Tears that can't wait. Sports injuries that may need repair during COVID-19

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Almost all orthopedic injuries must be repaired immediately. The old "wait-and-see" for most joint injuries has been proven to lead to scar tissue, loss of motion, and arthritis. Under the ever-changing conditions of COV-ID19, you may be confused about your options and treatment of your injury.

We recommend contacting your Orthopaedist or primary care physician for any injury causing you pain (most healthcare providers are still open and treating patients in their office or virtually, including The Stone Clinic). Here is a lineup of several fixes for injuries that need immediate repair to avoid long-term complications, and are likely to be approved for urgent surgical treatment:

Torn Achilles tendons can be repaired effectively without open incisions. When freshly torn, the free tissue ends are bathed in fresh blood, which contains healing growth factors. The tissue tries to heal, and if the ends are put back together, they can recover strongly. A percutaneous stitching technique permits sutures to be weaved into the torn ends without an open incision—which would expose the tendon to air, lose the fresh blood, and increase the risk of scarring and infection. If you "wait-and-see," the ends scar down and become irreparable.

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Almost all orthopedic injuries must be repaired immediately. The old "wait-and-see" for most joint injuries has been proven to lead to scar tissue, loss of motion, and arthritis. Under the ever-changing conditions of COV-ID19, you may be confused about your options and treatment of your injury.

We recommend contacting your Orthopaedist or primary care physician for any injury causing you pain (most healthcare providers are still open and treating patients in their office or virtually, including The Stone Clinic). Here is a lineup of several fixes for injuries that need immediate repair to avoid long-term complications, and are likely to be approved for urgent surgical treatment:

Achilles Tendons:

Torn Achilles tendons can be repaired effectively without open incisions. When freshly torn, the free tissue ends are bathed in fresh blood, which contains healing growth factors. The tissue tries to heal, and if the ends are put back together, they can recover strongly. A percutaneous stitching technique permits sutures to be weaved into the torn ends without an open incision—which would expose the tendon to air, lose the fresh blood, and increase the risk of scarring and infection. If you "wait-and-see," the ends scar down and become irreparable.

Meniscus Cartilage:

Most torn menisci can be repaired, but aren't. When the meniscus is partially or entirely removed, the risk of arthritis skyrockets. This is due to the loss of the joint spacer. Unfortunately, there are 800,000 meniscus tears in the US annually, but only 10% are repaired, 0.01% are reconstructed with collagen scaffolds, and 0.02% are replaced with allografts. Yet if treated when freshly torn, they can often be repaired. New techniques of augmenting the torn meniscus with stem cells, growth factors, and collagen scaffolds make it easier to repair severely damaged meniscus tissue. Saving the meniscus is the key to preventing arthritis.

Ligaments:

The anterior and posterior cruciate ligaments in the knee joint guide the motion of the femur on the tibia. When torn, the abnormal mechanics lead to cartilage damage in much the same way that bad alignment leads to tire wear. While some knees do well with torn ligaments, the vast majority do poorly over time. There is no benefit to the "wait and see" approach. Freshly torn ligaments can sometimes be primarily repaired. Using improved techniques—including the selection of only the strongest tissues and the addition of anabolic factors to stimulate healing donor allograft tissues—we can usually avoid the second site injury of harvesting the patient's own patellar tendons or hamstrings.

Dislocated Shoulders:

"Once dislocated always torn" is the rule for the ligament labrum complex in the shoulder, which keeps the shoulder joint in place. Instability is never good for a joint, and the shoulder is no different. The labral repair techniques have become so effective that repeat dislocation (in the absence of bony injury) is uncommon.

Rotator Cuff Tears:

The tendons of the rotator cuff atrophy after tearing and retract away from their bony insertion. When freshly torn, they can be anchored back in their usual anatomic location, using an outpatient arthroscopic procedure. If they retract, the success rate declines proportionally to the degree of retraction and tissue health. Early repair leads to full recovery.

"Doc, I Twisted My Knee, Heard A Pop, And The Knee Swelled."

This story has a 90% chance of indicating a repairable lesion in the knee (torn meniscus, torn ligament, damaged articular cartilage surface). It needs to be examined, imaged with X-ray and MRI, diagnosed, and repaired promptly—followed by great physical therapy and fitness training. When done right, healing occurs. When ignored, the agony of defeat is around the corner.

If you like to learn more about an injury you're experiencing, you may use our symptom checker.


Topics: INJURY | COVID