Patella Dislocation in High School Athletes

What is the risk of having a patella dislocation or subluxation among high school athletes in the United States?

Many high school athletes, coaches, parents and physicians are discovering that the intensity and competition in high school athletics is growing every day. With this level of activity, it seems that athletes are more prone to injuries than ever before. A research study has been released that Patella dislocation and subluxation in high school athletesaddresses the issue of patella dislocation or subluxation in high school athletes. Before reviewing these research findings, it may be helpful to define these two types of injuries.

For young athletes, their kneecap is usually right where it is supposed to be during activities. In the event of a hard blow or fall, one’s patella may slip out of place.

A patella dislocation causes pain and loss of function for these young athletes. A subluxation is a temporary, partial dislocation that relocates the patella from its normal position in the leg.

Patella Dislocation and Subluxation for Young Athletes

Dr. Joshua Mitchell looked at the national high school sports-related injury surveillance system-reporting online information, which is an internet based sports injury surveillance system. What they found was that patients undergoing a patella dislocation or subluxation were most commonly reported secondary to a no-contact injury mechanism. When all contact subcategories were combined, the overall contact mechanism re-presented 59.3 percent of injury.

The authors noted after reviewing all the data in the computer system that patellofemoral instability rates vary by sport, gender, and type of exposure – competitive versus practice. This big word (patellofemoral instability) just means that there is loss of strength and instability in one’s kneecap.

The researchers also found that 60 percent of the athletes return to play after a patella instability injury within three weeks. Those returning to play after more than three weeks represented 15 percent of athletes. And a smaller percentage were unable to return to play for the remainder of the season.

When looking specifically at sports and gender, they found that the highest injury rates for patella dislocation or subluxation occurred in girls’ gymnastics, boys’ football, and boys’ wrestling.

The authors found that surgery was only required 8.5 percent of the times when a patella subluxed or dislocated.The authors noted that girls have a significantly higher proportion of injury caused by a non-contrast mechanism compared to boys. (more…)

NAWBO Louisville VIP Celebration Breakfast

As the recipient of the National Association of Women Business Owners (NAWBO Louisville) 2016 Epic award for small business owners, Dr. Grossfeld celebrated with a VIP celebration breakfast held at Big Springs Country Club in Louisville, Kentucky. NAWBO Louisville EPIC Award recipientsAs owner of Orthopaedic Specialists, a sports medicine and orthopedic surgery medical practice with multiple locations in Louisville, KY, Dr. Grossfeld has committed her time and efforts to providing excellent patient care, while also managing her own business. Dr. Grossfeld and Summer Auerbach, the owner of Rainbow Blossom stores and Large Business Owner of the Year recipient, were guest speakers at this event.

2016 NAWBO Louisville VIP Breakfast

Both award winners at the NAWBO Louisville event were instructed to speak about their experiences as female business owners. Dr. Grossfeld began her speech discussing the many things that she learned as an orthopedic surgery resident in a primarily male-dominated field. Only five percent of orthopedic specialists in the U.S. are women. With this gender disparity in the field of medicine, Dr. Grossfeld explained some of the challenges she faced while entering this field of medicine. For example, she discussed how it was often difficult for her to find surgical instruments to fit a smaller hand and she often had to use two step stools to reach the patient on the operating table.

Despite these obstacles, Dr. Grossfeld went on to become a distinguished orthopedic surgeon and sports medicine doctor in Louisville, Kentucky. As a small business owner, Dr. Grossfeld believes in creating a positive work environment for her employees. She explained that her workplace philosophy revolves around creating and maintaining a welcoming environment that can be described as a village. Dr. Grossfeld is full of gratitude when she sees her employees having a vested interest in their positions and in their interactions with the patients.

Before patients shake Dr. Grossfeld’s hand, they will have already had contact with four different employees. Dr. Grossfeld explained how all of these interactions are working to create a positive experience for every person that comes to Orthopaedic Specialists. She understands what it is like to be a working mother and creating that work life balance. Dr. Grossfeld said in speech, “We all change our hats when we come from working gal to mom.” This understanding is beneficial for Dr. Grossfeld as a female business owner working with female employees. (more…)

Centre College Student Spends Spring Break Learning About a Career in Orthopedic and Sports Medicine

Louisville orthopedic surgeon and sports medicine physician Dr. Stacie Grossfeld enjoys working with students who are interested in a career in medicine. And this has included students at many different points in their educational careers – ranging from high school, college and those in graduate school.

A couple of years ago, Orthopaedic Specialists formed a unique partnership with Centre College in Danville, Kentucky, to offer Centre students the chance to work with Dr. Grossfeld during school breaks. A number of students have taken advantage of this opportunity to complete medical internships. Most recently, Centre College sophomore Drew Burns Centre College Student works at Orthopaedic Specialistsdecided to spend his spring break vacation learning more about a career in medicine at Orthopaedic Specialists. Here is what Drew had to say about this:

Entering college, my best guess at what I wanted to major in was Economics. I soon discovered after my freshment year that I had a desire to pursue a science major, and started toying with the idea of medical school. From having two surgeries and being hospitalized for weeks due to MRSA, the compassion and skillset the doctors displayed was not only impactful but meaninful. Watching Dr. Grossfeld’s extreme competence in teh OR and building genuine caring relationships has taught and given me a lot to strive for. I am envious and impressed by Dr. Grossfeld’s compassion towards her colleagues, employees, patients and community. As a two-year collegiate basketball player, I would love to be a part of the incredible teamwork and environment that Dr. Grossfeld and her employees maintain. These experiences have strengthened my desire to pursue a career in medicine and I am extremely greatful to spend my spring break learning from Dr. Grossfeld and her staff.

(more…)

Returning to Sports at the Age of 70

Can you return back to sporting activities if you have a rotator cuff repair when you are older than age 70?

This specific question was answered through an article published at the Stedman Hawkins Clinic in Vail, Colorado. The research study specifically looked at patients who are recreational athletes over age 70, that underwent rotator cuff repairs. Dr. Bhatia’s research was published in the American Journal of Sports Medicine in July 2015. This article involved 44 patients with the average age of 73 years. They were all recreational athletes. Based on the analysis, more than three out of four, or 77 percent of the patients, were returning to sports at a similar level of intensity following rotator cuff repair surgery. Returning to Sports for Older Athletes

In addition, many of the patients had improvement in their levels of activity compared to what they were experiencing prior to surgeries. Their pain levels reduced, while their strength improved.

In conclusion, the authors noted that arthroscopic rotator cuff repairs were highly effective at reducing pain, improving function, and returning patients to the sport in high demand elderly individuals over 70 years of age.

A Growing Number of Seniors are Returning to Sports of All Kinds Including Competitive Events

Peak performance for athletes of many different ages has gotten better and better over the course of the last 100 years due to a wide variety of things. And more than ever before, older adults are participating in sports and setting records. Examples include Canadian runner Ed Whitlock who was the oldest person to complete a marathon in less than 3 hours (at 73 years of age) in 2003. (more…)

Risk Prediction Tools for Hip and Knee Replacement Surgery

The current healthcare environment in America has been driven by the concepts of quality, cost containment and value. Based on this, the federal government is starting a program that will incentivize physicians to maximize and reduce the patient’s risk factors prior to hip and knee replacement surgery. In fact, a physician’s reimbursement for the procedure will be directly related to post-surgical outcomes of their patients. Because of this, there are many studies right now looking at “tools” to predict high-risk patients to figure out if those patients should even be offered a knee replacement or if there are pre-surgical ways to reduce the risk factors.

There was an article published by Dr. David Manning in the American Academy of Orthopedic Surgeries Journal, this January. This report looked at risk prediction tools for hip and knee replacement surgery.

In this article, Dr. Manning noted that total knee Total Hip and Knee Replacement Surgeryand total hip surgeries comprised a largest procedural expenditure in the Medicare budget. And the complication rate for these surgeries varies anywhere between 2 percent and 14 percent. Higher complication rates are associated with the elderly and patients with additional disorders and high risk factors. Between 1991 and 2010, the mean number of comorbidities among Medicare patients undergoing elective total knee replacement nearly doubled from 1.2 to 2.1, and this trend is expected to continue.

Patients treated with total knee replacement show that the rate of diabetes mellitus increased from 10.5 percent to 24.2 percent. The rate of obesity increased from 4 percent to 10 percent during the same period. Complications that are seen after total joint replacement such as infection, blood clots, heart attacks, pneumonia, are associated with poor patient outcomes, and in addition represented a substantial cost burden to the American healthcare system.

Quality Improvement Initiatives Target Total Hip and Knee Replacement Surgery

Over the next five years, elective total hip and total knee replacements will be incorporated into several quality improvement initiatives, developed by the Center for Medicare and Medicaid Services. Because risk prediction tools or risk calculations are being developed, physicians are receiving help to determine who is eligible for a knee replacement or hip surgery. It is also working to understand if those risk factors can be modified pre-surgical efforts. (more…)

YMCA Norton Commons Gym Expansion

YMCA Board Members Norton Commons

Norton Commons YMCA Board of Directors visit the gym expansion site.

Members of the YMCA Norton Commons Board of Directors (including Louisville orthopedic Dr. Stacie Grossfeld) gathered with Norton Commons Elementary School principal, Allyson Vitato, on March 17th, to visit the new gym that is currently being built to connect to Norton Commons Elementary School. This 1,909 square foot expansion will allow the YMCA to increase their kids club space. The administrator of the Norton Commons YMCA, Mike Bramer, gave board members an informal walk-through of the current conditions of this expansion. He announced that construction will begin this summer in August 2016.

The board meeting kicked off with an introductory session, followed by a prayer and a relationship building discussion led by Dr. Grossfeld. She explained the importance of networking and relationship building for the YMCA and other organizations in Louisville. Dr. Grossfeld enjoyed sharing her ideas for this new expansion that involves connecting with the community in various ways. She has an idea to host a joint parent night out with the YMCA and Kentucky Country Day School.

Along with serving on the YMCA Norton Commons Board of Directors, Dr. Grossfeld is also on the Board of Directors for the Louisville Sports Commission. She is hoping to connect these two great organizations while increasing community involvement. The Louisville Sports Commission has discussed ideas for gathering used equipment, as well as creating other benefits through the YMCA. The board is in contact with family medicine practitioner, Dr. Jesse Jenkins, to discuss initiatives that (more…)

Experiencing Elbow Pain? 5 Things it Could be

5 Common Elbow Injuries that Cause Elbow PainMany people experience elbow pain at some point in time. Your elbow is a somewhat complex mechanism that relies on three different bones for support and movement. The elbow gives your arm the ability to rotate outward and inward, while also working like a hinge upward and downward.

The functional design of your elbow allows movement, flexion and rotation of your arms. Sometimes, these repeated and irregular movements can cause elbow pain. While minor elbow pain may indicate a small strain, more constant or severe pain may be cause for concern. For those struggling with elbow pain, here are 5 common causes.

5 Causes of Elbow Pain

  1. Tendinitis: Elbow tendinitis or “Tennis Elbow” is a real source of pain for many active individuals, and for those repeatedly using forearm muscles often in certain workplace environments. Activities like window washing, swinging a tennis racket, or making home repairs, can aggravate your elbow and cause the tendons to become inflamed. This is often followed by swelling and warmth at the site. Typically, when a physician identifies tendinitis as the cause of your elbow pain, he or she will suggest rest, ice and possibly a brace for the affected area. Anti-inflammatory medications may also be helpful when treating pain and inflammation.
  2. Bursitis: Bursae are fluid-filled sacs designed to provide cushioning between bones and tissue. In the case of elbow pain, the flat olecranon bursa is located at the back of the elbow. When this bursa becomes irritated and inflamed, the area may become fluid-filled and bursitis will start to develop. This injury tends to occur after trauma or prolonged pressure such as leaning on your elbows while typing on the computer. This condition causes pain, swelling and redness to the affected area. Following a physician’s examination and diagnosis, anti-inflammatory medications may be recommended. Changing your activities and wearing an elbow pad may also be advised. This condition is for the most part easily treatable and comes with a speedy recovery.
  3. Arthritis: Arthritis located in your elbow is the cause of swelling, tenderness, pain and decreased range of motion. This condition targets joints and causes inflammation and erosion of cartilage and bone. In order to combat this pain, your doctor may prescribe anti-inflammatory medications, while alternating between heat and ice for the affected area. Other possible treatment options for arthritis in your elbow include: bracing the elbow, changing activities and undergoing cortisone injections.
  4. Sprain or Broken Elbow: During irregular movements, accidents or intense physical activities, your elbow may take the brunt of the pain. A collision or unusual impact could cause your elbow to strain the ligaments or fracture the bones. If you suspect a break or strain, you should see a physician for a physical exam and possible x-rays. If your elbow is broken, the treatment generally requires immobilization or surgery. If a strain is present, your physician will suggest rest, ice, immobilization, compression and anti-inflammatory medications to reduce pain and swelling.
  5. Cellulitis: Another common cause of elbow pain actually involves inflammation of the skin. Cellulitis occurs when an abrasion or puncture wound allows bacteria to move from the surface of the skin, into the deeper layers. The symptoms of this condition are characterized by redness, warmth, swelling and heat on the surface of the skin. Often, individuals with cellulitis will exhibit a low-grade fever. Treatment for this condition involves antibiotic medication, rest and over-the-counter pain relievers. This infection can worsen if left untreated, so make sure to seek medical attention if you suspect cellulitis.

Just because you feel pain in your elbow doesn’t mean you have a broken elbow or cellulitis. (more…)

10 Differences Between Osteoarthritis and Meniscal Tears

Knee Osteoarthritis and meniscal tear types of knee painOsteoarthritis and meniscal tears are injuries that both occur in the knees. Both knee injuries tend to become more probable to occur with age; however, there are significant differences between osteoarthritis and meniscal tear injuries. The pain associated with both injuries require different treatment approaches. A big factor that decides treatment is if the pain is a result of a particular injury or health factor. To understand these two distinct injuries that occur in the knees, here are 10 major differences between the two.

1. Pain Type

You will be able to identify the type of injury you have as a result of the pain that occurs. Pain from osteoarthritis is a dull pain that aches constantly. Meniscal tears, on the other hand, give off sharp, stabbing pain in the knee area.

2. Location

Identifying where your pain is coming from will also help to differentiate between osteoarthritis and a meniscal tear. Meniscal tears are right on the joint line with very distinct localized region of pain. Osteoarthritis has a more generalized pain affecting the whole knee joint and is difficult to pinpoint with one finger.

3. Symptoms

A torn meniscus tends to have a clicking and popping along with mechanical symptoms where the knee will catch. Osteoarthritis produces a dull throbbing aching pain yet has no mechanical symptoms.

4. Diagnostic Imaging

Meniscal tears are diagnosed with an MRI scan while osteoarthritis is detected through a plain standing knee x-ray.

5. Definition

Meniscal tears involve the meniscus which is a shock absorber between the two bones in your knee joint that functions to cushion both bones. Osteoarthritis is the breakdown of the cartilage that covers the ends of your bones within the knee joint.

6. Age of Onset

Meniscal tears tend to occur in a younger population between ages of 40 and 60. Osteoarthritis more commonly occurs in patients over age 60.

7. Signs

Meniscal tear patients tend to have knee swelling with sharp stabbing pain which is localized. Patients with osteoarthritic knees may appear to be bow legged or knock-kneed with palpable bone spurs or osteophytes at the joint line.

8. Gender Predisposition

No gender predispositions effect either types of injury.

9. Genetic Predisposition

No data proves there is genetic predisposition to meniscal tears. Osteoarthritis has a strong genetic component.

10. Treatment

Treatment for meniscal tears in a young active patient involves surgery. However, osteoarthritis treatment involves oral NSAIDS, cortisone injections, hyaluronic acid injections, bracing, and physical therapy. When all else fails joint replacement surgery becomes an option.

If you suspect either type of injury or pain, call Dr. Grossfeld’s office today at 502-212-2663 to schedule an appointment. These injuries require a physical exam and possible further testing to determine either type of knee pain.

Cost Effectiveness of Weight Loss Surgery Prior to Total Knee Replacement In Morbidly Obese Patients

Weight Loss Surgery Knee ReplacementWith changes in healthcare, one new policy will be in effect in upcoming years that affects doctors and patients alike. A new policy will rate physicians based on their patient’s post surgery complications. This means that doctors will be treating patients’ current issues, and other contributing factors to receive a positive outcome. 

We know from the literature and studies that one common reason for post-surgical complications is the patients’ weight or BMI. The higher the BMI and the more obesity is present, the higher the risk of complications.

With patients undergoing joint replacement surgery it has been found that patients that had BMIs greater than 40 are at higher risk for complications than patients with a BMI <40. Because of this, surgeons will be recommending weight loss surgery prior to knee replacement.

Study Results

A study published in the Journal of Bone and Joint Surgery, December 2016 issue took computer model based evaluations and determined it is cost effective for patients that are morbidly obese to undergo bariatric surgery prior to knee replacement. The complications that occur secondary to the patient’s morbid obesity in a dollar value are more than the cost of the patient undergoing bariatric surgery.

Post-surgical complications reduce significantly when patient’s BMIs are less than 40. Therefore, in the future, your orthopedic surgeon may be recommending bariatric or weight loss surgery prior to knee replacement surgery.

 

 

Shoulder and Rotator Cuff Tears – Latest Research

Rotator Cuff TearsWe know that rotator cuff tears commonly affect one shoulder, especially in patients who are over age 55. However, there is a group of patients that not only tear one shoulder, but end up tearing their contralateral shoulder as well. There was a study published in the American Journal of Sports Medicine in May, 2015, that specifically looked at patients undergoing rotator cuff repairs and tears on the contralateral side, that is the other shoulder.

The study was completed through the Department of Orthopedic Surgery, College of Medicine, Korea University, Seoul, Korea. The first author was Dr. Kyung-Han Ro. Looking at 140 patients who underwent a rotator cuff repair, researchers found that 38.6 percent of them had a rotator cuff tear on the contralateral shoulder.

Understanding Different Sizes of Rotator Cuff Tears

Dr. Ro divided the patients into three groups: 1) patients that had a small rotator cuff tear, 2) patients who had a medium sized rotator cuff tear, and 3) those with a large size rotator cuff tear. Researchers compared each of the patient groups to determine the chance of suffering a cuff tear on the contralateral shoulder.

Researchers found that the patients that had a bigger rotator cuff tear, had a higher incidence of tears involving their contralateral shoulder. The patients that had small tears had a lesser chance of having a tear on the contralateral shoulder compared to the group that had large or massive rotator cuff tears. The conclusion of the study showed that the prevalence of rotator cuff tears of the contralateral shoulder tends to be higher in patients who are more symptomatic and have a larger rotator cuff tear on one side. (more…)