“HEALED” ATHLETES CRASHING AND BURNING! (Orthopedics This Week)
Athletes Who Frighten the Best Surgeons
When David Altchek takes a phone call from a despondent coach these days, it just may be because a “healed” player crashed and burned. Dr. Altchek is an attending orthopedic surgeon and is the Medical Director for the New York Mets. He tells OTW, “It is really eerie that high level players who have had a full year of recovery after ACL reconstruction of the knee or ulnar collateral ligament (UCL) reconstruction of the elbow are getting reinjured so often. It’s unsettling to think that we have done a solid procedure and that the patient has rehabbed well, and then everything falls apart. Postop, these patients pass all the required milestones easily; then, within several months of intense competition, they reinjure their knee or elbow.”
Dr. Altchek, clinical professor of Orthopedic Surgery at Weil Cornell Medical College, says, “We are now recruiting patients who have ‘failed’—for the knee it is high school, college, and professional athletes. For the elbow it’s college level or professional pitchers. We want to see what kind of similarities there are in these patients. We hypothesize that it’s something to do with healing, i.e., that the new ligament never really matures to ultimate strength so it can’t bear the loads involved. To what extent it is the biology we don’t know. In the ACL a clear pattern emerged immediately. If we did a hamstring graft on aggressive pivoting athletes in soccer and lacrosse (particularly females) there was less pain at the time of surgery when compared to patients with patellar tendon grafts. In the former group there was a higher incidence of this immediate re-tearing. A Scandinavian study of 45,000 ACLs confirmed that finding.”
“So we’re taking data from the past five years (failed surgeries versus those who did well) and comparing it to controls. The two study groups will include athletes from the same sport who had the same graft, same surgeon, and same physical characteristics. We will be getting a prospective MRI of the knee and elbow at three month intervals to examine variability in graft healing and maturity. It’s a scientific approach to determining if we are not waiting long enough to put these athletes back in the game. I will say, however, that I do believe we are waiting long enough because it is eerie how they just explode after a full year of recovery.”
“One hypothesis is that a subset of these patients injures an associated ligament known as the ‘anterolateral ligament’ (which is poorly defined). Repairing this ligament causes major trauma to the patient and does not result in a big difference in stability of recovery…so we never fix it. But, it may be that some patients need this repaired; their bodies may need the support of this ‘sister’ ligament.