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Thoughts from an orthopedic surgeon specializing in sports medicine and fracture care, including insight into the practice of medicine.

Cadaver ACL's Failing in Young Athletes

I have been seeing an alarming rate of failures (graft tearing) in young athletes who have gotten Anterior Cruciate Ligament (ACL) reconstructions with allograft (cadaver) tissue. In some of these cases, the graft tissue seems to just dissolve, almost as if no ACL reconstruction was ever done!


A recent study at the University of Pittsburgh found a 13% failure rate after ACL reconstruction using allograft in young athletes. 48% of these failed before the 9-month mark and an additional 44% failed in the first 9 months after returning to sports.


In my opinion, this is a pretty high number and as this is being reported more and more frequently in the literature, perhaps we need to reconsider use of allografts in the younger, active population, and maybe even be more restrictive in the timeframe for them returning to sports. Allograft tissue for ACL reconstruction has its advantages - quicker surgery and less pain immediately after surgery (though no long term benefit with regards to pain). That said, I don't think these reasons would outweigh the seemingly higher risk of re-tear. This is why I routinely use hamstring autograft (your own tissue) for ACL reconstructions. I have seen better short and long term results, with lesser risk.

Social Media for Doctors

Blogs, Facebook, Twitter....media becoming more and more popular with people all over the world. But these are only for people to catch up with each other right? WRONG. I resisted joining or participating in any of these forms of communication until recently I took the plunge. Why? I saw it as another way to communicate with not only my patients but people everywhere. According to kevinmd.com 24% of Americans read blogs and there are a combined 120 million monthly visitors to Facebook and Twitter. 120 million!! More than half of people that use Facebook and Twitter are under the age of 34. It stands to reason that as this population ages, they will consult social media outlets for medical advice.


The power of social media....as reported by The Globe and Mail - London Health Sciences Centre launched a public information campaign about a dying infant in its care. The case went viral, videos sprung up, petitions and campaigns started, a website and facebook page were created and within a short period of time the page had 13,300 members! Amazing.


Lets say you tear your Anterior Cruciate Ligament (ACL) and you see your doctor a few weeks later - your doctor recently came across a new technique for ACL Reconstruction or even the rehab afterwards....but forgets to tell you. With social media, that content can be posted or updated almost realtime and you have instant access and knowledge. And so do your family and friends.


But there are concerns, privacy being the biggest. I do not recommend discussing individual cases or providing patient advice via blog, facebook or twitter - a clear violation of HIPPA. Rather I envision it being a forum for education on general medical and orthopedic topics, from health care reform and medicare to rotator cuff tears and ankle fractures.


It has been said that doctors who are not on facebook, twitter, and blogs risk becoming irrelevant (kevinmd.com)....so I took the plunge. Follow me on Facebook (Amit Sahasrabudhe), Twitter (DrAmitSports), and my blog (www.doctoramit.com).

Compartment Syndrome in High School Football Players??
Monday, 23 August 2010 00:00

Compartment syndrome is a relatively rare condition that occurs when pressure in and around a muscle (or group of muscles) becomes too high and essentially causes a “strangulation effect.” As the amount and duration of the pressure increases, the muscle begins to die, often leaving long-term and permanent neuromuscular deficits. The condition typically occurs after a high energy trauma (car accident), but can also occur with blunt trauma (for example when someone breaks a leg from hitting the bumper of a car).


It was reported yesterday on espn.com (http://sports.espn.go.com/ncaa/highschool/news/story?id=5483568) that 19 players from an Oregon high school football team suffered muscle damage and had elevated levels of creatine kinase, which is released by muscles when they are injured. Three of the players had surgery after developing compartment syndrome, essentially without any reported specific trauma. The remaining players were treated with IV fluids to decrease chances of kidney failure, which can occur with high levels of creatine kinase.

Team Doctor for Colorado Rockies
Sunday, 22 August 2010 00:00

A few months ago, I was approached by the Colorado Rockies asking if I was interested in being their spring training orthopedic surgeon. They have always done spring training in Tucson, but are moving to Scottsdale in 2011 and needed a local orthopedic surgeon.


I was honored to be asked and given my love of sports, I jumped at the opportunity.This weekend was my first time covering a major league baseball (MLB) game for the Rockies and I had a blast! Having grown up playing baseball, it was a total thrill being in the clubhouse and getting to meet the Rockies players.

Unfortunately yesterday’s game ended in a loss, but today the Rockies pulled it out, behind great pitching by Jhoulys Chacin and a spectacular diving catch by Dexter Fowler (www.coloradorockies.com).
I am excited to be a part of the team and look forward to working with the players and the organization for years to come!

ACL Reconstruction: hamstring or patella tendon autograft?
Saturday, 21 August 2010 00:00




Anterior Cruciate Ligament (ACL) injuries are quite common. Historically, young athletes have been treated with bone-patellar tendon-bone autografts, but more and more athletes are being treated with hamstring autograft now. It has been unclear whether either graft consistently allows athletes to return to pre-injury levels of play.


A case study performed at the University of Pittsburgh (Drs Freddie Fu and Christopher Harner) and presented at the 2010 Arthroscopy Association of North America  (AANA) Meeting reported that there are similar outcomes regardless of which graft was used.

Health Care Reform
Sunday, 31 May 2009 00:00



Health care reform is on everyone’s mind, from President Obama trying to figure out how to solve a crisis to the un-insured barely making ends meet….from the Medicare patient wondering if he/she will have adequate coverage to the growing number of medical providers wondering if reimbursements will continue to drop.  Here is my take as a practicing orthopedic surgeon.


While it would be wonderful for every American to have affordable health insurance, there are certain things that the “experts” in Washington seem to be overlooking. First, as a culture, we are used to having access to the best care in a timely fashion. Under a nationalized plan, would that still be the case?  Or will it be like the United Kingdom and Canada where patients get on a waiting list that is months long to have their ACL reconstruction or their knee replacement?  Will Americans be ok with that?  Personally I don’t think so.

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