Rush Orthopaedics ranks #6 in U.S.

Transcription

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nk tho us
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#6 e
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In this issue
Volume 2 • Issue 4
The Age of Aquarius
New gender-specific knee implant
promises better results for women..................................6
A Dedicated Life
Surgeon wins acclaim and honors
for medical contributions
By Deborah Maxwell ....................................................................................................8
Preventing Youth Sports Injuries
Pitching a ban on Little League breaking balls ...............10
6
The Incredible Rush
Team physicians play their part in
Chicago’s ArenaBowl victory
By Paul Strandquist, Director of Marketing .......................................................14
Moving Up
Rush orthopaedics program
climbs to sixth in nation ..............................................................................17
The Gift that Keeps on Giving
Human allografts improve
quality of life for many patients
By Steven Gitelis, MD .................................................................................................18
A Winning Group
White Sox medical team honored
for contribution to World Series success .......................22
14
Reducing Noncontact ACL Injuries
Focus on entire kinetic chain corrects faults,
improves performance
By John L. Honcharuk, ATC, CSCS,
and Joe Meier, PT, DPT, MS, NASM-PES, NASM-CPT, CSCS ..............................26
Directory ................................................................................................................34
22
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Orthopaedic Excellence 3
President’s Letter
hings continue to flourish for Midwest Orthopaedics at Rush in 2006. The
Chicago White Sox are off to another fast start this year, and it looks like the
Chicago Bulls are poised for a championship run in the 2006-2007 season.
T
And at Midwest Orthopaedics at Rush, we continue to build and improve on our
foundation as well. We have three new physicians starting with us in 2006.
Jeffrey Mjaanes, MD, who has worked as a pediatrician at Rush, recently completed a primary care sports medicine fellowship and joined the Midwest Orthopaedics at Rush primary care sports medicine team, where he will work with Program Director Kathleen Weber, MD, and
Trish Palmer, MD. Dr. Mjaanes will focus his efforts on our Central DuPage Hospital office located in
Winfield. We believe Dr. Mjaanes has significantly improved our ability to take care of the younger athlete population that we see growing at a very fast rate.
In addition, Johnny Lin, MD, recently became part of our foot and ankle section, joining Section Head
George Holmes, MD, and Simon Lee, MD. Dr. Lin recently completed a foot and ankle fellowship at the
Campbell Clinic in Tennessee but is also familiar with the Rush program, having completed his residency at Rush. Dr. Lin will be primarily based out of the Central DuPage Hospital office in Winfield, and
his presence will enable us to continue to grow our subspecialty offerings at that location and in the
western suburbs.
Filling a role and a subspecialty that has been vacant and highly needed is Monica Kogan, MD, a pediatric orthopaedic surgeon. Dr. Kogan comes to us from Children’s Hospital in Oakland, California,
where she was the staff pediatric orthopaedic surgeon. Dr. Kogan is familiar with Chicago, though,
having completed her residency at Northwestern.
Besides welcoming these highly qualified physicians, we are also expanding our practice locations. We
recently opened a brand new office in Westchester at the just completed Prairie Medical Center at
2434 South Wolf Road (next door to our corporate offices). We are excited to be at this multispecialty
facility centrally located in the Chicago area. We currently plan to offer sports medicine, shoulder, foot
and ankle, and hand services at this facility.
We believe the addition of these physicians and this new practice location will help us in providing the
best, broadest, and most convenient menu of orthopaedic services possible for both you and your
patients. If there are ever any issues or deficiencies with the services we are providing to you, please
contact me or our CEO, Dennis Viellieu, at (708) 236-2611, and we will help you in any way possible.
Go Sox,
Charles A. Bush-Joseph, MD
Managing Member, Midwest Orthopaedics at Rush, LLC
[email protected]
4 Orthopaedic Excellence
A publication from
Midwest Orthopaedics at Rush
www.rushortho.com
Central DuPage Hospital
25 North Winfield Rd.
Winfield, IL 60190
Toll free: (877) MD-BONES
Phone: (630) 682-5653
Fax: (630) 682-8946
Chicago — South Loop/River City
800 South Wells, Ste. M30
Chicago, IL 60607
Phone: (312) 431-3400
Fax: (312) 427-6116
Oak Park Hospital
Medical Office Building
610 South Maple Ave., Ste. 1400
Oak Park, IL 60304
Phone: (312) 243-4244
Fax: (312) 942-1517
RUSH University Medical Center
1725 West Harrison St., Ste. 1063
Chicago, IL 60612
Phone: (312) 243-4244
Fax: (312) 942-1517
Chairman’s Letter
Physician Listing
Howard An, MD
Spine, Back, and Neck
Joshua Jacobs, MD
Joint Reconstruction
Gunnar Andersson, MD
Simon Lee, MD
Foot and Ankle
Bernard R. Bach Jr., MD
Sports Medicine
Gregory P. Nicholson, MD
Sports Medicine and Shoulder
Richard Berger, MD
Trish Palmer, MD
Sports Medicine and Women’s
Sports Medicine
Charles A. Bush-Joseph, MD
Sports Medicine
Mark S. Cohen, MD
Hand, Wrist, and Elbow
Brian Cole, MD
Sports Medicine, Cartilage
Restoration
Craig Della Valle, MD
John Fernandez, MD
Hand, Wrist, and Elbow
April Fetzer, DO
Physical Medicine/Pain
Management
Joseph Fillmore, MD
Management
Jorge O. Galante, MD
Steven Gitelis, MD
Orthopaedic Oncology/Joint
Reconstruction
Edward Goldberg, MD
George Holmes Jr., MD
Foot and Ankle
Wayne Paprosky, MD
Frank M. Phillips, MD
Anthony Romeo, MD
Sports Medicine, Elbow,
and Shoulder
Aaron Rosenberg, MD
Mitchell Sheinkop, MD
Kern Singh, MD
Scott Sporer, MD
Nikhil Verma, MD
Sports Medicine and Shoulder
Walter W. Virkus, MD
Orthopaedic Oncology/Trauma
Kathleen Weber, MD
Sports Medicine and Women’s
Sports Medicine
Yejia Zhang, MD
Management
his year continues to be both exciting and challenging. First and foremost, our plans to develop a
dedicated orthopaedic ambulatory destination on
the Rush campus continues to move forward and take
shape. We have selected the developer, architects, and
construction managers that will help us realize this
dream. We expect this facility to be completed and
come online in the first quarter of 2009, but there is
much planning and work to be completed first.
T
Rush’s plans for a new hospital and campus renovation are also moving forward. Rush has already received $167 million in pledges or donations
toward a goal of $300 million. Rush plans include a new hospital facility
that will incorporate a brand new concept called an “interventional platform.” Two floors extending from the new hospital into the renovated
Atrium building will be devoted to surgery, imaging, and specialty procedures. Nearby will be the facilities and equipment required for interventional
radiology, cardiology, and neurosurgery, fostering increased collaboration
and a multidisciplinary approach for specialists who are doing similar procedures. The interventional platforms will locate key services close to one
another on two easily accessible levels, minimizing the need for patients and
their families to travel to multiple locations in the medical center.
Rush’s new hospital also will include a state-of-the-art emergency services
facility designed to care for victims of major catastrophes. It will be named
the McCormick Tribune Center for Advanced Emergency Response in recognition of the foundation’s $7.5 million contribution in 2004. Rush and the
John H. Stroger Jr. Hospital in 2002 were named bioterrorism preparedness
Centers of Excellence by the Chicago Department of Public Health. Each
hospital has received grants to improve hospital capabilities in preparedness planning, disease detection and surveillance, infection control, communications, collaborations, education and training, and more.
The campus redevelopment also includes implementation of a new information technology system. New electronic software applications (Epic) will
ensure the integration of clinical and financial information, providing
streamlined registration and scheduling, faster and more accurate test
results, and real-time access to complete medical histories.
The department also continues to benefit from Rush’s philanthropic
endeavors with a recent contribution of $4.5 million. Donations such as
this enable us to advance our research efforts to the benefit of patients.
We hope that these coordinated efforts and improvements, along with the
implementation of new technologies, by Rush, the Orthopaedic
Department, and Midwest Orthopaedics at Rush will enable us to improve
the care and treatment of your patients both today and far into the future.
Best regards,
Gunnar Andersson, MD, PhD
Chairman, Orthopaedic Department
Rush University Medical Center
The Age of Aquarius
New gender-specific knee implant promises better results for women
flexibility. We simply have not had an implant that
meets these unique requirements.”
The Zimmer Gender Solutions High-Flex Knee is
the first knee replacement shaped to fit a woman’s
anatomy. Illustrations courtesy of Zimmer, Inc.
ccording to the National Center for Health
Statistics, women comprise nearly two-thirds
of the 400,000 knee replacement surgeries
performed annually. Even more surprising is that
in spite of experiencing a higher incidence of knee
pain, women are also three times less likely than
men to undergo joint replacement surgery.
A
That has changed with the launch of a new gender-specific implant designed to better match the
structure of a woman’s knee joint. This implant
can be placed using minimally invasive surgical
techniques, which typically produce smaller scars,
shorter hospital stays, and quicker recoveries.
“Less invasive procedures are helping patients get
back to enjoying their lives faster than ever before,”
adds Dr. Rosenberg. “Now that we have a knee
in women,” says Aaron Rosenberg, MD, Director shaped to fit a woman’s anatomy, we expect that
of the Section of Adult Reconstruction at far more women will consider knee replacement.”
Midwest Orthopaedics at Rush. “Women’s
knees are different from men’s in that they’re nar- Advantages of Women’s Implant
rower side to side for a given front-to-back
dimension. More importantly, women’s joints are The implant was developed through the extensive
shaped differently in all sizes and exhibit more research efforts of the Midwest Orthopaedics at
Although the current implant technology has
functioned well for both men and women, providing pain relief and significantly improving function, these implants are less likely to fit, feel, and
function naturally for female patients.
Relative to the knee joint, female anatomy is significantly different from male anatomy. Women
have wider hips than men, changing the angle at
which the femur connects to the knee. Women’s
knees have less cartilage, so women are more
likely to experience osteoarthritis, a leading factor
in knee replacement surgery. Lifestyle factors such
as pregnancy and wearing high-heel shoes are
additional contributing factors.
Meeting Women’s Needs
Since the implants are not precisely suited for
the female anatomy, the procedures are more difficult — for both the surgeon and patient. “I
think the lack of a gender-specific knee implant
has contributed to the lower utilization rate
All other total knee implants being used today fall within the same size and proportion ranges, which are
based on an average between the sizes of women’s and men’s knees. This approach does not optimally address
the differences in shape between women’s and men’s knees. The Gender Solutions High-Flex Knee from
orthopaedics leader Zimmer is the first and only implant to address the three distinct and scientifically documented shape differences between women’s and men’s knees.
Rush joint reconstruction team in collaboration
with Zimmer, Inc., the world’s leading manufacturer of knee replacements. According to Zimmer,
the Gender Solutions High-Flex Knee implant
offers the following three advantages:
TM
• Narrower shape, proportioned to
female anatomy: Surgeons typically
choose a knee implant size based on the
front-to-back measurement of the end of
the femur, which is key in allowing the
knee to move and flex properly. However,
an implant that provides a good fit for a
woman’s knee from front to back often
will be too wide from side to side. This
leads to the implant overhanging the
bone and potentially pressing on, or damaging, surrounding ligaments and tendons
and possibly causing pain. The Gender
Solutions High-Flex Knee is proportionally
contoured to the entire bone to provide a
more precise fit.
but still feel “bulky,”
which may result in
pain and decrease
optimal function.
The Gender
Solutions implant is
thinner in shape in
the front, so the
knee replacement
more appropriately
matches the natural
female anatomy.
The femur, or thighbone, portion of a typical woman’s knee (left) tends to be
narrower from side to side and more trapezoid shaped, while a man’s (right) is
wider and more rectangular shaped. The Gender Solutions High-Flex Knee is the
first knee replacement shaped to fit a woman’s anatomy.
• More natural
tracking: The angle
between the pelvis
and the knee affects
how the patella
tracks over the end
of the femur as the
knee moves through
a range of motion.
Women tend to have
• Thinner shape: The bone in the front of
a different angle
women’s knees is typically less prominent
than men due to To accommodate the different shape of women’s knees, the front of the Gender
Solutions Knee Implant (right) is narrower than a traditional implant (left).
than in men’s. Therefore, when a traditheir unique shape
Rosenberg. “The gender-specific implant is the
tional implant is used to replace the damand contour. Before the Gender Solutions
best of both worlds. It’s based on the current
aged bone, the joint may end up feeling
High-Flex Knee, all implant designs were
implant we use, a highly successful implant with
and functioning better than before surgery
based on an average of women and men.
great mechanics and 10 years of clinical success,
Therefore, the tradibut the shape of this new implant is different to
tional artificial knee
make it feel more natural.”
may tend to track at
an angle that leads to
The Future of Knee Replacements
a woman’s knee feeling unnatural as it
The development of the new gender-specific
moves. The Gender
implant comes at the forefront of a major
Solutions knee
groundswell of demand for joint replacement. As
implant was designed
baby boomers transition from middle age to sento accommodate the
different tracking
ior citizenship, the number of candidates for artiangle and function
ficial joints will increase markedly.
more like a woman’s
natural knee.
According to a new study by the American
Academy of Orthopaedic Surgeons (AAOS), the
“Knee implants have total number of knee implants performed in the
been functioning very United States will reach nearly 3.5 million by the
w e l l f o r m e n a n d year 2030. The majority of these will undoubtedly
women, but we want to be women.
meet women’s unique
needs by making knee In addition to the aforementioned contributing
replacements that feel, factors for joint replacement, women in the
The bone in the front of women’s knees is typically less prominent than in men’s.
The Gender Solutions implant is thinner in shape in the front, so the knee fit, and function even United States live longer than men on average,
replacement more appropriately matches the natural female anatomy.
b e t t e r, ” s a y s D r.
continued on page 12
A Dedicated Life
Surgeon wins acclaim and honors for medical contributions
By Deborah Maxwell
idwest Orthopaedic
at Rush joint replacement surgeon Joshua
J. Jacobs, MD, was elected
President of the
Orthopaedic Research
Society (ORS) at its recent
annual meeting in
Chicago. Dr. Jacobs served
on the ORS Board of
Directors for five years
prior to his election.
According to Dr. Jacobs,
“ORS is a complex organization that provides an
international forum for the
dissemination of rapid
developments in
orthopaedic research that
may ultimately have a dramatic impact on the diagnosis and treatment of
both common and rare
musculoskeletal diseases.”
M
“It is an honor to be
selected for the Knee Society
and join my distinguished
partners Dr. Galante, Dr.
Rosenberg, and Dr. Paprosky
in this influential organization,” says Dr. Jacobs.
Staying at the
Forefront
Dr. Jacobs’ accomplishments
are even more significant
when viewed in light of the
overall field of adult joint
reconstructive surgery, a
constantly changing
orthopaedic subspecialty.
The American Academy of
Orthopaedic Surgeons
(AAOS) states that joint
replacement surgery “…has
been one of the most significant advances in musculoskeletal surgical treatment
over the past 30 years.”2
Furthermore, AAOS statistics
show more than 500,000
total joint replacements are
performed each year in the
United States.2
As President, Dr. Jacobs
will manage the fiscal and
strategic mission of ORS.
Founded in 1954 and
incorporated as a nonprofit organization in
1982, ORS promotes
Dr. Jacobs holds hip prostheses that were recovered from a patient who underwent revision surgery
Despite these statistics, the
orthopaedic research, pro- and received new implants. Photo courtesy of the Associated Press.
vides mentorship for
AAOS Research Committee
young researchers, and
(2003) reports that joint
1
publishes the Journal of Orthopaedic Research. International Hip Societies (along with Midwest replacement surgery is not yet fully utilized across
ORS also lobbies for increased federal research Orthopaedics at Rush physicians Jorge Galante, all ethnicities and geographic areas.2 However,
funding for musculoskeletal diseases and works MD; Aaron Rosenberg, MD; and Wayne Paprosky, patients who do receive orthopaedic prostheses
to increase public awareness of the impact MD), Dr. Jacobs is considered among the elite are so accepting of the technology that not much
orthopaedics has made on patients’ lives.
adult reconstructive orthopaedic surgeons in the thought is given any more to the work, science,
world — those who have made significant contri- or scientists behind these modern-day miracles.
Also recently inducted into the Knee Society and butions to the body of orthopaedic research, Significant improvements in the scientific and
an already established member of the U.S. and knowledge, and clinical practice.
clinical body of knowledge in adult arthroplasty
OrthoFact
The Research Department at Rush University
Medical Center in Chicago is dedicated to the
pursuit of outstanding biomedical research
to advance knowledge and optimize patient
care. Rush aims to foster centers of excellence that combine clinical, basic, and population science to study areas of importance
to the community. Several programs have
been created to support and encourage
Rush investigators involved in more than
1,600 research studies, and Joshua J.
Jacobs, MD, of Midwest Orthopaedics at
Rush, serves as the Director of Orthopedic
Residency Program and the Director of the
Section of Biomaterials for the Rush
Research Department.
over the last generation have contributed to
improved quality of life for patients and therefore
have contributed to this sea change of almost
universal acceptance by patients.
Leading Research Efforts
One of Dr. Jacobs’ major contributions, a study
funded by the National Institutes of Health (NIH),
is a unique effort, according to Dr. Jacobs, who is
the principal investigator of the study. This longitudinal study, initiated approximately 15 years
ago by Dr. Jacobs’ partner Dr. Galante, studies
wear patterns and particulate debris generated by
prosthetic implants and the effect of this debris
upon surrounding body tissues and distant
organs. This study is ongoing and has already
yielded translational results in the ability for physicians to gauge how well an orthopaedic implant
is working via serum and metal blood levels.
“My work is at the
interface of medicine
and engineering.”
— Joshua J. Jacobs, MD
Review of the literature shows that particulate
debris can induce prosthetic failure; therefore, one
can expect Dr. Jacobs’ eventual results regarding
particulate debris to increase scientific understanding of cellular and systemic response to implants
and quite possibly the strengths and weaknesses in
prosthetic materials and design.3 Ultimately, these
results will be utilized to develop longer-lasting,
better performing prostheses.
yet his impact on current and future patients’ lives
has yet to be fully realized and will not be for
years to come.
Deborah Maxwell holds a Bachelor of Science
in business administration with a concentration
in management from Elmhurst College. She
has worked with the physicians of Midwest
Orthopaedics at Rush for 16 years and currently
serves as Marketing Analyst for the group. She
Putting Knowledge to Work
has previously written on other medical topics,
including osteoporosis and Rett Syndrome, and
An undergraduate degree in material science and has served as editor for “Common Call,” the
engineering from Northwestern University has newsletter for the Oak Park-River Forest
meshed perfectly with Dr. Jacobs’ clinical Community of Congregations.
work and research with
orthopaedic implants. His
knowledge of metallurgy
has been helpful in understanding many of the clinical problems that develop in
individuals with metal
implants, such as the relation between prosthetic failure and metal allergy.4 Dr.
Jacobs says, “My work is at
the interface of medicine
and engineering.”
In addition to his clinical and
research duties, Dr. Jacobs
is active with various
orthopaedic societies and Dr. Jacobs (right) has met with House Speaker Dennis Hastert (left) and will
travel to Washington later this year to advocate for federal policies to prochairs the AAOS Council on mote musculoskeletal health.
Research, Quality Assessment, and Technology.
Consistent with the council and the mission of ORS, References
Dr. Jacobs has met with House Speaker Dennis 1. Orthopaedic Research Society. (2006). [WWW document].
Retrieved: http://www.ors.org/Welcome.asp.
Hastert and will travel to Washington later this year
to advocate for federal policies to promote muscu- 2. AAOS Research Committee. (June 2003). Future directions
in musculoskeletal research: a summary report of the AAOS
loskeletal health. Health care policy, economics,
research committee panel studies. 53, 93.
and research funding are vital issues for Dr. Jacobs
and AAOS, particularly as the demand for 3. National Institutes of Health. (2000). Improving medical
implant performance through retrieval information: chalorthopaedic implants and health care services is
lenges and opportunities. [WWW document]. Retrieved:
projected to increase as the population ages.
http://consensus.nih.gov/2000/2000MedicalImplantsa019html
Dr. Jacobs also heads the Orthopaedic
Postmortem Retrieval study at Rush University
Medical Center in Chicago. Study participants
agree to removal of their prostheses as well as the
bone and tissue around the implant and possibly
remote tissue samples from their bodies shortly
after death.
.htm, paragraph 2 of Explant Analysis section.
From his work with the ORS to his federally
funded research, the halls of Congress, and 4. Jacobs, J. (2005). Commentary & perspective on
metal-on-metal bearings and hypersensitivity in
Midwest Orthopaedics at Rush, Dr. Jacobs is a
patients with artificial hip joints: a clinical and histoconstant advocate for orthopaedic science and
morphological study. The Journal of Bone and
patient care. His contributions to orthopaedic
Joint Surgery. [WWW document]. Retrieved:
research, knowledge, clinical practice, and policy
http://www.jbjs.org/Comments/2005/cp_jan05_jacobs.shtml.
are extensive. Dr. Jacobs’ mission is far from over,
Pitching a ban
on Little League
breaking balls
he breaking ball is a devastating weapon in a
Little League baseball game. To even the best
players, the pitch is nearly unhittable.
Unfortunately, the pitch’s nasty effect goes
beyond baffling opposing hitters.
T
Overuse Abuse
Among pitchers younger than 12 years of age,
nearly 45% complain of chronic elbow pain.
According to a study published by the Journal of
the American Academy of Orthopaedic Surgeons,
overuse and incorrect throwing mechanics are the
primary causes of elbow injuries in young pitchers.
“In youth baseball, there are certain
motions that are repeated over and over
again that are likely to create an overuse
injury,” says Bernard R. Bach Jr., MD,
Director of Sports Medicine at Midwest
Orthopaedics at Rush. “Even in a normal
throwing motion, the elbow is under a
tremendous amount of stress. Factor in
abnormal mechanics, such as the motion
used to throw a breaking ball, and the
stress is multiplied.”
Boys are often able to learn the curve ball at
10 or 11 years of age, which is, according to
Dr. Bach, well before their arms are ready for
the strain. Competitive coaches encourage their
pitchers to throw breaking balls and also exhibit
a tendency to overuse their better hurlers.
Patrick McKune, Treasurer of Oak Park Youth
Baseball, has witnessed the trend of injury and
overuse. “In the Little League World Series, it was
reported that 60% to 65% of the pitches thrown
were curve balls,” says McKune. “You just have to
shake your head. Another wake-up call for me
was last year when I witnessed my son throw six
straight curve balls in a game.”
Taking Action
When the condition is not treated, it can cause
long-term problems.”
Disturbed by this growing trend, McKune decided
to take action. Along with Dr. Bach and represen- Dr. Bach adds, “It seems that every parent thinks
tatives from AthletiCo, McKune arranged a meet- his or her kid is on the fast track to a Division I
scholarship, and, ultimately, a professional baseAmong pitchers younger ball career. There is a ‘graveyard’ of talented kids
careers ended prematurely because of
than 12 years of age, near- whose
throwing-related elbow and/or shoulder injuries.
ly 45% complain of chronic We advocate throwing a fast ball and a change
elbow pain. According to a up but no curve balls until approximately 13 or
14 years of age. The kids should focus on pitchstudy published by the
ing mechanics and control. Kids mature at differJournal of the American
ent rates, and mechanics can change
Academy of Orthopaedic dramatically when adolescents go through rapid
growth spurts, which may result in significant
Surgeons, overuse and
muscle imbalances.”
incorrect throwing
mechanics are the primary
causes of elbow injuries in
young pitchers.
McKune initially thought enforcement of the new
rules might be an issue, but to date, no infractions
have been observed. To his knowledge, the ban
enacted by Oak Park Youth Baseball may be
unique to the area. “It’s my hope that other
ing with the Oak Park Youth Baseball board, leagues will adopt similar rules to protect the
making the case for a ban on breaking balls com- health of their young players.”
bined with a mandatory pitch count. The board
agreed with Dr. Bach’s medical opinion Injury Prevention
and enacted both the ban on breaking
balls and pitch count restrictions. Dr. Dr. Bach’s work on the breaking ball issue
Bach is confident that it will have a dra- stems from his considerable interest in youth basematic effect on the occurrence of injury. ball and sports medicine. Serving as the Vice
President of the American Orthopaedic Society
“I’ve performed elbow surgery on 12- for Sports Medicine, Dr. Bach was instrumental in
and 13-year-old pitchers, and it’s just the development of Prevention and Emerheartbreaking,” says Dr. Bach. “These gency Management of Youth Baseball and Softball
overuse and stress-related problems Injuries (see Youth Baseball Safety).
can affect growing parts of the bone
(the growth plates), not just For a copy of Prevention and Emergency
muscles, tendons, and ligaments. Management of Youth Baseball and Softball
Injuries or for more
information on youth
baseball safety, visit
the American Orthopaedic Society for
Sports Medicine online
at www.sportsmed.org
or call Midwest
Orthopaedics at Rush at
(877) MD-BONES.
Overuse and stress-related problems can affect elbow ligaments (shown above),
muscles, and tendons, possibly leading to long-term problems.
Youth Baseball Safety
Prevention and Emergency Management of Youth Baseball and Softball
Injuries provides guidelines on youth
baseball safety to help coaches and
parents to
• be familiar with basic sports
injury terminology;
• be aware of up-to-date techniques for preventing sports
injuries;
• be able to differentiate between
mild, moderate, and severe
injuries;
• know appropriate first aid
techniques for the injuries they
will encounter;
• be able to design an emergency
plan for their league to use when
severe injuries occur; and
• know specific techniques to
determine whether an injured
player is ready to practice and
play again.
1986, Bernard Bach Jr., MD, has
developed a nationally recognized
sports medicine program. Dr. Bach
has published more than 240 scientific papers, abstracts, and book
chapters. He serves on numerous national sports
committees and editorial boards and is an educator
of residents, fellows, and his patients. Dr. Bach is
board certified (1989) and recertified (1999) by the
American Board of Orthopaedic Surgery. Dr. Bach
has served on the national boards of the Illinois
Special Olympics, the Orthopaedic Research and
Education Foundation, and the American
Orthopaedic Society for Sports Medicine. He is the
editor of the Journal of Knee Surgery. Dr. Bach was
selected as one of Chicago magazine’s “Top
Doctors” in 1996, 2000, 2004, and 2006, and is
recognized nationally and internationally as a
leader in sports medicine. He was inducted into the
Illinois Athletic Trainer’s Hall of Fame in 1995.
Along with the other members of the Sports
Medicine Division, he was selected as a Team
As Director of Sports Physician for the Chicago White Sox baseball team
Medicine at Rush since in 2004 and 2005.
The Age of Aquarius
Women’s Movement
continued from page 7
with a life expectancy of 80 years, compared to 75
years for men.
The following physicians are leading the way with gender-specific knee implants.
By increasing the utilization of knee implants in women with osteoarthritis, they are
helping improve their mobility and quality of life.
In addition to Dr. Rosenberg, Midwest Orthopaedics
at Rush surgeons Richard Berger, MD, and Wayne
Paprosky, MD, worked closely with biomechanical
engineers throughout the two-year research and
development process. The new implant, which has
received clearance from the FDA, is already being
utilized by Midwest Orthopaedics at Rush joint
reconstruction physicians and is expected to be
globally available this fall.
Richard A. Berger, MD, earned a degree in mechanical engineering from
MIT that has well equipped him for his biomechanics re-search on total hip
replacements. Dr. Berger was fellowship trained in adult reconstruction at
Rush University Medical Center by Jorge Galante, MD, and Aaron
Rosenberg, MD.
Aaron G. Rosenberg, MD, specializes in hip, knee and joint replacement
surgery. He is a graduate of Albany Medical College. He served as a resident at Rush University Medical Center in Orthopaedics and served as a
fellow in Adult Reconstruction and Oncology at Massachusetts General
Hospital in Boston, prior to beginning the practice of orthopaedic surgery
at Rush in 1984.
“The new implant is evidence of our dedication to
research over the past 25 years and to improving
our patients’ quality of life through decreased pain
with better implants,” says Dr. Rosenberg.
Wayne G. Paprosky, MD, specializes in hip and knee replacement. Dr.
Paproksy is a graduate of McMaster University School of Medicine. He
served his residency at Henry Ford Hospital in Detroit, and served as a fellow in Adult Joint Reconstruction at New England Baptist Hospital, Tufts
University, Boston.
For more information on joint replacement surgery
and gender-specific implants, contact Midwest
Orthopaedics at Rush at (877) MD-BONES or visit
www.rushortho.com.
Chicago
•
Oak Park
•
877-MD-BONES
www.rushortho.com
Winfield
The Incredible
Rush
Team physicians play
their part in Chicago’s
ArenaBowl victory
By Paul Strandquist, Director of Marketing,
Midwest Orthopaedics at Rush
Chicago Rush fans came out to support their team, helping make it the biggest crowd in
ArenaBowl history.
he Chicago Rush completed one of the most
improbable runs in Arena Football League
(AFL) history with a 69-61 win over the
Orlando Predators in ArenaBowl XX on Sunday,
June 11, 2006, at the Thomas and Mack Center
in Las Vegas. “I am so proud of this team,” says
Rush Head Coach Mike Hohensee, who won his
first AFL title after 20 seasons in the league.
“They believed in each other and played their
hearts out, and now they can call themselves
champions.”
T
The Rush was 5 and 9, and it looked like the
team might miss the playoffs. However, the
Rush responded by winning its final two regular
season games in convincing fashion to qualify
for the playoffs and then went on the road to
win four consecutive playoff games.
The Thrill of Victory
Rajeev Khanna, MD, and Paul Strandquist, Director of Marketing at Midwest Orthopaedics at Rush
I was at the final game, sitting with the Chicago
Rush families, staff, and corporate sponsors to
celebrate a great season and a fantastic ArenaBowl championship. What a thrill to be included
with the Chicago Rush front office staff, families,
and management and to share in their welldeserved excitement and celebration after they
won the championship. ArenaBowl XX was a
big sporting event, and Chicago fans came out to
support their team, helping make this the biggest
crowd in ArenaBowl history.
with the Chicago Rush as a corporate
sponsor and as the team’s orthopaedic consultants. Midwest Orthopaedics at Rush physicians
work closely during the AFL season with Rush
Head Team Physician Rajeev Khanna, MD, and
Th i s y e a r m a r ke d t h e s e c o n d s e a s o n his colleagues at Advanced Occupational
Midwest Orthopaedics at Rush has worked Medicine Specialists.
Dr. Khanna and John Connell, Athletic Trainer
for the Rush, were busy at ArenaBowl XX taking care of the players’ injuries before and after
the game. But they found time to come out of
the locker room after the Chicago Rush victory
to join the on-field celebration with all the
Rush players, families, and staff, as well as the
Chicago Rush fans.
Brian Cole, MD. “They were 5 and 9 but continued to battle and finished the season champions. We will do our part and continue to
provide the highest quality of subspecialized
sports medicine care to anyone, and that
includes championship professional sports
teams, college and high school athletes, and
the weekend warriors.”
Paul Strandquist, Director of Marketing at
Midwest Orthopaedics at Rush, earned a Bachelor
of Science in health and physical education from
Illinois State University. He has been in customer
service and marketing with Midwest Orthopaedics
at Rush for 20 years. He enjoys coaching baseball
and playing Chicago-style 16-inch softball.
“I am so proud of this team.
They believed in each other
and played their hearts out,
and now they can call
themselves champions.”
— Mike Hohensee, Rush Head Coach
A Little Luck, a Lot of Skill
Mike Ditka — now part owner of the Chicago
Rush, NFL Hall of Fame player, and of course “da
coach” of the Chicago Bears’ Super Bowl XX
champions — was also on hand for the celebration. Many fans and the media called “da
coach” a good luck charm, stating that Ditka
was a part of Super Bowl XX and now the
Chicago Rush ArenaBowl XX victory.
The same can also be said for the physicians of
Midwest Orthopaedics at Rush who were part
of the 2005 Chicago White Sox World Series
Championship team as their team physicians.
And now the Chicago Rush has won
ArenaBowl XX in 2006.
“All the credit for the ArenaBowl championship goes to the players and coaches,” says
David McClamroch, Corporate Sales Manager for the
Chicago Rush; Paul Strandquist, Director of Marketing
at Midwest Orthopaedics at Rush; and Mike Gordon,
Vice President of Sales for the Chicago Rush
Moving Up
Rush orthopaedics program climbs to sixth in nation
By Kerri Kossick
nce again, the Rush University Medical Center
Orthopaedic Program gained national recognition among orthopaedic practices by making
another appearance in U.S. News & World Report’s
“Best Hospitals” issue. This year, Rush was the
nation’s sixth best and Illinois’ top program.
O
Continuous Advancements
Rush was ranked tenth in 2004, climbed to eighth
place in 2005, and moved up to sixth in the
nation this year. This upward trend is one
that Rush expects to continue throughout the
upcoming years.
“I believe the program can achieve an even
greater status,” says Gunnar Andersson, MD, PhD,
Chairman of the Orthopaedic Department at Rush
and partner with Midwest Orthopaedics at Rush
(MOR). “As we continue to pioneer advancements
in orthopaedic medical science, the stature of the
program will only continue to increase.”
The Evaluation
This year, out of 5,189 hospitals nationwide, only
3 percent (176) were considered for evaluation.
Each hospital was ranked in one or more of the 16
specialties in this year’s “Best Hospitals” issue. For
the orthopaedic specialty, the annual report evaluates practices according to specific criteria, including reputation, mortality ratio,
discharges over the past three
years, nurse-to-patient index,
nurse Magnet facility status,
patient and community services, key technologies,
and trauma services.
In addition to its high overall ranking, the
Rush University Medical Center Orthopaedic
Program ranked among the survey’s best in
nearly every category.
progressive treatment alternatives, including minimally invasive joint replacement and spine surgery; anterior cruciate ligament and rotator cuff
repairs; cartilage restoration; arthroscopic knee,
shoulder, and elbow repair; and minimally invaA Strong Team
sive foot and ankle surgery. The orthopaedic surgeons at Rush led the way for many advances in
The strength and success of Rush University hip and knee implants, including minimally invaMedical Center is due, in part, to its partnership sive techniques that enable patients to return
with MOR. The Rush University Medical Center’s home within a day.
orthopaedic medical staff is comprised largely of
MOR physicians, who are highly trained in In addition to surgical practices, the physicians
orthopaedic surgery as well as in specialized fields hold academic appointments at Rush Medical
within orthopaedic medicine.
College and are active in research. Their research
leads to discoveries and leading-edge therapies
A qualified staff of physician assistants; registered that benefit patients, which is what the physicians
nurses; athletic, physical, and occupational thera- find to be their greatest reward.
pists; specialists in gait analysis; x-ray and cast
technicians; and administrative personnel helps “The physicians of MOR are extremely proud of
support the physicians and complete the range of this program’s success, which validates the vision
services provided at Rush. Physicians and nurse we share with Rush of providing the world’s best
specialists working in teams thoroughly evaluate orthopaedic patient care, education, and
each patient, accurately diagnose problems, and research,” says Dr. Andersson.
create individualized treatment plans.
For more information about the physicians at MOR or
the U.S. News & World Report “Best Hospitals 2006”
The collaboration
special issue, call (877) MD-BONES or visit
between Rush
www.rushortho.com.
University Medical
Center and MOR
generates
The Gift
that Keeps
on Giving
Human allografts
improve quality
of life for
many patients
By Steven Gitelis, MD,
Medical Director, Tissue Bank, Gift of Hope
he use of human tissue is not new. The first
reported tissue transplants occurred around
the turn of the 20th century. In recent years,
there has been increased popularity in the use of
allografts in orthopaedic surgery, and currently,
there are approximately 250,000 grafts transplanted per year in the United States.
T
There are many potential uses of these grafts, and
they can improve the quality of life of patients. It is
very important that the surgeon know the source
of these grafts and how they are processed and
screened. The state of Illinois has one of the largest
tissue banks in the United States. It operates with
the Gift of Hope, the organ procurement agency of
Fresh osteoarticular allograft of the hip and femur
Illinois. It is a not-for-profit tissue bank, and I have created to ensure a fair and equitable distribution
served as its medical director for 20 years.
of organs in the United States. Tissue banks frequently operate in conjunction with the organ
There are several important concepts that procurement organizations to acquire transorthopaedic surgeons need to understand related plantable allografts.
to procurement, processing, and safety issues.
When selecting a tissue bank, the surgeon needs When contacted, a transplant coordinator from
to know the bank and its banker.
the Gift of Hope then assesses the donor. The
coordinator talks to the donor family about tissue
Procurement
donation and describes the process and ultimate
use of these donated grafts. It is important that
Tissue procurement is a comprehensive process the organ procurement organization and the
that starts with the donor and donor hospital. The donor family develop a strong relationship. Even
donor hospital generally does its own initial though there is a driver’s license signature option
assessment and then contacts the organ procure- in Illinois, the donor family’s approval is still
ment organization in its area. Organ procurement sought for tissue donation. This is a critical
organizations are federally mandated and were informed consent process.
The transplant coordinator then evaluates the
donor for medical conditions that might preclude
procurement. These include but are not limited to
a history of cancer, hepatitis, and exposure to
other transmittable diseases. The donor is also
evaluated by an extensive battery of serologies to
rule out transmittable disease. Recently, we have
added nucleic acid testing to diminish the window
where a donor could be infected and not manifest
an immunological reaction to a virus.
Due to their work, the cells can be kept alive up
to 28 days, allowing the grafts to be appropriately
quarantined and placed with an acceptable donor.
All allografts, fresh or frozen, are cultured, and
these cultures are screened to determine the
acceptability of the allografts. After procurement
is performed, the donor is reconstructed for later
funeral services.
organisms; however, it has no effect on viral contamination and does cause some weakening of
the allograft. Other processes occur at Allosource
such as machining of allografts. These are techniques where the human tissue is shaped using
automated machines into grafts that are useful
for specific surgical applications. An example is a
spinal graft used for spinal fusions.
Processing
After the procurement has been
completed, the tissue acquired
by Gift of Hope is sent to Allosource, a not-for-profit organization that is the fourth largest tissue
processing operation in the United
States. All the work done on the
allografts at Allosource is performed in a highly filtered clean
room under sterile conditions.
Meniscal allograft with subchondral bone
The tissue transplantation team then goes to the
donor hospital, the operating room at the medical
examiner’s office, or, more recently, to our stateof-the-art operating room at the Gift of Hope
located in Elmhurst, Illinois. The procurement
process is nothing less than a very careful
orthopaedic operating procedure. The tissue is
procured in a very sterile environment and then
cultured. The tissue is initially refrigerated and
then ultimately frozen to -80 degrees Centigrade
for storage. This freezing process diminishes the
immunogenicity of the allografts.
The tissue will remain in quarantine until all
screening tests have been completed and
reviewed along with the detailed medical record.
All this information is reviewed by me and Ross
Wilkens, MD, the Medical Director of Allosource in
Colorado. Thus, the tissue is very carefully scrutinized for acceptability.
Recently, fresh tissue procurement and transplantation has become very popular. This tissue is
screened in a similar manner to our standard
frozen allografts. These grafts are placed in tissue
culture so the cartilage viability is maintained.
Much of the methodology to maintain the life of
articular cartilage was developed at Rush by the
Department of Biochemistry and Brian Cole, MD.
The grafts are debrided, cleansed, Bone tendon achilles allograft for cruciate reconstruction
and recultured. If the initial culture
at the time of procurement is a
low-virulent organization and if they are ren- Manufacturing techniques such as computerdered culture negative after processing, they are assisted design and manufacturing are used to
packaged and available for use. If the original prepare machined grafts. The freshly procured
cultures are of moderate virulence, then, in addi- articular grafts are washed and cleaned in
tion to preparation and cleansing, the grafts are Colorado and recultured. They are only released if
secondarily sterilized with gamma irradiation. all serologies and cultures are negative.
Finally, if the original cultures reveal a virulent
organism such as Clostridium, enterococcus, or a Safety
fungal organism, the grafts are discarded at the
As a result of the careful historical screening,
procurement agency.
serological testing, cleansing, and culturing of all
Secondary sterilization with gamma radiation is grafts, human tissue allografts are extremely safe.
quite effective to eradicate moderate-virulent Bacterial contamination is very rare, and there has
not been a viral transmission from a
human allograft in nearly 20 years.
The stated risk of viral transmission
is approximately one in 1.5 million.
Allograft-prosthetic composite arthroplasty of the knee
Surgeons need to know the accreditation of their tissue banks. The tissue banking industry is regulated by
the federal government, which has
created guidelines for procurement
and processing. In addition, the
American Association of Tissue
Banks (AATB) has rigid guidelines
that must be met in order to receive
its accreditation. Both the Gift of
Hope and Allosource are AATB accredited. This intercalary defect. Allografts are also used in con- life of so many people. Surgeons need to be mindaccreditation should be sought by surgeons trans- junction with implants as an allograft prosthetic ful of the source of their grafts and understand
planting human tissue.
composite that is useful for both tumor surgery procurement processing and safety.
and complex joint reconstructive surgery.
Application
Steven Gitelis, MD, currently serves
Spinal surgeons use allografts for fusions, both
as the Director of the Rush Center for
There are many clinical applications for human tis- interbody and posterior fusions. One of the more
Limb Preservation and the Medical
sue. One of the more common applications is the common uses of allografts is in knee reconstrucDirector of the Tissue Bank, Gift of
use of demineralized bone matrix, which is tion. Anterior cruciate ligament reconstruction
Hope. His numerous appointments
derived from human cortical bone. The donated with a bone tendon/bone allograft is a popular also include Endowed Chair, Rush Medical College
bone is ground and demineralized with a calcium technique and quite effective. Finally, fresh artic- Professor of Orthopaedic Oncology, and Director of
content of less than 3%. This process releases ular cartilage is being used by joint restoration Section of Orthopaedic Oncology, Rushbone proteins that participate in the cascade of surgeons. Unipolar defects of the lower femur or Presbyterian-St. Luke’s Medical Center. Dr. Gitelis
events leading to bone repair. Proteins such as upper tibia can be replaced with a fresh living has enjoyed a longstanding relationship with Rush,
bone morphogenic proteins are released in this allograft. Unfortunately, there is a greater completing both his orthopaedic surgery residency
manner. These proteins are very effective as demand for this tissue than there is a supply, but and general surger y internship at Rushosteoinductive materials that aid in bone repair. new techniques are being developed to increase Presbyterian-St. Luke’s Medical Center in
the available tissue.
Chicago. His early orthopaedic oncology experience
Long bone allografts are still used today to restore
came from fellowships at the prestigious Rizzoli
the skeleton after tumor surgery. If a segment In conclusion, human allografts are safe and Institute in Bologna, Italy (under renowned
of the femur or tibia is removed, a frozen long effective. They are the result of a generous gift by Professor Mario Campanacci), and Mayo Clinic in
bone allograft is frequently used to restore the the donor family and can improve the quality of Rochester, Minnesota.
A Winning
Group
erm Schneider, Head Athletic Trainer for the
World Series champion Chicago White Sox,
presented World Series gifts to the White Sox
medical team at Rush University Medical Center
in May.
H
Members of the medical team receiving
gifts included Midwest Orthopaedics at
Rush physicians Charles A. Bush-Joseph, MD;
Kathleen Weber, MD; Bernard R. Bach Jr., MD;
Gregory P. Nicholson, MD; Nikhil
N. Verma, MD; Anthony A.
Romeo, MD; and Brian J.
Cole, MD. Also honored were
Rush University Medical
Center physicians Joseph
Hennessy Jr., MD; Dragan
Djordevic, MD; Scott
Palmer, MD; and Syed
Shah, MD. Clinical
staff members from
both the hospital and
Midwest Orthopaedics
White Sox medical team
honored for contribution
to World Series success
at Rush also received
gifts, including Marci
Bilkey, Naveed Kazi,
Ke r r y K ra u s h a a r,
Jessica Delgado, and
Leigh Lundberg.
Head Team Physician
D r. B u s h - J o s e p h
(orthopaedic surgery)
and Dr. Weber (primary care sports
Members of the medical team receiving gifts included Midwest Orthopaedics at
medicine/internal Rush physicians Charles A. Bush-Joseph, MD; Kathleen Weber, MD; Bernard R. Bach
Jr., MD; Gregory P. Nicholson, MD; Nikhil N. Verma, MD; Anthony A. Romeo, MD; and
medicine) received
Brian J. Cole, MD. Also honored were Rush University Medical Center physicians
official World Series
Joseph Hennessy Jr., MD; Dragan Djordevic, MD; Scott Palmer, MD; and Syed Shah,
MD. Clinical staff members from both the hospital and Midwest Orthopaedics at
r i n g s, t h e s a m e
also received gifts, including Marci Bilkey, Naveed Kazi, Kerry Kraushaar,
r e c e i v e d b y t h e Rush
Jessica Delgado, and Leigh Lundberg.
White Sox players.
“We’re honored to receive World Series rings and An Intense, Active Role
truly value our three-year relationship with the
White Sox,” says Dr. Bush-Joseph. “We hope the Midwest Orthopaedics at Rush is proud of the role
White Sox have another healthy season and we it played in a remarkably healthy and successful
White Sox World Series championship season.
can add another ring!”
Throughout the year, Midwest Orthopaedics at
Rush served as team physicians, working closely
with the head athletic trainer to keep the team in
top playing condition.
team physicians. All are on the faculty of Rush
Medical College. Dr. Bush-Joseph, Dr. Bach,
Dr. Nicholson, Dr. Cole, and Dr. Romeo are
orthopaedic surgeons who specialize in sports
medicine, treating everything from broken bones
Apart from being on the field for every home game to torn anterior cruciate ligaments and rotator
during the season and every home and away game cuffs. And Dr. Weber is board certified in internal
during the playoffs and World Series, the Midwest medicine and sports medicine.
Orthopaedics at Rush physician team was also
involved with player conditioning and training Dr. Weber served as the team’s primary internal
throughout the year. The team physician function medicine physician and is one of Major League
covered a broad range of responsibilities, including Baseball’s few female team physicians. With her
direct diagnosis and treatment on the field; provid- combined training in sports medicine, internal
ing care for visiting team players, coaches, and medicine, and exercise physiology, she was
umpires; follow-up and continued care in the uniquely qualified to address both orthopaedic
office; phone consultation; facilitation of emer- injuries and the medical aspects of sports medi- Head Team Physician Dr. Bush-Joseph (orthopaedic
surgery) and Dr. Weber (primary care sports medicine/
gency care; managing care when the team was on cine, such as heat illness, head injuries, allergies, internal medicine) received official World Series rings,
the road; and coordination of all medical person- viral infections, high blood pressure, and diabetes. the same received by the White Sox players.
nel involved in ensuring the overall health of the
Another Winning Season Ahead
third year with the White Sox,” says Dr. Weber.
players, their families, and the White Sox staff.
“And we will be able to use the solid foundation
When injuries did occur, Midwest Orthopaedics at The future looks bright for the 2006 season — we have built thus far to further develop a model
Rush physicians were on hand to provide an accu- not only for the White Sox but also for Midwest system of comprehensive medical care for both
rate, rapid diagnosis and initial care to minimize Orthopaedics at Rush’s involvement. “This is our the individual athlete and the team.”
time away from the game. “Our close working
relationship with the White Sox training staff
enabled us to diagnose and treat injuries quickly,
minimizing player downtime,” says Dr. BushJoseph, lead team physician. “In professional
baseball, with such a fine line between success
and failure, a few additional effective innings by a
pitcher or a couple of extra healthy games by a
position player can make a huge difference. I think
we definitely saw that with the White Sox this
year, when some key players were able to work
through injuries to make important contributions
at critical times.”
Best Sports Care Available
Schneider sought out Midwest Orthopaedics at
Rush to provide the most comprehensive level of
medical service available. “I wanted our players,
staff, and front office personnel to have the best
medical expertise available,” he says. “In addition,
I wanted the team to have access to a full-service
academic medical center like Rush University
Medical Center, which is just minutes away from
U.S. Cellular Field.”
In addition to Dr. Bush-Joseph, colleagues Dr.
Bach, Dr. Nicholson, Dr. Weber, Dr. Cole, Dr.
Romeo, and Dr. Verma also served as primary
Working Partners with
Midwest Orthopaedics at RUSH
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Reducing Noncontact ACL Injuries
Focus on entire kinetic
chain corrects faults,
improves performance
By John L. Honcharuk, ATC, CSCS,
and Joe Meier, PT, DPT, MS, NASM-PES, NASM-CPT, CSCS
Anterior
cruciate
ligament
Posterior
cruciate
ligament
Anterior view of a
flexed knee showing
menisci ligaments and
condyles prior
to knee arthroplasty
nterior cruciate ligament (ACL) injuries have
become one of the most devastating and
common injuries among athletes today.
Annually, there are between 80,000 and
100,000 ACL repairs performed in the United
States. At least 60% to 70% of all ACL injuries
are from noncontact situations, and the majority
of those injuries occur to athletes between the
ages of 15 to 45.1,2
A
Most of these athletes will undergo an ACL reconstruction (approximate cost is $17,0003) and
complete an extensive bout of rehabilitation (six
to 12 months) to allow for a safe return to their
sport or recreational activity.
AthletiCo has successfully rehabilitated hundreds
of athletes after this type of reconstruction. As we
have developed our Performance Enhancement
services, it became obvious that there was a need
for ACL injury prevention programs for athletes of
all ages, as well as the ability to assess relative
risk prior to injury.
injuries has yet to be determined but may be a
combination of factors, including anatomical
structural factors, hormonal risk factors in
females, and biomechanical issues.
We set out to determine if there is a way to
potentially identify risk factors and, as a result,
decrease the likelihood of serious knee injury. This
Determining Risk Factors
could be used as a preseason screening tool as
well as a bridge from formal physical therapy to
The majority of noncontact ACL injuries involve athletic performance.
some type of decelerating motion bringing the
knee into flexion and the femur into adduction Several commercial athletic injury risk-assessment
and internal rotation while the tibia and foot are tools were reviewed and implemented. These
planted. The exact cause of noncontact ACL include but are not limited to Cincinnati
SportsMetrics Valgus Digitizer , The Santa
Monica PEP program, and The Reebok Functional
Movement Screen. Each of these screening tools
has unique merits and uses. The predominant tool
that we feel addresses the entire
kinetic chain is the National
Academy of Sports Medicine
Optimum Performance Training
Model (NASM OPT™).4 We have
taken what we feel are the best
components of each of these programs and created a hybrid that
currently fits our clinical as well as
performance enhancement needs.
TM
TM
Before an individual’s risk can be
addressed, we must evaluate and
determine all limiting factors that
could predispose an individual to
an ACL injury. Functional movement screens have been valuable
in revealing faulty movement patterns. The most popular test
includes having athletes perform
some form of squat with their
arms over their head and a single
leg activity to challenge their core
and balance.4,5
The plane of motion for a track athlete (sagital
plane dominance) is different from that of a basketball player (transverse plane dominance). The
aforementioned would be included in our full ACL
range of motion through flexibility. The two types
of flexibility we will primarily focus on in this article are self-myofascial release and static stretching. However, there are other levels of flexibility
the athlete would progress to once
normal range of motion is achieved
and the overhead squat assessment
has visibly improved.
Tissue extensibility can be improved
by self-myofascial release through the
use of a foam roll. This will prepare
the tissue for further lengthening in
order to achieve optimal length tension relationships. For example, selfmyofascial release to bilateral rectus
femoris, hip adductors, and gastrocnemius/soleus complex can be
achieved by slowly rolling through the
muscle group searching for tender
areas. The individual would then rest
on the tender area for 20 to 30 seconds to inhibit overactive muscles.4
Myofascial release is followed by
static stretching, which helps restore
optimal range of motion for functional movement and strengthening
of muscles that have been overpowered by their
stronger antagonist. An example is to static
stretch the rectus femoris, hip adductors, and gastrocnemius/soleus complex bilaterally. Typically,
we prefer to use multijoint, closed kinetic chain
activities if possible. A good example of this type
of activity would be the standing hip flexor
stretch. This particular movement addresses the
gastrocnemius/soleus complex, illiopsoas, rectus
femoris, quadratus lumborum, and latisimus dorsi.
Squatting in a valgus position puts the ACL in great jeopardy if the individual is
unable to control the position of the knee because of insufficient range of motion,
core stability, neuromuscular control, or strength.
prevention evaluation. Only after that can an indiOne aspect of our ACL Injury Prevention Program vidualized program be created.
is a functional movement assessment, which consists of the overhead squat. The overhead squat is This type of assessment was highly effective in
performed by having athletes stand with their feet determining potential faulty movement patterns
parallel and shoulder-width apart with arms over- in some members of the USA Men’s Rugby Team
head and then having them perform a squat. This while the team was in New Zealand for an interin effect reproduces, on a much slower scale, the national tournament. The findings were then
eccentric movement.
applied to each team member’s training program
to address deficits.
Since the majority of ACL injuries occur while
decelerating eccentrically, the clinician will be able One of the most predominant faulty movement
to visualize a good portion of the faulty move- patterns we see clinically with the overhead squat
ment patterns. This assessment allows us to deter- is adduction of the knee or valgus, which can be
mine which muscles are dominant in the caused by excessive pronation of the foot and/or
movement and where the athlete is in need of poor control at the hip. It is at this point that the
improved flexibility and strength.
ACL is placed in great jeopardy if the individual is
unable to control the position of the knee because
We further determine limitations through gonio- of insufficient range of motion, core stability, neumetric measurements, functional core assessment, romuscular control, or strength.
neuromuscular evaluation, and upper and lower
extremity power assessments. As with any pro- Restoring Proper Range of Motion
gram design, an assessment of the demands of
the sport must also be included. What energy sys- We will begin as we would with a complete protem is dominant: ATP/PC, anaerobic, or aerobic? gram by first addressing the restoration of proper
Improving Stability, Control,
and Strength
Once flexibility issues have been addressed, we
then begin improving the stability of the core.
The core is where all movement begins and
plays a major role in control of the upper and
lower extremities.6 When strengthening the
core, one must focus on the lumbopelvic hip
complex. An excellent exercise to achieve this
is the stability ball bridge. This particular exercise involves use of the transverse abdominus, gluteus maximus, quadriceps, hamstrings,
and the gastrocnemius/soleus complex. In
addition, the use of the stability ball increases could be further progressed with stability ball
the proprioceptive demand.
squats with a resistive band around the knees to
cue the gluteus medius to prevent valgus of the
Once the core has been stabilized, we take an knee during descent of the squat.
inside-out approach by improving neuromuscular
control. As a result, the gluteals would be the next Taking a Total-Body Approach
area to be addressed. Again, we emphasize
closed-chain, multijoint, multiplanar exercise to Typically, this total-body approach would be permaintain neuromuscular efficiency. The triplane formed at every session. This is done to ensure that
setup is the modality of choice. This exercise is the entire kinetic chain is addressed. This ensures
performed with proper activation of the trans- that the participant continually works on the correcverse abdominus and gluteal complex to ensure tion of faulty movement patterns while improving
stability of the lumbopelvic hip complex, resulting total athletic performance. Again, the frequency,
in improved knee position. These types of exer- duration, and intensity levels should be directly procises have been shown, when properly cued, to portionate to the result of the initial findings.
decrease the incidence of serious knee injury7.
The above examples are just that — a small sampling of a comprehensive program. To elaborate
on the full ACL Injury Prevention Program is
At least 60% to
beyond the scope of this article. The comprehen70% of all ACL injuries
sive program is based upon a thorough evaluation
are from noncontact
of not only the knee and lower extremity but the
entire kinetic chain. Then and only then can an
situations, and the
majority of those injuries individual program be designed to address
deficits. We believe through proper evaluation,
occur to athletes between elimination of muscular imbalances, core stability
the ages of 15 to 45.
training, neuromuscular training, and education
on plyometrics, the likelihood of an individual sustaining noncontact ACL injuries can be greatly
The athlete is prepared for plyometric training reduced. Further research and education in the
upon stabilization through activation of the core benefits of the use of an ACL prevention program
and gluteus complex. Within the training pro- is required.
gram, the focus should be placed on technique of
John L. Honcharuk, ATC, CSCS, is also
the plyometric exercise. It is imperative that the
a Certified SportsMetrics Instructor.
individual be able to maintain an athletic position
He is the Facility Manager of the St.
prior to any plyometrics. The athletic position can
Charles AthletiCo and Co-Chair of
be defined as feet forward and shoulder-width
AthletiCo’s ACL Injury Prevention
apart with center of gravity over the balls of the
Committee.
feet. The knees should be slightly flexed and natural curvature in the spine maintained.8 The athlete should be able to take off and land in this
Joe Meier, PT, DPT, MS, NASM-PES,
posture. Advanced plyometric techniques can
NASM-CPT, CSCS, is the Assistant
consist of box jumps to stabilization. This exercise
Facility Manager of AthletiCo’s
can be performed on a 6- to 12-inch box and
Arlington Heights location and Colanding posture should be maintained for a fiveChair of AthletiCo’s ACL Injury
second hold.
Prevention Committee.
TM
The Role of Biomechanics
Anatomical or gender-related factors
associated with increased risk of
anterior cruciate ligament (ACL)
injuries cannot be altered. However,
according to Athletico, noncontact
ACL injuries could be greatly reduced
by altering potentially faulty biomechanics. This can be achieved by correcting muscle imbalances, improving
core strength, retraining the neuromuscular system, and educating on
proper take-off and landing techniques through plyometric exercises.
References:
1. Wilk, K. E., C. Arrigo, J. R. Andrews, and C. G. William.
“Rehabilitation after Anterior Cruciate Ligament
Reconstruction in the Female Athlete.” Journal of Athletic
Training, Vol. 34, No. 2 (1999), pp. 177-193.
2. Daniel, D. M., and D. Fritschy. “Anterior Cruciate Ligament
Injuries.” In Orthopaedic Sports Medicine: Principles and
Practice, Vol. 2 (Philadelphia, PA: W. B. Saunders, 1994),
pp. 1313-1361.
3. Griffin et al. “Noncontact Anterior Cruciate Ligament
Injuries: Risk Factors and Prevention Strategies.” Journal of
the American Academy of Orthopaedic Surgeons, Vol. 8
(2000), pp. 141-150.
4. Clark, M. A., and A. M. Russell. Optimum Performance
Training for the Health and Fitness Professional (Course
Manual). Calabasas, CA: National Academy of Sports
Medicine, 2004.
5. Cook. G., L. Burton, and B. Hoogenboom. “Pre-participation Screening: The Use of Fundamental Movement as an
Assessment of Function-Part 1.” North American Journal
of Sports Physical Therapy, Vol. 1, No. 2 (May 2006),
pp. 62-72.
6. Wilson, J. D., C. P. Dougherty, M. L. Ireland, and I. M.
Davis. “Core Stability and Its Relationship to Lower Extremity
Function and Injury.” Journal of the Academy of
Orthopaedic Surgeons, Vol. 13, No. 5 (September 2005),
pp. 316-325.
7. Hewett, T. E., T. N. Lindenfeld, J. V. Riccobene, and F. R.
Noyes. “The Effect of Neuromuscular Training on the
Incidence of Knee Injury in Female Athletes: A Prospective
We would complete the session with exercises
designed to strengthen musculature that has
been inhibited by tight structures. For instance,
weak gluteus medius musculature could be
addressed by having the athlete perform lateral
walks with a resistive band around the knees. This
Study.” American Journal of Sports Medicine, Vol. 27,
No. 6 (1999), pp. 699-706.
Editor’s Note: John L. Honcharuk and Joe Meier
are not affiliated with Midwest Orthopaedics at 8. Meyer, G. D., K. R. Ford, and T. E. Hewett. “Rationale and
Clinical Techniques for Anterior Cruciate Injury Prevention
Rush. Treatment recommendations presented in
among Female Athletes.” Journal of Athletic Training,
this article are solely the professional opinions of
Vol. 39, No. 4 (2004), pp. 352-364.
the authors.
Directory
Midwest Orthopaedics at Rush thanks the
following advertisers for helping make this
publication possible.
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(800) 237-8228 • (708) 730-3324 Fax
Banking
Citibank..........................................see back cover
Harris Bank.........................................see page 20
Collection Agencies
Illinois Collection Service, Inc. .............see page 32
Financial Planning
William Blair & Company, L.L.C. ........see page 21
Health Care
Accelerated Rehabilitation Centers .....see page 33
Rush Oak Park Hospital ......................see page 31
Health Care Technology
Scribe, Inc...........................................see page 32
Health Insurance Brokers & Consultants
Benefitdecisions, Inc.
125 S. Wacker Dr., Ste. 2075, Chicago, IL 60606
(312) 606-4800 • (312) 606-8108
www.benefitdecisions.com
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Girling Health Care, Inc. .....................see page 29
Insurance — Medical Malpractice
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Insurance Services, Inc..................see page 12
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www.mcguirewoods.com
Spada Law Office, P.C. ..................... see page 32
Marketing Communications
Omnia Marketing & Design ................see page 33
Medical Device Companies
Tornier................................................see page 24
Office Equipment
Chicago Office Technology Group
1 E. Wacker Dr., Ste. 1305, Chicago, IL 60601
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Column Office Equipment, Inc. .........see page 33
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Scheck & Siress...................................see page 15
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Apac Groupe Centers
for Pain Management ....................see page 13
Physical Therapy & Sports Medicine
AthletiCo............................................see page 29
ATI........................................see inside front cover
Chicago Rehabilitation Services, Inc. . see page 16
Integrity Physical Therapy ...................see page 31
OccuSport Physical Therapy................see page 34
Performance Physical Therapy ............see page 29
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Promotional Products
Presto Marketing, Inc. ........................see page 25
Publishing
Chicago Magazine................see inside back cover
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Affiliated Radiologists S.C. .................see page 30
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