TOCA’s Dr. Gerald Yacobucci Shares the Benefits of Knee Preservation vs. Knee Surgery

The Benefits of Knee Preservation … And Why Knee Replacement Should Be a Last Resort

Have you put off seeking relief for knee pain for fear of having knee replacement surgery? The Orthopedic Clinic Association’s Dr. Gerald Yacobucci, MD, a fellowship-trained orthopedic sports medicine specialist, wants to educate patients about the many benefits of minimally invasive knee preservation and why knee replacement surgery should be viewed as a last resort.

Knee Preservation

When it comes to preserving knees, Dr. Yacobucci says, “My mission is to provide all available options to patients with damaged knees in order to relieve their pain and restore maximum function. Even more importantly, I aim to delay or even eliminate the need for total knee replacement. My sports medicine background has taught me to approach these complex knees from a preserve and protect standpoint. If possible, I only want to repair what is damaged and never replace what is still viable.”

Knee Replacement

Regarding knee replacement surgery, Dr. Yacobucci says, “I always use biology (growing or grafting with living tissue) when available and only move on to prosthetic (non-biologic) implantation when all else fails. If biology is not an option, I use a minimalist approach to prosthetic implantation. This involves using mini-implants that resurface the damaged areas only, leaving the remainder of the knee intact. Partial knee replacement is explored in many cases when the patient is younger and has a large portion of the knee that is undamaged.”

Learn more about the benefits of knee preservation below and contact TOCA today for a knee pain consult with Dr. Gerald Yacobucci: 602-277-6211.

Knee Preservation Postcard

 

Dr. Lederman’s Findings Featured in “Orthopedics Today”

TOCA’s Dr. Evan Lederman, MD, regularly educates, lectures, and participates in groundbreaking research to further the field of orthopedics. His expertise in arthroscopic surgery of the shoulder and knee has earned him the honor of being one of only two Arizona surgeons to be accepted into the American Shoulder and Elbow Surgeons (ASES) as an associate member.

Orthopedics Today recently highlighted the results of one of Dr. Lederman’s studies comparing functional outcome scores and revision rates between different surgical techniques in total shoulder arthroplasty. Dr. Lederman presented the results of the study at the American Shoulder and Elbow Surgeons Annual Meeting, which was held in Chicago this past fall.

Read more about Dr. Lederman’s impressive study HERE.

Stress Fracture Symptoms and Treatment Tips from TOCA’s Orthopedic Experts

“You have a stress fracture” is a diagnosis shared all too often by orthopedic specialists, especially when treating athletes. Athletes are most at risk due to repetitive activity and overuse of their feet and legs. Overuse causes the lower extremities to continually absorb these forces and potentially causing tiny cracks in the bones.

If athletic activity is too frequent, it diminishes the body’s ability to repair and replace bone. And the likelihood of sustaining a stress fracture increases. That’s why runners, dancers, soccer players, and basketball players are particularly vulnerable to stress fractures.

And, according to The Orthopedic Clinic Association (TOCA) orthopedic and sports medicine care expert, Dr. Gerald Yacobucci, MD, “If they are already experiencing consistent pain, the more these athletes train and compete, the more they may be placing themselves at greater risk for injury – and time away – from the sport or activity they enjoy.”

Here’s what Dr. Yacobucci and the TOCA team want ALL athletes, parents, and coaches to know in order to recognize stress fracture symptoms, help prevent stress fractures from occurring, and remain injury-free.

Stress Fracture Symptoms

What are some of the signs of stress fracture to watch out for? Rather than the sharp pain resulting from an acute fracture, stress fractures are typically accompanied by a dull pain that increases gradually. Often, the pain subsides during rest and intensifies during activity. Swelling around the site may be present as well as some tenderness and bruising. As mentioned above, stress fractures can be caused by overuse of lower extremities, common in athletes, but they can also arise from a sudden upsurge in physical activity. Osteoporosis can also increase the chance of a stress fracture.

It’s important to remember that, if dull pain persists, it’s time to seek help from an orthopedic specialist!

Treatment of Stress Fractures

Immediately after injury or stress fracture symptoms occur, patients are encouraged to follow the RICE (Rest, Ice, Compression, Elevation) method. Once you consult with you orthopedic specialist, he/she will examine the “pain point” and X-rays will likely be taken. If the stress fracture is not visible via X-ray, but your doctor still suspects that you have a stress fracture, he/she may recommend that you get an MRI.

Nonsurgical treatment options for stress fractures include keeping weight off of the area (perhaps wearing a boot or using crutches), and modified activity for a period of up to 8 weeks. In some, more severe, cases, surgery may be necessary to allow the stress fracture to heal properly. This typically entails using a pin, screw, or plate to “fasten” the bones together in order to promote healing. The key to recovery is to allow ample time for rest, healing, and rehabilitation. Taking time off ensures that you can eventually get back to the activities you enjoy safely and without placing yourself at risk for additional injury.

Stress Fracture Prevention

According to Dr. Yacobucci, “One of the most important pieces of advice I share with patients, especially athletes, is to monitor and be mindful of your activity and pain level. If you find that you’re consistently experiencing pain during training or workouts, then it’s time to listen to your body’s signals. Refrain from activity until you seek further treatment from an orthopedic expert.”

Additional stress fracture prevention tips from Dr. Yacobucci and TOCA experts include:

  • Wearing footwear with good support.
  • Strength training and cross-training to avoid overuse of certain muscle sets and strain on bones.
  • Good nutrition, including plenty of calcium and Vitamin D for optimal bone strength.
  • And good common sense. Listen to your body’s signals and seek help if pain persists after adequate rest.

To schedule a consult with Dr. Yacobucci, or one of TOCA’s knowledgeable and highly trained orthopedics specialists, please contact us at 602.277.6211.

Dr. Blazuk and colleagues study the Validity of Indirect Ultrasound Findings…

Title: Validy of Indirect Ultrasound Findings in Acute Anterior Cruciate Ligament Ruptures

Ken Mautner, MD, Walter I. Sussman, DO, Katie Nanos, MD, Joseph Blazuk, MD, Carmen Brigham, ATC, Emily Sarros, ATC

Objectives: Ultrasound (US) is increasingly being used as an extension of the physical examination on the sidelines, in training rooms, and in clinics. Anterior cruciate ligament (ACL) injury in sport is common, but the literature on US findings after acute ACL rupture is limited. Three indirect US findings of ACL rupture have been described, and this study assessed the validity of these indirect signs.

American Institute of Ultrasound in Medicine /  J Ultrasound Med 2018; 9999:1-8 / 0278-4297

Click here for full article!

 

Dr. Lederman and colleagues present a study comparing new techniques for rotator cuff repair!

Title: Triple-Loaded Suture Anchors Versus a Knotless Rip Stop Construct in a Single-Row Rotator Cuff Repair Model

Matthew Noyes, MD, Christopher Adams MD, Evan S. Lederman MD, Patrick Denard MD

Purpose

To compare the biomechanical properties of single-row repair with triple-loaded (TL) anchor repair versus a knotless rip stop (KRS) repair in a rotator cuff repair model.

Full article link below.

The Journal of Arthroscopy and Related Research: 2018 Feb 15. pii: S0749-8063(18)30029-X. doi: 10.1016/j.arthro.2017.12.024. [Epub ahead of print]

https://www.arthroscopyjournal.org/article/S0749-8063(18)30029-X/fulltext

Dr. Evan Lederman and colleagues review how bone reacts to shoulder replacements and propose a classification system for critical review of implant/bone interaction

Title: Stress shielding of the humerus in press-fit anatomic shoulder arthroplasty: review and recommendations for evaluation

Patrick Denard MD, Patric Raiss MD, Reuben Gobezie MD, T. Bradley Edwards MD, Evan S. Lederman MD

Introduction

Uncemented press-fit humeral stems were developed with the goal of decreasing operative time, preserving bone stock, and easing revision. In recent years, short stems and stemless humeral implants have also become available. These press-fit humeral implants have varying designs that can lead to changes in stress distribution in the proximal humerus. Such stress shielding manifests as bony adaptations and may affect long-term functional outcome and the ability to perform revision. However, current studies of humeral fixation during total shoulder arthroplasty are complicated because a variety of classification systems have been used to report findings.

Full article link below.

Journal of Shoulder and Elbow Surgery E-pub February 6, 2018

https://doi.org/10.1016/j.jse.2017.12.020

Dr. Lederman and colleagues discuss the outcome and safety of a short stem shoulder replacement

Title: Short-term clinical outcome of an anatomic short-stem humeral component in total shoulder arthroplasty

Anthony A. Romeo MD, Robert J Thorness MD, Shelby A Sumner MPH, Reuben Gobezie MD, Evan S Lederman MD, Patrick J Denard MD

Background

Short-stem press-fit humeral components have recently been developed in an effort to preserve bone in total shoulder arthroplasty (TSA), but few studies have reported outcomes of these devices. The purpose of this study was to evaluate the short-term clinical outcomes of an anatomic short-stem humeral component in TSA. We hypothesized that the implant would lead to significant functional improvement with low rates of radiographic loosening.

Full Article: https://doi.org/10.1016/j.jse.2017.05.026

The Journal of Shoulder and Elbow Surgery

Volume 27, Issue 1, January 2018, Pages 70-74

Dr. Lederman and Dr. Harmsen compare different techniques for shoulder replacement*

Title: Glenohumeral osteoarthritis in young patients: Stemless total shoulder arthroplasty trumps resurfacing arthroplasty—Opposes

Samuel Harmsen MD and Evan S Lederman MD

Abstract

When considering shoulder arthroplasty in a younger patient the surgeon can choose between stemmed, stemless or resurfacing implants for humeral reconstruction. Resurfacing arthroplasty can reproduce humeral anatomy independent of the humeral shaft, minimize bone resection and offer potential easier revision surgery. The resurfacing implant has been in use for over 30 years and has favorable long-term outcome.

Seminars in Arthroplasty

Volume 28, Issue 3, September 2017, Pages 121-123
*This is based on a lecture/Debate by Dr. Lederman with Dr. Sumant Krishnan at the 2017 Current Concepts in Shoulder Arthroplasty Conference in Las Vegas, NV.