main ligaments stabilizing the knee. The PCL is responsible for providing resistance to posterior (or backward) movement of the tibia bone in relation to the femur bone. Posterior cruciate ligament injuries are rather infrequent; however they usually occur from either a direct blow to the front of the knee or a hyperflexion injury when the athlete falls to the ground with the knee flexed. Injuries to the PCL are categorized into three main types based on the degree of severity: grade I – mild; grade 2 – moderate; and grade 3 – complete. This classification is based on the amount of knee laxity exhibited with a backward stress applied to the flexed knee.

Conservative treatment is typically recommended for grade 1 and grade 2 injuries which represent the majority of injuries. This consists of physical therapy with strengthening of the quadriceps muscle and gradual resumption of athletic activity over the next several weeks. Surgery is recommended only for complete grade 3 injuries. Surgical reconstruction of the PCL involves the placement of a reconstructive graft taken from either the patient’s knee or from a donor graft (allograft). The procedure is done in an arthroscopic fashion on an out-patient basis and takes less than two hours to perform. The incidence of complications following PCL reconstruction is approximately 1%.

Physical therapy is prescribed postoperatively with emphasis on re-establishing knee range-of-motion, followed by strengthening the thigh muscles and progression to a functional rehabilitation regimen. Return to sports activities is usually allowed at approximately 6 to 8 months following surgery. Modern methods of PCL reconstruction result in 85% to 90% return to full activity.

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